Three Approaches to Psychotherapy 3: Dr. Aaron Beck

0:00 [Music] um [Music] cognitive therapy is a system of psychotherapy it consists of a theory and an organized body of principles for applying this theory to the treatment of patients

0:45 the various principles involved in the theory the major principle is that the way an individual perceives his reality will influence the way he behaves and the way he feels and the way he approaches his problems consequently if he misperceives reality then he's going to have our barren feelings he's going to behave in a maladaptive way and he's going to have difficulty in solving his problems underneath this type of misperception we often find there are many distorted beliefs in depression the beliefs center around the negative bias towards the self the depressed person

1:31 perceives himself in a negative way he sees himself as a loser as he looks back on his past he thinks of himself as a failure the present is filled with predicaments and the future with futility in contrast the anxious patient may not see himself in a negative way but he sees himself as surrounded by dangers and he believes that he is not able to cope adequately with these dangers the paranoid patient in contrast sees himself as the victim of abuse persecution intrusion blockage frustration and like all of these disorders have a particular type of thinking disorder first there is selective abstraction the

2:19 individual fastens his attention on a few significant details in a particular situation but he ignores all of the other details the depressed patient for instance may only perceive those incidents in which he fails or does not live up to his standards and he misses all of the very positive aspects of a situation second the individual may jump to sweeping conclusions on the basis of minimal or inadequate information or data third the individual tends to over generalize thus if he makes a mistake in one situation he may believe that he mistake makes mistakes in every situation finally patients and these disorders

3:05 tend to show all or nothing thinking for instance if a depressed patient is not totally successful he is likely to see himself as a total failure how do we apply these theoretical principles to the actual therapy situation actually the theory is a kind of a blueprint which we use in order to organize the information that we obtained from the patient this blueprint helps us to understand the patient better and it also enables us to select those tech tactics and strategies that will enable us to treat the patient the main objective in the therapy is to try to adjust the patient's bias thinking in such a

3:50 way that it conforms in a more regular and accurate way to the actual external reality now there are many techniques that we use in cognitive therapy first and foremost it is important to establish a good working relationship with the patient this is something that we call collaborative empiricism the patient and these therapists work hand in glove testing out the patient's belief evaluating them seeing whether they're accurate or not and modifying them according to the requirements of reality secondly the therapist uses questioning in order to unravel the mystery of the patient's problems this is something that we call guided

4:37 discovery the patient and the therapist try to work to ascertain just what the distorted thinking is and then they attempt to evaluate the distorted thinking there are many ways in which one can evaluate conclusions that a patient makes which do not seem to conform to reality first one can ask what is the evidence for your conclusion are you leaving anything out are you omitting contradictory evidence does your conclusion follow logically from the observations that you have made and finally are there alternative explanations that may be more accurate in explaining a particular episode

5:26 the ultimate goal of course is to correct the patient's misconceptions once they are corrected the depressed patient becomes less depressed the anxious patient becomes less anxious and the paranoid patient becomes less paranoid what do you feel about being here i'm very nervous anything else uh my stomach is turning i think my palms are starting to perspire a little bit and i am concerned about how well i'll come across if if if i can maintain my faculties to communicate keep a good conversation going now do you remember having thoughts of

6:11 that nature will i come across well will i be able to carry on a conversation will i be able to perform properly did you recall having had those thoughts uh the closer i i got to your office the more severe the thoughts got and as the thoughts got more severe what happened to your symptoms the anxiety the stomach the sweaty pond my my stomach started to churn more and more i felt a lump in my throat i found it very difficult to breathe so in addition to the stomach you had other physical symptoms such a lump in your throat and some problem and breathing yes now can you see any connection between these fear fearful thoughts that you had

6:58 and the symptoms that you're experiencing they they they run together they they're just i'm just i'm almost like jelly yeah so one of the things we want to look at is to see whether this type of thinking that you do produces the types of effects both psychologically in terms of the anxiety that you feel and also physically the funny feelings in your stomach and the sweaty palms and the choking sensation that you get we want to see if indeed the thinking produces the anxiety symptoms now if the thinking isn't reasonable if it's way out of line you can correct the anxiety symptoms by correcting the thinking

