Cognitive Behavioural Therapy For Dummies
Page 9
In other situations, you may feel anxious but you don't have a specific task to attend to. In such a situation, for example while sitting in a crowded waiting room, you can direct your attention to your surroundings, noticing other people, the features of the room, sounds and smells.
With practice, you can be both task- and environment-focused rather than self-focused, even in situations that you regard as highly threatening.
The following exercises aim to increase your understanding of how paying attention to sensations and images limits your ability to process information around you. The exercises will also help you realise that you can attend to external task-related behaviours. In other words, you can master choosing what you pay attention to in situations when your anxiety is triggered.
Intentionally directing your attention away from yourself does not mean distracting yourself from your sensations or suppressing your thoughts. Sometimes, people try to use thought suppression as a means of alleviating uncomfortable sensations and anxiety. However, suppression usually works only briefly, if at all.
Concentration exercise: Listening
For this exercise, sit back-to-back with someone else, perhaps a friend or your therapist. Ask the person to tell you a story for about two minutes. Concentrate on the story. Then, summarise the story: note how much of your attention you direct towards the task of listening to the other person, towards yourself and towards your environment - try using percentages to do this. Your partner can give you feedback on your summary to give you some idea how you did.
Now do the exercise again, but this time round sit face-to-face with the storyteller and make eye contact. Ask the person to tell you a story, but on this occasion consciously distract yourself by focusing on your thoughts and sensations, and then redirect your attention towards the storyteller. Summarise the story, and note (using percentages again) how you divide your attention between yourself, listening to the other person and your environment.
Repeat the storytelling activities, sitting back-to-back and then face-to-face, several times until you become readily able to redirect your attention to the task of listening after deliberate distraction through self-focusing. Doing so helps you to develop your ability to control where you focus your attention.
Concentration exercise: Speaking
Follow the same steps for this speaking exercise as you do for the listening exercise, as we describe in the preceding section. Starting with your back to the back of the other person, tell a two-minute story, focusing your attention on making your story clear to the listener.
Next, position yourself face-to-face with the listener, making eye contact. Deliberately distract yourself from the task of storytelling by focusing on your feelings, sensations and thoughts. Then, refocus your attention towards what you're saying and towards the listener, being aware of her reactions and whether she understands you.
Again, using percentages, monitor how you divide your attention among yourself, the task and your environment.
Concentration exercise: Graded practice
For this exercise, prepare two lists of situations. For your first list, write down five or so examples of situations you find non-threatening. As you write down the situations, practise distracting yourself by focusing on your internal sensations and thoughts. Now read back through the list of these situations, but this time try refocusing your attention outwards. For your second list, write down ten or so examples of situations you find threatening. Arrange the situations in a hierarchy, starting from the least anxiety-provoking and graduating up to the most anxiety-provoking. Now you can work through your hierarchy by deliberately entering the situations while practising task concentration until you reach the top of your list. This means you can start to practise mastering your anxiety in real-life situations.
Concentration exercise: Taking a walk
For this exercise, walk through a park, paying attention to what you hear, see, feel and smell. Focus your attention for a few minutes on different aspects of the world around you. First, focus your attention mainly to what you can hear. Then shift your attention to focus on smells, and then on to the feel of your feet on the ground, and so on. You can move your attention around to different sensations, which can help you tune your attention onto the outside world. Switching between your five senses can also help you realise that you have the ability to direct your attention as you choose.
After you've practised directing most of your attention to individual senses, try to integrate your attention to include all aspects of the park. Try to do this for at least 20 minutes. Really let yourself drink in the detail of your surroundings. Discover what hooks your attention. You may be drawn to water or have a keen interest in birds, plants, or perhaps even woodland smells. Notice how you feel much more relaxed and less self-conscious as you train your attention on the world around you.
Tuning in to tasks and the world around you
If you're suffering from anxiety, you're probably self-focused in social situations and fail to notice the rest of the world. On top of feeling unnecessarily uncomfortable, your self-focus means that you're likely to miss out on a lot of interesting stuff. Luckily, you can change your attention bias and overcome much of your anxiety.
You can also use re-training your attention onto the outside world to help interrupt yourself from engaging with the stream of negative thoughts that accompanies depression, which will help you to lift your mood.
Here's an example of how you can use task-concentration techniques to overcome anxiety, specifically anxiety, worry and panic episodes (see Chapter 9 for more on these).
