Journal Feb 7, 2015

I’ve slept on the boat enjoying the return of the mild weather. My electric heater has been sufficient to maintain cozy. I’m walking about in sarong and t shirt missing the Sea of Cortez. Gilbert has been bringing me the ball to throw every minute or two.  Outside there is steady cool rainfall.  I offered to let Gilbert out on the dock to pee but he returned inside the boat instead.
Rachel, his north shore Pet Smart groomer took all his fur. He was so matted and it was pulling at his skin making him very sensitive. He yelped when touched the last day. Thankfully the girl who runs the coffee shop in our office building recognized the problem.  I was just about to take him to the vet and took him to Rachel instead.  Problem solved. Gilbert has been happy and energetic as never before.  His only concern was having to share his friend Laura and me with her new cat, George.
My anxiety today is this three day weekend.  It’s clearly a cadillac problem. Yet if I get any time off I want to use it well.  I’ve become a workaholic with increasing demands and a fear of aging without a pension, no house and concerns about public care of the elderly. If I didn’t have that to think about this week I’d be back to thinking about zombie wars or alien invasion.
The fact is, I feel I’m thinking about ‘security’ in a way I don’t know if I’ve ever thought of before.  My friends say I’m ‘growing up’.  It’s not that I don’t love my work, the idea of it, the service and the people, (I really love the people), it’s just that for the first time in my life I’ve been asking ‘would I go to work” if I was a millionaire.  I can honestly say that I would have answered that in the affirmative for most of my life.  I loved being a physician, doing psychiatry and then addiction medicine. Yet today I am feeling overwhelmed and exhausted by the hostility in the workplace and the direction of our health care system.
I spent two years ‘getting people off benzodiazepines”.  The College of Physicians and Surgeons announced that people on methadone couldn’t be on benzodiazepines because research showed the combination was potentially deadly.  They gave a deadline.  Doctors began referring patients to me. I began benzo tapers.  The problems arose when the patients wanted me to keep them at the same dose or give them more. Repeatedly my life was threatened. Twice people brought guns to the office and showed me ‘they were serious’.  That wasn’t the first time so I just ignored it and continued with the ‘program’.  Eventually dozens of people were tapered off benzos.  I’ve only got one or two of the group left and they buy there’s on the street and their urines are occasionally positive.  The process exhausted me. I was terrified to go to work some days knowing no one cares.
In my other practice I encountered hysterics and threats when I tried to reduce benzos since the research goes for all benzo and narcotic combinations, as well the new research shows that benzos are dangerous for the aging populations as they reduce the possibility of recovery from stroke.  Each week I have one or another patient really angry with me (they’re frightened) and I’m tired by these wrenching sessions because in the past repeatedly when I’ve refused people what they wanted and followed the oath ‘do no harm’ the patients have escalated by complaining to the College of Physicians and Surgeons or lawyers or Ministers of Health.  Repeatedly I’ve been bullied for ‘doing the right thing’, ‘doing what my teachers taught me ‘ , doing what is ‘good medicine’  doing what is ‘pure and right’ and ‘good’ only to have a gang come down on me and punish me claiming that somehow it was the ‘way” i said ‘no’ .  I’m terrified of saying ‘no’ yet in my personal life I’m struggling with working through my own illness which has me in fear wanting to be a ‘people pleaser’.
Now I’m dealing with all the angry entitled pot heads whose marijuana use makes their care impossible for families and care givers. These are the patients with head injury or addiction and the ‘harm reduction’ models are highly supportive of ‘marijuana use’ but don’t seem to recognize how difficult it is to deal with people who are so stoned they may as well have consumed a 26 of vodka before the doctors appointment.
