It is not a bad idea to just jot down your thoughts, as currently they exist, on one side of an A4 sheet of paper. The task thereafter is to spot and distinguish between realistic negative thoughts and errors in thinking. By teasing out and restructuring one’s overall pattern of thought in this way (using help where appropriate and available, since more often than not “two heads” are “better than one” for such an undertaking) a huge step in the direction of enhanced quality of life can realistically be taken. Nor does one need a diploma in CBT to successfully manage this sort of thing. (Perhaps even reading this blog through together, might be sufficient to at least get things started).

A further helpful word might be quite simply to avoid over-generalizations. Here are few examples, which I have come across in my clinical practice: – “Unless I can somehow return to my state of mind of pre-illness days (which in itself is likely to be “rose-tinted” and thus distorted) there is no point in going on”. “My illness has been entirely negative in its impact upon my life”. “Somebody up there really does seem to have it in for me”. At the very commencement of these posted blogs, I made it clear that I would not say, “I know how you feel”, i.e. I wouldn’t make assumptions or jump to conclusions on the basis of insufficient evidence. By ‘teasing’ things apart and labelling your thoughts simply but accurately in the manner briefly illustrated above, you will avoid the greatest pitfall of all, namely, making assumptions about yourself. Remember that the cognitive aspect of CBT is not really about thinking positively or even more rationally or that this or that way of thinking is wrong. Rather does it encourage us to identify and check the merits/de-merits of these myriad thoughts against actual experience and what is appropriate.

Now for one final point about my patient; (who, you may recall, reached his doom-ridden and erroneous conclusions concerning his forebears on the basis of thinking errors). Even had there been ‘hard’ evidence in the form of large scale “cooperative research randomized controlled studies”, i.e. involving substantial numbers of patients scientifically sampled from different regional centres and showing that mean (or average) 5 year survival time*· for patients of his illness type/stage of progression, age, gender, cultural/social /environmental etc. was 50%; why should he or anyone else automatically assume that he is destined for the “50% failure” rather than the “50% success” group? Moreover, might not the “50% full” rather than the “50% empty” perception, of itself, impinge on other influential factors and issues predictive of likely success?

Thus if we can challenge and by so doing, “re frame” or restructure our thoughts (again, the ‘fancy’ word is “cognitions”) in the kinds of ways illustrated above and where appropriate (just as in my panoramic view of Edinburgh referred to in a previous blog) one spring morning, when I found a valid and credible way of keeping what might otherwise have become the dominating and otherwise threatening feature, in perspective) we can and will enable and reinstate a more comfortable awareness of control.

Another “cognitively orientated” way of achieving a similarly desired end, has already been touched upon in an earlier blog, namely that concerning the breaking down of problems into “manageable chunks”. The thought of several weeks or even months of radiotherapy or chemotherapy, are almost certainly likely to be overwhelming, just as would be – say – the taking on-board at any given point of three months en block, of normal occupational activity. You don’t do it with your work, so why should you do it regarding treatment, or with distorted or biased illness prospects, all or any of which might well not transpire? Furthermore and much to the good, you conserve all that energy for more profitable application elsewhere. (C)SB.

• “Science is nothing more than a refinement of everyday thinking”, Albert Einstein.
• This term as used here refers not – as many patients of my acquaintance (having heard the term)  have   been disposed to think, i.e. to a prediction that such patients will die in that five year period; but rather that they may be expected to survive at least  for such a period of time.