Cognitive Behaviour Therapy - Avy Joseph - E-Book

Cognitive Behaviour Therapy E-Book

Avy Joseph

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Beschreibung

Find out how to use CBT techniques in everyday life for emotionally healthy living What happens to you in life matters less than the way you feel about life; that's the message of Cognitive Behavior Therapy (CBT). If you've ever tried to change something about yourself--your mood, your weight, your behaviour--you'll have noticed that change often hurts, so you stop trying. CBT can help you when change starts to hurt. In the revised and updated edition of this bestselling title, professional CBT practitioner Avy Joseph shows you how to challenge negative thoughts and unhealthy beliefs to improve your outlook in your personal and professional life. * Contains new scenarios and exercises for the reader to practice using CBT techniques in a variety of situations * New introduction and conclusion from the author discussing the CBT technique and recent developments in the field * Addresses key topics such as anxiety, change, resilience and self-belief * Written by an expert in the field, Avy Joseph is widely-recognised as one of the UK's leading practitioners on the topic

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Table of Contents

Praise Page

Title Page

Copyright

Dedication

Acknowledgements

Introduction to the Second Edition

Chapter 1: Understanding CBT for Goal Achievement

The Emotional Responsibility Principle

The Behavioural Principle

The ‘Here and Now’ Principle

The Scientific Principle

Types of Thoughts

Theory Made Simple

Chapter 2: The Four Belief Pairs

Want to vs Have to

Bad vs Awful

Difficult vs Unbearable

Self-acceptance vs Self-damning

The Concepts at the Heart of Healthy Beliefs

Chapter 3: Setting Your Goals

Reflect on What You Want

Setting SMART Goals

Current Goal-Sabotaging Beliefs

Identifying Your Current Sabotaging Beliefs

Goal Achievement Beliefs to Support Your SMART Goal

Personally Persuasive Reasons – What's in it for Me?

Chapter 4: Overcoming Obstacles to Goal Achievement

Emotional Obstacles

Habitual and Behavioural Obstacles

Cognitive Obstacles

Environmental Obstacles

Tolerating Tension and Discomfort

Focusing on the Goal

Chapter 5: Developing Cognitive Skills Through Your Internal Dialogue

Internal Dialogue or Self-Talk

Negative Automatic Thoughts

Your Hot Thoughts

How to Change Internal Dialogue

How to Change Negative Automatic Thoughts

How to Change Your Hot Thoughts

Past, Present and Future Expressions

Force and Rigour

Chapter 6: Using Imagination and Visualization

Start with Your Imagination

Using Audio

Other Audio Recordings

Positive Imagery After You have Imagined Dealing with the Negative

More on Self-Talk

Future Image

Repetition

Chapter 7: Developing Resiliency

Challenges within Your Control

Challenges Outside Your Control

Resources for Resiliency

Cognitive Emotive Triggers

Chapter 8: Taking Action and Responsibility

Accountability and Action

Be Open and Learn from Failures and Disappointment

Acknowledge and Express Your Feelings Appropriately

Decision Making

Do it Again

Chapter 9: Accepting the Possibility of Failure and Disappointment

Failure and Failing

Chapter 10: Developing a Healthy Philosophy of Balance

Short-Term Comfort

Long-Term Gain

Balance

Fallibility

Summary

About the Author

Index

End User License Agreement

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Guide

Cover

Table of Contents

Begin Reading

“A must read for anyone looking for practical, realistic and easy to apply CBT techniques to improve their behaviours and beliefs to lead a more positive and fulfilling life. Applicable to anyone who has experienced behaviours and beliefs that are leading to negative feelings or consequences.”

Helen Keeble, Specialist Physiotherapist

“I love this book! Avy Joseph's clinical wisdom and straightforward CBT strategies and techniques gives the reader a clear understanding of how to identify and challenge unhealthy beliefs, emotions and behaviours. He gives encouragement and helpful advice on how to integrate the CBT toolkit into our everyday lives.”