Harold was particularly worried that people would notice that he blushed and sweated in social situations. He believed that people would think he was odd or a nervous wreck. Harold constantly self-monitored for blushing and sweating and tried very hard to mask these symptoms of his anxiety.
Here's Harold's list of situations, with each one becoming gradually more challenging:
1. Having dinner with his parents and brother.
2. Socialising with his three closest mates at a local pub.
3. Using public transport during quiet periods.
4. Eating lunch with colleagues at work.
5. Going to the cinema with a friend.
6. Walking alone down a busy street.
7. Socialising with strangers at a party.
8. Going to the grocery shop alone.
9. Going to the gym alone.
10. Initiating conversation with strangers.
11. Using public transport during busy periods.
12. Eating alone in a restaurant.
13. Going for an interview.
14. Offering his opinion during work meetings.
15. Giving a presentation at work.
Harold used the principles of task concentration to increase his ability to focus deliberately on chosen external factors in non-threatening situations. When Harold was at the pub with his mates, he focused his attention on what his friends were saying, other people in the pub, the music and the general surroundings. Harold also deliberately distracted himself by focusing on whether he was blushing and sweating, and then he refocused his attention again.
Harold then used the same techniques in more-threatening situations. In the grocery store, Harold found that the more he focused on his blushing and sweating, the more anxious he felt and the less able he was to pack up his shopping. When he paid attention to the task of packing his groceries, made eye contact with the cashier and even made a bit of small talk, Harold's anxiety symptoms reduced, and he became more aware of what he was doing and what was going on around him.
Harold worked diligently through his hierarchy of feared situations and now feels much more confident and relaxed in social situations.
Imagine that you're going to be called on by the police to act as an eyewitness. For a few minutes, try to take in as much information as you can about the environment and the people around you. Notice how much more detail you can
recount when you choose to focus outwards, compared with when you're concentrating on your thoughts and physical sensations.
Tackling the task concentration record sheet
You can keep an account of your task-concentration practice, and note the results, by using the task-concentration record sheet in Table 5-1. The brief instructions at the top of the sheet are there to remind you how to do your concentration exercises. You can find a blank copy of the form in Appendix B.
Becoming More Mindful
Mindfulness meditation, commonly associated with Zen Buddhism, has become popular in the past few years as a technique for dealing with depression, and managing stress and chronic pain. Evidence shows that mindfulness meditation can help reduce the chance of problems such as depression returning, and adds another weapon to your armoury against emotional problems.
Being present in the moment
Mindfulness is the art of being present in the moment, without passing judgement about your experience. The mindfulness process is so simple - and yet so challenging. Keep your attention focused on the moment that you're experiencing right now. Suspend your judgement about what you're feeling, thinking and absorbing through your senses. Simply observe what's going on around you, in your mind and in your body without doing anything. Just allow yourself to be aware of what's happening.
Mindfulness literature talks about the way your mind almost mechanically forms judgements about each of your experiences, labelling them as good, bad or neutral depending on how you value them. Things that generate good and bad feelings within you get most of your attention, but you may ignore neutral things or deem them to be boring. Mindfulness meditation encourages awareness of the present moment with an uncultured mind, observing even the seemingly mundane without judgement. The whole experience is a bit like looking at the world for the first time.
When you meet someone you know, try to see her through fresh eyes. Suspend your prior knowledge, thoughts, experiences and opinions. You can try this with acquaintances or people you know very well, such as family members and close friends.
Try mindfulness exercises when you're in the countryside or walking down the street. Whether the surroundings are familiar to you or not, try to see the details of the world around you through fresh eyes.
Letting your thoughts pass by
You can develop your mindfulness skills and use them to help you deal with unpleasant thoughts or physical symptoms. If you have social anxiety, for example, you can develop the ability to focus away from your anxious thoughts.
Watching the train pass by
Imagine a train passing through a station. The train represents your thoughts and sensations (your ‘train of thought'). Each carriage may represent one or more specific thoughts or feelings. Visualise yourself watching the train pass by without hopping into any carriage. Accept your fears about what other people may be thinking about you without trying to suppress them or engaging with them. Simply watch them pass by like a train through a station.
