Cognitive Behavioural Therapy For Dummies Read online

  Acting out

  The ways you think and feel also largely determine the way you act. If you feel depressed, you're likely to withdraw and isolate yourself. If you're anxious, you may avoid situations that you find threatening or dangerous. Your behaviours can be problematic for you in many ways, such as the following:

  Self-destructive behaviours, such as excessive drinking or using drugs to quell anxiety, can cause direct physical harm.

  Isolating and mood-depressing behaviours, such as staying in bed all day or not seeing your friends, increase your sense of isolation and maintain your low mood.

  Avoidance behaviours, such as avoiding situations you perceive as threatening (attending a social outing, using a lift, speaking in public), deprive you of the opportunity to confront and overcome your fears.

  Learning Your ABCs

  When you start to get an understanding of your emotional difficulties, CBT encourages you to break down a specific problem you have using the ABC format, in which:

  A is the activating event. An activating event means a real external event that has occurred, a future event that you anticipate occurring or an internal event in your mind, such as an image, memory or dream.

  The ‘A' is often referred to as your ‘trigger'.

  B is your beliefs. Your beliefs include your thoughts, your personal rules, the demands you make (on yourself, the world and other people) and the meanings that you attach to external and internal events.

  C is the consequences. Consequences include your emotions, behaviours and physical sensations that accompany different emotions.

  Figure 1-1 shows the ABC parts of a problem in picture form.

  Figure 1-1: A is the activating event, B is your beliefs and thoughts, and C is the consequences, such as the emotions you feel after the event, and your subsequent behaviour.

  Writing down your problem in ABC form - a central CBT technique - helps you differentiate between your thoughts, feelings and behaviours, and the trigger event. We give more information about the ABC form in Chapter 3, and you can find a blank ABC form at the back of the book.

  Consider the ABC formulations of two common emotional problems, anxiety and depression. The ABC of anxiety may look like this:

  A: You imagine failing a job interview.

  B: You believe: ‘I've got to make sure that I don't mess up this interview, otherwise I'll prove that I'm a failure.'

  C: You experience anxiety (emotion), butterflies in your stomach (physical sensation), and drinking to calm your nerves (behaviour).

  The ABC of depression may look like this:

  A: You fail a job interview.

  B: You believe: ‘I should've done better. This means that I'm a failure!'

  C: You experience depression (emotion), loss of appetite (physical sensation), and staying in bed and avoiding the outside world (behaviour).

  You can use these examples to guide you when you are filling in an ABC form on your own problems. Doing so will help ensure that you record the actual facts of the event under ‘A', your thoughts about the event under ‘B', and how you feel and act under ‘C'. Developing a really clear ABC of your problem can make it much easier for you to realise how your thoughts at ‘B' lead to your emotional/behavioural responses at ‘C'. (Chapter 3 describes the ABC form more fully.)

  Characterising CBT

  We give a much fuller description of the principles and practical applications of CBT in the rest of this book. However, here's a quick reference list of key characteristics of CBT. CBT:

  Emphasises the role of the personal meanings that you give to events in determining your emotional responses.

  Was developed through extensive scientific evaluation.

  Focuses more on how your problems are being maintained rather than on searching for a single root cause of the problem.

  Offers practical advice and tools for overcoming common emotional problems (see Chapters 9, 12 and 13).

  Holds the view that you can change and develop by thinking things through and by trying out new ideas and strategies (head to Chapter 4).

  Can address material from your past if doing so can help you to understand and change the way you're thinking and acting now (Chapter 16 covers this in depth).

  Shows you that some of the strategies you're using to cope with your emotional problems are actually maintaining those problems (Chapter 7 is all about this).

  Strives to normalise your emotions, physical sensations, and thoughts rather than to persuade you that they're clues to ‘hidden' problems.

  Recognises that you may develop emotional problems about your emotional problems, for example feeling ashamed about being depressed (see Chapter 6 for more on this concept).

  Highlights learning techniques and maximises self-help so that ultimately you can become your own therapist (head to Chapter 22).

  Getting complicated

  Sticking to the simple ABC formulation in which A+B=C can serve you well. But if that seems a little simplistic, you can consider the more complicated formulations shown here:

  This diagram shows the complex interaction between your thoughts, feelings and behaviours. Although your thoughts affect how you feel, your feelings also affect your thinking. So, if you're having depressed thoughts, your mood is likely to be low. The lower your mood, the more likely you are to act in a depressed manner and to think pessimistically. The combination of feeling depressed, thinking pessimistically and acting in a depressed manner can, ultimately, influence the way you see your personal world. You may focus on negative events in your life and the world in general and therefore accumulate more negative As. This interaction between A, B and C can become a vicious circle.