Dr. Jennifer Gomborone BA, MSc, PhD, CPsychol AFBPsS, hpc Registered Practitioner Psychologist

“I fully recommend this clearly written guide to CBT. The revised edition is even better than the first edition!”

Windy Dryden PhD, Emeritus Professor of Psychotherapeutic Studies, Goldsmiths University of London

Cognitive Behaviour Therapy

SECOND EDITION

Your route out of perfectionism, self-sabotage and other everyday habits with CBT

AVY JOSEPH

This updated edition first published 2016

© 2016 Avy Joseph

First edition published 2009

Registered office

John Wiley and Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com.

The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Wiley publishes in a variety of print and electronic formats and by print-on-demand. Some material included with standard print versions of this book may not be included in e-books or in print-on-demand. If this book refers to media such as a CD or DVD that is not included in the version you purchased, you may download this material at http://booksupport.wiley.com. For more information about Wiley products, visit www.wiley.com.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book and on its cover are trade names, service marks, trademark or registered trademarks of their respective owners. The publisher and the book are not associated with any product or vendor mentioned in this book. None of the companies referenced within the book have endorsed the book.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with the respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Names: Joseph, Avy, author.

Title: Cognitive behaviour therapy : your route out of perfectionism, self-sabotage and other everyday habits with CBT / Avy Joseph.

Description: Second edition. | Chichester, West Sussex : John Wiley & Sons, Inc., [2016]

Includes index.

Identifiers: LCCN 2015041919 (print) | LCCN 2015042202 (ebook) |

ISBN 9780857086471 (paperback) | ISBN 9780857086488 (pdf) |

ISBN 9780857086495 (epub)

Subjects: LCSH: Cognitive therapy—Popular works. | BISAC: PSYCHOLOGY /

Psychotherapy / General.

Classification: LCC RC489.C63 J67 2016 (print) | LCC RC489.C63 (ebook) |

DDC 616.89/1425—dc23

LC record available at http://lccn.loc.gov/2015041919

Cover design: Wiley

I wish to dedicate this book to the memory of my father who passed away nine years ago.

Acknowledgements

Chris Hynes for unconditional love, help and support. My family for the love and encouragement.

Professor Windy Dryden for his clinical and professional guidance. Maggie Chapman for her friendship and professional support.

Introduction to the Second Edition

Cognitive Behaviour Therapy (CBT) is recognized as one of the leading, evidence-based talking therapies. CBT places much emphasis on currently held beliefs and attitudes, painful emotions, and problematic behaviours that can sabotage a fuller experience of life. CBT teaches us a philosophy of life that can be learned by everyone in order to be happier.

The ideas and philosophies in CBT stem from ancient and modern philosophers, science, psychology, common sense and humanity. CBT is supported by a wealth of research, is used extensively by the NHS and is recommended by NICE (National Institute for Health and Clinical Excellence) for many emotional and psychological problems.

There are many types of CBT. Rational Emotive Behaviour Therapy (REBT) is one of the cognitive behaviour therapies under the CBT umbrella. It is an evidence-based, psycho- educational and philosophical model developed by Albert Ellis. Since the first edition, REBT has continued to grow. Research in REBT has demonstrated both its effectiveness and efficacy for both clinical and non-clinical problems.

REBT is grounded in acceptance: acceptance of the past, present, future and of the self, other and life. Acceptance does not mean approval. Sometimes people ask ‘but if I accept failure then doesn't it mean that I'm okay with it or that I didn't mind failing?’ The answer is an absolute no. Failure does matter to most people, and most of us don't like it, but it does happen. Acceptance means acknowledgement of this reality, in this particular example. When we overcome this mis understanding, self-confidence, emotional health and well-being and life goals become much easier to achieve.

This second edition is more concise than the first with more practical applications and tips. Some concepts are repeated in different ways. This is deliberate. Repetition helps us internalize the learning in order for it to become habitual and effortless.

The ideas in this book are heavily influenced by REBT theory but some concepts stem from other CBT models and self- image psychology. In this book I will show you how using CBT can help you set yourself up for success and overcome those beliefs and habits that sabotage your life.