Standing by the side of the road
Another version of the exercise is to imagine that you're standing on the side of a reasonably busy road. Each passing vehicle represents your thoughts and sensations. Just watch the cars go by. Observe and accept them passing. Don't try to hitch-hike, redirect the flow of traffic or influence the cars in any way.
Discerning when not to listen to yourself
One of the real benefits of understanding the way that your emotions influence the way you think, is to know when what you're thinking isn't likely to be helpful or very realistic. Being mindful means learning to experience your thoughts without passing judgement as to whether they're true or not.
Given that many of the negative thoughts you experience when you're emotionally distressed are distorted and unhelpful, you're much better off letting some thoughts pass you by, recognising them as symptoms or output of a given emotional state or psychological problem. Chapter 6 contains a table which covers the cognitive consequences of specific emotions, giving you an idea of the types of thoughts that can occur as a consequence of how you're feeling.
Becoming more familiar with the thoughts that tend to pop into your head when you feel down, anxious or guilty makes it easier for you to recognise them as thoughts and let them come and go, rather than treating them as facts. This familiarity gives you another skill to help manage your negative thoughts in addition to challenging or testing them out in reality.
Incorporating mindful daily tasks
Becoming more mindful about little everyday tasks can help you to strengthen your attention muscles. Essentially, everything you do throughout the day can be done with increased awareness. For example, think about the following:
Washing-up mindfully can help you experience the process more fully. Notice the smell of the washing-up liquid, the temperature of the water and the movement of your hands.
Eating mindfully can give you a more enjoyable eating experience. Slow down the speed at which you eat, and pay attention to the texture of the food, the subtlety of the flavours and the appearance of the dish.
Tolerating upsetting images and unpleasant ideas
Certain psychological problems such as depression and anxiety disorders like OCD are frequently accompanied by unwelcome, unsettling images or thoughts. Depressed people can have ideas about harming themselves or even get strong visual images of doing so - even when they've no real intention of taking suicidal action. These thoughts are understandably very distressing and people may worry that they indicate a real risk. Happily this is not often the case; most of these thoughts are merely an unpleasant bi-product of depressed mood. It's easy to misinterpret these images and thoughts as dangerous or portentous but learning to see them as what they really are - just unpleasant symptoms of depression or anxiety - can render them less frightening.
Not all suicidal ideas are to be ignored. If you find yourself becoming increasingly preoccupied with ideas of harming yourself or ending your life, seek help immediately. This advice is especially important if you've begun to develop a plan and find your suicidal thoughts comforting. Talk to your doctor, a family member or friend, or take yourself to the psychiatric emergency unit at your nearest hospital. Chapter 12 deals with depression. You can also read Chapter 21 for valuable information about seeking professional help.
People with OCD (more on this disorder in Chapter 13) often experience intrusive thoughts and images. The content of these thoughts and mental pictures can vary widely but they're frequently about harming people you love or acting in a way that dramatically violates your moral code. Other emotional or anxiety problems can also give rise to a host of nightmarish ideas and images. Some classics may include:
Losing control of your bladder or bowels in public
Blurting out something really offensive
Behaving in a sexually inappropriate manner
Jumping on to a train track
Driving your car recklessly
Harming an animal
Harming yourself or another person (a child or loved one)
Having a panic attack in a public place
Making a bad decision which results in irreparable consequences
Being harshly rejected or humiliated
Experiencing thoughts and images about death or violence (to self and others)
When you have such unsolicited ghoulish mental activity, it's very understandable that you want to get rid of it. Typically however, the harder you try to rid yourself of such thoughts and images, the more they take hold. This is because your attempts to eliminate, avoid or neutralise unwelcome thoughts are driven by the fundamental rule:
‘I must not have such thoughts; they're unacceptable and mean something dreadful.'
When you put effort into preventing or eliminating a certain thought, you're inadvertently focusing more attention on it. If you regard certain kinds of mental activity as taboo, then you increase your fears of it occurring. Paradoxically, you may end up increasing the frequen
cy of intrusive images and thoughts plus elevating your disturbance in response to them. Everyone has intrusive thoughts and images from time to time. Even if you're not in any form of psychological or emotional distress, you're not immune to the occasional gruesome mental image. People without anxiety or depression, however, are more readily able to dismiss the thought or image as unpleasant (or even shocking) but of ultimately no real importance. You can begin to tolerate unpleasant thoughts by adopting the following attitude: