COPOW is a just short for Cognitive Power. It’s a term that I use to communicate the power of our minds, that can be harnessed to help us feel happier, more relaxed, calm, and confident. I learned about it from George Murphy M.D during my psychiatric residency. It was 1980 and Dr. Murphy was an internationally known expert for his pioneering research in the study of suicide. It was an exciting time in psychiatry and Washington University in St. Louis was considered to be at the forefront of the new direction in the field, called Biological Psychiatry because of all the new information we were discovering about brain chemistry and metabolism as well as all of the new medicines that were being developed to treat people’s psychiatric illnesses.
The first antidepressant medication had already been approved for use 22 years before that, but it had a potentially dangerous side effect that led to its removal from the market. Safer antidepressants were developed after that, but in a well-known study, they only worked for 31% of people after 3 months of treatment; a long time to wait when you’re suffering from emotional pain and impairment that could lead to losing your job, your relationships, or even your life. Even after 6 months on antidepressants, 35% of people still had clinical depression. As a young doctor, who wanted to help people get relief from emotional pain, that fact was a stark reality that I saw daily in the faces of too many patients at the hospital.
If you wanted treatment for depression without medication and didn’t want electroconvulsive therapy, for decades the traditional gold standard for treatment of depression was psychoanalysis. It took a long time (often 1 to 2 years) and it was often expensive. Many patients, who had it, told me they felt very dependent on their therapist and felt like they didn’t know where the therapy was going, which increased the tendency to just drop out of treatment. Even when the therapy was concluded, they often hadn’t learned effective coping skills to handle new problems in the future.
But a new line of thinking began to develop and it centered on the power of our thoughts. My instructor, Dr. Murphy learned about it from Aaron Beck, M.D., the psychiatrist who developed a new form of psychotherapy that broke away from the old traditional rules, with surprising results. While doing traditional psychoanalysis Dr. Beck noticed that some of his patients had unexpected negative mood shifts and the causes were unexpected.
In one session, a patient criticized Beck angrily and that same patient revealed that he had begun to feel guilty. The old school model would have said the man’s hostility directly caused him to feel guilty, but the patient told Dr. Beck that while he was expressing the anger, he had a simultaneous parallel stream of thoughts that went something like this:
’’I am wrong to criticize him ‥. I′m bad ‥. I have no excuse for being so mean.” In effect, the patient recognized that he had felt guilty as a result of a simultaneous stream of self-criticism. Beck investigated this phenomenon of parallel streams of thought with other patients, and discovered the same thing:
A previously unrecognized cascade of thoughts that popped up just seconds before a sudden shift to negative emotions like sadness, fear, or anger.
Beck called them ′ ′automatic thoughts′ ′ because of their tendency to emerge spontaneously and often too fast for patients to notice. And we’re all constantly interpreting the meaning of whatever we experience with our five senses, as well as what we think and feel emotionally, in fractions of a second. What it all boils down to, is that it’s how we interpret the things that happen to us, that determines how we feel. For instance, suppose two people get fired from their jobs. Person A thinks to himself “This is the worst thing that could possibly happen to me. I’ll never find another job, they’ll repossess my car, I’ll get evicted, everybody will look down on me, and my life will be a living hell.” Person B, on the other hand thinks to herself, “This really sucks, but other people lose jobs and find new ones. I’ll go to the library, I’ll look online and read the best books available about how to upgrade my resume, how to find the best key words for job applications, and how to handle tough job interview questions. I’ll find out where the biggest networking events are held and even though it’s scary, I’ll attend regularly in order to expand my connections. I’ll ask some of the contacts I make, to give me mock interviews to get critiques of how I come across to interviewers so I can improve my chances of getting another job soon.” So here are two people, the same stressful event happens to both, but Person A feels helpless, hopeless, and is almost paralyzed with anxiety, whereas Person B feels disappointed, but still has hope, enough motivation to mount a successful job search, and a mental state clear enough to devise a plan of action. What caused them to react so differently? It was the difference in how they each interpreted the meaning of what had happened to them, that made the difference in how they felt.
Dr. Beck studied a group of depressed patients to determine whether there might be anything unique about the way they interpreted the meaning of events and the behavior of people.
It turned out that their thoughts had common characteristics. The main feature was an abnormally high number of mistaken judgments that were highly biased in a globally negative fashion. They tended to view themselves, the world, and the future negatively, and Beck called this the “negative cognitive triad.” It leads to patterns of automatic destructive thoughts that Beck called cognitive distortions. These cognitive distortions set people up to experience excessively intense negative emotions in response to the everyday problems they faced, as well as the more stressful life events. He devised techniques to enable his patients to recognize the errors in their thoughts, to see if it would have a positive effect.
