Cognitive Behavioural Therapy For Dummies

by Branch, Rhena

  ‘I don't like these thoughts but they aren't abnormal or important. They don't mean something about me.'

  Knowing a thought is just a thought

  Because the content of these type of thoughts is so abhorrent to you, they can feel terribly important. You might assume that they mean you're more likely to do some horrendous deed or that something terrible is now going to happen to a loved one because you thought them. More accurately, these type of thoughts are merely a reflection of what you hold dear and value. Rather cruelly, you tend to get afflicted by the kind of thoughts that run counter to your true character and value system.

  You can try to think of intrusive thoughts and images as ‘waking nightmares'. When you have a nasty dream you probably shake it off pretty quickly because you just think ‘Yuck; oh well, it was just a bad dream'. You probably don't usually give the content of your dreams much credence. Do the same with unpleasant images that come when you're awake. Just because you're awake doesn't make them any more valid or important.

  Even though some thoughts and images are uncomfortable - you can tolerate them. As you increase your tolerance for unwelcome mental images, you simultaneously reduce your fear of them. Disliking specific kinds of thought is okay but remind yourself that thoughts are all they are.

  Letting unwelcome thoughts extinguish by themselves

  Worrying and upsetting thoughts and images won't last forever. If you do nothing, they'll eventually fade away. As we've already mentioned, trying to control unwelcome thoughts rarely works for long. The key is treating these thoughts as though they're of no importance. When something is of little or no importance, you tend to ignore it or give it little attention. Instead of fighting against these trivial (though tormenting) thoughts, do nothing. Take off the boxing gloves and just let your mind move onto other more neutral images and thoughts naturally. Doing so sounds pretty simple and straightforward but just letting go can be hard to master. Your feelings of anxiety, disgust or horror about intrusive thoughts can compel you to action. Resist the pull of your feelings.

  Try these tips:

  Let unwelcome thoughts play out in the background as though they were just noise. Think of these thoughts like static on the radio or street noise outside your office window. You can filter them out and refocus your attention onto a task.

  Get your mind busy doing something else more interesting or compelling. Pick up the phone and make some important calls, do a crossword puzzle or go for a walk.

  Raise your heart rate. Going for a run, playing a sport or vacuuming vigorously can help relieve anxiety and clear your mind.

  As you pay less attention to unwelcome thoughts, you'll probably find that your adverse feelings about them become less intense. Eventually just allowing your thoughts to extinguish will become much easier because you'll have reduced their emotional impact.

  It may be tempting to ask for reassurance from friends (or even your CBT therapist) that your thoughts are not dangerous. This can be a slippery slope since you unwittingly reinforce fear and intolerance of unwanted thought content. Instead of repeatedly seeking reassurance, remember to treat thoughts of this ilk as unimportant. You probably don't dwell on or talk incessantly about unimportant things - so practise the same policy in this instance.

  Part II

  Charting the Course: Defining Problems and Setting Goals

  In this part . . .

  More than a feeling . . . we help you to clearly name your emotions and also help you to work out the difference between helpful and unhelpful emotions. In this part you discover what you want to change in your life, and realise how some of your current solutions to problems may not be benefiting you in the long run. We also offer alternatives to current solutions that may not actually be working for you!

  Chapter 6: Exploring Emotions

  In This Chapter

  Identifying healthy and unhealthy negative emotions

  Understanding the thinking, behaving and attention components of emotions

  Defining the emotional problems you want to solve

  This chapter aims to introduce you to some of the key differences between the unhealthy negative emotions you may experience and their healthy counterparts. The information we offer also helps you to discover ways to identify whether you're experiencing a healthy or an unhealthy emotional response.

  You may be wondering why we're focusing on negative emotions in this chapter and neglecting positive feelings such as happiness. You may be asking: ‘What is it with these two? They're so bleak!' The reason for dealing with the negative is that few people pitch up for therapy because they're having problems with positive emotions. Not a lot of people come to us looking for a way to overcome their relentless feelings of contentment. The emotions that give people trouble typically include guilt, anger, depression and shame.

  Although feeling bad when bad things happen is natural, you don't need to make things worse for yourself by giving yourself unhealthy negative emotions. Healthy negative emotions are generally less profoundly uncomfortable and less problematic than their unhealthy counterparts. For example, feeling intensely sad (a healthy negative emotion) is less uncomfortable than feeling intensely depressed (an unhealthy emotion). Likewise, feeling intense sadness can prompt you to do things to improve your situation, but depression's more likely to lead to your inaction and resignation.

  Fortunately, you can think what to feel, to a greater or lesser extent, which can reduce your emotional discomfort. By choosing to think in healthy and helpful ways, you're more likely to experience healthy emotions.

  Naming Your Feelings

  If someone asks you how you feel, you may have difficulty describing exactly which emotion you're feeling. You may not be sure what name to give to your internal experience, or perhaps you're feeling more than one emotion at the same time.

