5. Identifying & Investigating

"**Stoicism provides the clearest example of a system of psychotherapy in ancient Greek or Roman philosophy.** Albert Ellis acknowledged that some of the central principles of **Rational Emotive Behaviour Therapy** were “originally discovered and stated” by the Stoics and Beck that “the philosophical origins of cognitive therapy can be traced back to the Stoic philosophers...This article highlights Stoicism’s similarities to modern mindfulness and acceptance-based CBT and its potential as an approach to building emotional resilience."

Cognitive Processing Therapy (CPT) is cognitive behavioral therapy for trauma. In CPT, patients learn to identify problematic beliefs, termed “stuck points,” that drive their distress and negatively impact their ability to function. Through dialogue between a clinician and patient, as well as the use of structured worksheets, patients are taught the necessary skills to identify stuck points and develop alternative ways of thinking about themselves, others, and the world.

What is a Stuck Point? Stuck points are thoughts that keep us from recovering. Stuck points are concise statements that reflect a thought – not a feeling, behavior, or event

• These thoughts may not be 100% accurate.

• Stuck Points may be:

—Thoughts about your understanding of why a traumatic event happened.

—Thoughts about yourself, others, and the world that have changed dramatically as a result of a traumatic event.

• Stuck Points are concise statements (but they must be longer than one word—“trust” is not a Stuck Point).

• Stuck Points can often be formatted in an “If–then” structure. Here is an example: “If I let others get close, then I will get hurt.”

• Stuck Points often use extreme language, such as “never,” “always,” or “everyone.”

Examples of Stuck Points

1. If I had done my job better, then other people would have survived.

2. Because I did not tell anyone, I am to blame for the abuse.

3. Because I did not fight against my attacker, the abuse is my fault.

4. I should have known he would hurt me.

5. It is my fault the accident happened.

6. If I had been paying attention, no one would have died.

7. If I hadn’t been drinking, it would not have happened.

8. I don’t deserve to live when other people lost their lives.

9. If I let other people get close to me, I’ll get hurt again.

10. Expressing any emotion means I will lose control of myself.

11. I must be on guard at all times.

12. I should be able to protect others.

13. I must control everything that happens to me.

14. Mistakes are intolerable and cause serious harm or death.

15. No civilians can understand me.

16. If I let myself think about what has happened, I will never get it out of my mind.

17. I must respond to all threats with force.

18. I can never really be a good, moral person again because of the things that I have done.

19. Other people should not be trusted.

20. Other people should not trust me.

21. If I have a happy life, I will be dishonoring my friends.

22. I have no control over my future.

23. The government cannot be trusted.

24. People in authority always abuse their power.

25. I am damaged forever because of the rape.

26. I am unlovable because of [the trauma].

27. I am worthless because I couldn’t control what happened.

28. I deserve to have bad things happen to me.

29. I am dirty.

30. I deserved to have been abused.

31. Only people who were there can understand.

If I don't explain everything in detail, then you won't understand (or believe me).

What does it mean to hold on to this belief;

What does holding on to this belief do for you;

What if you no longer held on to
this belief, then what?

Our ability to step back from our thoughts grows stronger as we practice. When we learn defusion skills, we can take the energy of our counterproductive yearning and pivot it toward learning to be gently guided by our experiences.

Acceptance and Commitment Therapy (ACT) teaches a concept of cognitive defusion- "I’m having the thought that…” creates psychological distance, greater perspective, and emotional regulation. In REBT this is called metacognititon or thinking about our thinking.

Defusion: How to Detangle from Thoughts & Feelings

YOU are not your THOUGHTS

Thoughts are merely sounds, words, stories, and bits of language passing through our minds.Thoughts may or may not be true. We don’t automatically believe them.Thoughts may or may not be important. We pay attention only if they’re helpful.Thoughts are not orders. We don’t have to obey them.Thoughts may or may not be wise. We don’t automatically follow their advice.

Rumination: A Cycle of Negative Thinking

Rumination involves repetitive thinking or dwelling on negative feelings and distress and their causes and consequences. The repetitive, negative aspect of rumination can contribute to the development of depression or anxiety and can worsen existing conditions.

American Psychiatric Association home

"take steps on your own to help break the cycle of rumination.^{1, 2, 4}... Distract yourself with activities that will interrupt the negative thinking and focus on more positive memories.Try to deliberately recall times when things worked out even with challenges. Enlist the help of family or friends in remembering past positive experiences, times when things turned out well. This can help shift your thinking down a different path. Physical activity and change in environment, especially to a place that has positive associations for you, can help too. Try to separate out different problems or break down larger problems into smaller parts. Tackle one issue at a time. Make a step-by-step plan, be as specific as possible. Write it down. Then begin to move forward, taking action one step at a time.

"Research on unconditional self-acceptance found that a low level of unconditional self-acceptance correlates with depression, anxiety, anger, and neuroticism (Popov, 2019; Prihadi et al., 2019; Andronikos, 2021). High levels of unconditional self-acceptance were in general strongly related to mental health, happiness, self-esteem, life satisfaction, well-being, respect for the differences between individuals, and low levels of anxiety and depression (Vural-Batik, 2019; Bernard M. E., 2020). Unconditional self-acceptance also correlates positively with dispositional forgiveness (Porada et al., 2018), self-compassion and flourishing (Venet, 2019; Andronikos, 2021).

"Any life stressor, if big enough, can increase your risk of having intrusive thoughts."

Obsessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over

Information on obsessive-compulsive disorder (OCD) including signs and symptoms, causes, and treatment options such as psychotherapy and medication.

National Institute of Mental Health (NIMH)

"Cognitive behavioral therapy (CBT): CBT is a type of talk therapy that helps people recognize harmful or untrue ways of thinking so they can more clearly view and respond to challenging situations. CBT helps people learn to question these negative thoughts, determine how they impact their feelings and actions, and change self-defeating behavior patterns. CBT has been well studied and is considered the “gold standard” of psychotherapy for many people. CBT works best when customized to treat the unique characteristics of specific mental disorders, including OCD."