Fear of heights: James is afraid of heights because he believes that the ‘pulling' sensation he experiences in high places means that he's at risk of unintentionally throwing himself to his death. To cope with this sensation, he digs his heels firmly into the ground and leans slightly backwards to resist his feelings. He also tries to avoid high places as much as he can. These behaviours fuel his fear and leave him believing that somehow he's more at risk than other people in high places.
After you've drawn up a list of your avoidance and safety behaviours, you can have a better understanding of what areas you need to target for change. In essence, the real solution to your problem lies in exposing yourself to feared situations without using any safety behaviours. You can then see that you are able to cope with anxiety-provoking events and that you need not rely on distractions or spurious attempts to keep yourself safe. Give yourself the chance to see that your anxiety is not harmful in itself and that anxious feelings diminish if you let them do so of their own accord. (Chapter 9 contains more information about dealing with safety behaviours and devising exposures.)
Wending Your Way Out of Worry
One of the dilemmas faced by people who worry too much is how to reduce that worry. Some degree of worry is entirely normal - of course problems and responsibilities will cross your mind from time to time. Yet, you may be someone who worries all of the time. Being a true worrywart is intensely uncomfortable. Understandably, you may want to stop worrying quite so much.
Two reasons may account for your excessive worrying:
You may think that by worrying about unpleasant events, you can prevent those events from happening. Or, you may believe that your worry can give you clues as to how to prevent negative events from coming to fruition.
You may think that worry protects you by preparing you for negative events. You may believe that if you worry about bad things enough, they won't catch you off guard and you'll be better fixed to deal with them.
If you can convince yourself that excessive worry really doesn't prevent feared events from happening or prepare you for dealing with bad things, you may be in a better position to interrupt your repetitive cycle of worries.
Ironically, many people worry about things in a vain attempt to get all possible worries out of the way so they can then relax. Of course, this never happens - worry's a moveable feast, and something else always comes along for you to worry about.
If you worry excessively about everyday events, you may try to solve every possible upcoming problem in advance of it happening. You may hope that your worry will solve potential problems, and thus you won't have to worry about them any more.
Unfortunately, trying too hard to put your mind at rest can lead to increased mental activity and yet more worry. All too often, people then worry that worrying so much is harmful, and they end up worrying about worrying!
Try to see your worrying as a bad habit. Instead of focusing on the content of your worries, try to interrupt the worry process by engaging your mind and body in activities outside of yourself. Chapter 5 has some helpful hints on refocusing your attention away from you actively worrying.
Preventing the Perpetuation of Your Problems
Sometimes, the things you do to cope with your problems can bring about the very things that you're trying to avoid. An example of this is when you try to push upsetting thoughts out of your mind. Pushing away unpleasant thoughts is called thought suppression, and can generally make unwanted thoughts intrude more often. Research shows that when people try to suppress an unwanted thought, it can intrude into their mind twice as often than if they accept the thought and let it pass.
Close your eyes and try really hard not to think of a pink elephant. Just for a minute, really push any images of pink elephants out of your mind. What happened? Most people notice that all they can think of are pink elephants. This demonstrates that trying to get rid of thoughts by pushing them out of your mind usually results in them hanging around more persistently.
Trying too hard not to do, feel or think specific things, and attempting to prevent certain events, can actually bring about what you most fear and wish to avoid. For example:
Trying too hard not to make a fool of yourself in social situations can make you seem aloof and uninterested.
Trying too hard to make sure a piece of work is perfect can lead you to miss a deadline, or become so nervous that you produce poor work.
Insisting that you must succeed at a task, like passing an exam or learning a skill, makes you concentrate too much on how well you're doing and not enough on what you're doing. This misplaced attention focus can lead to poor results.
Feeling jealous and repeatedly checking up on your partner, testing them or demanding reassurance that they're not about to leave you, can potentially drive your partner away.
Lying in bed, trying to deal with fatigue when you're depressed, can lower your mood further and may lead to feelings of shame and guilt about your inactivity.
Helping Yourself: Putting the Petals on Your Vicious Flower
The vicious flower exercise is a way of putting together different elements of your problem to aid your understanding of how your problem is maintained. Look at the example in Figure 7-1, and turn to Appendix B for a blank flower to photocopy and fill in. Follow these steps to fill in your own vicious flower:
1. In the Trigger box, write down the trigger that makes you feel anxious or upset.
2. In the central circle, write down the key thoughts and meanings you attach to the trigger.
3. In the flower petals, write down the emotions, behaviours and sensations you experience when your uncomfortable feeling is triggered. In the top petal, write down what you tend to focus on.