7:45 for instance it might very well be that it doesn't matter how you perform here and if you could be convinced that it doesn't really matter that it's my job rather than your job then you wouldn't feel anxious anymore that would help yes so let's look at it right now and see if it's true whose responsibility is it to carry on the interview yours of mine yours right and what's your role my role i'm here to gain knowledge and help me with my anxiety that's why i'm here right and so your role is simply to be able to answer questions and performance or being nervous and so on doesn't at all interfere with giving us

8:31 information because your nervousness itself is a form of information isn't it yes so the responsibility isn't on you isn't it no right and the question of evaluation isn't on you either no right now what do you think would be a more reasonable way to put your role in this particular interview i am to respond to what you ask me but i also have to be honest with you because if i'm not honest with you then you won't be able to feed it back to me right now does the anxiety prevent you from being honest no so you can be honest whether you're anxious honesty has got nothing to do with performing performing well carrying on a good conversation being a polish speaker

9:17 and so on right okay now that we've gone through that and restructured your role uh how are you feeling i feel better i'm i'm still uh i'm still anxious right but i feel more comfortable what you can see when a person changes his thinking from something that's kind of exaggerated such as i have to perform well too i just have to do whatever comes my way you can see when the thinking gets modified then the emotions do change so let's see how this develops now in terms of your major problems now what is the reason why you're coming for therapy at this time i just went through a divorce and i'm i'm depressed and i have a lot of anxiety

10:08 now first what i'd like to do is look at your depression itself is that okay yeah so let's let's examine the depression and see just what it's made up of uh now on what basis do you think uh you can make the diagnosis that you're depressed uh i i have that terrible feeling in my stomach that i am just very lonesome and that i will be alone for the rest of my life and at this point in my life no one wants me now it seems that your depression then is made up of the fabric of several conclusions one is that you're lonesome number two

10:54 is that you're alone now three is that you're going to be alone for the rest of your life and for that nobody wants you so this is the way you see your life situation in a very negative way in terms of you and other people yes now how do you view yourself as you look at yourself do you see yourself in glowing positive terms i i feel good about myself and i feel that after the divorce with a with a new uh with a new position with a new company that i'm ready to get started in life all over again at age 47 but it still does not eliminate the

11:42 loneliness of today so the major thing that seems to bother you is your loneliness yes now as you look back on the past how does your past history seem to you stinks in what way you feel your past history stinks because uh i was very lonesome as a child i had no brothers and sisters my parents were alcoholics i married made very few friends as a youngster and i felt that uh from as far back as i can remember i i have always had a shell around myself i've always kept everyone's arms length i would never get close to anyone

12:28 and in recent years did you feel that you made a success out of life and say the last five or ten years i made when i got married five years ago i felt it was a tremendous emotional experience for me because i it was my first marriage and here was a woman which i felt at the time was the most wonderful woman in the entire world wanted me and that made me feel very good about myself at that time uh as far as uh but now going back through the divorce again i'm i'm back having some doubts about myself again and now as you look back on your past how do you view yourself

13:15 i view myself as a product of my childhood and it wasn't my fault that i was that way as a youngster and and how do you feel then this childhood development has affected you say in recent years uh as a child i spent my practically my entire childhood by myself i received virtually no love as a youngster being an only child and my parents drinking a lot i had no one to communicate to and there was there was a lot of fighting in our family with my mother and father because i would just hide in the bedroom and it it made me a very very sheltered

14:02 person yeah now sometimes when people have a childhood like that they reach certain conclusions about themselves and about other people what conclusions you think you have now that may have originated back there how do you see yourself now in terms of the childhood experience after uh going through some counseling this last year i feel good about myself now and prior to going through the counseling how did you feel about yourself i was a goddamn jerk so you regarded yourself as a jerk in what ways were you quote a jerk at that time um hooray for me and screw the world i had a lot of anger in me i i looked at i didn't try to look at the positive

14:48 side of people i always looked at their bad side and i was very negative and i had an attitude of uh i'm going to get them before they get me so up until you started the counseling you had a lot of attitudes about other people which was kind sounds kind of competitive dog eat dog is that right and who's like who's superior and who's inferior yes and i'm going to hold people at arm's length yes and at that particular time the loneliness did not bother you it yes it did bother me even so it bothered me then i didn't know any better i didn't know what to do

15:33 where do i go to change to change into being a good human being how do i get started i was very i've been very lonely all my life but i either i was too stupid or i just didn't know what to do to get started on the right track yeah now you think that this kind of standoffish attitude that you had being aloof from other people uh set you up for being a lonely person like before you started the counseling you say i'm going to step on these people before they step on me this idea of seeing people as an opposition to you do you think that that might have affected you in terms of your relationships with other people oh yes by all means yes sir

