Cognitive Behavioural Therapy (CBT) Cognitive Behavioural Therapy (CBT) E-Book

Clair Pollard

• Herausgeber: Icon Books
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 227

Veröffentlichungsjahr: 2016

Beschreibung

Change can often seem like an impossible task, but this practical book will help you put it into perspective. With guidance from two experts, you'll recognise the behaviours and thoughts that hold you back, and will develop skills to think more positively, act more calmly and feel better about yourself. Using the same tools employed by CBT practitioners, this book is full of activities and experiments to explore and challenge, stories and exercises to provide perspective, and a clear framework to encourage and guide you. The authors' friendly and supportive approach will help you learn to manage recurrences of negative thinking and behaviours, and to develop strong coping strategies. CBT incorporates the latest therapies and research, including ACT and mindfulness, and explicitly addresses problem areas like insomnia and depression.

Leseprobe

CBT

Cognitive Behavioural Therapy

Elaine Iljon Foreman & Clair Pollard

CBT

Cognitive Behavioural Therapy

YOUR TOOLKIT TO MODIFY MOOD, OVERCOME OBSTRUCTIONS AND IMPROVE YOUR LIFE

Published in the UK in 2016

by Icon Books Ltd, Omnibus Business Centre,

39–41 North Road, London N7 9DP

email: [email protected]

www.iconbooks.com

First published in the UK in 2011 by Icon Books Ltd

Sold in the UK, Europe and Asia

by Faber & Faber Ltd, Bloomsbury House, 74–77 Great Russell Street,

London WC1B 3DA or their agents

Distributed in the UK, Europe and Asia by Grantham Book Services,

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ISBN: 978-184831-950-9

Text copyright © 2011, 2016 Elaine Iljon Foreman and Clair Pollard

The authors have asserted their moral rights

No part of this book may be reproduced in any form, or by any means, without prior permission in writing from the publisher.

Typeset in Adobe Caslon by Marie Doherty

Printed and bound in the UK by Clays Ltd, St Ives plc

About the authors

Elaine Iljon Foreman is a Chartered Clinical Psychologist specializing in the treatment of anxiety-related problems. Her clinical research into Cognitive Behavioural Therapy techniques, developed over 30 years, has meant she is regularly in demand by the media for her expert contribution. Elaine’s research into the treatment of anxiety and particularly fear of flying has generated invitations to present her research in this field across Europe, the Americas, Australia, the Middle and Far East.

Dr Clair Pollard is a Chartered Clinical Psychologist and is accredited by the BABCP (British Association for Behavioural and Cognitive Psychotherapies). Clair works in the NHS with adults with mental health problems and for a charity called The Back-Up Trust, working with people with spinal cord injury. Clair has a particular interest in issues around adjustment to disability and in post-traumatic coping and growth.

Acknowledgements

A book’s value is based on its usefulness to the reader. Ian McLeod, Visiting Professor of Law at Teesside University has provided invaluable input to enhance clarity and simplicity, contributing greatly in the usefulness stakes. Our very grateful thanks are expressed to Ian and also to Duncan Heath, our editor, and his team at Icon Books for their assistance in making this book amongst the most useful in enabling people to change.

We would also like to acknowledge the following people who have made particularly significant contributions to the development and practice of CBT and on whose work we have drawn:

Aaron T. Beck, Judith Beck, Gillian Butler, David Clark, Albert Ellis, Paul Gilbert, Ann Hackman, John Kabat-Zinn, Paul Kennedy, Marsha Linehan, Stirling Moorey, Christine Padesky, Paul Salkovskis, Maggie Stanton, Richard Stott, John Teasdale, Adrian Wells and Mark Williams.

Dedication

No man is an island, it is said – nor woman either. We would like to thank the rocks surrounding us (you know who you are) who have given such support and encouragement in our writing – and in everything else. On your solid foundation we can stand firm and strong, deal with life, and enjoy!

Authors’ note

It’s important to note that there is much frequently-used research employed in cognitive behavioural therapy. Where we know the source we have been sure to reference it, but our apologies here to the originators of any material if we have overlooked them.

Contents

About the authors

Acknowledgements

Dedication

Authors’ note

1.Introducing CBT

2.The ABC of CBT

3.Managing anxiety

4.Kiss insomnia goodnight – and goodbye

5.Beating bad habits and building better ones

6.Dealing with depression

7.Coping with bad times

8.Maintaining progress and reducing recurrences

9.What now? Further helpful resources

Index

CHAPTER 1

Introducing CBT

Men are disturbed not by things but by the views which they take of them … when, therefore, we are hindered, or disturbed, or grieved, let us never blame anyone but ourselves: that is, our own judgments.

