Cognitive Behavior Therapy Quotes

“Someone's got to do some more research, but I would really like to know: when a CBT therapist really gets distressed, who does he go see?”
― Irvin D. Yalom

“Our thoughts have prepared for us the
happiness or unhappiness we experience.”
― Hazrat Inayat Khan

“For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.”
― Irving Kirsch, The Emperor's New Drugs: Exploding the Antidepressant Myth

“However one may interpret this culturally, the upshot is the same: people carry within them a great number of wishes to which they react passively and which they hide. Stoicism, in our day, is not strength to overcome wishes, but to hide them. To a patient who, let us say, is interminably rationalizing and justifying this and that, balancing one thing against another as though life were a tremendous market place where all the business is done on paper and tickertape and there are never any goods, I sometimes have the inclination in psychotherapy to shout out, “Don't you ever want anything?” But I don't cry out, for it is not difficult to see that on some level the patient does want a good deal; the trouble is he has formulated and reformulated it, until it is the “rattling of dry bones,” as Eliot puts it. Tendencies have become endemic in our culture for our denial of wishes to be rationalized and accepted with the belief that this denial of the wish will result in its being fulfilled. And whether the reader would disagree with me on this or that detail, our psychological problem is the same: it is necessary for us to help the patient achieve some emotional viability and honesty by bringing out his wishes and his capacity to wish. This is not the end of therapy but it is an essential starting point.”
― Rollo May, Love and Will

“ME/CFS has been classified as a neurological disease by the WHO since 1969 [59] and a growing number of researchers theorize that ME/CFS might be a neuro-immunological condition [60–63]: yet the BPS framework does not account for ME/CFS as a neurological or immunological disease – instead, much of the pro- BPS model literature on ME/CFS adopts what Nassir Ghaemi terms the ‘eclectic approach’; whereby everything appears important, all bio, all psycho, and all social factors [33]. Yet in clinical practice (the BPS framework), there is strong emphasis on psychological interventions (CBT and GET).”
― Keith Geraghty

“A useful first step is to reverse engineer the situation back to the triggering event and to define the specific problem you are facing. You can then determine options for handling it. The various manifestations of anger reflect a sense that something is “not fair,” which is related to a should statement, such as “this should not happen.” Dealing with “shoulds” involves acknowledging that you obviously are not happy that something happened, but that you must still face the fact that it did happen. Thus, the task then turns to dealing with the situation.”
― J. Russell Ramsay, The Adult ADHD Tool Kit

“…we encourage you to trust your coping plan over the long haul. It is useful to acknowledge your small and daily successes, such as facing things you would typically avoid. There will likely be daily examples of slipups, too, but, similar to looking at a garden, we encourage you to focus on the flowers as much, if not more so, than you do the weeds.

As an aside, both of us have taken up bike riding in the past few years. In our appreciation of the multiday, grand stage races in Europe, such as the Tour de France, we have seen a metaphor that helps to illustrate the goal of coping with ADHD. These multiple stage bike races last from 3 or 4 days on up to 3 weeks. Different days are spent climbing steep mountain roads, traversing long flat stages of over a hundred miles that end in all out sprints to the finish line, and individual time trials where each rider goes out alone and covers the distance as quickly as possible, known as “the race of truth.” The grand champion of a multiday race, however, is the rider whose cumulative time for all the stages is the fastest. That is, if you ride well enough, day-in and day-out, you will be a champion even though you may not be the first rider to cross the finish line on any single day’s race.
Similarly, managing ADHD is an endurance sport. You need not cope perfectly all day, every day. The goal is to make progress, cope well enough, handle setbacks without giving up, and over time you will recognize your victory.

Just keep pedaling.”
― J. Russell Ramsay, The Adult ADHD Tool Kit

“Genom våra tankar och föreställningar konstruerar vi den inre och yttre världen. Vår unika värld beror i hög grad på de ögon som ser, och — icke att förglömma — den själ som gömmer sig bakom de ögon som ser.”
― Irene Henriette Oestrich, Tankens kraft - kognitiv terapi i klinisk praktik

“What about the claim, by the PACE trial, that Graded Exercise Therapy and CBT can treat ME? This is a trial where you could enter moderately ill, get worse in the trial, and be declared ‘recovered’ at the end. Even the recent follow-up study conceded that, long-term, Graded Exercise and CBT are no better for ME than doing nothing. Investigative journalists and academics alike have dismissed the PACE trial as ‘clinical trial amateurism’.

