Cognitive Behavioural Therapy For Dummies

by Branch, Rhena

  • Is my thought rigid or flexible?

  • Am I thinking objectively and realistically or are my thoughts being biased by how I feel?

  Consider long and hard your negative or unhelpful thoughts in the light of the preceding questions. Don't simply give glib ‘yes' or ‘no' answers. Instead, think things through and perhaps write down your challenges to your unhelpful thoughts in column D. See the list of questions and prompters at the bottom of the ABC form II, which can help you further with this.

  7. Generate alternatives for each of your unhelpful thoughts, attitudes and beliefs.

  This step is critical as it's your alternative thoughts that will help you to feel better! In column D, write down a flexible, non-extreme, realistic and helpful alternative for each thought, attitude or belief that appears in column B. The following questions may help you to generate some alternatives:

  • What's a more helpful way of looking at the situation?

  • Do I encourage friends to think in this way?

  • When I'm feeling okay, how do I think differently?

  • Have any past experiences shown me that another possible outcome exists?

  • What's a more flexible or less extreme way of thinking?

  • What's a more realistic or balanced way of thinking that takes into account the evidence that does not support my thought?

  • What do I need to think in order to feel and act differently?

  Some thoughts are more stubborn than others, and you won't turn your thinking around completely in one go. Wrestling with NATs for a while before they weaken is typical and appropriate. Think of yourself as training your mind to think more flexibly and constructively over a period of time.

  Some intrusive thoughts, images and doubts can be made worse if you engage with them. If you have obsessive-compulsive disorder (OCD), health anxiety, body dysmorphic disorder (BDD), worry or a jealousy problem, be sure to develop the capability to live with doubt, and allow catastrophic thoughts to pass through your mind rather than challenging them. We explain this in more depth in Chapters 5, 9 and 13. So if you think you need to learn to live with doubt, or to tolerate upsetting, intrusive thoughts in general, we suggest steering clear of using ABC forms for these problems.

  8. In column E, rate the effects of your alternatives on your feelings.

  Rate your original feelings 0-100 per cent. Also note whether you experience any alternative healthier emotions such as:

  • Concern

  • Annoyance

  • Sadness

  • Remorse

  • Disappointment

  • Sorrow

  You won't always notice a great deal of change in how you feel at first, so keep persevering! Changes in the way you behave and think tend to precede improved emotional responses. Keep thinking and acting in line with how you want to ultimately feel.

  9. Develop a plan to move forward.

  The final step on the ABC form II is to develop a plan to move forward. Your plan may be to conduct a behavioural experiment to help you gather more information about whether your thoughts are true or realistic, or to behave differently in a specific situation. Go to Chapters 4 and 5 for more ideas.

  Figure 3-2: An example of a filled-in ABC Form II.

  10. Set yourself some homework.

  When you've completed several ABC forms, you may well begin to notice recurring themes, thoughts, attitudes or beliefs. Such repetitions may suggest that you need to add some other CBT techniques in order to overcome certain emotions or behaviours, for example:

  • Facing a fear until it reduces (Chapter 9)

  • Conducting a behavioural experiment to test out a thought (Chapter 4)

  • Acting repeatedly ‘as if' you believe an alternative thought, attitude or belief (Chapter 17)

  • Completing a Zig-Zag form to strengthen an alternative thought, attitude or belief (Chapter 17)

  Read on and set yourself some more therapy assignments using the CBT principles in this book.

  Keeping your old ABC forms can be a rewarding record of your progress, and a useful reminder of how to fill them in if you need to use one again in the future. Many of our clients look back over their ABC forms after they feel better and tell us: ‘I can't believe I used to feel and think like that!'

  An ABC a day keeps the doctor at bay!

  If you want to develop any skill, remember these three words: Practice, practice, practice! You may not need to fill out an ABC form everyday. Other days, you may need to complete more than one form. The point is that practising ABC forms regularly is worthwhile because:

  Practice helps change disturbing feelings and the thoughts that underpin them.

  Sinking a new thought into your head and heart takes repetition.

  By completing forms on paper, you can become increasingly able to challenge unhelpful thoughts in your head - although you may still need to do it on paper sometimes.

  As you progress in your ability to overcome difficulties and develop your CBT self-help skills, you may still find the ABC form useful when you're hit with a biggy. And remember: If you can't work out your unhelpful thinking on the hoof, do sit down and bash it out on paper.