  CBT pays a lot of attention to changing both unhealthy thinking patterns and unhealthy patterns of behaviour.

  Chapter 2: Spotting Errors in Your Thinking

  In This Chapter

  Identifying classic pitfalls in human thought

  Correcting your thinking

  Getting to know the thinking errors you make most

  You probably don't spend a lot of time mulling over the pros and cons of the way you think. Most people don't - but to be frank, most people ideally ought to!

  One of the central messages of CBT is that the thoughts, attitudes and beliefs you hold have a big effect on the way you interpret the world around you and on how you feel. So, if you're feeling excessively bad, chances are that you're thinking badly - or, at least, in an unhelpful way. Of course, you probably don't intend to think in an unhelpful way, and no doubt you're largely unaware that you do.

  Thinking errors are slips in thinking that everyone makes from time to time. Just as a virus stops your computer from dealing with information effectively, so thinking errors prevent you from making accurate assessments of your experiences. Thinking errors lead you to get the wrong end of the stick, jump to conclusions and assume the worst. Thinking errors get in the way of, or cause you to distort, the facts. However, you do have the ability to step back and take another look at the way you're thinking and set yourself straight. In this chapter we show you how to do just that.

  Months or years after the event, you've probably recalled a painful or embarrassing experience and been struck by how differently you feel about it at this later stage. Perhaps you can even laugh about the situation now. Why didn't you laugh back then? Because of the way you were thinking at the time.

  To err is most definitely human. Or, as American psychotherapist Albert Ellis is quoted as saying, ‘If the Martians ever find out how human beings think, they'll kill themselves laughing.' By understanding the thinking errors we outline in this chapter, you can spot your unhelpful thoughts and put them straight more quickly. Get ready to identify and respond in healthier ways to some of the most common ‘faulty' and unhelpful ways of thinking identified by researchers and clinicians.

  Catastrophising: Turning Mountains Back Into Molehills

  Catastrophising is taking a relatively minor negative event and ima
gining all sorts of disasters resulting from that one small event, as we sum up in Figure 2-1.

  Figure 2-1: Catastroph-ising.

  Consider these examples of catastrophising:

  You're at a party and you accidentally stumble headlong into a flower arrangement. After you extract yourself from the foliage, you scurry home and conclude that everyone at the party witnessed your little trip and laughed at you.

  You're waiting for your teenage daughter to return home after an evening at the cinema with friends. The clock strikes 10:00 p.m., and you hear no reassuring rattle of her key in the door. By 10:05 p.m., you start imagining her accepting a lift home from a friend who drives recklessly. At 10:10 p.m., you're convinced she's been involved in a head-on collision and paramedics are at the scene. By 10:15 p.m., you're weeping over her grave.

  Your new partner declines an invitation to have dinner with your parents. Before giving him a chance to explain his reasons, you put down the phone and decide that this is his way of telling you the relationship's over. Furthermore, you imagine that right now he's ringing friends and telling them what a mistake it was dating you. You decide you're never going to find another partner and will die old and lonely.

  Catastrophising leads many an unfortunate soul to misinterpret a social faux pas as a social disaster, a late arrival as a car accident or a minor disagreement as total rejection.

  Nip catastrophic thinking in the bud by recognising it for what it is - just thoughts. When you find yourself thinking of the worst possible scenario, try the following strategies:

  Put your thoughts in perspective. Even if everyone at the party did see your flower-arranging act, are you sure no one was sympathetic? Surely you aren't the only person in the world to have tripped over in public. Chances are, people are far less interested in your embarrassing moment than you think. Falling over at a party isn't great, but in the grand scheme of things it's hardly society-page news.

  Consider less terrifying explanations. What other reasons are there for your daughter being late? Isn't being late for curfew a common feature of adolescence? Perhaps the film ran over, or she got caught up chatting and forgot the time. Don't get so absorbed in extreme emotions that you're startled to find your daughter in the doorway apologising about missing the bus.

  Weigh up the evidence. Do you have enough information to conclude that your partner wants to leave you? Has he given you any reason to think this before? Look for evidence that contradicts your catastrophic assumption. For example, have you had more enjoyable times together than not?

  Focus on what you can do to cope with the situation, and the people or resources that can come to your aid. Engaging in a few more social encounters can help you put your party faux pas behind you. You can repair a damaged relationship - or find another. Even an injury following an accident can be fixed with medical care.