16:19 i can see you know just in the last six months i can see a different attitude uh of people towards me when i go to someone and i'll put my hand out and i'll shake their hand and i'll and i'll radiate warmth and love and kindness whereas before it was who's got the strongest grip and don't look me now as you son of a because i'll stare you down now how strongly do you feel this other notion i don't want to hop on it too much but it does seem to be the core of your depression as you said that you've always been lonely you always will be lonely nobody wants you and you're never going to be able to find somebody who will want you how strongly do you believe that i don't believe it at all so you don't really believe it no uh

17:05 so on the one hand you say it but on the other hand you don't really believe it it's when i'm laying around the the house by myself and i have absolutely nothing to do i've got nobody to call and uh i'm just it's saturday afternoon and i have no date and i've got nothing to do and i just what am i gonna nobody wants me i have to start feeling sorry for myself i see so when you're actually in an isolated condition then these thoughts come up but right now when you look at these very same thoughts you don't believe them no you don't now let me play the devil's advocate why don't you believe them because i feel now at my age i have i am maturing and i am becoming a good person

17:50 and i have something to offer to society and since you were maturing becoming a good person and you have something to offer society what does this tell us about the probability of you finding somebody that you can be close to excellent so right now you are still feeling depressed no i'm not starting this minute i'm starting to feel better okay now what's going to happen when you're lying in bed it's saturday afternoon it's kind of gray outside nobody's calling you you're all alone what are you going to be thinking then i there's a real good chance i'll be depressed very good and you're going to be thinking thoughts like i'm all alone i'm

18:38 always going to be alone and nobody wants me yes and what are you going to do about it then i've got to call somebody okay one thing is you can call somebody up yes and what will that if you call somebody up and that person responds positively what will that tell you it tells me that somebody cares for me that's right somebody cares me in other words your belief is wrong and has that happened that sometimes you had this belief that nobody cares for you you called somebody up and you got some positive feedback yes so you've already demonstrated to yourself the belief is wrong yes at times but one demonstration doesn't do it once

19:23 while it doesn't make a spring right you have to keep demonstrating it to yourself so the next time when you're home alone saturday afternoon and you get this belief you can test it out by calling up somebody but suppose that person isn't home what happens you just go back to lying in bed and then i'm then i'm very hurt yes that's happened i'm hurt i'll try calling somebody else and yes this has happened i'll call three or four people none of them are home they're all out they're doing something they're they're having a good time and i'm sitting at home by myself yeah and so you feel hurt and what do you think what thought makes you feel hurt i think that that person doesn't care because they're not home and they didn't call me that day that's right first of all they don't care

20:08 because if they really cared they'd be home waiting for your phone call yes right and secondly if they really really cared they would be on that phone calling you yes now is there any other reason that they might not call you besides your explanation that they don't care is there an alternative explanation why a person might not call you they're busy with their life and and and they some of the people that i have communicated with over the last year so feel that you can only support someone for so long

20:55 and then they have to do it on their own well they have to take more initiative but okay now let's see this may be helpful to you because your big problem is these great saturday afternoons when you're alone so could we do a little bit of a role play and let's imagine that um i'm you saturday afternoon and i'm kind of lounging in the bed and i'm having these thoughts and then you tell me what my thoughts should be or see if they're incorrect and how you might correct them okay now here i am home all alone i don't know nobody has called me all day that's awful that means nobody cares for me how are you going to answer that

21:42 people do care for you you have lots of friends i do who who some of my friends i can't think of any right now don oh jim jim the other jim dennis steve all the guys you play golf with so it's only don jim jim dennis steve that's not so money is that at all no we've got two other guys that we play golf with regularly yeah what's their name uh steve they give you steve and there's another dentist in there too i know two i know two dentists and i know two dons and i know two gyms well if they really care for me how come they aren't calling

22:29 that's what i ask myself to you're supposed to yes i know that's right the so we'll go over that again if they're not calling is there any other explanation why they might not call they're busy with their own lives right now is that reasonable that they're busy they have lives of their own and that if you want to become part of the lives you have to take the initiative is that right that's what you should do yes you should take the initiative okay but i still don't know what to do i'm lying right here and feel nobody loves me nobody's ever going to love me and maybe i'll go live in a cave and eat worms