  Chapter 4: Behaving like a Scientist: Designing and Conducting Behavioural Experiments

  In This Chapter

  Testing out your thoughts and assumptions as predictions

  Exploring theories and gathering information

  Designing and recording your experiments

  Often, CBT can seem like common sense. Behavioural experiments are particularly good examples of the common-sense side of CBT. If you want to know whether your hunch about reality is accurate, or your way of looking at something is helpful, put it to a test in reality.

  This chapter is an introduction to behavioural experiments, a key CBT strategy. We include in this chapter an overview of several behavioural experiments that you can try out for yourself. We also give you examples of these experiments in action. As with the other examples we use in this book, try to look for anything useful you can draw from them. Try not to home in too much on how the examples differ from your specific problem. Instead, focus on what you have in common with the examples and work from there to apply the techniques to your own problems.

  Even in a ‘talking treatment' like CBT, actions speak louder than words. Aaron Beck, founder of cognitive therapy, encourages a therapeutic perspective where client and therapist work on ‘being scientific together'. Beck emphasises that testing your thoughts in reality, rather than simply talking about them, underpins effective therapy.

  Seeing for Yourself: Reasons for Doing Behavioural Experiments

  The proof of the pudding's in the eating. The same can be said of your assumptions, behaviours, beliefs and predictions about yourself and the world around you. Use experiments to test out the truth about your beliefs and to assess the usefulness of your behaviours.

  You can use behavioural experiments in the following ways:

  To test the validity of a thought or belief that you hold about yourself, other people or the world.

  To test the validity of an alternative thought or belief.

  To discover the effects that mental or behavioural activities have on your difficulties.

  To gather evidence in order to clarify the nature of your problem.

  Living according to a set of beliefs because you think they're true and helpful is both easy and common. You can also easily stick to familiar ways of behaving because you think that they keep you safe from feared events, or that they help you to achieve certain goals. An example of this may be holding a belief that other people are out to find fault with you - with this thought in mind, you then work hard to hide your mistakes and shortcomings.

  The beauty of a behavioural experiment is that you may well find that your worst imagined scenarios don't happen, or that you deal with such situations effectively when, or even if, they do occur.

  We may be stating the obvious, but change can
be less daunting if you keep in mind that you can always return to your old ways of thinking about things if the new ways don't seem any better. If your old ways seem to be the best option, nothing's stopping you from going back to them. The trick is to prepare yourself to try out new strategies and to give them a chance before returning to your former ways. Find out what works best for you and your particular situation.

  Testing Out Predictions

  When testing out your predictions, strive to get unambiguous disconfirmation, in so far as you can. Unambiguous disconfirmation means discovering conclusively that your fears don't come true, whether or not you actually do something to prevent them occurring. An example of unambiguous disconfirmation may be finding out that your dizziness is caused by anxiety, and that you won't collapse even if you don't sit down or hold on to something.

  Go through the following four steps to devise a behavioural experiment:

  1. Describe your problem.

  Write down the nature of your problem and include your safety behaviours (things you do to try to prevent your feared catastrophe - head to Chapter 7 for loads more on safety behaviour). Phrase the problem in your own words and make a note of how the problem negatively affects your life.

  2. Formulate your prediction.

  Decide what you think will happen if you try out a new way of thinking or behaving in real life.

  3. Execute an experiment.

  Think of a way of putting a new belief or behaviour to the test in a real-life situation. Try to devise more than one way to test out your prediction.

  4. Examine the results.

  Look to see whether your prediction came true. If it didn't, check out what you've learned from the results of the experiment.

  You can rate the degree to which you believe a prediction will come true on a percentage between 0 and 100 at the start of your experiment. After you've done the experiment and processed your results, re-rate your conviction in the original prediction.

  Take care not to use subtle ways of keeping your feared catastrophe at bay, such as doing experiments only when you feel ‘right', are with ‘safe' people, have safety signals to hand (such as a mobile phone or a bottle of water), or are using safety behaviours (such as trying to control your anxiety with distraction or by gripping tightly to your steering wheel). Using these subtle safety measures during your exposure to a fear can leave you with the impression that you've had a narrow escape, rather than highlighting that your predicted fear didn't come true.

  For example, consider the following experiment, which Nadine initiates to examine her fear of rejection and social anxiety:

  Describe the problem. Nadine's afraid of people thinking negatively of her and of being rejected by her friends. In social situations, Nadine monitors her body language and censors what she says, taking great care not to cause offence. She often plans in advance what she's going to say.

  Formulate a prediction. Nadine predicts ‘If I express an opinion or disagree with my friends, they'll like me less.' She rates her conviction in this idea as 90 per cent.

