Fertility Cognitive Therapy

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from Reproductive Wellness © Copyright 2008, Pages 26-27

When addressing infertility issues with Cognitive Behavioral Therapy (CBT), it is important to evaluate cognitive distortions as well as negative self-talk.

We are all guilty of some distorted thinking. Our distortions are unique to our experience- there may be a set of common distortions but how we misperceive the world depends on what our individual issues and experience is. For instance, for those of us raised in families where “guilting” is frequent, “shoulds” and “musts” are going to be part of our daily vocabulary.

In Cognitive Behavioral Therapy (CBT), there are a number of cognitive distortions that are described in the literature. These include, but are not limited to the following:

  1. Filtering: You perceive and overemphasize all the negatives in a situation and filter out all the positives. It is very common for a woman who is trying to become pregnant to look at the presentation of her menses as a BAD event. From a healthier perspective, we could appreciate the menses as another opportunity to clear out toxins that inhibit pregnancy.
  2. All or nothing thinking: Things are either all good or all bad. This rigidity generates thoughts that you are either perfect or a failure. Couples come in for treatment at all stages of infertility. Often, couples that have all or nothing thinking will believe that if they haven’t conceived in the first few months of trying, they will never be able to become pregnant and have therefore, failed.
  3. Overgeneralization: You make overarching conclusions about circumstances or events based on a single factor or component. If one bad thing happens, you take it to mean that everything is going down the tubes.
  4. Mindreading: Without any communication from others, you believe you know how they feel about things, and particularly about you.
  5. Catastrophizing: Whether or not there is evidence to support it, you expect disaster. You are constantly engaged in a series of “What ifs?”
  6. Personalization: You are constantly comparing yourself to others and perceive the reactions and behaviors of others as response to you.
  7. Control Fallacies: If you have an external locus of control, you are likely to see yourself as a victim much of the time. If you have an internal locus of control, you may see yourself as always to blame.
  8. Fallacy of Fairness: You believe that you know what’s fair, and resent it when others don’t agree with you. But, who said life’s supposed to be fair?
  9. Blaming: If you have an external locus of control, you often blame others for your life circumstances. If you have an internal locus of control, you blame yourself for every challenge that arises.
  10. Shoulds: You maintain an internal list of rules about how people should behave and how things should go. You feel guilty or anxious if you’re unable to maintain those standards.
  11. Emotional Reasoning: You perceive feelings as fact. “I feel fat, therefore I must BE fat.”
  12. Fallacy of Change: You believe that others will change to suit your needs if you convince them enough. You believe that your state of mind relies on the willingness of others to change.
  13. Global labeling: You take a few insignificant items or issues and perceive them as evidence of a negative global judgment.
  14. Being right: You go to any lengths to prove that you are right. Being wrong is unacceptable.
  15. Heaven’s Reward Fallacy: You “keep score”, knowing that in the end, you’ll get yours. When you don’t, you are resentful and bitter.

Consider how you may distort what you hear, and the impacts that it may have on you- and your fertility.

Altering self-talk
In addition to cognitive distortions, we are all vulnerable to negative self-talk from time to time. Self-talk describes the voice or voices in our head (not the crazy kind!). Sometimes self-talk is described as “old tapes” or internal narrative. Self-talk, at its simplest, is the way that we talk to ourselves about the choices we are making and their impact on our lives.

Self-talk can be positive or negative. Positive self-talk, such as “Good job!” when you have performed well, enhances your self-esteem and increases the likelihood that you’ll make that choice again. We also use positive self-talk when we need to calm down. When trying to keep an argument from escalating, we might say to ourselves, “Calm down” or “Chill out.”

Negative self-talk, on the other hand, can be very detrimental to our well-being, sense of self, and our reproductive wellness. Imagine the argument from the last example, what if you said, in your mind, “That jerk!” instead of “Calm down”? How would that change the scope and intensity of the argument? Far more dangerous are the negative self-statements such as “I can’t” or “we won’t” have a baby.

Consider what fills your head, and where it my have come from.

In order to eliminate negative self-talk, we must first become aware of it. Once aware, we must make conscious choices for more positive and healthy self-talk. The process by which we do this (clinically) is referred to Cognitive Restructuring. We can also utilize techniques from Rational Emotive Therapy (RET) in order to transition negative self-talk into rational, or reasonable, self-talk or thought. Exercises to promote healthy, positive self-talk are available in Chapter 15 of your Conception Workbook.

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