Key negative thoughts, attitudes or beliefs are at the heart of your vicious flower. The petals are your attentional, emotional, physical and behavioural responses to the meaning you've attached to the trigger.
This chapter (and Chapter 6) suggests various emotions, behaviours, attention focus issues and thoughts to use to fill in your petals. If you suffer from anxiety, read Chapter 9; Chapter 12 for depression; Chapter 13 for obsessional problems; and Chapter 15 for an anger problem.
One of the most important aspects of building a vicious flower is to think through how the petals affect the thought or ‘meaning' that underpins your emotional problem. For example, the effect of anxiety on your thinking is to make you more likely to interpret experiences as more dangerous than they really are. The effect of depression is to make your thinking more gloomy and negative (see Chapter 6 for more on these and other emotions).
Focusing your attention on a sensation usually makes that sensation feel more intense. Acting upon an unhelpful thought or meaning usually makes that meaning seem more real. Unpleasant physical sensations accompanying your reaction can make upsetting thoughts seem even more real. You can design behavioural experiments to test out the effect of increasing or reducing a behaviour on your problems (refer to Chapter 4).
When you understand the mechanisms that maintain your problems, it will seem far more practical and sensible to target your petals for change.
The ‘physical sensations' petal is the aspect of your problem that you're least able to change directly because physical sensations are outside your immediate conscious control. However, you can minimise the impact of physical sensations by learning to tolerate them whilst you overcome your problem, and to interpret them as no more dangerous than they really are.
Figure 7-1: A vicious flower of panic.
Put down that shovel and empty out your pockets!
One of the best metaphors for the kinds of behaviour we discuss in this chapter is the idea that some of your coping strategies may be like unwittingly trying to dig your way out of a hole. Naturally, the first step to overcoming your problems is to put down the shovel - to stop your self-defeating strategies, and gradually work out more productive ways of overcoming your emotional problems.
Over time, you may seek ou
t bigger and better shovels in the guise of bigger and better avoidance and safety behaviours. We regularly invite those of our clients who suffer with agoraphobia, panic attacks, obsessive-compulsive disorder and body dysmorphic disorder, to share with us the contents of their pockets or handbags, which is often very illuminating. Examples of safety props that people carry ‘just in case' include over-the-counter drugs, packets of tissues, antiseptic wipes, glucose sweets, handheld fans, make-up, plastic bags, paper bags, deodorant sprays, laxatives and alcohol.
To help clients eliminate safety behaviours, we often encourage them to throw out or hand over these seemingly innocent everyday items in the spirit of getting rid of problematic solutions. Go through your pockets and handbag and collect all of your safety props. Throw them in the bin or hand them over to someone who knows about your problems and has an interest in helping you (this person can be anyone in your life if you aren't currently seeing a CBT therapist). Be wary of purchasing or accumulating items to replace what you've already handed over or tossed away. Work on the basis that you only need essentials in your purse and pockets such as money, keys and travel cards.
Chapter 8: Setting Your Sights on Goals
In This Chapter
Defining your goals for emotional and behavioural change
Motivating yourself
Recording your progress
If we had to define the purpose of therapy, its purpose would not be to make you a straighter-thinking, more rational person. Rather, the purpose of therapy is to help you achieve your goals. Thinking differently is one way of achieving those goals. CBT can help you change the way you feel and behave. This chapter helps you define your goals and suggests some sources of inspiration for change.
Aaron Beck, founder of cognitive therapy, says that CBT is whatever helps you move from your problems to your goals. This definition emphasises the pragmatic and flexible nature of CBT, and encourages clients and therapists to select from a wide range of psychological techniques to help achieve goals in therapy. The crucial message, though, is that effective therapy is a constructive process, helping you to achieve your goals.
Putting SPORT into Your Goals
Many people struggle to overcome their problems because their goals are too vague. To help you develop goals that are clearer and easier to set your sights on, we developed the acronym SPORT, which stands for:
Specific: Be precise about where, when and/or with whom you want to feel or behave differently. For example, you may want to feel concerned rather than anxious about making a presentation at work, and during the presentation you may want to concentrate on the audience rather than on yourself.
Positive: State your goals in positive terms, encouraging yourself to develop more, rather than less, of something. For example, you may want to gain more confidence (rather than become less anxious) or to hone a skill (rather than make fewer mistakes).