Epictetus, Greek philosopher

COGNITIVE BEHAVIOURAL THERAPY: WHERE DID IT COME FROM?

Some readers may be familiar with the name of Pavlov, and his early experiments in the 1900s looking at the way in which dogs can be ‘conditioned’ to salivate at the sound of a bell. What many people don’t know is that Pavlov was actually studying the digestive system of dogs and just happened to observe this ‘conditioned reflex’. However, he opened up a whole new field of study, allowing new insights into understanding the way in which animals learn. From there, it was but a small step to transfer this knowledge from four-legged to two-legged creatures. So the field of behaviour therapy was born. It stemmed from applying the principles of learning theory to shaping the behaviour of first animals and eventually humans, looking at ways in which altering behaviour might help alleviate psychological ‘disorders’.

Dr Aaron Beck, originally a psychoanalyst, is generally credited with founding cognitive therapy in the 1970s. Working with depressed patients, he noticed they experienced a series of spontaneous negative thoughts, which he called automatic thoughts. He divided them into 3 categories: negative thoughts relating to the self, to the world and to the future. Working to identify and challenge these thoughts enabled patients to re-evaluate them more realistically. The result? The patients felt better and showed positive changes in behaviour. They became able to think in a more balanced, realistic way; to feel better emotionally and to behave in a more functional manner. The key concept of cognitive therapy concentrates on how we process information, organize it, store it, and relate new information to old. In cognitive therapy we focus on understanding the way in which humans think and applying these principles to the treatment of psychological disorders.

In the 1970s and 1980s furious debate raged over whether behaviour therapy or cognitive therapy held the key to understanding and overcoming psychological difficulties. Eventually, although there is no general agreement of exactly when, it became clear that this wasn’t a contest with a winner and a loser. People neither operate on purely behavioural principles, nor live their lives based purely on thinking. It is in this realization that we find the roots of CBT.

There is an apocryphal tale of a paper written in the early 1990s. It was about understanding the nature and treatment of a particular anxiety disorder. The author believed in its importance (which author doesn’t?!) and was convinced that the research had international significance. But there was a conundrum – two world conferences appeared to address the subject matter. One was the World Congress of Behaviour Therapy, the other the World Congress of Cognitive Therapy. The two were apparently miles apart, the conceptual separation reflected geographically, with one taking place in Canada, the other in Australia!

How to make a decision? As a behavioural experiment, the author sent an identical abstract to both. The result? BOTH were delighted to accept the paper as truly representative of research in that field! This is actually no shaggy dog’s tale – the author in question is the first author of this book!

So what happened the following year? A historical first took place – the first World Congress of Behavioural and Cognitive Therapies. This fortunately meant that from then on, Elaine only had to submit her research to one conference, instead of two!

Modern ‘Cognitive Behavioural Therapy’ – the CBT which this book explores – applies principles of both schools of thought to the treatment of psychological distress. It looks at the way in which our thoughts, emotions, behaviours and physical states all interact to cause and maintain difficulties. Since we know all of these factors interact, it follows that altering any one of them will have an effect on the others. CBT focuses on the way we can change patterns of thinking and behaviour in order to feel better.

Now, nearly 20 years later, we are moving into what is called the ‘third wave’ of CBT. Instead of just ‘mind’ and ‘behaviour’, CBT is moving into domains previously addressed primarily by other traditions, in the hopes of improving both understanding and outcomes. Thus third-wave therapies include concepts such as mindfulness meditation, acceptance, values and relationships. The emphasis in these newer ways of working is less on changing the content of thoughts; rather it is on changing our awareness of and relationship to thoughts. If you are interested in reading more about this see our list of suggested resources in Chapter 8. So, where are we now?

WHAT IS COGNITIVE BEHAVIOURAL THERAPY?

Cognitive Behavioural Therapy (CBT) techniques have been developed from extensive research. Studies indicate that treatments for psychological disorders based on CBT principles:

Are as effective as medication in treating many psychological disorders and often more effective in effecting long-lasting change and preventing relapseAre particularly effective for common mental health problems such as anxiety, depression, panic disorder, phobias (including agoraphobia and social phobia), stress, eating disorders, obsessive-compulsive disorder, post-traumatic stress disorder and difficulties with angerCan help if you have a low opinion of yourself, or physical health problems like pain or fatigueCan also be useful in helping to manage more severe mental health problems like bipolar disorder (previously called ‘manic-depression’) and psychosis.