23:17 why don't you uh why don't you put on a pair of jeans and a shirt brush your teeth and comb your hair and take a shower and go down to el torito what you're saying is that there are ways in which you could really counteract this negative thinking that you do and you just showed an example of this right now now do you think that it's possible when this occasion comes up again and it's bound to come up again that you can reason with yourself just the way you've been reasoning with me yes okay so that's part of what we call cognitive therapy which is trying to modify people's erroneous views what turn what it turns out is that uh the views that you have of yourself

24:03 are erroneous you do have a lot of friends i thought from the way you were talking you didn't have a friend in the world now i guess if we polled various people we'd probably find we do have as many male friends as anybody and you have good times you play golf with them and so on now the other part of your problem though that seems to bother you is that at the present time you don't have a woman in your life yes and evidently having a woman in your life uh is very important to you having a woman means what having a like a steady girlfriend someone i don't have to call up and ask him out every week and when you have this woman in your life what do you think it's going to do to you it will give me someone to hold and

24:48 caress which will make me feel better because i i want to express my love now am i correct in saying that you seem to believe that having a woman the way you describe that means that you're going to be happy i think that is initial step for me to be happy yeah so having a woman means happiness and not having a woman means unhappiness that seems to be a formula you operate on yes well let's examine this and see if the history shows that now when's the last time you had a woman in your life during your marriage i suppose my marriage which was uh i haven't connie and i broke up uh it had to be a year ago

25:35 about approximately a year ago and since that time uh when we first broke up or separated i had an awful lot of dates lots of dates most of them were one or two dates and i couldn't find a woman that i found attractive or i felt was uh socially on my same level yeah so you had a difficult uh transitional period now how about before you split up with connie well just like the week before the month before what were you feeling real happy then no we we were going through uh counseling that time and we but the last year of our marriage year and a half

26:20 uh we were both pretty unhappy so when at least we do know for at least a year and a half you had a woman in your life and you're unhappy so having a woman in your life doesn't necessarily equal happiness now let's go back in time and see there were many years before you were married and were there periods of time before you were married when you did not have a woman in your life yes and how did you feel then i felt i was lonesome men did you feel depressed then yes uh-huh yes and were there ever any periods when you're neither lonesome nor depressed prior to marriage yes yes you were so

27:06 having a woman in your life isn't an absolute necessity in terms of being happy it's not knocking it right it's just saying it's possible to be happy without having a woman in your life can i can be a whole person myself right without a woman and being a whole person is really what you have to do you can't be really dependent on somebody else to make you into a whole person let's think about that for a minute i i understand what you're saying and i feel i'm on the right track now

27:51 for the most part i feel good about myself i can be a good person i am a good person without a woman but i miss them missing them is part of human natures to miss something that you want but missing them isn't quite the same thing as feeling that they're so essential to your survival that you can't exist without being depressed in the absence of a woman now what you just seem to tell me is you can be a whole person without having a woman in fact you might get there faster without the woman because you can learn to stand in your own feet yes right yes so if one of your objectives is to be a whole person to be independent to be strong to be

28:37 mature and so on you might be able to get that without having to make a quick commitment to a woman i went after i had all these series of dates which uh i just didn't care for over a period of six months and i just quit asking women out i just wasn't interested in anymore because i couldn't find what i was looking for all one month there just went so some period of time all of a sudden i did feel good about myself i felt good about myself and i was satisfied sitting home i wasn't depressed i wasn't didn't have a lot of anxiety i didn't i didn't feel the need to go

29:24 out and grab the first chick off the street corner or something like that i did feel good about myself for about a period of a month uh maybe two months and this was right before the holidays which i was kind of proud about myself because i was devastated by the fact of going through the holidays with without a without a female friend i just didn't want to spend so i did have a period of about 30 to 60 days there where i just really didn't need anybody at all but now the last uh last 30 days the the the old depression feelings the anxiety the loneliness that nobody wants me is starting to creep back into me so you're able to overcome that belief that you need a woman in order to exist in a happy way you really would overcome it

30:10 temporarily because you no longer believed it and indeed you were happy now reasonably yes now if you have the notion that in order to be happy i have to have a woman what kind of a position does that put you in it makes me a dependent on a woman right and it means that if you don't have a woman that the form is going to have its day and you're going to be depressed but if you could change the formula around to it would be desirable and nice and enriching to have a woman but i can be happy without a woman then what does that do to you it makes me a complete person and when i do meet the woman eventually someday she will respect me