Avy Joseph

Chapter 1Understanding CBT for Goal Achievement

‘People are not disturbed by events but by the view they hold about them.’

Epictetus, Stoic philosopher c. AD 75

This chapter will introduce you to some of the basic ideas and principles of Cognitive Behaviour Therapy (CBT) and how you can use it to help you achieve your goals. First though, what does Cognitive Behaviour Therapy (CBT) actually mean?

Cognitive simply means our ‘thinking processes’: how we think, how we acquire information and knowledge, how we store it in our head, how we evaluate it and how we base some of our decisions on it.

Behaviour means our action or reaction to something. It's the doing bit. Our behaviour can be conscious or unconscious (out of our conscious awareness). In CBT, the word ‘behaviour’ comes from a branch of psychology called ‘behaviourism’, which is concerned with what can be observed rather than what can be speculated or assumed. It is based on what you have learned and become accustomed to, how this affects your actions and feelings, and how you can unlearn what you have learned in order to change.

Therapy means the treatment for a health problem after a diagnosis or an assessment has been made.

CBT is a form of therapy that examines how our thinking, attitudes, beliefs, opinions and behaviour are formed, how they affect our success, our lives and feelings, and how changing them impacts on our performance. The ideas stem from both ancient and modern thinking in philosophy, science, psychology, common sense and humanity.

Here are some of basic principles central to CBT. Many may be shared by other therapeutic approaches, but the combination of these principles goes some way towards understanding CBT.

The Emotional Responsibility Principle

‘People are not disturbed by events but by the view they hold about them.’

This principle is at the heart of nearly all emotional and behavioural change. It can be challenging because you may believe that it's what has happened to you that ‘makes’ you feel how you feel and do what you do in the here and now.

I hope that by questioning this you will learn that what you believe may be stopping you from empowering yourself to move forward with your life. This in turn may help you in the pursuit of your desired goals.

Is it true that events, situations or people make us feel what we feel?

First, let's look at the popular notion that your feelings are ‘caused’ by events, situations or other people.

Think of a past event that you think ‘made’ you feel and do something. By this logic the only way you can change your feelings now is to wish the event had not happened in the first place.

Maybe you think there's someone else who has ‘made’ you feel and act in a certain manner. In which case, the only way you can change your feelings now is to get that person from the past to undo what they did or said. And if that person is now deceased, how can this be done?

Believing that the past, or a particular situation or person, causes our feelings today, means that no one would ever be able to move forward or to change. We would all be totally stuck without any possibility or hope of ever changing anything. We would be slaves to the things that had happened to us or the people we had been involved with.

Can you imagine what it would be like if everyone felt hurt every time they experienced a rejection of some sort?

Rejection = Hurt

10 people rejected = 10 people feeling hurt

100 people rejected = 100 people feeling hurt

1000 people rejected = 1000 people feeling hurt

As an example, when you experience rejection you might feel hurt. However, if you believe that your feelings are caused by others, you may then believe that being rejected by someone is the cause of your hurt feelings. But don't some of us experience different emotions if rejected by someone we like? Maybe anger, sadness, depression or relief?

In fact, different people may feel different emotions when they experience the same event:

Some people feel hurt

Some people feel angry

Some people feel depressed

Some people couldn't care less

Why do different people feel different things and what is at the heart of their feelings?

Is it true that events or people make us do what we do?

Let's think about what we do and assume that situations or people make us behave as we do.

A colleague criticizes you = You start avoiding them

If it is true that a colleague's criticism ‘made’ you avoid them, this means that every criticism made by your colleague would have the same effect on everyone. It means that avoidance is the only possibility whenever your colleague criticizes you, or anyone else for that matter.

A colleague criticizes 10 people = 10 people avoid them

A colleague criticizes 100 people = 100 people avoid them

A colleague criticizes 1000 people = 1000 people avoid them

Does this make sense?

The problem is that people say, ‘he made me do it’ or ‘she made me lose my temper’. It is as if they have absolutely no control over their behaviour. Once again, if we do not have a part to play in how we behave then we would be completely stuck, unable to move forward, learn or do anything useful. Is this what you see happening to everyone around you?

