Category Archives: Cognitive behavioural therapy

Dealing with dread

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Image: Courtesy of: https://pixabay.com/en/users/MasimbaTinasheMadondo-1388843/

Dealing with dread

There are many times when I feel dread. Often, it emerges prior to the expectation of something unfamiliar. When there is a fear of the unknown, dealing with dread effectively can be a huge asset in life. The feeling of dread often arrives unannounced, feeling like a knot in my stomach or a feeling of fear and anxiety. Dealing with dread can help you to feel braver and approach life more than avoiding situations that you fear. ‘Approach behaviour’ leads to greater resilience and confidence.

Identify the thoughts

Invariably, a feeling of dread comes from the thoughts we have. These thoughts will be negative in nature. Thoughts such as, “I am not going to cope” or “I won’t enjoy myself” will lead to feelings of dread.

Change the story

Once you have identified the thoughts, get in the habit of challenging them. Thoughts aren’t facts – you can choose to tell yourself a different story. Instead of thinking, “I am not going to cope”, you could choose to think, “I will find a way to manage whatever comes my way. I have managed something similar to this in the past”. This will automatically life the feeling of dread.

What we think determines our quality of life. Choose your thoughts wisely.

Cultivate optimism

It serves no purpose to worry unnecessarily about the future. Wherever possible, assume a position of positive expectancy and you find this difficult to do, at least try to be as neutral and objective as possible about the future. People often assume that worrying about the future will keep them safe but this is a fallacy. All worry does is keep your ‘mental torture’ going.

Create goals

Instead of unnecessary worrying, create SMART goals. SMART stands for Specific, Measurable, Achievable, Realistic and Time-bound. Goals create a structure to work towards and inject purpose into our lives. Goals can help to alleviate dread as they help us maintain direction in life. A clear sense of where we are going and what we would like to achieve can effectively limit dread in our daily lives.

Believe in yourself

Self belief can neutralise dread. When we have faith in our ability to cope, we feel more capable. Believe that you can overcome difficulties in life. You will surely have had to deal with challenges in the past. Use these past triumphs to strengthen your belief in yourself. Talk to yourself positively and remind yourself of your strengths regularly.

Life is more about perception than about the actual events we experience. We can reframe things and change the story in our minds and make anything in life seem less scary. It takes practise but it’s well worth it.

Mandy X

 

Reject rigid rules

 

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Reject rigid rules

Let’s get one thing straight. I’m not talking about breaking the law. I do however think it is important to reject rigid rules when it comes to your subjective world. In Cognitive Behavioural therapy, we talk about unhelpful thinking styles (also known as cognitive distortions) and one of these is black and white thinking – also known as rigid rules.

Rigid thinking styles limit you in life – they narrow your focus and make you judgemental. The more rigid your thinking is, the more rules you tend to live by. The inevitable result is that the more rules you have for life, the more often they will be broken.

Some common rigid rules:

People must always like me

I am only worthy if I am in a relationship

I am only good enough if I have lots of money

People must see me as successful

Life should always go smoothly

I should not have to experience any set backs

It’s my parent’s fault

I should cope all the time

Showing emotion is a sign of weakness

The above examples lead to anxiety and stress as we try to live according to them and find they are constantly being challenged. The key to contentment is psychological flexibility. Learn to go with the flow more. Open up your thinking and look for other ways to look at your life and your attitudes. The easier you find it to adapt your thinking and reject rigid rules, the happier you will be for it.

Life won’t always go as planned (in fact it rarely does). You will find that acceptance rather than resistance works much better. Rigidly trying to make the outside world conform to your rules is a waste of energy and won’t ultimately work. Know your values of course but live with an open mind. Be curious…you may learn far more than if you stick doggedly to your rigid rules.

Mandy X

Tips on how to get the most therapeutic value out of psychological therapy

 

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Tips on how to get the most therapeutic value out of psychological therapy

You are emotionally struggling – weighed down by different feelings or profound sadness/anxiety/hopelessness.. you might have been going through a number of things that life threw at you from left, right and centre. You might have just realised how sad you have been throughout your whole life. You might have just lost someone, a relationship or a sense of self/achievement/control. And you are thinking about talking to a stranger all about it. Perhaps someone said ‘you better go and talk to a professional about it’. Maybe your GP was not happy to prescribe any medication at this point. Maybe you don’t want to take any pills.

As a therapist, I can tell you that it’s not an easy thing at all. You are letting a stranger see your inner self and your life including the parts you don’t want to think about (although not all therapy will result in digging up the past or your deepest darkest secrets). You have to verbalise how you feel, which can be the most daunting thing ever. You have the right to feel nervous and apprehensive, as well as feeling relieved (because a. you have decided to get help, b. there’s actually someone whom you can unload your internal burden without feeling guilty c. Things might change. In a good way. There’s hope.)
So, it is really, really important that you get into the right type of therapy and you get the most out of it. Based on my 8 years of experience in mental health service, I thought these tips might be helpful for people who are in need of and considering accessing psychological therapy.

1. Do tell your GP how you feel and how you might need emotional support/psychological therapy from a professional. GP may not know about all types of therapy but can point you in the right direction.

2. Not all therapy is ‘counselling’. If you say you need counselling, GP might only give you option for counselling. There are Cognitive behavioural therapy (CBT), psychodynamic therapy, systemic therapy…a variety types of therapy. Bear in mind, though, CBT is the evidence-based therapy recommended for various mood disorders (depression, anxiety, panic, PTSD, OCD, phobia all included) by the National Institute for Health and Care Excellence. You can do a little research on different types of psychological therapy.