Like MS or epilepsy, which were also once wrongly believed to be psychiatric disorders, ME is a neurological disease, and the World Health Organisation lists it as such. I am too weak to walk more than a few metres, needing to lie in bed 21 hours a day. With the little energy I have, I am an ME patient activist.”
― Tanya Marlow

“Historically in the literature CBT [Cognitive Behavioral Therapy] was inappropriately touted as a cure for patients with ME/CFS if they changed their “belief system”. ME/CFS is a physical illness and not a psychological illness, therefore CBT cannot cure ME/ CFS. What CBT can do is to help patients cope with being chronically ill and manage their emotional reactions better so that they do not waste valuable energy on worrying or feeling guilty about things that they cannot control. We like to think of CBT as “emotional energy conservation”.”
― Alison C. Bested

“You will invariably face jobs that are associated with uncomfortable feelings, ranging from relatively minor annoyance (e.g., taking out the garbage in the rain) to more persistent and recurring feelings of stress and discomfort (e.g., dissertation, organizing income taxes) that activate your procrastination script. Even a minimal degree of stress or inconvenience (what we have come to describe as the feeling of “Ugh”) can be potent enough to make you delay action.
Think about some of the mundane examples of procrastination, such as watching a boring television show because the remote control is out of reach (e.g., “It’s ALL THE WAY over there.”) or exercise (e.g., “I’m TOO TIRED to change into my workout clothes.”). The use of capital letters is meant to illustrate the tone of voice of your selftalk, which serves to exaggerate and convince you of the difficulty of what you want to do. You are capable to perform the action, but your thoughts and feelings (including feeling tired or “low energy”) makes you conclude that you are not at your best and therefore cannot and will not follow through (for seemingly justifiable reasons).

You might think, “I have to be in the mood to do some things.” But, how often are any of us in the mood to do many of the tasks on which we end up procrastinating? The very fact that we have to plan them indicates that these tasks require some targeted planning and effort. When facing emotional discomfort, ADHD adults are particularly at risk for bolting to pleasant, easy, and yet often unsatisfying activities, such as eating junk food, watching television, social networking, surfing the Internet, etc.

In fact, sometimes you may escape from stressful tasks by performing other, lower priority errands or chores. Thus, you rationalize violating your high-priority project plan in order to run out to fill your car with gas. This strategy can be seen as a form of “plea bargaining”—“I will do something productive in order to justify not doing the higher priority but less appealing task.” Moreover, these errands are often more discrete and time limited than the task you are putting off (i.e., “If I start mowing the lawn now, I will be done in 1 hour. I don’t know how long taxes will take me.”), which is often their appeal—even though they are low priority, you are more confident you will get them done.

You need not be “in the mood” for a task in order to perform it. A useful reframe is the reminder that you have “enough” energy to get started and recall that once you get started on the first step, you usually feel better and more engaged. Breaking the task down into its discrete steps and setting an end time help you to reframe the plan (e.g., “I’m tired, but I have enough energy to do this task for 15 minutes.”). Rather than setting up the unrealistic expectation that you must be stress-free and 100% energized before you can do tasks, the notion of acceptance of discomfort is a useful mindset to adopt and practice.”
― J. Russell Ramsay, The Adult ADHD Tool Kit

“The topic of motivation often comes up when dealing with the issue of follow-through on plans. Many adults with ADHD may aspire to achieve a goal (e.g., exercise) or get through an unavoidable obligation (e.g., exam, paying bills), but fall prey to an apparent lack of motivation, despite their best intentions. This situation reminds us of a quote attributed to the late fitness expert, Jack LaLanne, who at the age of 93 was quoted as saying, “I’m feeling great and I still have sex almost every day. Almost on Monday, almost on Tuesday . . .”