Just yesterday I was condemned by a family member angrily because I wouldn’t see their relative immediately and in addition to that agree to see them twice a week. I’m struggling to see people monthly, or every three or six months and constantly for years working without any resources of time or medications.  Increasingly the patients aren’t ‘funded’ for medications and every day I’m adding a phone call and begging session with a bureaucrat to get my patient the medication they need.  Not only that weekly I’m writing ‘begging’ letters to get my patient services their politicians promised.  Then daily or weekly I’m ‘answering’ to some other beaurocratic authority why I ordered a test or gave a medication. These individuals I talk to are utterly ignorant of clinical care and responding to a ‘flag’ on a computer program about one ‘detail’ while I’m dealing with the multitude of face to face issues that are in real life with real patients.
My favourite and most ludicrous of these calls was the one from the young hospital tech telling me my patient had walked out and refused their ‘blood thinner’ after their emboli.  “Did you know my patient is an IV heroin user?”
“Yes,"
“Do you really think she should be on blood thinners?"
“Well, yes if she isn’t she’ll throw another clot?"
“And what’s going to happen when she takes the IV out of her arm?"
“She shouldn’t be on heroin when you’re giving her methadone."
“Yes, but if she does do heroin and is on blood thinners she’d bleed out wouldn’t she."
“Well that’s a possibility”
“And I’d say that possibility outweighs the possibility of her having another emboli?"
“Is there any research on that?"
“I doubt it. But if you can find it I’d be very interested. I happen to like any research that deals with the real life considerations of multifactorial probabilities coupled with non compliance and suicidal tendencies and limits of public funding and mixed messages to the addicted populations. In the mean time I’m not going to force my patient to take something she doesn’t want to take when it might well kill her."

That’s a daily conversation or in a good week, weekly.  And it’s always against the back drop of the gross ignorance in the community about addiction and public policy and the conflicting ‘messages’ of experts.  Businessmen all the while are wanting to encourage people that the problem is ‘society’ despite the fact that deadly addictions exist in every society in the world just like schizophrenia which is 1% of all societies but still there are those who say schizophrenia is caused by environment.  The ignorance about genetics and environment is increased by the rich shifty salesmen with a hustle.
I realize too that if I was rich today, I’d sail away.  That’s what’s got me in conflict.  I really would like to hoist the sails and head out alone on the Pacific to taste the downwind sailing experience in the trade winds again.  I’d like to sit back and let the autopilot and wind veins do their work while I drank coffee and read novels in the sun.  I”m forgetting all the negatives about ocean crossings and focusing on the escapes.  I’m also thinking I have a limited life and do I really want to argue with bureaucrats and lawyers all day long week in an week out begging for the services the government promised.
I’ve had a flu for two weeks and that’s really limited my patience with the never changing only worsening bureaucracy.  I’m on the front lines but there’s now dozens so far removed from reality that they’re on space stations and they’re calling me up on the phone, emailing me and faxing me their ‘opinions’. There are so many chiefs today and not a single person wanting to be an indian.  And all these chiefs don’t have any experience and their training is minuscule and usually by academics who are so far removed from reality as to simply not be able to remember the last actual human contact.
And I feel superior.  yea. A day doesn’t go by now when I feel I don’t know what the hell I’m doing since the government, thanks to the Supreme Court, that appointed odd body of seniors opinion, says that ‘physician assisted suicide’ is all the rage now.  Meanwhile they’re giving heroin down the street from me and everyone wants me to write up their ‘medical marijuana’ and I’m missing out on the big bucks that are going around with all this hustle.  It’s the same as the abortion industry, what a racket,  Abortion doctors get a half million a year but they have the least amount of work and are one trick ponies, suck and scrape.  Just walk in the door and you get the dead baby.
Meanwhile I’m plagued with all manner of ethical concerns.  I’m constantly asking if this is ‘do no harm’. Am I ‘helping’ the patient. The drug dealer just asks if he’s charging enough money and how many customers has he. I’m looking back at my life and comparing it against the business model and realizing I’ve been a fool.
