About Cognitive Behavioural Therapy

What we think, can impact on what we feel and do

There's John, why isn't he waving back? He's ignoring me! What have I done wrong? He's angry with me for something, I'd better phone Jim and find out what I've done.

Simon adopts an unhelpful interpretation (he does some impossible "mind reading" & makes unhelpful assumptions) - he then feels anxious and bothers his other friend (Jim) with paranoid checking.

The real story - John wasn't wearing his glasses and he did not see Simon. What vicious cycles do you set up with unhelpful thinking, coupled with unhelpful behaviour? CBT helps you to break these cycles - turning vicious into virtuous cycles, and works to reduce the level of emotional upset. CBT works on the basic idea that we can live more effectively and happily if we are thinking and behaving in more helpful ways.

What is CBT?

CBT, or Cognitive Behaviour Therapy is a talking therapy. It is an evidenced based therapy - meaning that a great deal of research has been conducted, proving it’s helpful impact on many areas such as: anxiety, depression, OCD, Panic disorder, Schizophrenia & psychosis, Bi-polar disorder, anger, chronic pain, sleep, stress, eating disorders and substance misuse.


 

CBT in a Nutshell

We are interpreting our experiences all day everyday, and some of these interpretations are skewed, too rigid and incorrect. What we then think impacts on what we feel and do. We then set up unhelpful maintenance cycles (vicious cycles if you like). CBT helps to turn these vicious cycles into virtuous (helpful cycles).

Some Basic Information

Anxiety – the basics
 

The CBT model of anxiety is that we tend to overestimate the threat or danger and we underestimate our ability to cope. We then tend to avoid or embrace safety-seeking behaviour. In other words, we think that something bad is going to happen and that we’ll feel overwhelmed and won’t be able to cope. Once we interpret a threat, the body’s alarm system then sends an adrenaline response and this prepares us for flight or fight. Our heart beats faster; we can sweat, feel dizzy, breathless and even experience a sense of choking. Our ability to concentrate is also reduced. The problem is, that we are not always in a fight or flight situation, and many times we are experiencing ego discomfort (i.e. what do I, others and the world thinkof me?) or emotion discomfort (feeling like we cannot tolerate embarrassment, anger or upset), however, we have already sent the message to our brains that “something awful” will occur, and so we feel very uncomfortable physically and emotionally, and this is because our threat system has gone off. We can usually tolerate emotion and ego discomfort, but we are used to telling ourselves that it is 100% awful and we cannot stand the discomfort. We have set up a vicious cycle.

CBT starts by asking if the threat really is a threat and then helpful behaviour - such as deep breathing, taking things slowly and addressing the issue rather than avoiding it is encouraged. CBT teaches us to break the thinking and behaviour maintenance cycle.

Panic Disorder – the basics
 

Panic attacks result from the “catastrophic misinterpretation” of bodily or mental events. We misinterpret these events as a sign of immediate impending disaster, such as the sign of having a heart attack, passing out, suffocating or going crazy. Again, the starting point is to question the interpretation and couple this with helpful behaviour. A panic attack starts off as high anxiety.


Depression – some basic information
 

The Depression Model

  • Experience a sense of loss – failure
  • Core belief: negative view of self, daily life & future
  • Underlying assumptions: pessimistic, hopeless
  • Strategies: withdrawal, inactivity
  • Automatic thoughts: negative
 

What is Depression?

  • Depression is more than simply feeling unhappy or fed up for a few days.
  • Depression affects people in many different ways and can cause a wide variety of symptoms.
  • The symptoms can range from lasting feelings of sadness and hopelessness to losing interest in the things you used to enjoy and feeling very tearful and anxious.
  • There can be physical symptoms too such as constantly feeling tired, sleeping badly, having no appetite or sex drive and complaining of various aches and pains.
 

Causes

There is no single cause of depression; you can develop it for different reasons. Depression has many different triggers, for some, an upsetting or stressful life event, such as bereavement, divorce, illness, isolation and loneliness, job loss or money worries. When such stressful events are experienced you have a higher risk of becoming depressed. People often talk of a “downward spiral” of events that leads to depression.

CBT helps to rework the negative bias in your thinking, and introduces more helpful behavioural responses to assist in breaking the depression maintenance cycle.