  Execute an experiment. For the next six social gatherings Nadine attends, she decides that she'll speak up and try to offer an opinion. If at all possible, she'll find a point on which to disagree with someone.

  Examine the results. Nadine discovers that no one took exception to her saying more. In fact, two friends commented that it was nice to hear more about what she thought about things. Nadine re-rates her conviction in her original prediction as 40 per cent.

  By conducting a behavioural experiment, Nadine observed that her feared prediction - ‘Others will like me less if I express my opinions' - didn't happen. This result gives Nadine the opportunity to change her behaviour according to the results of her experiment; therefore, to speak up more often. It also helps to reduce how much she believes the original prediction. Nadine can now adjust her thinking based on evidence gathered through the experiment.

  Nigel used a behavioural experiment to test out his prediction that he wouldn't enjoy engaging in social activities. Since self-isolating and disengaging from previously enjoyed activities promotes depression, Nigel really needs to understand the benefits of becoming more active. Nigel worked through an experiment as follows:

  Describe the problem. Nigel's depression typically leads to him having gloomy and pessimistic thoughts. He tends to avoid going out with his friends or doing any of his regular hobbies because he doesn't feel like it these days. He believes that he won't enjoy himself; therefore, there's no point in trying any of these activities. (As we note in Chapter 12, self-isolating behaviour is one of the key ways in which depression is maintained.)

  Formulate a prediction. Nigel chooses to experiment with the prediction ‘Even if I do go out, I won't enjoy myself and I'll end up feeling even worse once I get home.' He rates his strength of conviction in this thought as 80 per cent.

  Execute an experiment. Nigel plans to structure his week and to schedule two occasions to see friends. He also plans to spend two half-hour sessions riding his bike, which he used to enjoy. He rates each day over the next seven days in terms of his mood and of how much he enjoys his activities.

  Examine the results. Nigel notices that he does get some enjoyment from seeing his friends, although less than he usually would. Although he doesn't particularly enjoy his cycling and feels more tired than usual, he notes that he at least felt glad he had done something. He re-rates his conviction in his original prediction as 40 per cent, and decides to conduct further experiments to see whether his mood and energy levels improve over the next two weeks if he continues to be more active.

  This experiment helped Nigel to see that he felt better for doing something, even if he didn't enjoy cycling or socialising as much as he would when he wasn't depressed. Noting these results can help Nigel to stick to a schedule of activity and ultimately help him to overcome his depression.

  Seeking Evidence to See Which Theory Best Fits the Facts

  The scientific principle known as Occam's razor states that all things considered, the simplest theory is usually the best. Whichever theory explains a phenomenon most simply is the one a scientist adopts. When you want to test out a theory or idea you hold about yourself, others or the world, developing an alternative theory is a good idea. This gives you the chance to disprove your original theory and to endorse the healthier alternative.

  Some emotional problems don't respond well to attempts to disprove a negative prediction. In such cases, you may be better off developing some competing theories about what the problem actually is. You then devise experiments to gather more evidence and see which theory reflects reality most accurately.

  For example, imagine that your boss never says a cheerful ‘good morning' to you. You develop the following two theories:

  Theory A: ‘My boss doesn't like me at all.'

  Theory B: ‘My boss isn't friendly in the mornings and is a bit rude, but he's like this to a lot of employees, not just me.'

  You're now in a position to gather evidence for whether theory A or B best explains the phenomenon of your boss failing to be cheerful towards you in the mornings.

  A theory is just an idea or assumption that you hold, which to your mind, explains why something happens - a seriously technical word for a simple concept.

  Often, developing one additional theory to compete with your original theory is enough. However, you can develop more alternative theories if you think they may help you get to the bottom of what you're experiencing. Taking the above example, you may have a third theory, such as ‘My boss is cheerful only with employees that he knows very well', or even a fourth theory, such as ‘My boss is cheerful only with employees of the same rank or above him'.

  Developing competing theories can be particularly helpful in the following situations:

  Dealing with predictions that may be months or years away from being proven. If you fear you'll go to hell for having an intrusive thought about causing harm to someone, then this outcome
is likely to be sometime away. Similarly, if you have health anxiety and spend hours each day preoccupied with the idea that physical sensations in your body may be signs that you'll become ill and die, you're unlikely to know straightaway whether this will actually happen. With these kinds of catastrophic thought, you need to design experiments to help you gather evidence that supports the theory that you have a worry or anxiety problem, rather than a damnation or terminal illness.