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CBT - Cognitive Behavioural Therapy Cognitive Behavioural Therapy or CBT as it is more commonly known is all about learning to adjust automatic negative thinking. In life, we are taught to wash daily, brush our teeth, wear clean clothes and keep a tidy home. This is our personal hygiene and most of us take pleasure in it. We accept it as a given that it is something which requires maintenance. So what of “mental hygiene”? Who teaches us that this is important to maintain too? Mostly…….nobody! Think about it. Your brain is also your home. You live there consciously for 16 hours a day. Do you devote the same level of maintenance to your mental processes as you do to your physical processes? If you think about things this way, you can begin to see that it is unreasonable to expect your house to be bright and tidy…a nice place to spend time if you never clean it. Negative thoughts are like cobwebs, weeds, or dirty socks in the mind. They obscure, constrict and leave a bad smell! The mind too therefore requires maintenance. Of course once a house is clean it’s much easier to keep clean! Habitual
negative thinking can be both the cause of anxiety and also
the result of anxiety. Spending any length of time feeling
anxious or depressed will wear a person down, and this
naturally leads to the formation of negative thinking styles
because the outlook can begin to feel hopeless. So anxiety
causes us to think negatively and negativity causes us to feel
anxious. A negative feedback loop is created
It’s actually a mistake to believe that the outlook is hopeless and accepting that the future is truly hopeless is the surest way to remain anxious or depressed. For someone in the midst of anxiety however it is often very difficult to see a way out because the FEELINGS of impending doom are so convincing. Often the cause of chronic anxiety (anxiety that continues over a long period of time) is that we develop a habit of thinking negatively which becomes accepted as the way life is and this negative outlook then sustains anxiety throughout time. So even though the original cause of anxiety passes, sometimes the anxiety itself remains, because the brain continues to explain our experience of the world through the negative lens created during the period of crisis. A negative lens tends to see the worst in things and then we feel “unsafe” because everything looks threatening or unsatisfactory and we forecast (naturally) that things will remain this way. Unfortunately, the habit of thinking negatively can develop as the result of short illness, a traumatic experience, or just a short period of anxiety and depression. Just like any bad habit, it’s easier to acquire than it is to shake! Most people will bounce back from life’s temporary difficulties, and reinstall positive thought patterns quite naturally. But, equally, sometimes negative thinking styles are often so insidious and easy to fall into that we won’t even notice that we have adopted them. We often hear people say “I’ve never been the same since…the *such and such* incident…...” Whilst there is much that can be said about life’s experiences changing us forever (and they do for sure!), it is always worth considering whether we have also simply fallen into the bad habit of automatically assuming the worst?! This will account in many cases for at least some part of our continued anxiety. You can pretty much take it as a given that if you are experiencing anxiety and/or depression, then you will definitely be experiencing a negatively focused world which may appear to you as an objective reality. Rest assured a worldview is ALWAYS subjective. It can almost certainly be improved! The
formula is simple: Negativity creates anxiety. Anxiety is
converted to fear. Fear must have a focus…... And there is
your problem.
So part
of the solution then is to cease the negativity. The good news
is, it is possible to change these patterns of negative
thought, and this will improve the way you feel. Changing old
patterns of negativity does however take effort. There are a
number of reasons why we might fail personally to address
this. Let’s explore some of these: - · The benefits are not immediately apparent – One can easily decide it’s simply not worth the effort. Negative thinking itself will often argue…”Don’t bother…it won’t help….!” One has to be willing to press on regardless of such feelings and to hold some trust that the benefits will become apparent through time. · Negative thinking has become a friend. Believe it or not, anger and raving about how terrible everything is for us can feel good in the moment – Anger can stimulate the production of opioids (in readiness for a battle/wounds) which are the bodies own natural pain relief chemicals (the same chemical family as heroin), and we can easily become psychologically addicted to this rush. Unconsciously we enjoy staying angry or depressed. Unfortunately, although this presents as a workable strategy in the short term, it creates more anxiety and low mood overall, and is never a successful strategy for long term happiness. · Overcoming negative thinking is like breaking any habit. We have to continually think and behave differently. We have to keep making adjustments. Imagine being asked to do anything differently in your life. You can see it takes mindfulness and effort to create a new pattern. If we factor in our first two points we can begin to see that this can feel like work. It is however work that is essential if we are to create and maintain a state of good mental health. Treatment: Cognitive