Concerns and Issues I Work WIth

Anxiety (including social anxiety, performance anxiety & health anxiety); GAD (General Anxiety Disorder); Panic Disorder /Panic Attacks; OCD; Compulsive Behaviours; Fear of Flying; Depression; Bereavement; Binge Eating; Self Confidence & Self Criticism issues; Struggles with Assertion & saying "No"; Anger & Resentment issues; Alcohol & Drug Misuse (this includes people who may not wish to stop drinking alcohol altogether, rather reduce the amount they are drinking to improve overall physical health and general well being and to feel more in control of the consumption); Gambling issues; Work Related Stress; Bullying; Meaninglessness at work and in relationships; Relationship Struggles & struggles in Work/Life balance; Decision Making difficulties (i.e.procrastination); Difficulties in Sexual Relationships; Boredom & Difficulties with Motivation.


 

What to Expect?

The length of everyone’s therapy is different - given the issues and the complexity of those issues, and everyone works at a different pace, however, there are some general guiding principles for CBT.

First Session

This is known as the assessment session. You will be asked about the specifics of the issues and how you experience them. You may also be asked some brief history and where you think these issues may have stemmed from. At the end of the first session, a possible treatment plan will be put to you. If you agree with this plan, then an initial 5 -6 consecutive sessions are normally booked, as weekly sessions initially help to promote a clear understanding of the model and assist in the application of the tools.

Subsequent Sessions

Each session will commence with a mood check & general check-in (either via a verbal check-in or with the use of a psychometric question sheet like the Beck’s anxiety and or depression questionnaires). Working collaboratively with your therapist is key to CBT. The main issues will be agreed upon and then tangible goals set. An agenda is then agreed for the session. Feedback is asked regarding the previous session and any small exercises you have completed are incorporated into the session.

Exercises

Each week small exercises are agreed – this is usually to help you to understand the CBT tools. Also, small behavioural experiments are agreed – this can also help to further develop your overall ability to sustain a change.

Length of Treatment

This does vary for each client. However, many issues can be effectively addressed in 10 – 20 sessions. Some people may take longer, as they may also wish to further explore other areas that have presented through the course of the therapy. The therapy is usually reviewed every 4 – 6 sessions. Booster sessions are also helpful. Booster sessions can be booked fortnightly or monthly for example, basically, whatever the client may find helpful.

Helpful References:

Cognitive Behavioural Therapy: Teach Yourself, Christine Wilding (Note: this is a basic and no fuss small book with easy steps and references. It will complement what you are being introduced to in session) Mind Over Mood 2, Padesky & Greenberger (Note: this is a larger work book designed to address anxiety & depression) CBT for Dummies, Branch & Willson (Note: this is a good reference book and like the Wilding book it is easy to follow but a larger book than the first reference). Don’t Sweat The Small Stuff , Richard Carlson (Note: this is a small book outlining CBT in action in the form of stories. It has a chatty and accessible style)


 

Further helpful tools:

Breathing exercises: There are a number of breathing exercsies that can help to calm our systems: The 4x4 Breathing Technique: Navy Seals use this to calm themselves during training and anxiety provoking experiences: breathe in for 4 seconds, hold for 4 seconds, breathe out for 4 seconds, hold for 4 seconds, rinse and repeat. The 4-7-8 Breathing Exercise can also help (breathe in for the count of 4, hold for 7, and exhale for the count of 8 - do 4 breath cycles a minimum of 2 times per day). Google 4-7-8 breathing techniques and Dr Andrew Weil's videos will come up, and he outlines how to use this affective calming exercise. It can aid in an overall reduction in anxiety, stress and assist as a sleep aid. Experiment to see which works best for you. The 4x4 approach seems to be a good tool "in the moment" and the longer 4-7-8 method is more of a meditation/yoga approach, working as a daily mindful practice that can aid in our overall wellbeing.

Head space meditation – headspace.com offers 10 minutes of guided meditation for 10 days free! Meditation is another tool assisting to calm the mind, helping to promote an increased capacity to respond to life’s dilemmas in a more measured manner – Google: www.headspace.com

Location

344 - 354 Grays Inn Road
London
WC1X 8BP

Contact Details

enquiries@centrallondoncbt.co.uk

07788 776 012

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