I was in the bank yesterday looking for a misplaced amount of money. They recorded a ‘withdrawal’ for $30,000 which I didn’t make that I know of.  And the girl said that ‘withdrawal’ didn’t mean that it was ‘withdrawn’ but it may have been moved to another account. Well, it was frightening and confusing and she would sort it out for me.  Just a minor matter but she was so judgemental in her tone when I said I ‘didn’t know’ whether the $30,000 was a GSP or MST or some other bank acronym. “I know I didn’t ‘withdraw’ $30,000 from my bank at that time. I don’t know what form the $30,000 was in.
And that is when I ‘lost it’.  “Do you know the names of the molecules that make up your DNA? Is your adenine in balance with your quinine? Has your GFR being tested recently? Do you know what your hematocrit is.  What is your LD or HD ratio. I didn’t even get into asking about dopamine, serotonin, and 50 other neurotransmitters or asking her if she was ‘real’ or the nature of the universe?  I just rattled off some acronyms we use daily with patients and pointed out they dealt with life and death and that no I don’t pay attention to what mutual fund acronyms my ’savings’ are in but I know I didn’t ‘withdraw’ $30,000.  The fact is i wouldn’t have noticed except it showed up on a bank statement as ‘withdrawn’ and I didn’t do it.
 She’s all smiling and treating me like an idiot because it’s clear that in her world ‘right and wrong’ and decided by ‘financial numbers’. I’m not a ‘valuable’ person because I only have ‘$30,000 whereas if I had $3,000,000,000 I’d be ‘more valuable’.  I don’t know why I even care about ‘making money and saving money’ because the banks can’t even keep track of it and they take it willy nilly and make gross errors just like the government but I’m not supposed to make an error. Like given warfarin to a heroin addict.  My mistakes show up in body bags.  At best lawyers and accountants and bankers will have a committee meeting where they’ll all be paid above my pay grade and maybe they’ll find my $30,000 which took years to save and came from working 12 hours a day 7 days a week.  But I lose faith in the system daily and go back to praying because there’s only certainty in God as this world is corrupted and dominated by theft and lawlessness.
I was thinking of sailing today.  I could clean up my boat and take it out.  I don’t know what to do. It’s raining so hard and I’m not happy with walking in the rain but I could since the dog probably would like to pee.
I look back on my life and realize that I never read financial magazines but read neurology and psychiatry journals. Instead of getting an accounting degree or law degree to improve my MD I went not to specialize in psychiatry and then addiction and then spirituality. Now I ‘answer’ to people who are less educated and less experienced so all my training in specialization has made me ‘ignorant’ because my ‘superiors’ instead got accounting and law degrees and laugh at how silly I was to think I should learn more how to deal with the patients illness.  We’re all just slaves to the money men and women and I’m just a better trained ‘indoor slave’.
I remember when my wife looked at me with disdain because I wouldn’t focus on making more money so she could have more things and more status. She thought it was ridiculous that I’d stay up all night trying to find an answer to the clinical question I’d encountered in the office looking back decades for descri[topms reading translations for journals from around the world, trying to ‘cure’ my patient.  It’s such a joke now. Even the government says kill them Give them pot or heroin. Give them cake.
The girl laughed at my not knowing what ‘kind’ of mutual fund I had my money in her in her bank. It was just ‘savings’ and yes I understood there were three risk levels and that they had pretty little names to sell their pretty little promotions but I know that the chassis on different cars and vans is the same chassis and I know how to fix a diesel and a gas motor and I can survive out in the wilderness and I can stop a baby screaming that has screamed for days and you think I’m just a ‘silly’ old man.  Ignornat of what is most important.
I didn’t notice the designer label on her clothes but it was there.
I’m a dinosaur and increasingly I find myself wanting to sail away.  I love Joni Mitchell’s song’ Skate Away.
But this is just the shaking off phase. This is just the feelings that everyone has at the end of a day of work.  They shake it off. They eat dinner, play wit their kids, do whatever hobby gets them through the night and they sleep.
