Cognitive Behavioural Therapy For Dummies Read online

  Appendixes

  Appendix A gives you a list of useful organisations and Web sites that you may wish to investigate.

  Throughout the book, we refer to and explain various forms and CBT tools that may be helpful to you. Appendix B provides you with blank forms to photocopy at will and use to your heart's delight.

  Icons Used in This Book

  We use the following icons in this book to alert you to certain types of information that you can choose to read, commit to memory (and possibly interject into dinner party conversation), or maybe just utterly ignore:

  This icon highlights practical advice for putting CBT into practice.

  This icon is a cheerful, if sometimes urgent, reminder of important points to take notice of.

  This icon marks out specific things to avoid or possible traps to keep your eye open for in your quest for better emotional health.

  This icon highlights CBT terminology that may sound a bit like psychobabble but is commonly used by CBT practitioners.

  This icon alerts you to stuff that has a bit of a philosophical basis and may need some mulling over in your spare time.

  This icon indicates a CBT technique that you can try out in real life to see what results you get.

  Where to Go From Here

  We'd really like you to read everything in this book and then recommend it to all your friends and random people you meet on the street. Failing that, just use this book as your reference guide to CBT, dipping in and out of it as and when you need to.

  Have a browse through the table of contents and turn to the chapters that look as if they may offer something helpful to you and your current difficulties.

  When you've used the book in one way or another, you may decide that you want to get stuck into CBT treatment with a therapist. If so, consult Chapter 19 for more advice on getting treatment.

  Part I

  Introducing CBT Basics

  In this part . . .

  You'll get to grips with what CBT stand for and why it's such a hot topic among mental health professionals. You'll get a good idea of how your thinking about events leads to how you feel. We'll get you started on recognising and tackling your negative thought patterns, and give you some tips about exerting control over your attention.

  Chapter 1: You Feel the Way You Think

  In This Chapter

  Defining CBT

  Exploring the power of meanings

  Understanding how your thoughts lead to emotions and behaviours

  Getting acquainted with the ABC formula

  Cognitive behavioural therapy - more commonly referred to as CBT - focuses on the way people think and act to help them with their emotional and behavioural problems.

  Many of the effective CBT practices we discuss in this book should seem like everyday good sense. In our opinion, CBT does have some very straightforward and clear principles and is a largely sensible and practical approach to helping people overcome problems. However, human beings don't always act according to sensible principles, and most people find that simple solutions can be very difficult to put into practice sometimes. CBT can maximise on your common sense and help you to do the healthy things that you may sometimes do naturally and unthinkingly in a deliberate and self-enhancing way on a regular basis.

  In this chapter we take you through the basic principles of CBT and show you how to use these principles to better understand yourself and your problems.

  Using Scientifically Tested Methods

  The effectiveness of CBT for various psychological problems has been researched more extensively than any other psychotherapeutic approach. CBT's reputation as a highly effective treatment is growing. Several studies reveal that CBT is more effective than medication alone for the treatment of anxiety and depression. As a result of this research, briefer and more intense treatment methods have been developed for particular anxiety disorders such as panic, anxiety in social settings or feeling worried all the time.

  Scientific research of CBT continues. As a result, more is being discovered about which aspects of the treatment are most useful for different types of people and which therapeutic interventions work best with different types of problems.

  Research shows that people who have CBT for various types of problems - in particular, for anxiety and depression - stay well for longer. This means that people who have CBT relapse less often than those who have other forms of psychotherapy or take medication only. This positive result is likely due in part to the educational aspects of CBT - people who have CBT receive a lot of information that they can use to become their own therapists.

  CBT is growing in popularity. More and more physicians and psychiatrists refer their patients for CBT to help them overcome a wide range of problems with good results. These problems include:

  Addiction

  Anger problems

  Anxiety

  Body dysmorphic disorder

  Chronic fatigue syndrome

  Chronic pain

  Depression

  Eating disorders

  Obsessive-compulsive disorder

  Panic disorder

  Personality disorders

  Phobias

  Post-traumatic stress disorder

  Psychotic disorders

  Relationship problems

  Social phobia

  We discuss many of the disorders in the preceding list in more depth throughout this book but it is very difficult to cover them all. Fortunately, the CBT skills and techniques in this book can be applied to most types of psychological difficulties, so give them a try whether or not your particular problem is specifically discussed.

