Cognitive Behavioural Therapy For Dummies

by Branch, Rhena

  Dealing with beliefs that are impossible to prove or disprove conclusively. Perhaps you're anxious about others having negative opinions of you. You cannot know for sure what other people think, but even if someone tells you that your fears are unfounded, you can never know with absolute certainty what he's thinking. Similarly, if you have jealous thoughts that your partner desires someone else, but he reassures you otherwise, you may remain uncertain of his true feelings.

  For both of these situations, you can employ the theory A or theory B strategy:

  Design an experiment to gather evidence to support the idea that your jealous feelings are based on your jealous thoughts (theory B), rather than on reality (theory A).

  Similarly, devise an experiment to test out whether your original theory A that, ‘People don't like me', or alternative theory B that, ‘I often think that people don't like me because I'm so worried about others' opinions of me that I end up seeing a lot of their behaviour as signs of dislike', best explains your experiences in social situations.

  Here is an example of how Alex used the competing theories approach to get a better understanding of his physical sensations. Originally, Alex assumed his theory that uncomfortable bodily sensations signalled the onset of a heart attack was correct. By testing this in practice, Alex was able to consider that an alternative theory - uncomfortable bodily sensations are a by-product of anxiety - may be more accurate.

  Describe the problem. Alex suffers from panic attacks. He feels hot and his heart races, sometimes out of the blue. When he feels these sensations, he fears he's having a heart attack. Alex sits down to try to reduce the strain on his heart (an example of a safety behaviour). He goes out of his way to avoid situations in which he has experienced these symptoms.

  Develop competing theories. Alex devises two theories about his raised heart rate:

  • Theory A: ‘My heart beating quickly means I'm vulnerable to having a heart attack.'

  • Theory B: ‘My heart beating quickly is a consequence of anxiety.'

  Execute an experiment. Alex decides to deliberately confront situations that tend to trigger off his raised heart rate and to stay in them, without sitting down, until his anxiety reduces. He predicts that if theory B is correct, then his heart rate will reduce after his anxiety subsides and he can leave the situation without having come to any harm.

  Examine the results. Alex finds that his heart rate does indeed reduce when he stays with his anxiety. He's struck by what a difference this knowledge makes to his confidence, and that he's not going to come to any harm from his raised heart rate when he resists the urge to sit down. He concludes that he can reasonably have about 70 per cent confidence in his new theory that his raised heart rate is a benign consequence of anxiety.

  You can't always prove conclusively that something isn't so. However, you can experiment to see whether certain emotional states, and mental or behavioural activities, have a beneficial or detrimental effect on the kinds of thoughts that play on your mind.

  Conducting Surveys

  You can use the clipboard and pen of the survey-taker in your endeavours to tackle your problems, by designing and conducting your own survey. Surveys can be especially helpful in terms of getting more information about what the average person thinks, feels or does.

  We suggest you have more than one type of behavioural experiment in your repertoire. Surveys are very useful if you believe that your thoughts, physical sensations or behaviours are out of the ordinary. If you have upsetting, intrusive thoughts and images, or experience urges to say socially unacceptable things (symptoms typical of obsessive-compulsive disorder, OCD), feel pulled to the edge of high places (as in vertigo), or get a sense of impending doom when you're not in a familiar place (symptoms associated with agoraphobia), you may think that you're the only person who ever feels this way. Use surveys to see whether other people have the same thoughts and urges. You'll probably discover that other people experience the same things as you do. You may also discover that the symptoms you experience are actually less of a problem than the way you currently deal with them.

  Henry suffers from OCD. His particular obsessional problem is related to frequent intrusive images of harm coming to his family. Henry's convinced that he's the only person in the world who gets such unpleasant and unwanted images entering his mind. Henry concludes that there's something very different and wrong about him because he has such images. He tests his theory about his abnormality by conducting the following survey:

  Describe the problem. Henry's convinced that his intrusive thoughts about his family being hurt in a car accident are unusual, and mean that he has to protect his family by changing the image in his mind to them being happy at a party.

  Formulate a prediction. Henry comes up with the prediction ‘No one will admit to having the kind of thoughts I have'. He rates his strength of belief as 70 per cent.

  Execute an experiment. Henry tests his perception that his images are abnormal by devising a checklist of intrusive thoughts and asking his friends and family members to tick any that they experience.

