Introducing Cognition and Emotion Connections through Cognitive Behavioral Therapy

Introducing Cognition and Emotion Connections through Cognitive Behavioral Therapy

By: Jush Brunotte

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There is a growing awareness that mental health disorders such as anxiety and depression can have a direct impact on how students function in the classroom and how effective instructors can be at facilitating learning. Teachers at the tertiary level need to educate themselves on not only the prevalence of these disorders in the student population, but also the best methods for discussing and destigmatizing mental illness within their own classrooms. Students may enter the learning environment already dealing with a myriad of anxieties that affect learning, including communication apprehension, classroom communication anxiety, public speaking anxiety, foreign language anxiety, and more (Brunotte, 2019). In the US, around one-eighth of young adults have anxiety-related disorders, and an estimated 80% of them are not receiving treatment for those issues (IBCCES, 2020). Anxious thoughts can create a “powerful illusion of truth” (Burns, 1999, p. 48), and without intervention these illusions often lead to unnecessary mental distress and excessive avoidance of risk.

For students, depression can be connected to university dropout or even suicide, and can also negatively impact the ability to learn in the classroom. Those suffering from depression have been found to receive assessment scores a half grade lower than their non-depressed counterparts, but when treatment is sought and received, those grade deficits often disappear (Hysenbegasi et al., 2005). Historically, Japan has dealt with depression and suicide as major health and safety issues, and the COVID-19 pandemic has exacerbated this problem in at least one segment of the population. Although suicide rates of males in Japan have remained mostly flat over the course of the 2020-2021 pandemic, there has been a rise in the suicide rates of females over the same period (Harding, 2021).

Clearly the issues of anxiety and depression continue to affect the wellbeing and learning outcomes of many university students in Japan and abroad, and therefore intervention and discussion in the classroom are as important now as ever. In this article, I would like to introduce a powerful instrument for dealing with anxiety and depression—cognitive behavioral therapy (CBT). CBT can help us understand the important connections between our cognition and the subsequent emotions that stem from our thinking, and may be an effective platform for introducing topics related to the brain, including mental health, self-care, and suicide prevention, in the classroom. There is potential for using these same techniques to help students reduce anxiety related to foreign language ability, and these methods may be useful for altering pre-conceived notions about English learning.

This article explains the basics of CBT and how teachers may be able to introduce these techniques to their students in the classroom setting. However, please remember that only licensed therapists should intervene when students are experiencing severe levels of depression or suicidal thinking. If you notice a student in acute mental distress, please refer them to the counseling services available at your institution.

Cognitive Behavioral Therapy Basics

The basis for CBT is the Cognitive Model—the idea that all psychological disturbances have underlying thinking patterns that are dysfunctional. This concept revolutionized psychological thinking and helped show that thoughts and feelings do not always result from external issues and factors (Beck, 2011). The idea that much of the suffering related to mental health disorders may be greatly alleviated by promoting changes in thinking not only simplifies the therapeutic process, but also puts some control in the hands of an individual to help improve her own wellbeing.

"All psychological disturbances have underlying thinking patterns that are dysfunctional. "
Beck, 2011

CBT has been found to be effective for treating a range of mental health disorders across a diverse spectrum of individuals (e.g., age, cultural background, etc.) (Beck, 2011). CBT-only treatments can affect the structure of the brain (Baxter et al., 1992), and this approach can be as effective as psychopharmacological intervention for the treatment of depression in many cases (Burns, 1999). One crucial thing about the CBT approach is that it is designed to be implementable by an individual patient, often outside of the traditional therapeutic setting, through self-study and bibliotherapy (learning self-care therapeutic techniques through psychology literature) (Burns, 1999). Even when done under the instruction of a psychotherapist, those CBT sessions are meant to be time limited (6-14 meetings), with the goal of empowering a patient to use CBT techniques on her own (Beck, 2011). Because of this accessibility of CBT methods through just a short period of self-study, I would argue that university instructors, after a brief period of learning about CBT, can feel confident in introducing these concepts and techniques to their students.

One main goal of CBT is for the individual to begin noticing thought patterns that lead to negative emotions, often in the form of automatic thinking. People are often unaware of these styles of thinking but, through a psychoeducational process (either through a therapist or self-study), these patterns can be noticed, analyzed, and altered. For anxiety disorders, this involves learning to accurately assess risk in a variety of situations (Beck, 2011). This process of learning to address automatic thinking often requires the use of homework (individual work done outside of the therapeutic setting) in the form of journaling and testing new CBT-based skills in the real world. Anxiety and depression can cause a sense of paralysis and result in a state of inaction in those suffering from these disorders, and just beginning this process of confronting our dysfunctional thinking can create a great sense of relief (Beck, 2011). As a result, university instructors should feel encouraged to begin this dialogue with students when the opportunity or need arises, as the benefits of confronting and adjusting automatic thinking can be profound.