  Understanding CBT

  Cognitive behavioural therapy is a school of psychotherapy that aims to help people overcome their emotional problems.

  Cognitive means mental processes like thinking. The word ‘cognitive' refers to everything that goes on in your mind including dreams, memories, images, thoughts and attention.

  Behaviour refers to everything that you do. This includes what you say, how you try to solve problems, how you act and avoidance. Behaviour refers to both action and inaction, for example biting your tongue instead of speaking your mind is still a behaviour even though you are trying not to do something.

  Therapy is a word used to describe a systematic approach to combating a problem, illness or irregular condition.

  A central concept in CBT is that you feel the way you think. Therefore, CBT works on the principle that you can live more happily and productively if you're thinking in healthy ways. This principle is a very simple way of summing up CBT, and we have many more details to share with you later in the book.

  Combining science, philosophy and behaviour

  CBT is a powerful treatment because it combines scientific, philosophical and behavioural aspects into one comprehensive approach to understanding and overcoming common psychological problems.

  Getting scientific. CBT is scientific not only in the sense that it has been tested and developed through numerous scientific studies, but also in the sense that it encourages clients to become more like scientists. For example, during CBT, you may develop the ability to treat your thoughts as theories and hunches about reality to be tested (what scientists call hypotheses), rather than as facts.

  Getting philosophical. CBT recognises that people hold values and beliefs about themselves, the world and other people. One of the aims of CBT is to help people develop flexible, non-extreme and self-helping beliefs that help them adapt to reality and pursue their goals.

  Your problems are not all just in your mind. Although CBT places great emphasis on thoughts and behaviour as powerful areas to target for change and development, it also places your thoughts and behaviours within a context. CBT recognises that you're influenced by what's going on around you and that your environment makes a contribution towards the way you think, feel and act. However, CBT maintains that you can make a difference to the way you feel by changing unhelpful ways of thinking and behaving
- even if you can't change your environment. Incidentally, your environment in the context of CBT includes other people and the way they behave towards you. Your living situation, workplace dynamics or financial concerns are also features of your larger environment.

  Getting active. As the name suggests, CBT also strongly emphasises behaviour. Many CBT techniques involve changing the way you think and feel by modifying the way you behave. Examples include gradually becoming more active if you're depressed and lethargic, or facing your fears step by step if you're anxious. CBT also places emphasis on mental behaviours, such as worrying and where you focus your attention.

  Progressing from problems to goals

  A defining characteristic of CBT is that it gives you the tools to develop a focused approach. CBT aims to help you move from defined emotional and behavioural problems towards your goals of how you'd like to feel and behave. Thus, CBT is a goal-directed, systematic, problem-solving approach to emotional problems.

  Making the Thought-Feeling Link

  Like many people, you may assume that if something happens to you, the event makes you feel a certain way. For example, if your partner treats you inconsiderately, you may conclude that she makes you angry. You may further deduce that their inconsiderate behaviour makes you behave in a particular manner, such as sulking or refusing to speak to her for hours (possibly even days; people can sulk for a very long time!). We illustrate this common (but incorrect) causal relationship with the following formula. In this equation, the ‘A' stands for a real or actual event - such as being rejected or losing your job. It also stands for an activating event that may or may not have happened. It could be a prediction about the future, such as ‘I'm going to get the sack', or a memory of a past rejection, such as ‘Hilary will dump me just like Judith did ten years ago!'. ‘C' stands for consequence, which means the way you feel and behave in response to an actual or activating event.

  A (actual or activating event) = C (emotional and behavioural consequence)

  CBT encourages you to understand that your thinking or beliefs lie between the event and your ultimate feelings and actions. Your thoughts, beliefs and the meanings that you give to an event, produce your emotional and behavioural responses.

  So in CBT terms, your partner does not make you angry and sulky. Rather, your partner behaves inconsiderately, and you assign a meaning to her behaviour such as ‘she's doing this deliberately to upset me and she absolutely should not do this!' thus making yourself angry and sulky. In the next formula, ‘B' stands for your beliefs about the event and the meanings you give to it.

  A (actual or activating event) + B (beliefs and meanings about the event) = C (emotional and behavioural consequence)

  This is the formula or equation that CBT uses to make sense of your emotional problems.

  Emphasising the meanings you attach to events

  The meaning you attach to any sort of event influences the emotional responses you have to that event. Positive events normally lead to positive feelings of happiness or excitement, whereas negative events typically lead to negative feelings like sadness or anxiety.