I’m asking God does he really want me to be doing this.  Am I really meant to just fight daily with bureaucrats ‘begging’ for resources or just tell the patients ‘no’.  “The life saving measures are no longer available but we have assisted suicide should you desire.”
If I was a young man I’d go fight Is.  I’d be like Ernest Hemingway in the 30’s .  I realism demands simplicity.  I’ve concluded the enemy is me and my thinking and the external world a reflection of my own unresolved conflicts.  I think everything is about spirituality and materialism. I believe that whatever I have , a new car or a new boat is just a ‘fix’ that serves a short period of time to give me a sense of ‘wholeness’. I believe Pascal was right that we have a  hole inside ourselves and we keep trying to fill it with the wrong things.
I have life today. Albeit I’ve had the flu and when Im under the weather especially when the outdoors weather is so putrid I feel hopeless and worthless and inadequate.  I could go to church , go to a meeting, visit a friend, help a sicker person or do any number of the things I know which would make me feel better.  What I probably will do is walk the dog. When I get back from that I may even clean up my boat.  I left it like this because friend said he’d be buy to install a new part so I’ve not tidied or cleaned because when work is done on the boat it’s always ugly and all my cleaning and tidying is for naught. Yet I know if I cleaned this boat up I’d feel good inside.
Right now there’s no reason for me to feel bad except that I’m taking incidents from the past and selecting them to bitch and complain about. IF I was truthful I’d now write a ten volume text on how good the week was.  For every negative altercation with a patient I have dozens of positive ones. Ive got so many patients who are no longer doing drugs. All the suicidals who were going to kill themselves in December and January are still alive and all but one is no longer suicidal.  That’s what I used to think of as ‘success’. I used to have these ‘morbidity and mortality’ statistics that showed me I was a great doctor. I loved that my patients with actual physical illnesses that should have them dead were living long past the projections of the physical doctors. I loved that patients were improving with work and relationships and using these multifactorial tools to demonstrate that I was actually involved in their upward mobility.  My c students gots a’s , my drop outs , returned to school., my never going to date again, dated again, my no reason to live, continued to live.  I held their hands for weeks months or years and felt I got them through some tough times. My model was that of medicine. I know the person has chronic obstructive lung disease but with this ‘focal’ therapy I’ll get them over this ‘crisis’ and they’re go on to manage their copd better and will seek help sooner and will know how to get the best mileage out of their beater.  I even overhauled a whole lot of farraris and got the drivers to see how best to get the most out of their life vehicle. I did this for years, an ‘unsung hero’.  We’re all doing this as doctors but now we’re being told that death and stupidity are what we’re supposed to be doing. The slippery slidy slope began with the killing abortion epidemic and now we’re going to off the sick, mentally ill and elderly. The Dutch experience is horrid.  They’ve just turned `180 on their drug policy and yet we in Canada are following them 20 years behind and jumping on their euthanasia band wagon which has shown equal corruption and problems.
So I can focus on these or focus on the positives.  I have a few joints that are in pain but the rest are good. I’m fat but I’m not starving. I can worry about the bank taking $30,000.  The ex wife took a million. The gf’s son in law stole $15,000.  The staff took $50,000.  My renter when I had a house did $50,000 destruction. I’m just rolling the ball up hill all day and having it roll back down on me. I can’t help but believe if I was anywhere but this horrible corrupt and gang dominated port city of Vancouver with all the problems things would be better. But whenever I travel I learn of even worse corruption in the cities I go to.
I’ve got everything insured but I pay $500 or $1000 for every claim and then I pay taxes for the police and courts which say I should be more insured.  It’s all so ‘crazy making’ that I understand why my patients prefer personal insanity to the collective insanity alternative the city offers.
Any external observer would say I have a fantastic life. They’d not want my work but they’d definitely want my ‘problems’ compared to the ‘problems’ they experience in their ‘after work’ lives. My principal problem is getting the work off when i get home at night or have a weekend. I can’t shake the work and get into the present. I’m living in the past and fearing returning to work.  I just read about Jeramiah and the drought.