  Don't get caught up on words! When you start to make a distinction between healthy and unhealthy feelings, what you call them isn't terribly important. The main point is to be able to analyse your thoughts and behaviours, and to take notice of where your attention is focused (CBT refers to this as attention focus). These three areas are ultimately your most reliable guides as to which type of emotion you're experiencing.

  For the sake of clarity, therapists can often encourage people to use different words for unhealthy and healthy alternatives to common feelings. For example, you could use the word ‘anger' to describe an unhealthy emotion and ‘annoyance' to describe the healthy counterpart.

  Some people find it simpler to choose a descriptive word for their emotion and to add the term ‘healthy' or ‘unhealthy' to that word. Whatever way you prefer to describe your emotions is okay - the important bit's understanding the category each emotion falls into. Different people have different ways of describing things. Think about how you'd describe an oil painting compared with the way a friend or art critic may talk about it. Similarly, people describe emotional states in diverse ways. You, a friend and a psychotherapist (someone highly skilled in discussing emotions) may all use very different words to describe the same type of feeling.

  If you're not used to talking about the way you feel, you may have a hard time finding the words to reflect your feelings.

  The following is a reference list of common human emotions and their synonyms, which you can use to increase your vocabulary of emotive (relating to emotions) terminology. This list is not broken down into healthy and unhealthy emotions.

  Angry: aggressive, annoyed, bad-tempered, complaining, confounded, cross, displeased, enraged, fractious, fuming, furious, hostile, ill-tempered, incensed, irritated, livid, miffed, peevish, prickly, resentful, testy, touchy, truculent.

  Anxious: agitated, apprehensive, bothered, concerned, edgy, fearful, fretful, frightened, jumpy, nervous, nervy, panicky, restless, tense, troubled, uneasy, vexed, worried.

  Ashamed: belittled, debased, defamed, degraded, discredited, disgraced, dishonoured, humiliated, mortified, scorned, smeared, sullied, tarnished, u
ndignified, vilified.

  Disappointed: crestfallen, deflated, dejected, discouraged, disenchanted, disheartened, disillusioned, dismayed, gutted, let down, thwarted.

  Embarrassed: awkward, diminished, discomfited, humiliated, ill at ease, insecure, self-conscious, small, timid, uncomfortable, unconfident, unsure of oneself.

  Envious: green with envy, malevolent, malicious, Schadenfreude, sour, spiteful.

  Guilty: answerable, at fault, blameworthy, condemned, culpable, deplorable, indefensible, inexcusable, in the wrong, liable, reprehensible, unforgivable, unpardonable.

  Hurt: aggrieved, broken-hearted, cut to the quick, cut up, damaged, devastated, gutted, hard done by, harmed, horrified, injured, marred, offended, pained, wounded.

  Jealous: bitter and twisted, distrustful, doubtful, green-eyed, sceptical, suspicious, wary.

  LOVE: (we threw this one in just to lighten the mood) admiring, adoring, affectionate, besotted, blissful, crazed, devoted, enamoured, esteemed, fond, head over heels, infatuated, keen, loved-up, love-struck, mad about, on cloud nine, smitten, struck by cupid's arrow, worshipping.

  Sad: bereft, blue, depressed, distraught, distressed, down, downcast, downhearted, grief-stricken, heartsick, inconsolable, melancholic, mournful, shattered, sorrowful, tearful.

  Thinking What to Feel

  One benefit of understanding the difference between healthy and unhealthy emotions is that you give yourself a better chance to check out what you're thinking. If you recognise that you're experiencing an unhealthy emotion, you're then in a position to challenge any faulty thinking that may be leading to your unhealthy emotional response. Disputing and correcting thinking errors can help you to experience a healthy, negative emotion instead of an unhealthy feeling (see Chapter 2 for more on thinking errors and how to correct them).

  A common axiom is ‘I think therefore I am'; a CBT version is ‘I think; therefore I feel.'

  Feelings aren't as one-dimensional as they may seem. How you feel is more than just the emotion itself, because feelings don't just come out of thin air - they have a context. When you begin to make a distinction between your healthy and unhealthy emotions, look at the interaction between your thinking, your actions, your attention focus, your memory, your themes or triggers, and the way you feel. Take a look at Table 6-1 in the section that covers comparing healthy and unhealthy emotions further on in this chapter, which gives a clear breakdown of the characteristics of healthy and unhealthy emotions.

  Understanding the Anatomy of Emotions

  Figure 6-1 shows the complex processes involved in human emotion. Whenever you feel a certain emotion, a whole system is activated. This system includes the thoughts and images that enter your mind, the memories you access, the aspects of yourself or the surrounding world that you focus on, the bodily and mental sensations you experience, physical changes such as appetite, your behaviour, and the things you feel like doing.