  However, the meanings you attach to certain types of negative events may not be wholly accurate, realistic, or helpful. Sometimes, your thinking may lead you to assign extreme meanings to events, leaving you feeling disturbed

  Tilda meets up with a nice man that she's contacted via an online dating agency. She quite likes him on their first date and hopes he'll contact her for a second meeting. Unfortunately, he doesn't. After two weeks of waiting eagerly by the computer, Tilda gives up and becomes depressed. The fact that the chap failed to ask Tilda out again contributes to her feeling bad. But what really leads to her acute depressed feelings is the meaning she's derived from his apparent rejection, namely: ‘This proves I'm old, unattractive, past it and unwanted. I'll be a sad singleton for the rest of my life.'

  As Tilda's example shows, drawing extreme conclusions about yourself (and others and the world at large) based on singular experiences can turn a bad distressing situation into a deeply disturbing one.

  Psychologists use the word ‘disturbed' to describe emotional responses that are unhelpful and cause significant discomfort to you. In CBT terminology, ‘disturbed' means that an emotional or behavioural response is hindering rather than helping you to adapt and cope with a negative event.

  Consider the reactions of ten people

  Different people can attach different meanings to a specific situation, resulting in the potential for a vast array of emotional reactions to one situation. For example, consider ten basically similar people who experience the same event, which is having their partner treat them inconsiderately. Potentially, they can have ten (or maybe more) different emotional responses to precisely the same event, depending on how they think about the event:

  Person 1 attaches the meaning, ‘That idiot has no right to treat me badly - who the hell do they think they are?' and feels angry.

  Person 2 thinks, ‘This lack of consideration means that my partner doesn't love me' and feels depressed.

  Person 3 believes that ‘This inconsideration must mean that my partner is about to leave me for someone else' and feels jealous.

  Person 4 thinks, ‘I don't deserve to be treated poorly because I always do my best to be considerate to my partner' and feels hurt.

  Person 5 reckons the event means that ‘I must have done something serious to upset my partner for them to treat me like this' and feels guilty.

  Person 6 believes that ‘This inconsideration is a sign that my partner is losing interest in me' and feels anxious.

  Person 7 thinks, ‘Aha! Now I have a good enough reason to break up with my partner, which I've been wanting to do for ages!' and feels happy.

  Person 8 decides the event means that ‘My partner has done a bad thing by treating me in this way, and I'm not prepared to put up with it' and feels annoyed.

  Person 9 thinks, ‘I really wish my partner had been more considerate because we're usually highly considerate of each other' and feels disappointed.

  Person 10 believes that ‘My partner must have found out something despicable about me to treat me in this way' and feels ashamed.

  You can see from this example that very different meanings can be assigned to the same event and in turn produce very different emotional responses. Some emotional responses are healthier than others; we discuss this matter in depth in Chapter 6.

  For example, if a potential girlfriend rejects you after the first date (event), you may think ‘This proves I'm unlikeable and undesirable' (meaning) and feel depressed (emotion).

  CBT involves identifying thoughts, beliefs and meanings that are activated when you're feeling emotionally disturbed. If you assign less extreme, more helpful, more accurate meanings to negative events, you are likely to experience less extreme, less disturbing emotional and behavioural responses.

  Thus, on being rejected after the first date (event), you could think ‘I guess that person didn't like me that much; oh well - they're not the one for me' (meaning), and feel disappointment (emotion).

  You can help yourself to figure out whether or not the meanings you're giving to a specific negative event are causing you disturbance by answering the following questions:

  Is the meaning I'm giving to this event unduly extreme? Am I taking a fairly simple event and deriving very harsh conclusions about myself (others and/or the future) from it?

  Am I drawing global conclusions from this singular event? Am I deciding that this one event defines me totally? Or that this specific situation indicates the course of my entire future?

  Is the meaning I'm assigning to this event loaded against me? Does this meaning lead me to feel better or worse about myself? Is it spurring me on to further goal-directed action or leading me to give in and curl up?

  If your answer to these questions is largely ‘yes', then you probably are disturbing yourself needlessly about a negative event. The situation may well be negative - but your
thinking is making it even worse. In Chapters 2 and 3 we guide you toward correcting disturbance-creating thinking and help you to feel appropriate distress instead.