Cognitive Behavioural Therapy For Dummies
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If you frequently disqualify or distort your positive attributes or experiences, you can easily sustain a negative belief, even in the face of overwhelming positive evidence.
Low Frustration Tolerance: Realising You Can Bear the 'Unbearable'
Low frustration tolerance refers to the error of assuming that when something's difficult to tolerate, it's ‘intolerable'. This thinking error means magnifying discomfort and not tolerating temporary discomfort when it's in your interest to do so for longer-term benefit, as we show in Figure 2-11.
Figure 2-11: Low frustration tolerance.
The following are examples of low frustration tolerance:
You often procrastinate on college assignments, thinking, ‘It's just too much hassle. I'll do it later when I feel more in the mood.' You tend to wait until the assignment's nearly due and it becomes too uncomfortable to put off any longer. Unfortunately, waiting until the last moment means that you can rarely put as much time and effort into your coursework as you need to in order to reach your potential.
You want to overcome your anxiety of travelling away from home by facing your fear directly. And yet, each time you try to travel farther on the train, you become anxious, and think ‘This is so horrible, I can't stand it', and quickly return home, which reinforces your fear rather than helping you experience travel as less threatening.
The best way to overcome low frustration tolerance is to foster an alternative attitude of high frustration tolerance. You can achieve this way of thinking by trying the following:
Pushing yourself to do things that are uncomfortable or unpleasant. For example, you can train yourself to work on assignments even if you aren't in a good mood, because the end result of finishing work in good time, and to a good standard, outweighs the hassle of doing something you find tedious.
Giving yourself messages that emphasise your ability to withstand pain. To combat a fear of travel, you can remind yourself that feeling anxious is really unpleasant, but you can stand it. Ask yourself whether, in the past, you've ever withstood the feelings you're saying you presently ‘can't stand'.
Telling yourself you can't stand something has two effects. First, it leads you to focus more on the discomfort you're experiencing. Second, it leads you to underestimate your ability to cope with discomfort. Many things can be difficult to tolerate, but rating them as ‘intolerable' often makes situations seem more daunting than they really are.
Personalising: Removing Yourself from the Centre of the Universe
Personalising involves interpreting events as being related to you personally and overlooking other factors. This can lead to emotional difficulties, such as feeling hurt easily or feeling unnecessarily guilty (see Figure 2-12).
Figure 2-12: Personal-ising.
Here are some examples of personalising:
You may tend to feel guilty if you know a friend is upset and you can't make him feel better. You think, ‘If I was really a good friend, I'd be able to cheer him up. I'm obviously letting him down.'
You feel hurt when a friend you meet in a shop leaves quickly after saying only a hurried ‘hello'. You think, ‘He was obviously trying to avoid talking to me. I must have offended him somehow.'
You can tackle personalising by considering alternative explanations that don't revolve around you. Think about the following examples:
Imagine what else may contribute to the outcome you're assuming personal responsibility for. Your friend may have lost his job or be suffering from depression. Despite your best efforts to cheer him up, these factors are outside your control.
Consider why people may be responding to you in a certain way. Don't jump to the conclusion that someone's response relates directly to you. For example, your friend may be having a difficult day or be in a big hurry - he may even feel sorry for not stopping to talk to you.
Because you really aren't the centre of the universe, look for explanations of events that have little or nothing to do with you.
Getting intimate with your thinking
Figuring out which thinking errors you tend to make the most can be a useful way of making your CBT self-help more efficient and effective. The simplest way of doing this is to jot down your thoughts whenever you feel upset and note what was happening at the time. Remember the maxim: When you feel bad, put your thoughts on the pad! See Chapter 3 for more on managing unhelpful thoughts by writing them down.
You can then review your thoughts against the list of thinking errors in this chapter. Write down beside each unhelpful thought the specific thinking error you're most probably making. With practice you can get better at spotting your thinking errors and challenging them. In all probability, you may notice that you're more prone to making some errors than others; therefore you know which alternative styles of thinking to develop.
You may also become aware of patterns or themes in the kinds of situations or events that trigger your negative thoughts. These can also help you to focus on the areas in which your thoughts, beliefs and attitudes need most work.