CBT works on the principle that our behaviour and emotions depend to a large degree on our perception of what we understand is happening. What we think and anticipate can greatly affect our reaction to events and people. Having understood what you are thinking and how to deal with your thoughts, it is possible to train yourself to respond in a different way. This new style of thinking and behaving can then lead to a potentially more satisfying way of life, becoming part of your normal lifestyle.

CBT uses practical techniques and exercises to help you make lasting changes in the way in which you think and behave in order to help you feel better.

REMEMBER

In this book we concentrate on the practical skills and techniques that have been developed using the principles of CBT. They are presented in a format that is easy to use, so you can develop the life and lifestyle that is right for you. We have focused on the more common areas of mental distress and discomfort experienced by a large number of people.

Please note: If at any point when you are working through this book you find that things are getting worse rather than better, do seek professional help immediately. Likewise if your mood drops and you start to feel overwhelmed, ensure that you see either your GP or one of the mental health professionals described in Chapter 9.

CHAPTER 3

Managing anxiety

From ghoulies and ghosties

And long-leggedy beasties

And things that go bump in the night,

Good Lord, deliver us!

Traditional Cornish prayer

UNDERSTANDING ANXIETY

The internet offers around 46.5 million answers to what anxiety is all about! So that you don’t have to go through them all (at 5 minutes per website that’s around 450 years of your time) in this section we condense it down to the basic essentials:

What it isWhere it comes fromWhat forms it takes and, most important of all …What you can DO about it.

WHAT IS IT?

Anxiety is often described as a feeling of worry, fear or trepidation. But it’s much more than just a feeling. It encompasses feelings or emotions, thoughts and bodily sensations.

try it now

You might be more sensitive to one or two of these. Remember when you last felt really scared? Write down what you remember noticing, and then look at the examples we have given. Don’t worry if one column’s blank – it’s common not to notice everything when you first start looking at your emotions, thoughts and physical feelings.

Situation when you last remember feeling terrified

Physical sensations

What happened in your body?

Emotions

What did you feel?

Thoughts

What went through your mind? Words? Pictures?

   

Examples of typical reactions

Heart racing, sweating

Feeling absolutely petrified

What will happen next? Will I have a heart attack? Will I look like an idiot?

Occasional anxiety is absolutely normal within our everyday experience. If you didn’t feel anxious, ever, that would be something to worry about! Life presents us with challenges, which we aren’t always confident we can handle, so a degree of anxiety is natural. The challenges can be stressful events including actual danger, happening in the real world, and/or the things our minds conjure up, such as what if a catastrophe did occur – like meeting those ghoulies and ghosties which we mentioned at the start of this chapter.

FEELINGS OR EMOTIONS

When we experience severe anxiety we usually feel terrified. While sometimes it is quite straightforward to identify what it is that we are scared of, at other times we just get an overwhelming feeling of panic. But whether you love or hate this feeling depends to a great extent on your personality and the context.

Believe it or not some people seek strong sensations, and for these people sometimes the more powerful, the better! Experiencing high anxiety can be pleasurable, even though that might sound peculiar. Think of horror films, amusement parks or ‘extreme sports’ holidays. Certain people love the adrenaline rush these activities provide. The key is that usually the enjoyment is linked to it being a time, place and activity that they have chosen. They would probably be less enthusiastic about something that was happening to them uninvited, unwanted, out of their control and downright dangerous!

THOUGHTS

We all usually try to make sense of our environment, and to understand what is happening to us. It can be really frightening not to know what is happening, and to anticipate that whatever is going to happen next will be even worse. Anyone experiencing feelings of panic and terror is likely to try to figure out why it’s happening, and what it means. How we make sense of our world is what tells us whether it is safe or dangerous. Shakespeare neatly summed this up, writing in Hamlet, ‘there is nothing either good or bad, but thinking makes it so’.

So the link between thoughts and emotions is already becoming apparent – if you think something is really dangerous, you are likely to be seriously scared of it. People watching a horror movie are less likely to enjoy it if they then start looking out for aliens and monsters when they leave the cinema, while those who recognize it as being ‘only make believe’ can safely enjoy the scariness in the confines of the cinema, knowing that in reality there are no such dangers.

BODILY SENSATIONS

It can be quite astonishing to discover how many different sensations can be triggered by anxiety and how many different parts of the body can be affected. You may get just a few of these or most of them. The most common sensations are:

Your heart may beat faster and harderYour chest may feel tight or painfulYou may sweat profuselyYou may tremble or have shaking arms and legsYou may have icy cold feet and handsYou may have a dry mouthYou may have blurred visionYou may need to go to the toilet or have a churning or fluttering stomachYou may have a horrible headacheYou may feel that you’re ‘not really here’ or that you are somehow out of your body, looking down on everything, detached from your surroundingsYou may feel as if everything is very unrealYou may feel dizzy, light-headed or faintYou may feel you have a lump in your throat or that you can’t swallowYou may feel nauseous – you may even vomitYou may feel tense, restless or unable to relaxYou may have general aches and pains.