30:58 more right and so you'll be more independent in a sense and you'll be in a more mature level now it may be very it may be the case though that something's happened in the past month that made you slip because sometimes that happens was there anything that's occurred during the past month that may have slid you back into this negative thinking no i i i'm just i just miss the touch uh-huh i want to touch their skin isn't anything was there any other relationship that you have that's being threatened no uh my grandmother's dying but i don't i don't relate that to me that's two different things my grandmother raised me but for the most part i was bounced

31:44 around from one house to another my grandmother is in the hospital right now and we don't think she's going to pull out of it does that have any effect on you the fact that i even though my grandmother is very close to me i i want her to die she's old i see she can't take care of herself that relationship is not really affecting you now no i i don't think that has anything to do with my own personal depression or anxiety at this time well then we want to look at one other thing and that is just said that at times you've gone through these periods of anger is that anger still a factor in your life uh some of it is i'm i'm still very angry at my wife

32:30 and um what's the basis for you and what remember we had some automatic thoughts that you had that seemed to lead you to feeling anxious like how am i going to perform today or make you depressed like i'm a loser i'm never gonna find somebody what kind of thoughts do you have in connection with your anger i'm angry that my wife divorced me when she divorced me it took everything away from me that that that i got when we were married now you feel that connie has taken everything away from his that's the thought that you get yes she's taking everything away let's examine it is there anything left i got the barbecue set okay uh i have material things we split the

33:18 furniture 50 50. uh i have embarked on a new career how about the children since they were here children i am i am going to sh she is being very good about that she has encouraged the children to stay in touch with me and encourage me to stay in touch with the children so now as you look at it is it really true that she took everything away from you she took away the things that were most important to me mainly herself she took away herself yes but she's still allowing you in fact

34:03 encouraging you to have contact with the children yes so it's not a total type of takeaway no the other thing is you make it sound as though this was something she deliberately did just out of pure cussedness do you think that's the reason why this happened no she did it because she was unhappy and she didn't want to be merging me yeah and when people are unhappy oftentimes they do things that either damaging to themselves or to other people and one of the things is we don't want you to do anything that's damaging to yourself because you're unhappy have you thought at all of damaging yourself in some way yes i thought of suicide how often did you thought of that uh it's generally about uh

34:51 probably one saturday afternoon a month uh-huh okay now the next saturday afternoon when you start getting the suicidal thoughts what are you going to say to yourself i'm going to tell myself that people do care about me you have to name names right yes you can't just say it in the abstract yes and i didn't think you wanted all the names right no no but this is just to instruct yourself you've got to name names to yourself then and what else do you have to say to yourself uh that people do like me people do care about me they don't want me to commit suicide i have something to offer to society

35:41 okay and so what you have to do is counteract the negative thinking with reality because none of the things you just told me are untrue they're all true but you have something to contribute now the final thing you might just want to consider is that although connie did take many things out of your life that were present before she did not take the most essential thing away from you she did not take you away from you yes uh a year from now or two years from now i don't know when the time will be after this is all over and i've got both feet back on the ground again this will be a tremendously good experience for me i think it'll be a big spirit towards your maturation yes

36:28 well we've covered a lot of territory today do you have any questions on any of the things that we touched on uh no i i i i can see myself as telling myself convincing myself that uh when i'm so depressed because i i i know what it's like to be depressed and you're telling you're sitting there telling yourself well she was i'm really a good person and uh do you have all these friends and everything and and i kind of have doubts about that yeah about how it's going to work how it's going to work because every time i say something gee whiz you've got 14 guys you can call and and shoot the bull with uh but then all that but then i'll hit it back with something negative yeah well this is what i was trying to do

37:14 i can't answer all of your negative things in such a short period of time but i can teach you how to do it yeah and what you have to do is get a paper and pencil probably even before this depressing saturday comes on you ought to put down some of these rebuttal statements that we've had just now so you can take them out and then when you get the counter rebuttals that'll come up but if they really like me why don't they call and so on then you have to be prepared to use the same skill that you showed here today in answering your re-rebuttals so work on that and see how it how it progresses well i'd still be interested in one thing before we finish with today how did you feel about what we covered today i i feel very good about it