Returning to the executive dysfunction view of ADHD, motivation is defined as the ability to generate an emotion about a task that promotes follow-through in the absence of immediate reward or consequence (and often in the face of some degree of discomfort in the short-term). Said differently, motivation is the ability to make yourself “feel like” doing the task when there is no pressing reason to do so. Thus, you will have to find a way to make yourself feel like exercising before you achieve the results you desire or feel like studying for a midterm exam that is still several days away. You “know” logically that these are good ideas, but it is negative feelings (including boredom) or lack of feelings about a task that undercut your attempts to get started. In fact, one of the common thinking errors exhibited by adults with ADHD when procrastinating is the magnification of emotional discomfort associated with starting a task usually coupled with a minimization of the positive feelings associated with it.

Adults with ADHD experience the double whammy of having greater difficulty generating positive emotions (i.e., motivation) needed to get engaged in tasks and greater difficulty inhibiting the allure of more immediate distractions, including those that provide an escape from discomfort. In fairness, from a developmental standpoint, adults with ADHD have often experienced more than their fair share of frustrations and setbacks with regard to many important aspects of their lives. Hence, our experience has been that various life responsibilities and duties have become associated with a degree of stress and little perceived reward, which magnifies the motivational challenges already faced by ADHD adults.

We have adopted the metaphor of food poisoning to illustrate how one’s learning history due to ADHD creates barriers to the pursuit of valued personal goals. Food poisoning involves ingesting some sort of tainted food. It is an adaptive response that your brain and digestive system notice the presence of a toxin in the body and react with feelings of nausea and rapid expulsion of said toxin through diarrhea, vomiting, or both. Even after you have fully recuperated and have figured out that you had food poisoning, the next time you encounter that same food item, even before it reaches your lips, the sight and smell of the food will reactivate protective feelings of nausea due to the previous association of the stimulus (i.e., the food) with illness and discomfort. You can make all the intellectual arguments about your safety, and obtain assurances that the food is untainted, but your body will have this initial aversive reaction, regardless. It takes progressive exposure to untainted morsels of the food (sometimes mixing it in with “safe” food, in extreme cases) in order to break the food poisoning association.

Similarly, in the course of your efforts to establish and maintain good habits for managing ADHD, you will encounter some tasks that elicit discomfort despite knowing the value of the task at hand. Therefore, it is essential to be able to manufacture motivation, just enough of it, in order to be able to shift out of avoidance and to take a “taste” of the task that you are delaying.”
― J. Russell Ramsay, The Adult ADHD Tool Kit

“Adults with ADHD as a group have often experienced more than their fair share of disappointments and frustrations associated with the symptoms of ADHD, in many cases not realizing the impact of ADHD has had on them. When you reflect on a history of low grades, forgetting or not keeping promises made to others, repeated exhortations from others about your unfulfilled potential and the need to work harder, you may be left with a self-view that “I’m not good enough,” “I’m lazy,” or “I cannot expect much from myself and neither can anyone else.” The end result of these repeated frustrations can be the erosion of your sense of self, what is often called low self-esteem.

These deep-seated, enduring self-views, or “core beliefs” about who you are can be thought of as a lens through which you see yourself, the world, and your place in the world. Adverse developmental experiences associated with ADHD may unfairly color your lens and result in a skewed pessimistic view of yourself, at least in some situations. When facing situations in the here-and-now that activate these negative beliefs, you experience strong emotions, negative thoughts, and a propensity to fall into self-defeating behaviors, most often resignation and escape. These core beliefs might only be activated in limited, specific situations for some people with ADHD; in other cases, these beliefs color one’s perception in most situations. It should be noted that many adults with ADHD, despite feeling flummoxed by their symptoms in many situations, possess a healthy self-view, though there may be many situations that briefly shake their confidence.

These core beliefs or “schema” develop over the course of time from childhood through adulthood and reflect our efforts to figure out the “rules for life” (Beck, 1976; Young & Klosko, 1994). They can be thought of as mental categories that let us impose order on the world and make sense of it. Thus, as we grow up and face different situations, people, and challenges, we make sense of our situations and relationships and learn the rubrics for how the world works.