So what provokes your feelings and behaviour? Most of the time the simple answer is that you do. You provoke your feelings and actions by the way you think, the attitudes you've formed, the habits you no longer question and the beliefs you hold.

This is the principle of emotional responsibility: you are largely responsible for the way you feel and act.

The principle of emotional responsibility can be challenging, particularly if you are going through a difficult time or have experienced trauma or personal tragedy. It's natural to feel angry, sad, depressed or hurt in response to accidents, illness and other challenges in life, but if you get stuck in these feelings then you can change them.

The thought manifests as the word; The word manifests as the deed; The deed develops into habit;

And habit hardens into character;

So watch the thought and its ways with care. (Buddha)

The way you think about something affects how you feel and how you behave. Here are some examples:

If you think that your partner's late arrival for dinner proves that you are not lovable then you might feel hurt and sulk.

If you think that your partner was nasty and selfish because they arrived late for dinner then you might feel angry and shout.

If you think that your partner's late arrival for dinner is no big deal then you can feel calm about it and ask what happened.

This shows that it is not the situation or what happens to us that provokes our feelings and behaviour. It is the way we think about the situation. The way we think about something can then influence how we behave.

The Behavioural Principle

CBT considers behaviour as significant in maintaining or in changing psychological states. If, for example, you avoid some event, such as giving a presentation to your team, then you will deny yourself the opportunity to disconfirm your negative thoughts about yourself or capabilities. Furthermore, avoidance only sabotages what you want to achieve. Changing what you do is often a powerful way of helping you change thoughts and emotions and ultimately what you can achieve.

The ‘Here and Now’ Principle

Traditional therapies take the view that looking at problems in the here and now is superficial. They consider successful treatment must uncover the childhood developmental issues, hidden motivations and unconscious conflicts that are supposed to lie at the root of the problem. These approaches argue that treating the current problem rather than the supposed hidden ‘root’ causes would result in symptom substitution, that is the problem would re-surface in another form later on. There is little evidence to support this idea. Behaviour therapy also showed that such an outcome, although possible, was very rare.

CBT offers theories about how current problems are being maintained and kept alive and how they can be changed.

The Scientific Principle

CBT offers scientific theories. Scientific theories are designed in a way so they can be tested. CBT has been evaluated rigorously using evidence rather than just clinical anecdote. This is important for a couple of reasons:

The treatment can be founded on sound and well-established theories.

Ethically, CBT therapists can have confidence in the therapy they are advocating.

Exercise

List five things that people manage to change about themselves despite doing it badly at first (for example, learning to drive).

List five positive things that you have learned in your life despite experiencing difficulties (for example, moving on from a failed relationship).

Think of an inspirational person who has overcome enormous obstacles by having a powerful and constructive attitude and positive behaviour.

Truth

In CBT we examine our thoughts and behaviours to check if they are realistic. This means we judge and evaluate an event based on facts rather than perception, which can be flawed. Why do you think that, when an accident occurs, the police take statements from a number of people instead of asking just one person what happened?

Truth is about being consistent with reality whilst striving for the goals that are important to you. It's about acknowledging and accepting the existence of the possibilities you dislike while persisting in your efforts to reach your goals.

Exercise

How many ‘F's can you count in the following statement?

FINISHED FILES ARE THE RESULTS OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF MANY YEARS.

Did you see 2 or 3 ‘F's?

There are 6.

I will leave you to find the rest but simply draw your attention to the word ‘of.’

The above is a popular example used to highlight the fact that we don't necessarily see the whole truth. We interpret what we see and experience. What you have learnt from this simple but effective exercise is that your version of the truth can be faulty. It is important to question the truth that you hold about yourself and your ability just in case you are seeing only a few of the good things and missing many others. Sometimes we only see a few ‘F's, when in reality there are more. If the ‘F's represent your positive abilities and qualities, how many of the good qualities are you seeing?

This is just one of the reasons why in CBT we question the validity or reality of our thoughts.

Common sense

In CBT we suggest taking a logical and common-sense approach to thinking.