38:00 because i really have not been trying to combat the situation when i get depressed i just kind of lay around the house watch tv have a beer coke kind of lay around lay around wait for wait till i get sleepy and then go to bed yeah and hopefully when i wake up the next morning i'll feel better sure well how do you feel now at the beginning of the interview you said you were feeling very queasy and anxious yes which may have been related to the interview itself but you also did look rather sad how do you feel right now i feel good about myself and i feel that we could continue this conversation for another hour if we wanted to great good well thank you for coming in

38:46 to see me all right pleasure okay well okay in this interview i tried to demonstrate how one could apply the blueprint that is the cognitive model of depression as a way of understanding the patient's problems and helping him with them at the very beginning of the interview i tried to show the patient how his fearful thinking about the interview was leading to his feeling anxiety symptoms of physical symptoms and various psychological symptoms the patient was able to see at least that the negative thinking the fearful type of

39:32 thinking that he was experiencing was related to the anxiety symptoms themselves this was really important because it meant that the patient could see the connection between cognition and affect between thinking and symptom having demonstrated to the patient that there was some connection between the thinking and the anxiety symptoms i then moved into a discussion of the patient's depression the patient initially talked about his loneliness which ultimately related to kind of a deprived barren childhood in which nobody really seemed to care for him and which eventually led up into a somewhat aloof

40:19 lonely adulthood this background probably did help the patient to form certain negative beliefs about himself in the outside world for a large part of his life he was largely aware of how the beliefs influenced him his attitudes towards other people he lived a kind of dog eat dog highly competitive dominant submissive type of relationship with other people as the result of that he did not get a great deal of very positive feedback from the people that he had contact with this type of belief that people have to be kept at arm's length

41:06 probably prevented him from developing the type of social skills that are necessary for an individual to form some type of permanent bridges with other people the result of this was that the loneliness got perpetuated in recent times however he has been making some progress in this particular way and uh it is very interesting to find uh that he himself feels that he has matured a great deal ever since he started the counseling the loneliness however for reasons we weren't able to quite establish had a resurgence approximately a month ago and he now finds that in particular times such as saturday afternoons when there is nobody around to give him

41:51 reassurance that he is indeed liked he falls into certain very fixed beliefs one of the beliefs is that i have nobody i don't have any friends another belief is nobody cares for me and the third belief is that i will always be lonely now while he's sitting here talking to me he can see that these beliefs really don't hold much water however there's every likelihood that once again when he's alone there will be a recrudescence of these beliefs consequently i tried to teach him a few skills in dealing with them these skills won't in themselves annihilate the beliefs but they will give him some kind of a foothold in order to be able to counteract them

42:38 as a way of promoting this type of skill training i played the role of devil's advocate and i had him answer me now the chances are that this would not be sufficient for him to be able to rebut the negative thinking when he's in a highly depressed state but he does follow through with his homework assignment which is to write down the rebuttal type statements prior to becoming depressed again it is likely that he will be able to utilize these to some degree at that particular time further i tried to emphasize the importance of developing this skill and he did seem to be quite cooperative in that way the skill of being able to evaluate the validity of his negative thinking and then if they seem to be invalid to come up

43:24 with a more appropriate interpretation of reality i also tried to test his assumption or belief that he needs a woman to be happy this type of belief unfortunately becomes a self-fulfilling prophecy if the patient believes that a woman is necessary for his happiness then when a woman isn't present he will as a consequence start to feel unhappy because that's the way things should be so i tried to produce some evidence first that there were times in his life when he did not have a woman and he was happy and secondly there were times in his life when he did have a woman and he was unhappy the major thrust of all of this is to try to teach him a greater degree of

44:10 independence so that having a significant other person is given its due importance but doesn't become a matter of life and death and speaking of death i then tried to touch on what is always a potential danger in patients who are depressed and that is they are likely to be suicidal and i did give him a few cues as to what to do if he got so depressed that the suicidal wishes would come up again and basically the thrust would be to try to undermine the suicidal wishes by looking at the beliefs that are feeding into them by attenuating or vitiating the hopelessness the suicidal wishes will start to become attenuated

44:55 themselves finally i did ask him at the end of the interview how he was feeling and uh he did say that he felt less depressed it's possible that this may have been a byproduct of the interview itself whether the interview was indeed responsible for his feeling depressed or not at least he does have one thing that he can take home with him he now has a repertoire of cognitive skills that he can apply at times in the future when he is either depressed anxious or angry

45:44 so [Music] you