The capacity to form schemas and to organize experience in this way is very adaptive. For the most part, these processes help us figure out, adapt to, and navigate through different situations encountered in life. In some cases, people develop beliefs and strategies that help them get through unusually difficult life circumstances, what are sometimes called survival strategies. These old strategies may be left behind as people settle into new, healthier settings and adopt and rely on “healthy rules.” In other cases, however, maladaptive beliefs persist, are not adjusted by later experiences (or difficult circumstances persist), and these schema interfere with efforts to thrive in adulthood.

In our work with ADHD adults, particularly for those who were undiagnosed in childhood, we have heard accounts of negative labels or hurtful attributions affixed to past problems that become internalized, toughened, and have had a lasting impact. In many cases, however, many ADHD adults report that they arrived at negative conclusions about themselves based on their experiences (e.g., “None of my friends had to go to summer school.”). Negative schema may lay dormant, akin to a hibernating bear, but are easily reactivated in adulthood when facing similar gaffes or difficulties, including when there is even a hint of possible disappointment or failure. The function of these beliefs is self-protective—shock me once, shame on you; shock me twice, shame on me. However, these maladaptive beliefs insidiously trigger self-defeating behaviors that represent an attempt to cope with situations, but that end up worsening the problem and thereby strengthening the negative belief in a vicious, self-fulfilling cycle. Returning to the invisible fences metaphor, these beliefs keep you stuck in a yard that is too confining in order to avoid possible “shocks.”
― J. Russell Ramsay, The Adult ADHD Tool Kit

“In his book-length review of the executive functions, Dr. Russell Barkley (2012) explored the reasons that these skills evolved in humans in the first place. He makes the compelling case that it was the selection pressures associated with humans living in larger groups of genetically unrelated individuals, which made it selectively advantageous to have good self-regulation skills. That is, these abilities became more important to survival as humans became more interdependent with and reliant on dealings with people
who were not family.

Attention-Deficit/Hyperactivity Disorder (ADHD) and executive dysfunction continue to have effects on the myriad relationships and social interactions in daily life. These connections include romantic and committed relationships/marriage, relationships with parents, siblings, children, and other relatives, friendships, and interactions with employers, coworkers, and customers. The executive functions in relationships also figure in the capacity for empathy and tracking social debt, that is, the balance of favors you owe others and favors owed to you. The ability to effectively organize behavior across time in goal-directed activities gains you “social collateral.” That is, the more you deliver on promises and projects, the more that you will be sought out by others and maintain bonds with them.

Some of the common manifestations of ADHD and executive dysfunction that may create problems in relationships include:

• Distractibility during conversations
• Forgetfulness about matters relevant to another person
• Verbal impulsivity—talking over someone else
• Verbal impulsivity—saying the “wrong thing”
• Breaking promises (acts of commission, e.g., making an expensive purchase despite
agreeing to stay within a household budget)
• Poor follow-through on promises (acts of omission, e.g., forget to pick up dry
cleaning)
• Disregarding the effects of one’s behavior on others (e.g., building up excessive debt
on a shared credit card account)
• Poor frustration tolerance, anger (e.g., overreacting to children’s behavior)
• Lying to cover up mistakes
• Impulsive behaviors that reduce trust (e.g., romantic infidelity)”
― J. Russell Ramsay, The Adult ADHD Tool Kit

“Most people are who they are because of fear. They had changed their character, personality and their being because they fear something or someone.”
― De philosopher DJ Kyos

“Most people are who they are because of fear. They had changed their character, personality, behavior and their being because they fear something or someone.”
― De philosopher DJ Kyos

“Choose to take care of your Mental health.
Crazy people are considered to be normal these days.
We have lot of people who are facing mental breakdown and psychological problems.
Because we live in a crazy world these days.
Everyone who is crazy is considered normal and normal people considered crazy.
That is why we end up with the messed-up society, community, and world.”
― De philosopher DJ Kyos

“I asked a Catholic friend who kindly offered to ask several Catholic theologians if it was okay to fantasize about Jesus having sex with the Virgin Mary in all the positions of the Kama Sutra. They agreed to debate the topic and came up with this unanimous conclusion: Cognitive flooding would be okay if the goal was healing and not entertainment.”
― David D. Burns, Feeling Great: The Revolutionary New Treatment for Depression and Anxiety