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CBT - Cognitive Behavioural Therapy 

Cognitive Behavioural Therapy or CBT as it is more commonly known is all about learning to adjust automatic negative thinking.

In life, we are taught to wash daily, brush our teeth, wear clean clothes and keep a tidy home. This is our personal hygiene and most of us take pleasure in it. We accept it as a given that it is something which requires maintenance. So what of “mental hygiene”? Who teaches us that this is important to maintain too? Mostly…….nobody!

Think about it. Your brain is also your home. You live there consciously for 16 hours a day. Do you devote the same level of maintenance to your mental processes as you do to your physical processes?  If you think about things this way, you can begin to see that it is unreasonable to expect your house to be bright and tidy…a nice place to spend time if you never clean it. Negative thoughts are like cobwebs, weeds, or dirty socks in the mind. They obscure, constrict and leave a bad smell! The mind too therefore requires maintenance. Of course once a house is clean it’s much easier to keep clean!

Habitual negative thinking can be both the cause of anxiety and also the result of anxiety. Spending any length of time feeling anxious or depressed will wear a person down, and this naturally leads to the formation of negative thinking styles because the outlook can begin to feel hopeless. So anxiety causes us to think negatively and negativity causes us to feel anxious. A negative feedback loop is created  

Cycle Diagram

It’s actually a mistake to believe that the outlook is hopeless and accepting that the future is truly hopeless is the surest way to remain anxious or depressed. For someone in the midst of anxiety however it is often very difficult to see a way out because the FEELINGS of impending doom are so convincing. Often the cause of chronic anxiety (anxiety that continues over a long period of time) is that we develop a habit of thinking negatively which becomes accepted as the way life is and this negative outlook then sustains anxiety throughout time. So even though the original cause of anxiety passes, sometimes the anxiety itself remains, because the brain continues to explain our experience of the world through the negative lens created during the period of crisis. A negative lens tends to see the worst in things and then we feel “unsafe” because everything looks threatening or unsatisfactory and we forecast (naturally) that things will remain this way. Unfortunately, the habit of thinking negatively can develop as the result of short illness, a traumatic experience, or just a short period of anxiety and depression. Just like any bad habit, it’s easier to acquire than it is to shake! Most people will bounce back from life’s temporary difficulties, and reinstall positive thought patterns quite naturally. But, equally, sometimes negative thinking styles are often so insidious and easy to fall into that we won’t even notice that we have adopted them. We often hear people say “I’ve never been the same since…the *such and such* incident…...” Whilst there is much that can be said about life’s experiences changing us forever (and they do for sure!), it is always worth considering whether we have also simply fallen into the bad habit of automatically assuming the worst?! This will account in many cases for at least some part of our continued anxiety. You can pretty much take it as a given that if you are experiencing anxiety and/or depression, then you will definitely be experiencing a negatively focused world which may appear to you as an objective reality. Rest assured a worldview is ALWAYS subjective. It can almost certainly be improved!

The formula is simple: Negativity creates anxiety. Anxiety is converted to fear. Fear must have a focus…... And there is your problem.

 

So part of the solution then is to cease the negativity. The good news is, it is possible to change these patterns of negative thought, and this will improve the way you feel. Changing old patterns of negativity does however take effort. There are a number of reasons why we might fail personally to address this. Let’s explore some of these: -  

·        The benefits are not immediately apparent – One can easily decide it’s simply not worth the effort. Negative thinking itself will often argue…”Don’t bother…it won’t help….!” One has to be willing to press on regardless of such feelings and to hold some trust that the benefits will become apparent through time.

·        Negative thinking has become a friend. Believe it or not, anger and raving about how terrible everything is for us can feel good in the moment – Anger can stimulate the production of opioids (in readiness for a battle/wounds) which are the bodies own natural pain relief chemicals (the same chemical family as heroin), and we can easily become psychologically addicted to this rush. Unconsciously we enjoy staying angry or depressed. Unfortunately, although this presents as a workable strategy in the short term, it creates more anxiety and low mood overall, and is never a successful strategy for long term happiness.

·        Overcoming negative thinking is like breaking any habit. We have to continually think and behave differently. We have to keep making adjustments. Imagine being asked to do anything differently in your life. You can see it takes mindfulness and effort to create a new pattern. If we factor in our first two points we can begin to see that this can feel like work. It is however work that is essential if we are to create and maintain a state of good mental health.

There could easily be more reasons, but the above are commonly noted and worth being aware of.  

Treatment: Cognitive Behavioural Therapy.