Cognitive Distortions and Automatic Thinking

A central tenet of CBT is to help people learn to “identify, evaluate, and respond to their dysfunctional thoughts and beliefs” (Beck, 2011, p. 10). Healthy individuals are usually able to test their negative thoughts against reality and adjust them when discrepancies are apparent. But for those suffering from anxiety or depression, these dysfunctional cognitions are thought to be representative of reality, and may often be pushed toward larger judgments about the self (I was rude to him yesterday. → I’m rude to everyone. I’m such a bad person.). For students in a foreign language classroom, these personal judgments might be happening in regard to self-perceived abilities (I’m not understanding today’s lesson. → I’ll never be good at English.). While reading this section, please imagine how this CBT process may be used to target your students’ perceptions and beliefs about their own learning abilities, in addition to its usefulness in anxiety and depression reduction.

To begin this process of thought pattern analysis, start by first asking a student, “What is going through your mind at this moment?” Developing an awareness of our own cognitions and emotions is part of the process of Guided Discovery, in which this recognition about thoughts and feelings is generated first from within the individual (Beck, 2011). The guided discovery process requires the participant to evaluate automatic thoughts (e.g., “I’ll never be happy”; “Everyone hated me at that party.”) using a series of questions, including, “What is the evidence that my thought is true?”; “What is an alternative way of viewing this situation?”; “What should I do?”, and more (Beck, 2011, p. 23).

Once these thought patterns are noticed, the next step is to have the student evaluate them in terms of their “validity and utility” (Beck, 2011, p. 139). Some of these thought distortions are objectively untrue (= go against available evidence; the most common type), are true but the subsequent conclusion is off (“I did X so I must be a bad person.”), or are true but have no utility (“I’m going to have to study for hours for this test. I hate my life.”). This process of evaluating and adjusting thoughts based on reality can lead to a reduction in feelings of anxiety and depression, and is a key tool gained from CBT practices.

Of course, some life events are “universally upsetting,” such as being physically/mentally hurt by another person, facing rejection, or experiencing tragedy (Beck, 2011, p. 137). However, depressed or anxious individuals often take neutral or even positive life events and distort them through this automatic thinking process, creating unnecessary mental suffering. Changing the automatic nature of these types of catastrophic and distorted thinking can make the student feel better in a substantial and long-lasting way.

The CBT process also involves the search for Cognitive Distortions and their connections to negative emotions. Burns (1999) created a helpful list of the most prominent cognitive distortions (see Table 1). Introducing these categories of thought patterns and including specific examples can make the existence of these automatic thoughts evident to students, and can help begin the process of adjusting these types of thinking.


Table 1
: Burns’ list of cognitive distortions (1999, p. 42)

1. All-or-Nothing Thinking

You expect perfection from yourself. If an outcome is not 100% ideal, you think of it as a failure.

2. Overgeneralization

You take a single negative event and create a larger sense of defeat and continuing failure in your life.

3. Mental Filter

You focus on only a negative aspect of a complicated event or outcome, blocking out thoughts related to positive or neutral parts of the same event.

4. Disqualifying the Positive

You reject positive outcomes or events, insisting that a larger negative pattern or system of belief must be true.

5. Jumping to Conclusions

You interpret something negatively despite lack of evidence for that conclusion. Can include Mind Reading (assuming people are thinking bad of you) or Fortune Telling (making negative predictions about the future).

6. Magnification/Minimization

You increase the importance of a small negative event in your mind (e.g., a mistake) or reduce the importance of a positive outcome or your own good qualities.

7. Emotional Reasoning

You believe that if you feel something negative, it must reflect an objective reality outside of yourself.

8. Should Statements

You use judgments in the form of “I should” or “I shouldn’t” statements to motivate yourself. You might also think about how others “must” or “ought” to be or act that leads to anger or resentment.

9. Labeling and Mislabeling

Extreme overgeneralization, in which you label yourself or others with judgment statements instead of just describing a mistake or problem (e.g., “I’m such a loser”; “He’s an idiot.”).

10. Personalization

You think you cause negative events that were not solely your fault.

Now that the key concepts of the cognitive model, automatic thinking, and cognitive distortions within CBT have been introduced, I would like to discuss ways in which we can present these concepts to university students and design discussions and tasks that may help foster this process of self-discovery and adjustment of dysfunctional thinking.

CBT-based Classroom Activities and Approaches

CBT in therapeutic settings almost always features work completed between sessions, where patients monitor their thinking, do journaling, explore adaptation techniques, and do further study. Similar activities could easily be done within a university classroom or as part of homework. Begin by having students write about what they are thinking and feeling in that moment. This explorative process is the first step in learning CBT techniques. This monitoring can continue at home, especially when students notice their mood changing in a negative direction.

One easy home journaling technique is the “triple column writing” method developed by Burns (1999, p. 63). This method is especially effective once your students have studied the cognitive distortion categories. See Table 2 for an example of how this journaling is done.

Table 2: The triple column writing technique for monitoring thoughts (Burns, 1999, p. 63)

Automatic Thought

Cognitive Distortion

Rational Response (self-defense)

I never do anything right.

 

 

This shows what a bad person I am.

Overgeneralization

 

 

Labeling

Nonsense! I do a lot of things right!

 

I’m not a bad person. I’m a good person.