Behavioural Therapy. Albert Ellis - The creator of CBT put forward the following four insights. Insight 1 - How you feel is mainly determined by the way you think. - This notes that the beliefs you carry and action with feeling become your living emotional reality. Insight 2 - You become distressed when you endorse your own irrational beliefs - This notes that those beliefs that create unpleasant feelings will distress you when you "buy in" to them without challenging the assumptions. Insight 3 - Be kind to yourself. You like many people can think irrationally so don't judge yourself too harshly - This notes that CBT is not a self blame exercise….so one can be kind to oneself whilst adjusting thoughts and behaviours appropriately for easier feelings. Insight 4 - You have to make a sustained effort to recognise and challenge your irrational thoughts- This notes that effort is required over a sustained period of time to make the above adjustments. Essentially, the theory is very simple. It is based on the
elegant understanding that thoughts (cognition; thinking
styles) and behaviours influence feelings and emotions. It was
recognised that depressed or anxious people often have
automatically negative thinking styles which entail negative
feelings as a result, and that they often are not consciously
aware of these distortions. The idea behind CBT is that by
bringing these cognitive distortions into conscious focus, it
becomes possible to adjust those distortions by using the
rational thinking mind to challenge the automatic and negative
assumptions. With continued repeated adjustment, the
mind/brain can then learn over time to create new more
positive automatic associations. CBT research has shown that
the brain can literally re-pattern it’s neural pathways over
a period of approximately 45 days. We see this also in the
treatment of OCD (Obsessive Compulsive Disorders) using
behavioural therapy. You could think of this process of
continually adjusting negatively distorted thinking
metaphorically as beating a new path through the jungle. In
time, the old path grows over and your effort beats a new path
which leads eventually to a more satisfying destination. This
is a nice metaphor because it highlights that initially at
least we are taking the path of most resistance, but here we
are beating a path to a beautiful jungle waterfall. The old
path leads only to a rancid swamp. So, by continually changing
the way that we think about things using the conscious mind we
can create new habits of thought. We can literally change the
way that our brains think about things, and this ultimately
will change the way the way that we FEEL about things. This is
absolutely central to our understanding of creating positive
change. We know that negative introspection (that is to
spend time focusing attention inwards in a negative way) is a
primary driver (a driver refers to the factors which
"drives" a particular state or behaviour.....what
makes us do it this way) of depressed and anxious states, so
it is essential that we begin to create positive modes of
thinking in order to increase wellbeing. We also recognise
that the way we behave sends a message too. If we say we want
to reduce our anger levels and yet we still indulge in
shouting at other drivers when in the car, we can recognise
that we are not “behaving” in a manner congruent with our
intent, and this does nothing to help either our thoughts or
our feelings. In fact it simply creates confusion within the
psyche, because the message it sends to your poor old
emotional mind is that this situation must be threatening. Why
else would you be shouting? If we want to change our feelings
then our thoughts and our behaviours must support that
intent…again by using the rational mind to adjust the
behaviour accordingly. A
major technique in cognitive therapy is the four column
technique. It consists of a four step process. The first three
steps analyze the process by which a person has become
depressed or distressed. The first column records the
objective situation. In the second column, the client writes
down the negative thoughts which occurred to them. The third
column is for the negative feelings and dysfunctional
behaviors which ensued. The negative thoughts of the second
column are seen as a connecting bridge between the situation
and the distressing feelings. Finally, the fourth column is
used for challenging the negative thoughts on the basis of
evidence from the client's experience (What did you learn? Was
it anything like your original perception). This learning is
then applied if/when similar thoughts or feelings arise in the
future. It is the continued challenging of these distortions
that provides the habit change over time. Each successful
challenge further weakens the grip of the negativity and it
can begin to be seen for the useless junk (dirty socks!) it
is. The client is taught about the kinds of distortions which
can occur, and often in CBT it is considered essential that
the client is asked to write it down. It is recognised that the
habitual mind will find ways of avoiding the adjustment if the
process is not written down, in much the same way as an
overeater will be able to overlook the extra’s they ate if
not scrupulously recording their consumption in a food diary.
Here is a list of typical distortions which are made in
depressive thinking. List
of distortions You see
things in black-or-white categories. If a situation falls
short of perfect, you see it as total failure, or all bad. -
Over-generalisation You see
one or more negative events as never-ending pattern of defeat.