 Cognitive therapy or cognitive behavior therapy is a kind of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of mental disorder. It involves recognising distorted thinking and learning to replace it with more realistic substitute ideas. Its practitioners hold that much (though not all) clinical depression is associated with (although not necessarily caused by) irrational thoughts. Cognitive therapy is often used in conjunction with mood stabilizing medications to treat bipolar disorder - Wikipedia (http://www.en.wikipedia.org)

Cognitive Behavioural Therapy was created by Aaron T. Beck, M.D. (born July 18, 1921) and Albert Ellis (born September 27, 1913) and has developed since the 1950’s into a rather complex field of psychology with off-shoots and books akimbo. Some people say that the field has been over-developed and made unnecessarily complicated. Others argue that it is necessarily much more complicated than most people understand. In my experience it pays to understand the theory and to be mindful of it.  

Albert Ellis - The creator of CBT put forward the following four insights. 

Insight 1 - How you feel is mainly determined by the way you think. - This notes that the beliefs you carry and action with feeling become your living emotional reality. 

Insight 2 - You become distressed when you endorse your own irrational beliefs - This notes that those beliefs that create unpleasant feelings will distress you when you "buy in" to them without challenging the assumptions. 

Insight 3 - Be kind to yourself. You like many people can think irrationally so don't judge yourself too harshly - This notes that CBT is not a self blame exercise….so one can be kind to oneself whilst adjusting thoughts and behaviours appropriately for easier feelings. 

Insight 4 - You have to make a sustained effort to recognise and challenge your irrational thoughts- This notes that effort is required over a sustained period of time to make the above adjustments.

Essentially, the theory is very simple. It is based on the elegant understanding that thoughts (cognition; thinking styles) and behaviours influence feelings and emotions. It was recognised that depressed or anxious people often have automatically negative thinking styles which entail negative feelings as a result, and that they often are not consciously aware of these distortions. The idea behind CBT is that by bringing these cognitive distortions into conscious focus, it becomes possible to adjust those distortions by using the rational thinking mind to challenge the automatic and negative assumptions. With continued repeated adjustment, the mind/brain can then learn over time to create new more positive automatic associations. CBT research has shown that the brain can literally re-pattern it’s neural pathways over a period of approximately 45 days. We see this also in the treatment of OCD (Obsessive Compulsive Disorders) using behavioural therapy. You could think of this process of continually adjusting negatively distorted thinking metaphorically as beating a new path through the jungle. In time, the old path grows over and your effort beats a new path which leads eventually to a more satisfying destination. This is a nice metaphor because it highlights that initially at least we are taking the path of most resistance, but here we are beating a path to a beautiful jungle waterfall. The old path leads only to a rancid swamp. So, by continually changing the way that we think about things using the conscious mind we can create new habits of thought. We can literally change the way that our brains think about things, and this ultimately will change the way the way that we FEEL about things. This is absolutely central to our understanding of creating positive change. We know that  negative introspection (that is to spend time focusing attention inwards in a negative way) is a primary driver (a driver refers to the factors which "drives" a particular state or behaviour.....what makes us do it this way) of depressed and anxious states, so it is essential that we begin to create positive modes of thinking in order to increase wellbeing. We also recognise that the way we behave sends a message too. If we say we want to reduce our anger levels and yet we still indulge in shouting at other drivers when in the car, we can recognise that we are not “behaving” in a manner congruent with our intent, and this does nothing to help either our thoughts or our feelings. In fact it simply creates confusion within the psyche, because the message it sends to your poor old emotional mind is that this situation must be threatening. Why else would you be shouting? If we want to change our feelings then our thoughts and our behaviours must support that intent…again by using the rational mind to adjust the behaviour accordingly. So any behaviour which supports the negative thoughts must also be challenged. This is particularly important when thinking about how anxiety works. Anxiety will make us scared of more and more things if we let it. This is how people end up with agoraphobia (fear of going outside). They literally become afraid of everything. So if we have the feeling that says "I feel too afraid to go to the shops", then if we act on that feeling by refusing to walk to the shops, then our behaviour has actually strengthened the unconscious assumption that going to the shops is dangerous. With our behaviour we have effectively agreed with the fear, sending a message back to the unconscious mind that we agree that fear is an APPROPRIATE response to the thought of going to the shops. Now, every time we think about going to the shop, the mind does more of the same (creates fear) and each time we agree by not going we actually strengthen that response! So behavioural therapy means challenging  the negative assumptions and faulty logic, not only by what we think but also by what we DO. So here you have that famous cliché "Feel the fear and do it anyway!"

The Four Column Technique

A major technique in cognitive therapy is the four column technique. It consists of a four step process. The first three steps analyze the process by which a person has become depressed or distressed. The first column records the objective situation. In the second column, the client writes down the negative thoughts which occurred to them. The third column is for the negative feelings and dysfunctional behaviors which ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. Finally, the fourth column is used for challenging the negative thoughts on the basis of evidence from the client's experience (What did you learn? Was it anything like your original perception). This learning is then applied if/when similar thoughts or feelings arise in the future. It is the continued challenging of these distortions that provides the habit change over time. Each successful challenge further weakens the grip of the negativity and it can begin to be seen for the useless junk (dirty socks!) it is. The client is taught about the kinds of distortions which can occur, and often in CBT it is considered essential that the client is asked to write it down. It is recognised that the habitual mind will find ways of avoiding the adjustment if the process is not written down, in much the same way as an overeater will be able to overlook the extra’s they ate if not scrupulously recording their consumption in a food diary. Here is a list of typical distortions which are made in depressive thinking.