  Examine the results. Henry's surprised at the variety of thoughts that people report entering their minds. Henry concludes that perhaps his images aren't so abnormal after all. He re-rates his conviction in his original prediction as 15 per cent. Henry also learns that other people simply discount their unpleasant images and don't worry that they mean anything sinister.

  Charlotte worries a lot about her health and the possibility of developing a life-threatening illness. Sometimes, Charlotte notices funny sensations in her body and instantly interprets them as signs of an undiagnosed disease. Charlotte assumes that no one else gets unusual bodily sensations from time to time.

  Describe the problem. Charlotte worries that the bodily sensations she experiences are a sign of disease. She's unsatisfied by frequent reassurance from her family doctor and husband. Charlotte's problems are based partly on two ideas:

  • Physical sensations must have a clear medical explanation.

  • Any sensible person would seek an immediate explanation for the physical sensations she's currently experiencing.

  Formulate a prediction. Charlotte makes the following prediction: ‘Most people won't have many physical sensations, and if they do they go immediately to see their doctor.' She rates her strength of conviction in this idea as 80 per cent.

  Execute an experiment. Charlotte devises a list of physical sensations, including many of those that she worries about herself. Her checklist requires people to tick whether they've ever experienced the sensation and to indicate how long they might leave it before consulting their doctor about such sensations. She asks ten people to fill out her questionnaire.

  Examine the results. Charlotte's shocked that many people reported experiencing some of the bodily sensations she described and stated that they'd leave going to their doctor for several days, or even weeks. Some people reported that they probably wouldn't bother seeing their doctor at all regarding some sensations. Charlotte concludes that perhaps she's worrying too much about her health, and plans to delay consulting her doctor when she next has unexplained physical sensations. Her strength of belief in her original prediction reduces to 30 per cent.

  Making Observations

  Observations can be an easier way of getting started with doing experiments to test out the validity of your thoughts. Observations usually involve collecting evidence related to a specific thought by watching other people in action.

  You may assume, for example, that no one in their right mind would admit to not understanding an important point about a work procedure. If they did, they'd no doubt be ridiculed and promptly sacked on the basis of highlighting their incompetence.

  Test this assumption by observing what other people actually do. Behave like a scientist and gather evidence of others admitting lack of understanding, asking for clarification or owning up to mistakes. Observe whether your prediction that they'll be ridiculed or fired is accurate.
Making observations to gather evidence both for and against your assumptions is another way of behaving like a scientist.

  Ensuring Successful Behavioural Experiments

  To get the highest level of benefit when designing and carrying out behavioural experiments, keep the following in mind:

  Ensure that the type of experiment you choose is appropriate. Make your experiments challenging enough for you to gain a sense of accomplishment from conducting them. Equally, take care to devise experiments that won't overwhelm you.

  Have a clear plan about how, when and where (and with whom, if relevant) you plan to carry out your experiment.

  Be clear and specific about what you want to find out from your experiment - ‘to see what happens' is too vague.

  Decide in advance how you'll know whether your prediction comes true. For example, what are the clues that someone's thinking critically of you?

  Plan what you'll do if your prediction comes true. For example, how do you respond assertively if someone is actually critical of you?

  Use the behavioural experiments record sheet in this chapter to plan and record your experiment.

  Consider what obstacles may interrupt your experiment and how you can overcome them.

  When evaluating the outcome of your experiment, check that you're not being biased (for example, discounting the positive or mind-reading, thinking errors we describe in Chapter 2) in the way you process your results.

  Consider whether you rely on any (including subtle) safety behaviours. Safety behaviours can affect the results of your experiment or determine how confident you feel about the outcome - for example, thinking that you avoided collapsing by concentrating hard, rather than discovering conclusively that your feelings of dizziness are a result of anxiety, not imminent fainting.

  Plan ways to consolidate what you discover from your experiment. For example, should you repeat the experiment, devise a new experiment, change your daily activities, or some other action?

  Treating your negative and unhelpful thoughts with scepticism is a key to reducing their emotional impact. Experiments can help you to realise that many of your negative thoughts and predictions are not accurate in reality. Therefore, we suggest you take many of your negative thoughts with a pinch or more of salt.

  Think about therapy as an experiment, rather than a lifelong commitment, especially at the beginning. By thinking in this manner, you can feel less under pressure and more able to approach therapy with an open mind.