Beck taught his patients to recognize what he called Overgeneralization. It’s one of those cognitive distortions that he had identified because it occurred so often in people who suffer from clinical depression. He described it as “the pattern of drawing a general rule or conclusion on the basis of one or more isolated incidents and applying the concept across the board to related and unrelated situations”1 In other words, if one negative thing happened in a person’s life, they interpreted it as meaning everything that had ever happened in their life was negative. For example, his depressed patients often thought that because they had failed in a few instances, that they had failed in everything they had ever done, even though Dr. Beck could easily list numerous things they had done successfully.
“Arbitrary Inferences” is another one of the cognitive distortions that Dr. Beck identified. He described it as “..the process of drawing a specific conclusion in the absence of evidence to support the conclusion, or when the evidence is contrary to the conclusion.”2 In other words, the person makes judgments without any evidence or even when the evidence clearly disproves those judgments. One example of this, in depressed persons, is the habit of assuming that other people, even total strangers, are thinking negative thoughts about them, with no proof at all. Many cognitive therapists call this “mind reading” which of course, none of us can do, and when we act as if we could, it leads to endless misunderstandings, conflicts, and unnecessary emotional suffering. Dr. Beck noted that these and many other kinds of unhealthy thought errors led to excessive sadness, anxiety, irritability, self-defeating behaviors, and feelings of hopelessness.
He devised techniques to help people correct unhealthy thought patterns and when they used them, they started recovering faster than he had ever seen people get better before. He conducted a scientific study of people suffering from clinical depression and compared the rate of recovery with his new form of therapy, to the effectiveness of antidepressant medication. Beck’s therapy turned out to be just as effective and later studies showed that with this new form of treatment, patients stayed well longer. Dr. Beck called it cognitive therapy because it was treatment for their thoughts.
My instructor, Dr. Murphy heard about Dr. Beck’s promising new therapy and traveled to meet him. He learned, from Dr. Beck, how to use cognitive therapy and in 1980, Dr. Murphy asked all of the psychiatric residents in my group to be alert for any patients in the clinic, who suffered from moderate to severe symptoms of clinical depression and ask them if they would be interested in participating in a study of this new method of psychotherapy. I referred a number of patients to Dr. Murphy for possible participation in his research study. During my time under his direction I got a chance to see just how effective cognitive therapy really was and the results were striking. For me it was the realization of my whole purpose in going to medical school, which was that I wanted to do something that could help people to feel better, and to prevent unnecessary suffering.
Dr Murphy’s first study of cognitive therapy was published in 1983, demonstrating again that cognitive therapy was not only an effective treatment for clinical depression, but it was equal in efficacy to antidepressant medication. This confirmed Dr. Beck’s groundbreaking study. Since then more than 30 scientific studies have demonstrated that cognitive therapy is at least as effective as antidepressants and in a few studies it outperformed antidepressants. Cognitive therapy has also been demonstrated in numerous research studies, to be effective in relieving anxiety disorders.
Not only was it effective in helping my patients to feel better, it worked without the 2 to 4 week delay that antidepressants usually take. I’ve seen so many people say that it changed their lives for the better and gave them a sense of empowerment and control over their moods, that I’ve used it ever since.
I’ll always remember a very charming, friendly middle-aged man who had a history of childhood trauma and a very stressful job with a very difficult boss. He had been depressed all of his life. His symptoms worsened to the point of thoughts of suicide and he ended up in the hospital. When I went to see him, he was tearful and his voice and face reflected pure misery. He felt hopeless because he had tried every antidepressant medication and mood stabilizer that I had ever heard of, and none of them worked. He had also tried counseling by a licensed therapist and even electroconvulsive therapy with little or no improvement. He was absolutely convinced that there was no hope for him to ever get better unless I could start him on some new hi-tech treatment or experimental medication.
He’d had counseling, but not cognitive therapy like Aaron Beck created it, so I asked him to just sit down with me and try something. I introduced him to the basic principles of automatic thoughts and cognitive distortions, and it made sense to him so I gave him a series of simple pen and paper exercises, using Dr. Beck’s model, to try out on some destructive automatic thoughts that I gleaned from his life story.
When I came to see him the next day, he’d not only finished the exercises, but he said his suicidal thoughts had stopped and he was starting to have some hope that he might get better.
We talked some more about his life and, using those memories, I wrote down a few more destructive automatic thoughts for him to work on them in the same way as before. I told him to add any other destructive automatic thoughts that came to mind and use the same technique on those.