We have abundance but the world is limited by the wastefulness of men and women.
Here I’ve got duplicates of things with the original lost in a storage locker and me buying a new one rather than spending the day sorting through the storage locker.
it really is time to knock off squeezing the pus out of my brain onto paper.  Journalling leaves the nonsense outside. I’ve cleared my brain. Today I’ll get into gratitude.  I’ll start now being thankful. All that shit is out and it’s just a product of the ‘way I look at life’.  My life is joy and amazing. All life is incredible. God is great. Life is a wonder. Why I don’t see this moment by moment is that I refuse to remain in samadhi and nirvana and won’t just focus on Salvation. Thy will be done, not my will. Live in love and forget about fear.  An attitude of gratitude. Thank you God. Thank you Mom and Dad. Thank you all my teachers. Thank you family and friends. Thank you forest and sea and sky. Thank you governments and bureaucrats and police and courts. Tahnk you pets and Facebook and clothing and heaters and raincoats.  Thank you for life and thank you for my eyes, ears and senses even my nose which is in rebellion. Thank you for breath.  Thank you
Do the next right thing. Get dressed and walk the dog.

Gratitude

I am thankful for this day.  It began with Angel the cat crawling over my head and then Gilbert the dog licking my face.  I am thankful for such furry cozy loving alarm clocks.  I am thankful that Angel lead me to her food and takes such great delight in manipulating her human. I am really thankful that I am her human.  Gilbert meanwhile went back to sleep, his job of assisting his sister done, and now he would wait for the leash.  I am so thankful that I have these two curious companions.   I am thankful for my friend Laura who was in the bath while I was making coffee and enjoying immensely the aroma and taste of that first cup of coffee. I am thankful for the yoghurt and banana too.  Then I looked at my iphone which I am really thankful for and the friends who post on facebook and twitter and email me.  So I have this moment drinking coffee seeing what my local world of known friends is interested in.  I'm annoyed by the Facebook pigs and worry about missing family posts given the limits of display.  But really I'm very thankful for this communication and the BBC on line which gives me an reasonable headsup to world affairs. Meanwhile Laura is listening to CBC locally. So by the time I'm in the washroom thankful that everything is working we have got the scoop locally, nationally and internationally and learned we really have no excuse not to get dressed.  After a shower I am immensely grateful,  functioning bowel and bladder, and shower are right up there as number ones, well I'm ready to get dressed. This week I'm especially pleased that I got the laundry done and can find clean clothes relatively easily.  Gilbert has his Canucks jersey on. I say he must wear it for luck so the Canucks will win tonight.
Now with Gilbert I go outside and am really thankful for the clean air. I don't much like the rain right now or chill but the air is great. So are the colourful flowers. I'm especially thankful that I can get by with a simple leather jacket and don't have to wear a parka.  And I'm overwhelmingly thankful for my new car. I love the Mazda MX5 sportscar and after putting Gilbert in get on my side and get the top down. Then I'm really thankful for Blue Collar Comedy on Sirius Satellite Radio. I'm thankful for hearing and breathing and heart beating and feeling and the motion in my body and that the pain level is tolerable.  I'm thankful that beautiful Laura joins me and we head off to her work.  I'm grateful to have such a lovely friend.