  Keeping Records of Your Experiments

  All good scientists keep records of their experiments. If you do the same, you can look back over your results in order to:

  Draw conclusions.

  Decide what kind of experiment you may want to conduct next in order to gather more information.

  Remind yourself that many of your negative predictions won't come true.

  To help you keep records of your experiments, photocopy Figure 4-1, and use it as often as you like, following the instructions in the figure.

  Figure 4-1: Photocopy and fill in your own Behavioural Experiment Record Sheet.

  Try to have a no-lose perspective on your experiments. If you do one experiment and it goes well, then great! However, if you plan an experiment but ultimately avoid doing it, you can at least identify the thoughts that blocked you. Even if your negative predictions turn out to be accurate, you have an opportunity to see how well you cope - and very probably that it isn't the end of the world - and then decide whether you need to take further action. The point is, you can always gather information that you can make into a useful experience.

  Don't take our word for it . . .

  This book's full of suggestions on how to reduce and overcome emotional problems. If you're sceptical about whether CBT can work for you, you're in very good company. However, loads of scientific evidence shows that CBT is more effective than all other psychotherapies.

  So, CBT may well work for you, but how can you tell? The answer is to consider applying a specific tool or technique for a period of time as an experiment to see how the technique works for you. Depending on the outcome, you can then choose to do more, modify your approach or try something different.

  Chapter 5: Pay Attention! Refocusing and Retraining Your Awareness

  In This Chapter

  The role of attention in overcoming emotional problems

  Concentrating on tasks

  Directing and redirecting your attention

  Giving unpleasant thoughts and images time to subside

  Practising mindfulness

  Traditionally, CBT has tended to concentrate many of its techniques on helping people change the content of their thinking - from a negative to a more realistic thought, for example. However, modern CBT has begun to tackle another area of human psychology - how we focus our attention.

  This chapter does not discuss what you think, but does discuss how you manage your thoughts and attention. We introduce task concentration training and mindfulness, two techniques for managing problematic thoughts and exerting some power over your attention. This chapter has two main messages:

  For the most part, your thoughts, no matter how distressing and negative, are not the real problem. Rather, the importance or meaning you attach to those thoughts is what causes you the problem. If you view the notion, ‘I'm a hopeless case', as a thought rather than a fact, you can greatly lessen its impact.

  When you have an emotional problem, your mind tends to attach unhelpful meanings to aspects of yourself, the world around you and other people. You can also tend to overfocus on particular aspects of these unhelpful meanings. Fortunately, you can develop the ability to steer your attention towards, and away from, any features of your experience you choose, which can help improve your mood and reduce anxiety.

  Training in Task Concentration

  Becoming adept at redirecting your attention away from yourself (this includes your bodily sensations, thoughts and mental images), in certain situations, is the essence of task concentration. Rather than thinking about yourself, you focus your attention towards your external environment and what you're doing.

  Task concentration involves paying less attention to what's going on inside of you and more attention to what's happening outside of you.

  Task concentration can be particularly useful in situations that trigger anxiety in you. Task concentration can help you to counterbalance your tendency to focus on threats and on yourself when you feel anxious.

  As you begin to practise task concentration, break down the process into two rehearsal arenas - just as when learning to drive you begin on quiet roads and eventually advance on to busier roads.

  The two rehearsal arenas are as follows:

  Non-threatening situations: Here, you typically experience little or no anxiety. For example, if you have social phobia, you may feel a little anxious walking through a park, travelling on a very quiet train or socialising with family members and close friends.

  More challenging situations: Here, you may experience moderate to severe anxiety. More challenging situations may include shopping in a busy grocery store, travelling on a train during rush hour or attending a party with many guests whom you may not know.

  Typically, you gradually progress from non-threatening situations to more challenging situations as you practise and develop greater skill.

  After you've practised redirecting your attention in situations you regard as relatively non-threatening, you can move on to using the techniques in increasingly challenging situations.

  Choosing to concentrate

  The point of task-concentration exercises is not to lessen your overall concentration, but to concentrate harder on different aspects of the external environment. Some tasks require you to focus your attention on certain behaviours - such as listening to what another person is saying during a conversation, or attempting to balance a tray of drinks as you walk through a crowded room.