  No matter how great a travesty you create in your mind, the world's unlikely to end because of it - even if the travesty comes to pass. You're probably far more capable of surviving embarrassing and painful events than you give yourself credit for - human beings can be very resilient.

  All-or-Nothing Thinking: Finding Somewhere In-between

  All-or-nothing or black-or-white thinking (see Figure 2-2) is extreme thinking that can lead to extreme emotions and behaviours. People either love you or hate you, right? Something's either perfect or a disaster. You're either responsibility-free or totally to blame? Sound sensible? We hope not!

  Figure 2-2: All-or-nothing thinking.

  Unfortunately, humans fall into the all-or-nothing trap all too easily:

  Imagine you're trying to eat healthily in order to lose weight and you cave in to the temptation of a doughnut. All-or-nothing thinking may lead you to conclude that your plan is in ruins and then to go on to eat the other 11 doughnuts in the pack.

  You're studying a degree course and you fail one module. All-or-nothing thinking makes you decide that the whole endeavour is pointless. Either you get the course totally right or it's just a write-off.

  Consider the humble thermometer as your guide to overcoming the tendency of all-or-nothing thinking. A thermometer reads degrees of temperature, not only ‘hot' and ‘cold'. Think like a thermometer - in degrees, not extremes. You can use the following pointers to help you change your thinking:

  Be realistic. You can't possibly get through life without making mistakes. One doughnut doesn't a diet ruin. Remind yourself of your goal, forgive yourself for the minor slip, and resume your diet.

  Develop ‘both-and' reasoning skills. An alternative to all-or-nothing thinking is both-and reasoning. You need to mentally allow two seeming opposites to exist together. You can both succeed in your overall educational goals and fail a test or two. Life is not a case of being either a success or a failure. You can both assume that you're an okay person as you are and strive to change.

  All-or-nothing thinking can sabotage goal-directed behaviour. You're far more likely to throw in the towel at the first sign of something blocking your goal when you refuse to allow a margin for error. Beware of ‘either/or' statements and global labels such as ‘good' and ‘bad' or ‘success' and ‘failure'. Neither people nor life situations are often that cut and dry.

  Fortune-Telling: Stepping Away From the Crystal Ball

  Often, clients tell us after they've done something they were anxious about that the actual event wasn't half as bad as they'd predicted. Predictions are the problem here. You probably don't possess extrasensory perceptions that allow you to see into the future. You probably can't see into the future even with the aid of a crystal ball like the one in Figure 2-3. And yet, you may try to predict future events. Unfortunately, the predictions you make may be unduly negative:

  Figure 2-3: Fortune-telling.

  You've been feeling a bit depressed lately and you aren't enjoying yourself like you used to. Someone from work invites you to a party, but you decide that if you go you won't have a good time. The food will unpalatable, the music will be irksome and the other guests are sure to find you boring. So, you opt to stay in and bemoan the state of your social life.

  You fancy the bloke who sells you coffee every morning on the way to the office, and you'd like to go out with him on a date. You predict that if you ask him, you'll be so anxious that you'll say something stupid. Anyway, he's bound to say no thanks - someone that attractive must surely be in a relationship.

  You always thought that hang-gliding would be fun, but you've got an anxious disposition. If you try the sport, you're sure to lose your nerve at the last minute and just end up wasting your time and money.

  You're better off letting the future unfold without trying to guess how it may turn out. Put the dustcover back on the crystal ball, flog the ouija board on eBay, leave the tarot cards alone and try the following strategies instead:

  Test out your predictions. You really never know how much fun you might have at a party until you get there - and the food could be amazing. Maybe the chap at the coffee shop has got a partner, but you won't be sure until you ask. To find out more about testing out your predictions, have a read through Chapter 4.

  Be prepared to take risks. Isn't it worth possibly losing a bit of cash for the opportunity to try a sport you've always been interested in? And can't you bear the possibility of appearing a trifle nervous for the chance to get to know someone you really like? There's a saying ‘a ship is safe in a harbour', but that's not what ships are built for. Learning to live experimentally and taking calculated risks is a recipe for keeping life interesting and rewarding.

  Understand that your past experiences don't determine your future experiences. Just because the last party you went to turned out to be a dreary homage to the seventies, the last person you asked out went a bit green, and that scuba-diving venture resulted in a severe case of the bends doesn't mean that you'll never have better luck again.

  Typically, fortune-telling stops you from taking action. It can also become a bit of a self-fulfilling prophec
y. If you keep telling yourself that you won't enjoy that party, you're liable to make that prediction come true. Same goes for meeting new people and trying new things. So, put on your party gear, ask him out for dinner and book yourself in for some hang-gliding.