Chapter 3: Tackling Toxic Thoughts
In This Chapter
Identifying the thoughts underpinning the way you feel
Questioning your negative thoughts and generating alternatives
Using the ABC self-help forms to manage your emotions
In your endeavours to become your own CBT therapist, one of the key techniques you use is a tool known as an ABC form, which provides you with a structure for identifying, questioning and replacing unhelpful thoughts using pen and paper.
CBT therapists sometimes use similar tools to the ABC form which we offer in this chapter. All these tools can help patients to identify and replace negative thoughts. Different therapists may refer to these forms as thought records, thought diaries, daily records of dysfunctional thoughts or dysfunctional thought records (DTRs). Fret not - in general, all of these forms are simply different ways of saying largely the same thing: Your thinking impacts your feelings and actions.
The way you think affects the way you feel. Therefore, changing your unhelpful thoughts is a key to feeling better.
In this chapter, we give you two versions of the ABC form: one to get you started with identifying your triggers, thoughts and feelings, and another that takes you right through to developing alternative thoughts so you can feel and act differently in the future.
Catching NATs
Getting the hang of the ABC form is often easier if you break down the process into two steps. The first step is to fill out the first three columns (Activating event, Beliefs and thoughts, Consequences) of the form, which you can find further on in this chapter (ABC Form I). This gives you a chance to focus on catching your negative automatic thoughts (NATs) on paper and to see the connection between your thoughts and emotions.
Using the ABC form is great, but if you don't have one to hand when you feel an upsetting emotion, grab anything you can write on to scribble down your thoughts and feelings. You can always transfer your thoughts to a form later. As has been said by many a CBT therapist: When you feel bad, stick it on the pad!
Making the thought-feeling link
A crucial step in CBT is to make the thought-feeling link or B-to-C connection; that is, seeing clearly for yourself the connection between what goes through your mind and your resulting emotions. When you see this connection, it can help you to make much more sense of why to challenge and change your thoughts.
Becoming more objective about your thoughts
One of the biggest advantages of writing down your thoughts is that the process can help you to regard these thoughts simply as hunches, theories and ideas - rather than as absolute facts.
The more negative the meaning you give to an event, the more negative you'll feel, and the more likely you'll act in a way that maintains that feeling. Crucially, when you feel negative, you're more likely to generate negative thoughts. See how easily you can get caught in a vicious circle? Just one of the reasons to take your negative thoughts with a buc
ket of salt!
Stepping Through the ABC Form I
So, time to embark on this major CBT self-help technique using Figure 3-1. The basic process for completing the ABC form is as follows:
1. In the ‘Consequences' box, point 1, write down the emotion you're feeling.
Therapy's about becoming emotionally healthier and acting in a more self-helping or productive way. So, when you're filling out the ABC form, the most important place to start is with the emotion you're feeling.
Emotions and behaviour are consequences (C) of the interaction between the activating event or trigger (A) and the beliefs or meanings (B) in the ABC model of emotion.
Examples of emotions you may choose to list in the ‘Consequences' box include:
• Anger
• Anxiety
• Depression
• Envy
• Guilt
• Hurt
• Jealousy
• Shame
Fill out an ABC form when you feel emotionally upset, when you've acted in a way that you want to change, or when you feel like acting in a way that you wish to change. We give you more information on how to help you understand and identify emotions in Chapter 6.
2. In the ‘Consequences' box, point 2, write down how you acted.
Write down how your behaviour changed when you felt your uncomfortable emotion. Examples of the behaviour that people often identify as their actions in this box include:
• Avoiding something
• Becoming withdrawn, isolated or inactive
• Being aggressive
• Binge-eating or restricting food intake
• Escaping from a situation
• Putting off something (procrastination)
• Seeking reassurance
• Taking alcohol or drugs
• Using safety behaviours, such as holding on to something if you feel faint
3. In the‘Activating Event' box, write down what triggered your feelings.
As we discuss in Chapter 1, the A in ABC stands for activating event or trigger, which are the things that triggered your unhelpful thoughts and feelings. Activating events or triggers to put in this box can include:
• Something happening right now
• Something that occurred in the past
• Something that you're anticipating happening in the future
• Something in the external world (an object, place or person)
• Something in your mind (an image or memory)
• A physical sensation (increased heart rate, headache, feeling tired)
• Your own emotions or behaviour
An activating event can be pretty much anything. Use your feelings - rather than whether you think the event is important - as a guide to when you should fill out a form.