List of distortions

 -                     All or nothing thinking

You see things in black-or-white categories. If a situation falls short of perfect, you see it as total failure, or all bad.

-                     Over-generalisation

You see one or more negative events as never-ending pattern of defeat. Characterised by using the words "always" or "never"

 -                     Mental filter (Also known as Globalisation)

You pick out a single negative detail and dwell on it exclusively, so that your whole view of reality becomes darkened. Eg obsessive dwelling on a single criticism.             

-                     Discounting the positive

You reject positive experiences by insisting that they "don't count". Eg if you do a good job, you tell yourself that it wasn't good enough or that anyone could have done as well.

-                     Jumping to conclusions

Mind reading Without checking it out you arbitrarily conclude that someone is reacting negatively to you.

-                     Negative Forecasting 

You predict that things will turn out badly, or predict worst case scenarios.

-                     Magnification

You exaggerate the importance of your problems and shortcomings, or you minimise the importance of your desirable qualities, known as the "binocular trick."

-                     Emotional reasoning

You assume that your negative emotions necessarily reflect the way things really are. Eg "I feel so inadequate. I must really be hopeless."

 -                     Should statements

You tell yourself that things should be the way you wanted or expected them to be. Characterised by the words "should," "must," "ought to" and "have to." Should statements can be directed against yourself causing guilt and frustration, or they can be directed at other people causing anger and frustration.

 -                     Negative labelling

An extreme form of all-or-nothing thinking in which you attach a negative label to either yourself or another person that describes the person in an exclusively negative way. Eg "I'm a loser". If the label is directed against another person, eg "He's just a S.O.B", you feel that the problem lies with the person's "character" or "essence" instead of with their thinking or their behaviour. You see them as totally bad. This makes you feel hostile or hopeless about improving things.  

-                     Personalisation and blame

Personalisation occurs when you hold yourself personally responsible for an event that isn't entirely under your control. Blaming or scape-goating is the opposite: you blame other people or circumstances for your problems but overlook the part you might be playing in it.

-                     Relationships between thoughts and feelings

 ·          Thoughts of loss / loss to self esteem - sadness and depression

·          Unfulfilled expectations - frustration

·          Thoughts of danger to self or self esteem - anxiety and panic

·          Thoughts that you are bad - guilt

·          Thoughts that you are inadequate in comparison with others - feelings of inferiority

·          Thoughts of unfairness - anger

 The more awareness you have of your own negative patterns of thought the more leverage you have in making a change. Then you can be more mindful in the future. Then the next time you have that thought or make that assumption you will see it before you buy into it. You will see it for what it is...distorted....untrue...irrational...unproven. Then you can challenge it. You can say to yourself "I might FEEL as though that's how it is, but based on my past learning I KNOW differently. This then disempower's that negativity. We must recognise that negativity ultimately only lives on the power we give it. If we "buy in" to the negative thinking, we give it power. We reinforce it. We agree with the assumption. So CBT is about recognising that you have a choice! A choice to choose not to buy into distorted thinking...a choice to choose other conclusions...other strategies. Think how much stress you can save yourself through this process!  

A good hypnotherapist will adhere to the principles of CBT when using a solution focused (as opposed to analytical) methodology. Good hypnotherapy is at one level all about locating the faulty belief or logic (known as a "driver" because it drives behaviour), and using hypnosis and psychotherapy to help amend that belief. Talking therapies (psychotherapy, counselling, CBT) all seek to do the same thing, except they are generally slower in achieving results. We have an advantage with hypnotherapy, because hypnotherapy is a powerful tool for belief amendment at the core level. Here, we can effectively bypass a great deal of the conscious minds usual resistance to change, and establish new thought patterns and perceptions quite quickly, thereby alleviating at least some of the work of continued repetitive thought adjustment. When the limiting belief or thinking style is corrected at the core level then there is much less work to do because the faulty logic no longer carries the same emotional weight it once did. 

The British Medical Journal says the following about hypnotherapy: 

"There is good evidence from randomised controlled trials that both hypnosis and relaxation techniques can reduce anxiety…. They are also effective for panic disorders and insomnia....A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety."

So CBT can be used as a stand alone therapy or can be utilised within a hypnotherapeutic context too. This of course includes self-hypnosis which will be covered elsewhere on the site. 

For a further detailed look at Cognitive Behavioural Hypnotherapy you can visit my page here on the sister website. 

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Disclaimer: This article is given for information purposes only. The author cannot be held responsible for any effects arising from the use of the information contained herein, and any use of the information in this article is used entirely at the risk of the user.  Persons with poor mental health should not consider using these exercises but should refer themselves to their GP for assistance.

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