This process allows someone to notice and attend to automatic thinking, learn to apply the cognitive distortion labels, and begin adjusting thoughts to better reflect reality. A worksheet like the one below could be used by teachers to help students practice this writing technique while also answering some of the CBT guided discovery questions. Teaching how CBT may be used by students on their own could help address the continuing mental health crisis related to anxiety and depression in Japan and elsewhere.


Writing about Your Automatic Thinking

Answer the following questions and then complete the triple column writing practice:

1. What are some automatic negative thoughts you sometimes have?

·   Now choose one and think: do you have any evidence that confirms it?

·   Is it 100% true? Are there any times when the opposite is true? Are you possibly doing Mind Reading or Fortune Telling?

· How important is this belief or event in relation to everything else in your life?

2. Now, let’s explore more by using the three columns below. Use the questions above and the cognitive distortions chart to write about each of the negative things you wrote and explore better responses:

Automatic Thought

Cognitive Distortion

Rational Response (self-defense)

 

 

 

 

 

In a recent program I created to help Japanese students work through public speaking anxiety-related issues and improve their presentation skills, I provided participants with a worksheet that introduced some cognitive distortions and how they might appear in relation to thoughts about public speaking. Presenting these concepts using bilingual materials may help support comprehension and get students to begin applying the techniques to their thinking even more quickly. This matching exercise asks students to connect cognitive distortion categories to some specific thoughts about public speaking outcomes.

 

Cognitive Distortions Matching・認知のひずみのマッチング

Let’s review some of the cognitive distortions we learned in Session 3. Look at the cognitive distortion categories on the left and match them with the examples about public speaking on the right.

セッション3で学んだ認知のひずみを復習しましょう。左側にある認知のひずみの名前と右側にあるパブリックスピーキングに関する例文に合わせて下さい。

All or nothing thinking

全部かゼロかの考え方

____

 

A. I’m going to forget what I want to say. I always forget things in a speech.

言いたい事を絶対に忘れるだろう。いつもスピーチの時色々と忘れてしまう。

 

 

Overgeneralization

過剰一般化

____

B. The teacher said my speech was great, but I know it was actually bad.

先生はスピーチをほめてくれたけど、本当は悪かったんだろう。

 

Mental Filter

心理的なフィルター

____

C. When I stand in front of the class I am going to panic. I know it will happen.

皆の前に立つ時、パニックになる。絶対そうなる事が分かっている。

 

Disqualify the positives

良い事を受け入れない

____

D. I know everyone watching me didn’t like me. I could just tell.

発表を見ていた人が皆私の事が好きではなかった。何となくそれが分かった。

 

Mind Reading

心を読み取る

____

E. If I don’t get a high score on this presentation I’m going to be upset.

このプレゼンでいい成績が取れなかったら落ち込む。

 

Fortune Telling

占い

____

F. One person was sleeping while I was talking. It was all I could think about.

発表の時見ていた一人が寝ていた。そればかり気になってしまった。

 

 

For those interested in CBT-related concepts and wanting to introduce them to students, I recommend you start the process of learning these techniques through self-study with materials like the excellent Burns (1999) and Beck (2011) books I used throughout this article. Students can also benefit from reading about CBT outside of the classroom in either English or their native language. As teachers we have the power to begin these discussions regarding mental wellness, cognitive behavioral therapy, and self-reflection to the student populations we deal with. By doing this we might be able to positively impact the mental health of individuals in our classroom, as well as help create learning environments that are more effective, positive, and inclusive.

References

  • Baxter, L. R., Schwartz, J. M., Bergman, K. S., Szuba, M. P., Gauze, B. H., Mazziotta, J. C., Alazraki, A., Selin, C. E., Ferng, H.-K., Munford, P., & Phelps, M. E. (1992). Caudate glucose metabolic rate changes with both drug and behavioral therapy for obsessive-compulsive disorders. Archives of General Psychiatry, 49, 681-689.

  • Beck, J. (2011). Cognitive behavior therapy: Basics and beyond. New York, NY: The Guilford Press.

  • Brunotte, J. (2019). Varieties of anxieties: The multifaceted nature of students’ worries in the classroom. Think Tank: Bulletin of the JALT Mind, Brain, and Education SIG, 5(2), 20-23.

  • Burns, D. (1999). Feeling good: The new mood therapy. New York, NY: Harper Publishing.

  • Harding, R. (2021, February 10). Japan suffers rise in female suicides during Covid-19 pandemic. Financial Times. https://www.ft.com/content/e7f1d6a7-d56e-423f-a7c8-0803af9a6f02

  • Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the academic productivity of university students. The Journal of Mental Health Policy and Economics, 8, 145-151.

  • International Board of Credentialing and Continuing Education Standards (2020, April 17). Impact of anxiety and depression on student academic progress. https://ibcces.org/blog/2019/05/01/impact-anxiety-depression-student-progress/

Josh Brunotte is an associate professor at Aichi Prefectural University in central Japan. He primarily studies the intersection of technology and psychology, including the use of virtual reality for anxiety reduction purposes. He is currently pursuing a PhD at Nagoya University researching best intervention methods for reducing public speaking anxiety.

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