then I'm really grateful for the parking space and the second cup of coffee. I'm grateful for the work too. I'm grateful for the staff. I'm grateful that I'm able to get through the hundreds of email daily and the calls in addition to the countless demands that make up the work and that I've recorded everything as best I could though I know there are those far removed in ivory towers and Monday morning armchairs who would never think that my recording is good enough. My hand writing is not neat enough and my typing is not all encompassing. And I'm overwhelmed to answer the myriad of in depth questions in so little time.  There is never enough time and I feel like I'm squeezed in a chute going down a dark tunnel with a whole chorus of people shouting at me from every side saying remember me, I'm first, me first, me first, and all the time I'm trying to focus on the person in front of me who sometimes in the past has carried guns and knives and told me that they were going to kill me or have tried to kill themselves.  Complete strangers have walked in off the street making threats. Anonymous phone callers have phoned making threats.  I am afraid of the interactions of these new compounds. I'm hastily looking up and cross references and citing texts and talking. I used ot only listen but the change was so limitted. Now I talk more and people change positively more.  There's a sweet spot between talking and not talking and yet more and more as the medical model is demanded again I'm back to the general practice 'teaching' model and my brain is okay but yours is not. I miss the days when our minds were all that mattered but the economists don't know meaning. We're deluged with self important technicians.  I'm thankful for the lack of surprise today and that I was of use I hope to many. I'm glad I could be a cog in a great wheel. i am thankful for doing my part in the busyness of the multidimensional glass beed game that today's psychiatry is. At times I even felt like I was playing three dimensional chess again but I must restrict myself to unidimensional chess. My colleague who retired writes of resurrecting people and we know how dangerous that is.  I'm thankful for the anonymity.  I'm thankful for the mystery. I'm thankful for the colleagues. I'm thankful for the internet and wikipedia and the books in my office and the programs and all the learning that I've been so blessed to be apart of. I'm deeply thankful for my teachers, those ones who gave me such positive lessons and those one whose lesson was to teach me what not to do.
I'm thankful for my fingers.
I'm thankful for the close of day. I'm thankful for my dog. I'm thankful for driving home in a new car. I'm thankful I'm not on the motorcycle in this rain. I'm thankful that parking was so easy when I stopped at the store. I'm thankful for the delis in grocery stores. I'm thankful tonight for IGA. I'm thankful for the cellphone so that I could notify Laura that' I'd pick up dinner for us.  I'm thankfu for the great meal and the joy and fun of sharing barbecued chilcken with two cats and a dog, all of us nibbling togehter.  I'm thankful for the chicken tradition and the pets.  I'm thankful for my family. I've thought of them fondly through the day, cousins, nephews, brother, in laws, dad.  I'm thankful the Canucks won. I'm thankful for televison. I'm thankful for Cherry Garcia ice cream.  I'm thankful for this routine day, this relatively uneventful day.  I'm thankful for tradition and routine and the novel and amusing.
I'm thankful for this bed . I'm thankful for sleep and dreams.  I dreamed last night I was shooting a monstrous bear that was attacking me. I was using the small guage 30 30 that I crushed under the flipping ATV. I guess I probably incorporated the time the bear did attack me and I was shooting it repeatedly in the back as it came to within inches and feet of me but veered off to go up the tree where my last shot killed it.  When I skinned and butchered it I found my bullets had gone through the heart , both lungs and liver, guts and spleen and one hip.  It had fallen from the tree when I'd severed its spine.  It'd put a clip into it at close range and changed out the clip to shoot the final shots at it up the tree.  My 3006 rifle was touching fur in the final shots of the charge. A medium black bear.  In my dream the bear was monstrous and the 30 30 shells were having little effect yet I was backed up by afriend with a pistol and the bear didn't maul the person it was chasing who ran by me.  Odd dream.
It is bear season. This time last year I was climbing mountains and shooting over the heads of bear who lived to tell the day wary now of men with cockapoo dogs at their sides.
Iam thankful for the outdoors and nature, hunting and fishing, hiking and wilderness. I am thankful for this day. Thank you God for this day. Thank you.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy, CBT, is not new.  It was developed by Aaron Beck. I did 6 months of formal weekly training in this psychotherapy approach in my psychiatry residency in the mid 1980's.  At that time it was not a standard  part of the psychiatry residency. Psychoanalytic psychotherapy was the dominant form of therapy in my training program. CBT training was an 'elective' then whereas today it's fairly mainstream.