When I visited him the next day, he was smiling with a tremendous look of relief on his face. He could hardly believe that he was feeling so much better and he said that he not only wanted to live, but he even felt ready to go back to his job. He had learned to apply cognitive therapy principles like avoiding mind reading, magnification, and negative predictions.
To maintain that kind of progress you need to continue to practice the techniques, and to have the best results, it takes about 10-12 additional sessions with a cognitive therapist. But I’ve seen the same fast, dramatic turnaround in people so many times, and yet, when people come to see me for help with depression or anxiety problems, 95% of them have never heard of cognitive therapy. The few who have, almost never get a chance to reap the benefits, because well trained cognitive therapists are in such short supply.
But when you’ve seen how helpful cognitive therapy is in relieving pain and suffering, and the studies showing that it even reduces suicidal behavior by as much as 55%3, it’s more clear than ever, how urgently everyone needs to know about it. And that’s exactly what I’m trying to achieve.
I’ve watched it help people from all walks of life to handle not only ordinary life challenges like relationship problems, parent-child issues, bullying, horrible bosses, but also extraordinary stressors like cancer, death of a spouse or loved one, job loss or extreme poverty and different forms of trauma.
When I’ve done cognitive therapy with my patients, the results have included feeling better faster, less need for medication and fewer hospitalizations. In the rare instances where hospitalization was necessary for safety, I’ve used intensive cognitive therapy where other doctors in my area don’t, and as a result the statistics compiled by the hospital show significantly shorter lengths of stay and lower readmission rates than the national average.
In 1986 I wrote an article about cognitive therapy for a Mercy Medical Center publication. Since many psychiatrists were skeptical about it then, I titled it,” Cognitive Therapy: Passing Fad or Valuable Technique?” In it, I detailed the proven effectiveness of cognitive therapy in multiple scientific studies in both the U.S. and the United Kingdom. I also described the human drama of how people often told me that, at first, their destructive thoughts “seem so real”. But later, they realized that those same thoughts that were fanning the flames of sadness, anger, or anxiety, were based on false assumptions that could be changed, and it gave them new hope, and greater mastery of their emotions.
Also, I presented another great strength of cognitive therapy, which is that while it’s often helpful to figure out how destructive thoughts began in a person’s life story, it’s not necessary to do that in order for cognitive to work. That was a really radical idea for many mental health professionals in 1986 and for a fair number, it’s still hard to accept, even today. But I like to point out that when a person is drowning, you don’t spend time trying to figure out how they got into the water. You move fast to help them get out of it as quickly and safely as possible. Once they’re out of danger, then you can spend more time figuring out the cause and see if that knowledge helps to prevent future hazards. Based on multiple studies including those of Dr. Beck, Dr. Murphy, and Dr. Blackburn of the United Kingdom, I concluded that it was safe to say that cognitive therapy could no longer be called a “fad” and that it was time to consider it as a valuable and effective form of treatment for clinical depression.
Since it was first developed, I’ve found many new uses for cognitive therapy, ranging from coping with substance use disorders to posttraumatic stress disorder and insomnia. It never ceases to amaze me how much it helps people when they learn that they have the power to break out of the negative cognitive triad and feel good about themselves, the world, and the future. It just makes life more livable. I’ve used it to help myself, my friends, and my family.
Life has taught me no one is immune. I’ll always remember when my dad, who was a successful psychiatrist for decades, had a severe heart attack, and like 1 in every 5 survivors of heart attacks, he developed clinical depression. With his depression came painful anxiety because of constant worrying. My mother was still working when he was discharged from the hospital, and while he was at home recovering, he was terribly afraid that he would have more problems with his heart and have no one to help him. So I sat down with him and used some simple cognitive therapy techniques that helped him to recognize the cognitive distortions in his thoughts, which included Arbitrary Inferences that many cognitive therapists call Negative Predictions and Emotional Reasoning. We made a list of the many sources of immediate help available to him with all the phone numbers that he would need, so that he could easily refer to it and have an action plan. His anxiety just seemed to melt away and I saw this wonderful expression of relief wash over his face. It was one of the greatest experiences of my life to be able to bring healing to the man whose example inspired me to become a doctor.
In these times of great stress for so many, join us in our mission to put this healing power, Cognitive Power, the power to feel happier, more relaxed, calm, and confident at the fingertips of people everywhere.
Dale J. Anderson, M.D.
1. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression. New York: Guilford Press, 1919
2. Ibid.
3. Mendez-Bustos P, Calati R, Rubio-Ramirez F, Olie E, Courtet P, Lopez-Castroman J. Effectiveness of Psychotherapy on Suicidal Risk: A Systematic Review of Observational Studies. Front. Psychol., 19 February 2019