What are cognitions?

When you come for cognitive behaviour therapy, the anxiety and depression that you come forward to work on is addressed by looking at two main aspects - cognitions first, then the behaviours.

What are cognitions?

The definition of cognition is "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". This can sound quite confusing, so let’s break it down into understandable terms.

Cognitions are the thoughts you have in your mind. They can be positive or negative, and they can be about everything. It is said we have around 70,000 thoughts a day, so right now your mind will be having thoughts as you read this. The thoughts can be about anything from memories to current thoughts to thoughts about the future. The nature of the thoughts can be triggered by the five senses of sight, sound, touch, smell, and taste. In post-traumatic disorder, if a person was involved in a car accident, then the smell of petrol at the time of the trauma may still affect the client now. This is because if the client may smell petrol in the here and now, and it was quite evident at the time of the trauma, then it may bring back feelings of what they were feeling and thinking at the time of the trauma. This might lead to panicking or having flashbacks.

Or, if they hear a certain sound that reminds them of the certain past negative experience, that makes them worry a person may get anxious or scared in the here and now, as it may be reinforcing that fear from before in them. With these feelings, they will get thoughts of threats of danger, such as "I am in danger", "what happened before will happen again", or "something bad is going to happen".

Once we believe in these thoughts and take them as fact, we then end up basing our behaviour on these strong, negative thoughts, or we may want to dismiss them as they will be hard to deal with (as they may make us feel low).

In CBT, as the emotions we feel are negative, we come to therapy to work on them so we do not feel the anxiety, depression, panic, etc. We call these negative automatic thoughts - or NATS. In anxiety, common NATS we come across in therapy can be;

• "I get so nervous speaking in public"
• "What if I faint?"
• "What if people laugh at me?"
• "What if I go red?"
• "What if we have another accident and I die?"
• "I'll never feel normal - I’m always worrying"
• "If I’m not perfect then I will lose my job"

There are so many more thoughts; these are just some of them.

In depression, the thoughts are more like this;

• "I will fail"
• "I am worthless"
• "There's no point in doing anything"
• "No one loves me"
• "I am not wanted"
• "I can’t do that"
• "This is my fault"

Again, there are so many other thoughts. These thoughts, as you can probably guess by the content of them, will only lead to unhealthy feelings.

In CBT, one of the main focuses of the therapy is to make you aware of what you are thinking and the meaning behind it, and then to start to challenge these thoughts, because even though we think they are facts to us, in reality, they can be challenged or looked at differently. Once we can do this, you can start to feel better and more in control of your thoughts.

Thoughts can be very powerful and life-altering. They are consistent and never really go away; all we can do is learn to address them and manage them more effectively.

In CBT, working on thoughts is just one way (among many) to help improve your mood, and the way we address the thoughts is very much dependent on the anxiety or depression presentation you have. OCD thoughts, for example, might be addressed slightly differently than PTSD thoughts. We can also use different techniques to address the thoughts, and all of these can be very effective if used appropriately and during times of need.

The healing is in your hands and your mind - it just takes awareness and practice.