The principal behind CBT is that 'mood disorders' and other psychiatric dysfunctional states are a product of 'cognitive' internal process.  Simplified it says 'we feel what we think and behave what we feel.'  Therefore if you change your 'thinking' then feeling and behaviour will change accordingly.  Though the actual techniques that Beck developped were fairly original the idea of the effect of thinking on mood and behaviour was in fact ancient. It's part of the standard teaching of Christianity and Buddhist so heralds back thousands of years.  Beck himself acknowledged the origins of his work in the Stoic philosophers of the ancient world. In psychology 'positive thinking' therapy had turn of the century application in the early hypnotists proponents.  Mesner's  'Everyday in everyway I'm getting better and better" self affirmation may as well have been early CBT.
Beck's real genius was in the development of a particular strategy of positive thinking and teaching of this that could be replicated and reproduced to allow for scientific study of the basic premise. His methodology was such that with CBT alone there was an approximate 75% cure in the treatment of depression in a roughly a few months.. Without treatment depressions commonly lasted a year.  CBT was equal then to the response rates of patients treated with antidepressant medications. When the two forms of treatment were combined the response was enhanced even more.
In contrast to psychoanalytic psychotherapy which on a weekly basis similiarly administered resulted in relatively equivalent response rates, practitioners in CBT could be trained in shorter periods of time with great effectiveness.  My own training in psychoanalytic psychotherapy as a psychiatrist took place over 4 years and was quite intensive whereas I learned CBT in a matter of months.  Further CBT could be given to groups whereas psychoanalytic therapy was much more labour intensive and effective one on one.  Even better CBT could be self administered. Burns, a student of Aaron Beck, wrote the best seller 'Feeling Good' which today still stands as a terrific text for patients to be given suffering from mood disorders.
Being relatively cheap and easy to learn, it has also leant itself to being used as part of research, it's value shown to be beneficial far beyond just 'depression' and having benefit in anxiety disorders, thought disorders, and addictive processes.
In contrast to psychoanalytic therapy that worked to 'weed' out misinformation acquired in childhood, CBT focussed on the 'present' and didn't really consider it that important how a person had become 'misinformed' about how to think effectively.
For example 'catastrophizing', is seen as a 'cognitive distortion' in CBT.  It is recognised that people who tend to catastrophise in crisis are being 'irrational' and less 'effective'.  Individually, with a therapist or in a group one learns to 'identify' this trait, see it , in fact, as an 'error' and bypass it or work around it. The techniques that Dr. Beck developped for this included 'talking back' to the 'misinformation'.  As an example, "I don't get paid today because the mail doesn't arrive, I think, I'm not going to be able to pay the rent and am going to be homeless." Instead I should think, 'it's not the end of the world', I will contact the people who expect me to pay them that day and advise them that the mail has been delayed and I will pay them tomorrow. " This is 'normal reality' unless one is dealing with the mafia or government beaurocrats. Government beaurocrats actually respond humanly if you give them the same information in triplicate with a witness of a lawyer or doctor or prime minister as notary.   The world doesn't need to end.
Interestingly these 'irrational tendencies' were common and formed the basis of the development of the 'fallacies' in the study of 'logic'.  Beck's contribution was to simplify these 'fallacies'  for the lay person, counselloers,r psychologists and others by putting a memorable spin on them.  An example from Dr. Burn's list of Cognitive Distoritions in Feeling Good was 'disqualifying the positive".  In this situation the person says it doesn't matter if I have the money in the bank to cover the rent, I didn't get the cheque in the mail so I'm going to be homeless.  The nature of the focus here is to 'disqualify' the assets one has.
My mother used to say 'count your blessings' because frankly depressed and angry people commonly focus on the negatives and as long as they do commonly create a 'self fulfilling' prophecy. "CBT has been used in sports  training athletes not to 'psych themselves out' but rather to 'psych themselves up'
Ironically, the business psychology world had been using many variations on CBT in their 'inspirational' talks and 'motivational' sales training.  If anything the academic world in this case was commonly playing catch up to the business world and refining what worked.  Scientific study has proven what often common sense already knew.