As we mentioned, it is normal to experience anxiety when we feel we are in danger. Your body responds with the ‘triple F’ reaction, Fight, Flight or Freeze. It’s a really important automatic response – your body does it all by itself. The 3 Fs are linked to the survival of our species over the years. Take the example of disturbing a hungry wild animal out in the bush. Depending on both you and the type of animal, you might try to fight it, to run away as fast as you could, or to keep stock still in the hope that it had poor eyesight and wouldn’t charge at you. Which of the 3 Fs do you reckon you’d choose?

In situations you perceive as dangerous, your body produces a whole range of chemicals (including adrenaline) which trigger all of the physical symptoms above. These bodily changes are what have helped the human race to survive. The chemicals released cause physical changes which enable us to run far faster than otherwise, have greater strength, and generally have a better chance of defending ourselves and our loved ones. That’s great for an objective danger like a wild animal, but not particularly helpful when the perceived danger is more of a social one, like being afraid you will make a fool of yourself or a (most likely unfounded) fear of a physical catastrophe such as having a heart attack or brain haemorrhage.

In a moment we will go on to look at different specific types of anxiety problem. Each links to a range of thoughts about what is happening. So for instance, if you suffer from panic attacks you’ll probably fear that when you experience one something terrible will happen such as a heart attack, or a brain haemorrhage, or that you’ll go hysterical and make a total fool of yourself. If your problem is obsessive-compulsive disorder, then your fear may be that if you don’t do things in the right order, or clean or check sufficiently, then something dreadful will befall you or those close to you. A key feature of post-traumatic stress disorder is that the person tries to avoid reminders of the trauma. They frequently think that if they’re reminded too sharply of what happened, they’ll start re-experiencing it, and that the feelings might be more than they can bear. In this chapter we will look at different anxiety disorders in turn. However, the techniques we discuss to manage anxiety are general ones. If your anxiety problem is more severe or specific then the further resources in Chapter 9 will help you discover where else you might get help.

If you are someone who feels anxious a lot of the time, or your anxiety is so intense it’s starting to affect your everyday life, you may be suffering from one of the anxiety disorders. While we mentioned that anxiety is normal in certain situations, it becomes a problem when:

It is out of proportion to the stressful situationIt persists when a stressful situation has goneIt appears for no apparent reason when there is no stressful situation.

USEFUL TIP: WHERE TO START WITH ANXIETY

Try to understand your symptomsTalk things over with a friend, family member or health professionalLook at your lifestyle – consider cutting down or steering clear of alcohol, illicit drugs and even stimulants like caffeineApply some of the CBT techniques in this chapter.

It’s quite common for people who are suffering from anxiety to also have symptoms of depression. If this is true for you then Chapter 6 on managing depression may be helpful for you.

CBT looks at how our thoughts, emotions, physical sensations and behaviours all interact to maintain our anxiety. When we perceive a ‘threat’ of any kind – whether that is a fear of something that is happening right now or a worry about something that might happen in the future – our bodies and minds react in the ways we look at in the diagram opposite. When we notice the physical sensations of anxiety we assume that this means there really is a threat (even if in reality there is none) and so we get more anxious thoughts.

How CBT understands anxiety

This in turn leads to enhanced physical sensations as our bodies respond to our perceptions. When we are scared of something we naturally avoid it. However this in turn can lead us to believe more strongly that there really is something to be scared of – and by avoiding it, we never get the chance to test out our fears. Our anxiety about that situation therefore increases. Often we dwell on our fears and worries in order to try to make sense of them, keep ourselves safe or stop bad things happening. However, this habit is most often unproductive and simply serves to increase our anxiety without actually improving or changing our situation. Seeking out reassurance from people close to us, searching the internet, or consulting professionals might make good sense if we do it once and it serves to calm our fear in a lasting way. However, what tends to happen when people suffer from anxiety is that they will seek reassurance, feel better for a short time, but then keep needing more reassurance. This means that nothing changes and they never develop more effective, lasting ways of managing their anxiety.

REMEMBER

If you are suffering from problems with anxiety, you are certainly not alone. Difficulties with anxiety are common within the general population. One in eight adults will suffer from an anxiety disorder at some point in their life.