Characterised by using the words "always" or
"never" You pick
out a single negative detail and dwell on it exclusively, so
that your whole view of reality becomes darkened. Eg obsessive
dwelling on a single criticism.
-
Discounting the positive You
reject positive experiences by insisting that they "don't
count". Eg if you do a good job, you tell yourself that
it wasn't good enough or that anyone could have done as well. -
Jumping to conclusions Mind
reading Without checking it out you arbitrarily conclude that
someone is reacting negatively to you. - Negative Forecasting You
predict that things will turn out badly, or predict worst case
scenarios. -
Magnification You
exaggerate the importance of your problems and shortcomings,
or you minimise the importance of your desirable qualities,
known as the "binocular trick." -
Emotional reasoning You
assume that your negative emotions necessarily reflect the way
things really are. Eg "I feel so inadequate. I must
really be hopeless." You tell
yourself that things should be the way you wanted or expected
them to be. Characterised by the words "should,"
"must," "ought to" and "have
to." Should statements can be directed against yourself
causing guilt and frustration, or they can be directed at
other people causing anger and frustration. An
extreme form of all-or-nothing thinking in which you attach a
negative label to either yourself or another person that
describes the person in an exclusively negative way. Eg
"I'm a loser". If the label is directed against
another person, eg "He's just a S.O.B", you feel
that the problem lies with the person's "character"
or "essence" instead of with their thinking or their
behaviour. You see them as totally bad. This makes you feel
hostile or hopeless about improving things. -
Personalisation and blame Personalisation
occurs when you hold yourself personally responsible for an
event that isn't entirely under your control. Blaming or
scape-goating is the opposite: you blame other people or
circumstances for your problems but overlook the part you
might be playing in it. -
Relationships between
thoughts and feelings ·
Unfulfilled expectations - frustration ·
Thoughts of danger to self or self esteem - anxiety and panic ·
Thoughts that you are bad - guilt ·
Thoughts that you are inadequate in comparison with others -
feelings of inferiority · Thoughts of unfairness - anger The more awareness you have of your own negative patterns of thought the more leverage you have in making a change. Then you can be more mindful in the future. Then the next time you have that thought or make that assumption you will see it before you buy into it. You will see it for what it is...distorted....untrue...irrational...unproven. Then you can challenge it. You can say to yourself "I might FEEL as though that's how it is, but based on my past learning I KNOW differently. This then disempower's that negativity. We must recognise that negativity ultimately only lives on the power we give it. If we "buy in" to the negative thinking, we give it power. We reinforce it. We agree with the assumption. So CBT is about recognising that you have a choice! A choice to choose not to buy into distorted thinking...a choice to choose other conclusions...other strategies. Think how much stress you can save yourself through this process! A good hypnotherapist will adhere to the principles of CBT when using a solution focused (as opposed to analytical) methodology. Good hypnotherapy is at one level all about locating the faulty belief or logic (known as a "driver" because it drives behaviour), and using hypnosis and psychotherapy to help amend that belief. Talking therapies (psychotherapy, counselling, CBT) all seek to do the same thing, except they are generally slower in achieving results. We have an advantage with hypnotherapy, because hypnotherapy is a powerful tool for belief amendment at the core level. Here, we can effectively bypass a great deal of the conscious minds usual resistance to change, and establish new thought patterns and perceptions quite quickly, thereby alleviating at least some of the work of continued repetitive thought adjustment. When the limiting belief or thinking style is corrected at the core level then there is much less work to do because the faulty logic no longer carries the same emotional weight it once did. The British Medical Journal says the following about hypnotherapy: "There is good evidence from randomised controlled trials that both hypnosis and relaxation techniques can reduce anxiety…. They are also effective for panic disorders and insomnia....A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety." So CBT can be used as a stand alone therapy or can be utilised within a hypnotherapeutic context too. This of course includes self-hypnosis which will be covered elsewhere on the site. One of my favourite online sites for self help with CBT is Three Minute Therapy which anyone can easily read and start using! You can find it here: http://www.threeminutetherapy.com For a further detailed look at Cognitive Behavioural Hypnotherapy you can visit my page here on the sister website. Disclaimer: This article is given for information purposes only. The author cannot be held responsible for any effects arising from the use of the information contained herein, and any use of the information in this article is used entirely at the risk of the user. Persons with poor mental health should not consider using these exercises but should refer themselves to their GP for assistance. |