Maslow, developped the term 'self actualization' in his study of highly successful people.  He wasn't a CBT therapist but rather his approach was to study 'well people' and then suggest that the very strategies that made them well be applied to helping the sick.  Freud had originally in the early years of the study of mental illness only treated 'sick' people and learned their differences.  Today therapists have learned many 'effective' ways of thinking from those leaders in society and are taking these strategies into psychiatry. Not surprisingly Thessalonians of the New Testatment of the Bible had CBT recommendations telling people to 'think on positive things'.
In addiction work Hal Morley, now deceased, always encouraged an 'attitude of gratitude'. He said with an 'attitude of gratitude' one simply could not remain depressed and negative.
In CBT work the relationship with the 'client' or 'patient' is much more like a 'teacher' student relationship than the traditional psychoanalytic psychotherapy relationship where transference and counter transference, the 'process' and the 'relationship' itself were the focus of therapy. In CBT patients are given 'home work.'  They are encouraged to 'journal' and it's accepted that 'success' in therapy is no different than one would expect for  'success' in geometry'. The more one does, the better one gets at 'changing' one's negative thinking to 'positive thinking' and 'purposeful and effective' living.
I commonly ask patients with depression to avoid daily news since it's commonly negative and fear mongering. In this way I'm not acting at all like a traditional psychoanalytic psychotherapist but am being very directive and drawing from my experience as a family physician addressing allergies in children. In that world I'd remove those things that caused sneezing and today in the process of CBT  I help the patient remove daily news for instance from their daily repetoire  and not uncommonly see patient's moods improve immediately.  I also tell the depressed to stop listening Sylvia Plath. An analytically oriented session in constrast would encourage a patient to reflect on the meaning of their listening to, say Kurt Cobain, when they were insisting they wanted to live not die.  I might simply tell a person to listen to Bach or Sarah McLaughlan or Bare Naked Ladies.
Going over a particular stress we would look at what the person was thinking and how they could think more effectively. The questions asked are 'what could you have done differently?  What would you have liked to have said."  What were you thinking?. What would be a better way of thinking given those events?."
Indeed in the Christian community there seems to be a bit of CBT going on when people ask 'What Would Jesus Think/Say/or Do?"
CBT has been called physiotherapy for the mind because it's done in much a way as a person with a physical injury goes to a physical therapist to learn how to walk or move an arm in recovery.  In CBT people are trained to think differently about situations, people and relationships.  Often pen and paper examples are used much as teachers do in the class room.  In group therapy, examples of difficulty are shared and other members are asked how one could think better about such an experience.
It's not 'rocket science'.  It's common sense, mostly. However in day to day reality people rarely are exposed to what others are thinking. They just see that a person is 'acting' poorly and rarely know how 'odd' and 'different' their thinking may be.
As CBT therapists can themselves 'think' their 'thinking' is 'superior' and come across unknowingly as terribly arrogant, I encourage everyone who has studied CBT to read Job in the Old Testament.  Job is a character who is blameless, thinks well indeed, and accurately but his friends faced with his difficulties do their own version of CBT without any benefit and far too much judgement and arrogance.
That said, CBT is a tremendous asset for anyone and worth the learning. There are superior therapies and ones which are better for specific conditions and individualized therapy is usually better than any of the 'off the rack' therapies.  I'm an 'eclectic psychotherapist' so I've been formally trained in several of the major modalities of psychotherapy so am least at risk of the criticism of 'give a boy a hammer and everything is a nail."  That said I'm very thankful for my training CBT a quarter century ago and the advances I've acquired in this modality over the intervening years. I doubt a day goes by I don't get to use some aspect of this therapy.
For anyone interested in CBT I strongly recommend Feeling Good, by Dr. Burns.  I still remains a classic and can often be bought cheaply at a second hand store. The first copy written circa 1980 was probably better than later editions anyway. It's bright yellow, like sunshine. Go Figure!