Think of therapy as a journey. You're more likely to end up where you want to be if you focus on getting to your destination rather than on what you're trying to get away from.
Observable: Try to include in your goal a description of a behavioural change that you can observe. Then, you can tell when you've achieved your goal because you can see a specific change.
If you're finding it hard to describe an observable change, think to yourself: ‘How would the Martians, looking down from Mars, know I felt better simply by watching me?'
Realistic: Make your goals clear, concrete, realistic and achievable. Focus on goals that are within your reach, and that depend on change from you rather than from other people. Try to visualise yourself achieving your goals. Realistic goals help you to stay motivated and focused.
Time: Set a timeframe to keep you focused and efficient in your pursuit of a goal. For example, if you've been avoiding something for a while, decide when you plan to tackle it. Specify how long and how often you wish to carry out a new behaviour, such as going to the gym three times a week for an hour at a time.
Some goals, such as recovering from severe depression, can vary a lot in terms of how long they take to achieve. Setting schedules too rigidly can lead you to become depressed or angry at your lack of progress. So, set your deadlines firmly but flexibly, accept yourself if you don't achieve them on time, and persevere!
Homing In on How You Want to Be Different
Defining your goals and writing them down on paper forms the foundation of your CBT programme. This section helps you identify how you may want to feel and act differently.
Setting goals in relation to your current problems
To set a goal concerned with overcoming an emotional problem, you first need to define the problem, which we talk about in Chapter 6 (where we explore unhealthy emotions and behaviours and their healthy counterparts). Also refer to Chapter 7, in which we explore how attempts to make yourself feel better can sometimes make problems worse.
A problem statement contains the following components:
Feelings/emotions
A situation or theme that triggered your emotion
The way you tend to act in the situation when you feel your problem emotion
Defining how you want to feel as an alternative
CBT can help you attain changes in the way you feel emotionally. For example, you may decide that you want to feel sad and disappointed, rather than depressed and hurt, about the end of your marriage.
Aiming to feel ‘okay', ‘fine' or ‘relaxed' may not fit the bill if you're dealing with a tough situation. Feeling negative emotions about negative events is realistic and appropriate. Keep your goals realistic and helpful by aiming to have healthy emotions, and try to maintain an appropriate level of intensity of your emotions when faced with difficult events (take a look at Chapter 6 for more on healthy emotions).
Defining how you want to act
The second area of change that CBT can help you with is your behaviour. For example, after going through a divorce, you may decide that you want to begin seeing your friends and return to work, instead of staying in bed and watching TV all day.
You can also include changes to your mental activities within your goal, such as refocusing your attention on the outside world or allowing catastrophic (upsetting or worst-case scenario) thoughts to pass through your mind.
Making a statement
A goal statement is very similar to a problem statement - they have the same components, but the emotions and behaviours are different. A good goal statement involves the following:
To feel___________________________(emotion) about____________________________(theme or situation) and to__________________________________________(behaviour).
So, for example, you may want to feel concerned (emotion) about saying something foolish at a dinner party (situation) and to stay at the table in order to make further conversation (behaviour).
Maximising Your Motivation
Motivation has a funny way of waxing and waning, just like the moon. Luckily, you don't necessarily have to feel motivated about changing before you can take steps forward. Motivation often follows rather than precedes positive action - often people find they ‘get into' something once they've started. This section suggests some ways to generate motivation and encourages you to carry on working towards goals in the temporary absence of motivation.
Identifying inspiration for change
Lots of people find change difficult. Your motivation may flag sometimes, or you may not ever be able to imagine overcoming your difficulties. If either of these situations sounds familiar to you, you're in good company. Many people draw on sources of inspiration when starting with, and persevering through, the process of overcoming emotional problems. Sources of encouragement worth considering include the following:
Role models who have characteristics you aspire to adopt yourself. For example, you may know someone who stays calm, expresses feelings to others, is open-minded to new experiences, or is assertive and determined. Whether real-life or fictional, alive or dead, known t
o you or someone you've never met, choose someone who inspires you and can give you a model for a new way of being.
Inspirational stories of people overcoming adversity. Ordinary people regularly survive the most extraordinary experiences. Stories of their personal experiences can lead you to make powerful personal changes.
Focus on taking a leaf out of an inspirational individual's book, not on comparing yourself negatively with someone's ‘superior' coping skills.
Cognitive Behavioural Therapy For Dummies Page 13