This does not mean that you become totally unfeeling and emotionless.

Logic or common sense is about the purity of our reasoning skills, whether a conclusion correctly follows a premise or assumption.

For example, which one of these two statements makes sense?

A. Some men shave their heads … therefore anyone with a shaved head is a man.

B. Some men shave their heads … but it doesn't mean everyone with a shaved head is a man.

Clearly statement B makes sense. In statement A, the fact that some men shave their heads does not connect logically to the assumption that anyone with a shaved head is a man. Some women, children and teenagers also have shaved heads.

Logical thinking is useful because we all have the ability to think and use common sense. In CBT, using your common sense well can lead you to form better conclusions about yourself.

Some people think like this about certain goals:

I failed at achieving my goal

therefore, I am a total failure as a person

Others think like this:

I failed at achieving my goal

but that doesn't mean I am a total failure. I am fallible but worthwhile nevertheless. I will learn from my failure and improve

.

Which of the above two statements makes sense?

Helpfulness

Finally, in CBT we look at how helpful your thoughts are to you and in the pursuit of your goals. Your thoughts are responsible for how you feel about yourself and your abilities, so it is more helpful for you to have constructive and goal-oriented thoughts than not.

Exercise

Reflect on some thoughts you often have about yourself and your abilities. See if they are helpful to you. For example, you might think ‘I'm not very good at talking in front of people.’

How can you make your thoughts more realistic, logical and helpful? For example, ‘I could improve by facing my fears slowly and gradually.’

Types of Thoughts

In CBT we draw a distinction between different types of thoughts. Not all of our thoughts are involved with our feelings and behaviours. The thoughts that are involved in our feelings tend to have some sort of an assumption or judgement about ourselves, others or the world.

There are two particular types of thought that are involved in our emotions or feelings.

1. Inferences

Inferences are assumptions you make about the things that matter to you, which can be about yourself, others or about the world. For example, if your boss contradicted you during a meeting that was important to you, you might think, ‘he is undermining me’. Then you would be making an inference. This means that in that moment you have gone beyond the facts and made an assumption about what happened because it was significant to you. In this example you would have an emotional response: you might feel annoyed, concerned, anxious, angry or some other negative emotion.

The issue is whether your boss was undermining you or simply expressing a different opinion. In order to find out you would need to gather more information and evidence. Some of our inferences are accurate and some are not. In this ex- ample your inference has not been tested in reality.

If you had thought ‘he has a different opinion, he is not undermining me’ then your emotional response would be different.

Which of the following thoughts will lead to an emotion?

I saw a woman getting on a bus

.

My workmates are ignoring me

.

I'm a failure

.

Thoughts 2 and 3 will lead to an emotional reaction. The second thought is an inference. It may or may not be true. Your colleagues have been ignoring you – they may just have been very busy with work. You need more information to assess the accuracy of conclusion. But if you conclude that you were being ignored then you would have an emotional reaction.

The third thought also leads to an emotional response but it is more profound in its conclusion. ‘I'm a failure’ is an evaluative thought.

2. Evaluations or beliefs

Inferences influence our emotions but do not fully provoke them. Evaluations, on the other hand, are thoughts that are fully involved in provoking emotions and feelings. When you have an evaluative thought you are making a judgement about yourself, about others, or about the world. For simplicity let's call evaluative thoughts ‘beliefs’. These are fundamental in provoking either constructive feelings and helpful behaviours or destructive feelings and sabotaging behaviours.

If you judge yourself as ‘useless’ when you are thinking about applying for a job, this may trigger additional thoughts such as ‘I won't get the job’. When you hold such a belief, you will probably feel anxious when you go for the interview. In a state of anxiety, you will probably not perform as well as you are capable of doing and the likelihood of you getting the job decreases dramatically.

Theory Made Simple

Putting these principles and philosophies into a theoretical model helps you to see more easily how feelings, different thoughts, behaviours and events all interact with one another.

The easiest is the ‘ABC’ model of emotional response.

A = Activating Event (or trigger)

B = Belief

C = Consequences

The ‘A’ can be:

Real or imaginary