Distancing Techniques in Cognitive Therapy

Copyright © Donald Robertson, 2012.  All rights reserved.

This article briefly describes the basic technique of psychological “distancing” as employed in cognitive therapy.  The original cognitive therapy approach developed by Aaron T. Beck contained reference to a strategy referred to as “distancing”, which involves learning to be mindful of thoughts and to experience them as psychological events rather than confusing them with external reality. This concept was taken up by the founders of Acceptance and Commitment Therapy (ACT), which was originally called “Comprehensive Distancing” (Hayes, Strosahl, & Wilson, 2012). They developed the idea further and renamed it “defusion.” Cognitive distancing or defusion is therefore a central process in modern mindfulness and acceptance-based approaches to therapy but is not a novel concept in the CBT field, the earliest explicit reference appearing to date from 1976.

In his first book on cognitive therapy, Cognitive Therapy and the Emotional Disorders (1976), Beck explicitly defined the concept of “distancing” as follows:

Some patients who have learned to identify their automatic thoughts recognize their unreliable and maladaptive nature spontaneously. With successive observations of their thoughts, they become increasingly able to view these thoughts objectively. The process of regarding thoughts objectively is labeled distancing. (Beck, 1976, pp. 242-243)

He elsewhere repeats this view, that merely helping clients to become more aware of their automatic negative thoughts “tends to be accompanied by greater objectivity (distancing)” insofar as the client increasingly spots that their thoughts are not in accord with reality and corrects them spontaneously (Beck, 1976, p. 258).

Later, in their technical account of cognitive theory, Beck and Alford explicitly equate the clinical technique of distancing with the theoretical concept of “metacognition”, or thinking about thinking, stating that distancing constitutes an active, self-regulatory process that involves switching to a metacognitive level of processing information (Alford & Beck, 1997, p. 65).  At this time, he defined the term as follows:

“Distancing” refers to the ability to view one’s own thoughts (or beliefs) as constructions of “reality” rather than as reality itself. (Alford & Beck, 1997, p. 142)

Beck had originally explained that the term “distancing” came from the literature on projective tests such as the Rorschach ink-blot. Some individuals are “carried away” by strong emotional reactions to ambiguous pictures and view them as though they were literally equivalent to the things they take them to represent. Others are more able to “take distance”, perceiving the random ink-blots merely as a ink-blots (Beck, 1976, p. 258). As Beck goes on to explain, when someone automatically equates his thoughts with reality his distancing is described as poor. By contrast, his distancing is good, when he can view his thoughts as hypotheses or inferences, rather than facts. Beck therefore also described distancing as the ability to distinguish between “I believe” and “I know”.

In their 1985 manual for anxiety disorders, Beck and his colleagues also describe helping clients to achieve psychological distance from anxious thoughts and feelings by referring to themselves in the third-person throughout the day (“Bill is feeling anxious, he’s worried others are judging him negatively…”) to develop an objective stance on their feelings (Beck, Emery, & Greenberg, 2005, p. 194). Elsewhere in this manual, Beck and his colleagues refer to distancing in terms of developing “self-observation” and the ability of the client to “watch myself watch myself”, to be self-aware of one’s awareness.  In his later, theoretical text on cognitive therapy, Beck linked distancing to “perspective taking”. Hence, another technique for facilitating psychological distance is to have the client take the perspective of other people, who may disagree with his beliefs, and thereby distance himself from them temporarily. This approach is used with schizophrenic delusions in cognitive therapy but also with emotional disorders and subclinical problems (Alford & Beck, 1997, p. 143).

Self-monitoring strategies also play an important role in the development of psychological distance, when approached in the right way. The practice of writing thoughts down in automatic thought records was described by Beck and his colleagues as a simple method for achieving objectivity in relation to them (Beck, Rush, Shaw, & Emery, 1979, p. 164). This is more likely, perhaps, to lead to cognitive distance when genuine “automatic thoughts” are caught and recorded, which would normally have gone unnoticed, and when a clear distinction is maintained between thoughts and feelings.  (When we say “I feel like nobody likes me” rather than “I have the thought that nobody likes me”, we may undermine our ability to experience thoughts as hypotheses because of poor cognitive distance.)  Likewise, by counting the number of times certain automatic thoughts occur, using a golf or knitting counter, the client starts to view them as stereotypical and repetitive in nature.

Through practice with these devices, the patient learns to distance himself: “There’s another fearful thought. I’ll just count it and let it go.” The patient is told to accept the thoughts rather than fight them. He observes his thoughts and lets them go. (Beck, Emery, & Greenberg, 2005, p. 196)

Similarly, by recording automatic thoughts or writing them up on a chalkboard and literally taking a few steps back and viewing them from a distance, the client can also be helped to gain psychological distance (Beck, Emery, & Greenberg, 2005, p. 191).  It seems to help when a little longer is taken to patiently notice the physical properties of the thought-as-object.  For example, you might write the thought “My life is a failure” on a whiteboard or just imagine it projected on the wall and then take a couple of minutes to verbally describe the size of the letters, style of handwriting, colour of the letters, etc.  Doing so forces your mind to pay more attention to the properties of the thought as an object, and thereby gain psychological distance.

Summary

In short, the following are described by Beck and his colleagues as basic distancing strategies in standard cognitive therapy:

1. Writing down negative automatic thoughts on a daily thought record, particularly fleeting automatic thoughts that might normally go unnoticed or get conflated with feelings

2. Writing thoughts on a blackboard and literally viewing them from a distance, as something objective and “over there”, by patiently describing the colour, size, and style of the writing, etc.

3. Viewing thoughts as inferences or hypotheses instead of facts, distinguishing between “I believe” and “I know”, discriminating carefully between thoughts and facts

4. Referring to your thoughts and feelings in the third-person (“Bill is having anxious feelings, he’s thinking that people are criticising him…”)

5. Using a counter to keep a tally of specific types of automatic thoughts, seeing them as habitual and repetitive, as just a meaningless side-effect of previous experience rather than something important and meaningful that deserves to be taken seriously

6. Self-observation, being aware of your own awareness, noticing how you observe your thoughts, maintaining a sense of yourself as conscious observer, separate from the contents of your stream of consciousness

7. Shifting perspectives and imagining being in the shoes of other people, who might disagree with your beliefs and view things differently, adopting a different perspective on things and identifying a range of alternative views, among which your current thought is just one of many

Distancing is one of several initial symptom-relief strategies used to reduce anxiety prior to the systematic disputation of cognitions (Beck, Emery, & Greenberg, 2005, p. 232). It also formed part of the “AWARE” strategy described in Beck’s cognitive therapy for anxiety, which instructs clients to Accept their anxious feelings, Watch their thoughts from a distance, Act “as if” non-anxious, Repeat these strategies, and Expect to make progress in a realistic and optimistic manner (Beck, Emery, & Greenberg, 2005).