PRACTICAL USE OF COGNITIVE BEHAVIOURAL THERAPY

The main focus of CBT is examining the manner in which a person construes and understands his/her world and to experiment with new ways of thinking and responding.


HOW MEMORIES ARE STORED

Events are not recorded in the same way that a video camera records the picture; rather they are recorded with a degree of selective bias. Memories are extremely fluid, they tend to be distorted by time, experience, and their emotional content. As a result memories and thoughts are always extremely selective; when events are recalled they come, often very differently to the original experience.

To make matters even more complex each thought can trigger thousands of responses in many other parts of the brain.

An important aspect of the thinking process is that many thoughts involve emotional memories. Because of these strong connections memories of the past are often triggered by things such as smell, sight, sound or touch; and vice versa, the recollection of some past events, especially ones that were quite meaningful, can trigger strong emotional feelings.


INCORRECT THINKING (COGNITIVE DISTORTIONS)

People are the product of their life experiences. Each person is an individual in how that person thinks or believes. Two people seeing the same thing will see it differently depending on race, religion, culture, education, expectancy and the sum total of life’s experiences. Though the "thinking" may appear correct for that person it might be distorted.

•    All or nothing thinking; e.g. I am a total failure

•    Over generalization; It is always my fault

•    Disqualifying the positive; e.g. Nothing good ever happens to me

•    Emotional reasoning; e.g. Because I feel a failure I am a failure

•    Should/must/ought statements; Life should be fair. I must be in control at all times. I ought to visit the family every Sunday

•    Mind reading; e.g. I know they are thinking I am a bad person

•    Personalization; e.g. That comment was directed at me even though they say it wasn't

•    Negative predictions; e.g. I know it will turn out bad

•    What is included or excluded in assessing a given situation; e.g. You always say that

•    Perfectionism; e.g. merely doing a good job is not enough, I must do it perfectly.

An individual has many beliefs based on a lifetime of experiences. Some beliefs are useful, some are not. Beliefs lead to habits. It is usually these habits that can cause difficulties in day- to-day living.


SOME FALLACIES

• Worrying: if I worry enough it may not happen.
• Change: if my situation was different my problems would go away.
• Attachment: if I could be in a relationship I would be happy.
• Ignoring: if I don’t think about it, it will go away.
• Control: if I am not in control all of the time I will be totally out of control.
• Fairness: life should always be fair.
• Being Right: I have to be right all the time, otherwise people will take advantage of me.
• Righteousness is rewarded: How can anyone treat me so badly after all of the good I have done for others.

SOME WAYS OF BLOCKING UNWANTED THOUGHTS AND CHANGING THOUGHT PATTERNS

1.    Decatastrophizing/ reality testing:
Some people can build a mountain out of a molehill. If this happens take a small concern, exaggerate it, take it to the extremes then compare this to the real probabilities. E.g. if I try I will fail and that will be a total disaster. I will lose everything and the children will starve. This allows the person to deal with the real problem rather than the extreme, and an often, unlikely outcome.

2.    Consider the advantages and disadvantages:
What benefits are there to be had from hanging onto the previous beliefs? Does the belief such as not good enough protect against trying?

3.    Scaling:
Develop and use a numerical rating to measure strength. E.g. measure feeling on a 1-10 scale. The lowest scores might be a mild level of discomfort, the higher score a level of severe discomfort.

4.    Turning adversity to advantage:
Change focus from what is lost to what might be a better outcome or a gain. E.g. missing out on a basic job might become a positive if it takes you back to getting more qualifications and a better job. A lost relationship might afford the opportunity of a better relationship.

5.    Picturing the new:
Picture in mind other outcomes. Picture a different outcome. Replace the long practiced image of failing with a positive one of you succeeding.

6.    Rehearsal:
Use own words to rehearse, change “mind chatter”. Practice what you are going to do or say before you try it. E.g. Change the thought of If I stand up to speak I will look a utter fool! to something more positive, e.g. If others can do it, so can I.

7.    Role reversal:
Putting self into the others shoes. Sitting in the other person's chair, try to hear, think and see the other person's view.

8.    Rebut your old beliefs:
Consider your former ways of thinking, your beliefs and habits; rebut them, e.g. I used to have panic attacks BUT that was before I learned to manage the attack.
 

CREATING CHANGE

• Home work/paper work. These may be used to gain objective information by paper assessments, self-reports, journals etc.

• Practice new behaviours in a variety of situations. Reward effort and the end product if it leads in the desired directions. Accept the occasional failures and setbacks.

• Start with small, manageable things, then build up to larger or more difficult things.

• Learn how to perform the new behaviours. Old habits need to be replaced with new, adaptive ways.

• Create a new look, identify a role model and build new behaviour around it.

• Read relevant books, articles, browse the web, listen to tapes.

• Practice thinking the new behaviours, rehearse in the mind how the new way would appear, pick a role model and act as if you were that person.

• Relaxation/meditation/body-boundaries/hypnosis/sound /light entrainment. These may be used to assist in learning how to prevent stress reactions, recognize rising stress levels and deal with the stress effectively.

• Putting the new behaviours into real life practice. Try out the new skills in a safe situation before tackling the more difficult things. Rehearse before taken action.

• Have personal rewards for trying and for success. Accept the occasional lack of success. Do not punish self.

• Because new skills slowly replace the old it may be difficult to measure progress. Knowing that positive change is occurring may help with continuing the learning process.