To keep your ABC form brief and accurate, focus on the specific aspect of the activating event that you're upset about. Use the table of emotions in Chapter 6 to help you detect the themes to look out for if you're unsure about what may have triggered your thoughts and feelings.
4. In the ‘Beliefs' box, write down your thoughts, attitudes and beliefs.
Describe what the event (whatever you've put in the ‘Activating Event' box) meant to you when you felt the emotion (what you've written under point 1 in the ‘Consequences' box).
The thoughts, attitudes and beliefs you put in the ‘Beliefs' box often pop up on reflex. They may be extreme, distorted and unhelpful - but they may seem like facts to you. Some examples of these NATs include:
• Here I go again, proving that I'm useless!
• I should've known better!
• Now everyone knows what an idiot I am!
• This proves that I can't cope like normal people do!
Thoughts are what count, so think of yourself as a detective and set out to capture suspect thoughts. If your thoughts are in the form of a picture, describe the image, or what the image means to you - then write them down in the ‘Beliefs' box.
We think not only in words but also in pictures. People who are feeling anxious frequently describe that they see catastrophic images going through their mind. For example, if you fear fainting in a restaurant, you may get an image of yourself on the restaurant floor with staff fussing over you.
5. In the ‘Thinking Error' box, consider what your thinking errors may be.
One of the key ways to become more objective about your thoughts is to identify the thinking errors that may be represented in the thoughts you list in this box. (Have a look at Chapter 2 for more details on common thinking errors.)
Questions that you might ask yourself in order to identify your thinking errors include:
• Am I jumping to the worst possible conclusion? (Catastrophising)
• Am I thinking in extreme - all-or-nothing - terms? (Black-and-white thinking)
• Am I using words like ‘always' and ‘never' to draw generalised conclusions from a specific event? (Overgeneralising)
• Am I predicting the future instead of waiting to see what happens? (Fortune-telling)
• Am I jumping to conclusions about what other people are thinking of me? (Mind-reading)
• Am I focusing on the negative and overlooking the positive? (Mental filtering)
• Am I discounting positive information or twisting a positive into a negative? (Disqualifying the positive)
• Am I globally putting myself down as a failure, worthless or useless? (Labelling)
• Am I listening too much to my negative gut feelings instead of looking at the objective facts? (Emotional reasoning)
• Am I taking an event or someone's behaviour too personally or blaming myself and overlooking other factors? (Personalising)
• Am I using words like ‘should', ‘must', ‘ought' and ‘have to' in order to make rigid rules about myself, the world or other people? (Demanding)
• Am I telling myself that something is too difficult or unbearable or that ‘I can't stand it' when actually it's hard to bear but it is bearable and worth tolerating? (Having a low frustration tolerance)
Figure 3-1: The ABC Form I.
Creating Constructive Alternatives: Completing the ABC Form II
When you feel more confident about identifying your As, Bs, Cs and thinking errors, you can move on to the ABC form II. This second form helps you question your unhelpful thoughts in order to reduce their intensity, generate and rate the effects of alternative thoughts and focus on acting differently.
The first five steps for completing the ABC form II (see Figure 3-2) are the same as those for the ABC form I. Then come five more steps. You can find a blank version of the ABC form II in Appendix B. In the ABC form II, column A is the Activating Event, column B is Beliefs, column C is Consequences, column D is Dispute and column E is Effect.
6. Examine your negative thoughts more closely.
Ask yourself the following questions in order to examine and weaken your unhelpful thoughts:
• Can I prove that my thought is 100 per cent true?
• What are the effects of thinking this way?
• Is my thought wholly logical or sensible?
• Do people whose opinions I respect agree that this thought's realistic?
• What evidence exists against this thought?
• Is my thought balanced or extreme?