  As the diagram shows, these different dimensions interact in complex ways. For example, training your attention on possible threats is likely to increase the chance of anxious thoughts popping into your mind, and vice versa. Not sleeping well may increase the chances of you being inactive; continued inactivity can further disrupt your usual sleeping pattern. The advantage of understanding this system of emotion as presented in Figure 6-1 is that it gives you plenty of opportunity to make changes. Changing even one aspect of the system can make changing other parts easier.

  An example of change is becoming more active if you've been inactive, which may alleviate your feelings of depression and make it easier for you to challenge your depressive, pessimistic thinking. Being prescribed antidepressant medication, which works by affecting brain chemistry, can take the edge off your depression. Use of antidepressants can make it easier for you to train your attention away from your negative thoughts and uncomfortable symptoms and towards possible solutions to some of your practical problems. (See Chapter 12 for more about overcoming depression.)

  Figure 6-1: The anatomy of emotion.

  Comparing Healthy and Unhealthy Emotions

  Deciphering between healthy and unhealthy versions of negative emotions can be challenging, especially when the process is new to you. Think of Table 6-1 as your emotional ready reckoner for the characteristics of both healthy and unhealthy emotions. Everything you may need to identify the emotion you're experiencing is in this table. Plus, if you do identify that an emotion you're experiencing is unhealthy, you can implement the thoughts, attention focuses and behaviours of the healthy version to aid you in feeling better.

  Themes refer to situational aspects linked to emotion. Themes are the same for both healthy and unhealthy negative emotions. For example, when you feel guilty (an unhealthy negative emotion), the theme for that emotion is that you've ‘sinned' by either doing or failing to do something. Another way of saying that you're guilty is that you've transgressed or failed to live up to your moral code. Remorse, the healthy alternative to guilt, results from the same theme as guilt. However, your thoughts, behaviours and focus of attention are different when you are remorseful and when you are guilty.

  Themes can be useful in helping you to put your finger on the nature of the emotion you're experiencing. However, themes are not enough to help you decide whether your emotion is a healthy or unhealthy one. Consider the following situation:

  Imagine that you have an elderly aunt who needs your help to continue living independently. You usually visit her at the weekend and do jobs that she's too frail to do for herself, like changing light bulbs and cleaning windows. Last weekend you went skiing with friends instead of checking in on your aunt. She became impatient waiting for the light bulb in her hallway to be changed and tried to do it herself. Unfortunately, your aunt fell off the chair she was standing on and broke her hip.

  Thematically, this situation is one in which you broke or failed to fulfil a personal moral code, resulting in hurting or offending someone else.

  If you feel guilty (an unhealthy negative emotion), you're very likely to experience the following:

  Type of thinking: Your thinking becomes rigid and demand-based. You conclude that you've definitely done a bad thing (sinned). You assume more personal responsibility than may actually be legitimate, discounting or not considering mitigating factors. You may believe that some form of punishment is deserved and/or imminent.

  Focus of attention: You look for more evidence that you've sinned, or you look for evidence that others hold you responsible for the sin.

  Behaviour (action tendency): You may desire to escape from guilty feelings in self-defeating ways - for example, begging for forgiveness, promising that you'll never commit a sin again, punishing yourself, physically or through deprivation, or by attempting to disclaim any legitimate responsibility for the wrongdoing.

  Action tendency refers to an urge for you to behave in a certain way that you may or may not actually act upon. Different emotions produce an urge within you to do certain things. In some cases, you may actually do or say something, and in others you may just be aware that you want to do or say something; for example, wanting to run out of a room and hide when feeling ashamed, or feeling unhealthily angry and wanting to punch someone's lights out, without actually doing so. By contrast, you can think about the situation differently and feel remorse (a healthy negative emotion). Although the same theme (a broken or failed moral code, causing hurt or offence to a significant other) still applies, you experience the following:

  Type of thinking: Your thinking is more flexible and preference-based. You look at actions in context and with understanding before making a judgement about whether you sinned. You consider mitigating factors of the situation and do not believe that punishment is deserved and/or imminent.

  Focus of attention: You don't look for further evidence that you sinned. Neither do you look for evidence that others hold you responsible for the sin.

  Behaviour (action tendency): You face up to the healthy pain that comes with knowing t
hat you've sinned. You may ask for, but not beg for, forgiveness. You understand the reasons for your wrongdoing and act on that understanding. You may atone for the sin by taking a penalty and/or making appropriate amends. You avoid defensiveness and excuse-making.

  The theme involving both guilt and remorse is the same, but your thinking, action tendencies and focus of attention are very different.

  Spotting the difference in thinking

  As the example in the preceding section illustrates, unhealthy emotions can spring from rigid, demand-based thinking. Thoughts or beliefs like ‘other people must behave respectfully towards me at all times' and ‘I should always get what I want without hassle' can lead to unhealthy anger when other people and the world don't meet these demands.