3. You do need an assessment if you are unsure what type of therapy would be most helpful for what you are going through right now. Accessing your local IAPT service can help you with this. Their assessment will determine whether you would benefit from short-term treatment like CBT or you require more long-term/holistic treatment.

4. It really helps if you can think of what you want to achieve from the therapy e.g you want to improve your mood so that you can deal with your life stressors better, you want to reduce fear that’s been really getting in the way in your daily life, you want to resolve your feelings around your childhood. However, sometimes we are so overwhelmed we just can’t think clearly – where to start, what we need, what to focus on first. The person who assesses you might suggest one area to focus on. You might think ‘that’s not gonna be enough’ and feel hopeless/frustrated BUT remember, you need to start somewhere and the assessor is likely to be suggesting something that you can manage with a therapist’s help so try to put aside the uncomfortable feeling and see where it takes you/how it can help you.

5. At times, therapists (especially in NHS) encounter people who ask ‘are you qualified enough? Are you a psychiatrist? How old are you?’. When we are badly injured and our life feels upside down, we wouldn’t ask the consulting doctors and nurses these questions. Therapists need the same level of trust and respect and starting your assessment/therapy with scepticism is not likely to help you with being open and honest during the assessment, which is very important.

6. Just because you are going through 10 different problems, it does not mean that your treatment has to be the most complex, intense one. There are people who say ‘my problem is really complicated, I need to see a psychiatrist only’. If you are experiencing symptoms of psychosis such as visual/auditory hallucination, frequent urges to seriously harm yourself or others, or your paranoia is significantly disabling you, you may require psychiatric assessment and medication, and therefore a psychiatrist. However, try not to jump to conclusions and, again, be open-minded when you discuss your difficulties with your GP and assessor. You may only require a short-term CBT to understand the link between current difficulties and to learn to cope with them with new coping techniques (cognitive and behavioural), for example. Psychological therapy is most often delivered by psychologists and psychological therapists such as CBT therapists, psychological wellbeing practitioners and counsellors who are trained to deliver therapy.

7. Don’t be put off by the word ‘short-term’. It is not belittling your difficulties. Breaking down your difficult emotions and working through them one by one are more likely to have long-term benefit than trying to work on everything at the same time. Think of it this way – you are injured in several different places. Rather than going through a 24-hour surgery which will overwhelm your body and could be more detrimental, you get one treatment for one area, let it heal then move onto the next treatment, so have some gaps in between. You may also find that the first short-term treatment gives you what you need to manage/tackle some of the other difficulties, which can lead to great sense of independence and self efficacy.

8. Often drinking or taking drugs is used to cope with difficult emotions. However, when there’s been this self-medicating going on for some time, it can be difficult for your therapist to get a true picture of your current mental health because large amount and frequent use of alcohol/drug is very likely to have affected your mental health e.g. Exacerbated your anxiety, caused ‘extra’ factors around depression or panic etc. You are likely to be asked to engage with drug and alcohol support service first. This is not rejecting your difficulties or simplifying your difficulties as ‘substance misuse’. It’s not beneficial at all to be stuck in the middle – Therapy trying to pull you up to challenge dysfunctional thoughts while the impact of alcohol/drug is pushing you down to more dysfunctional thoughts and poorer concentration, for example. You will feel stuck, which may lead to further frustration/hopeless feeling/fear/disappointment.

9. Once you start the therapy, imagine that you have a driving instructor sitting next to you. You are still the driver. If you don’t put your foot down on that accelerator, your therapist won’t start the car for you. If you refuse to do that parallel parking although you were given and shown the knowledge and techniques that you require, your therapist will not do it for you. It is not because we refuse to help but because
We are here to help you become an independent driver, not to help you be a passenger.
Therapy is there to empower you, not to take the control away from you.

 

This post was written by an experienced colleague of mine – Scarlett Gallimore. To find out more click on the links below:

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The best possible life

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The best possible life

Don’t compare yourself to others

Don’t care about what others think

Be yourself

Enjoy the present moment

Revel in the small things – shared joke with a friend, a walk in the park…

Make time to play

Have a sense of humour – laugh a lot

Let go of the small things

Don’t take life too seriously

Try new things regularly

Look after yourself – physically, mentally and emotionally

Give love without expecting it back

Make regular time for friends and family

Strive for balance between work and leisure time

Seek out experiences over possessions

Ensure you have goals to works towards and a sense of purpose

When life seems sad and/or bad, try to see the bigger picture

There are many things that contribute towards the best possible life. These may be different for each one of us but there are some enduring aspects of life that we can all get happiness and fulfillment from. For me, living in the moment and trying not to take life too seriously are two that work well for me.

Mandy X

 

 

 

 

Are you approachable?

 

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Are you approachable?

Do you ever think about how you are coming across to others? There can be times when we are giving off negative body language to others but are not aware of this. Often, negative body language comes from what we are thinking about. If we are self conscious and self focused, we may feel stressed and this will show in our body language.

Cognitive behavioural therapy deals with many issues and among those is social anxiety, also known as social phobia. When we suffer from social anxiety, we are often plagued by self doubt and worry too much about what others think of us. We focus on how we are coming across and this self focus ends up making us feel even more anxious. Ironically, when we care too much about being liked and/or being popular, we can end up making the situation worse for ourselves by placing too much pressure on our behaviour.

An analogy that helps my clients is to ask them to think about a row of shops. If you are walking down a street full of shops, you will be unlikely to enter into a shop that looks as if it is closed, has the door closed or has the shutters down etc

On the other hand, a shop that has the door open and looks inviting is more likely to get interest from passers by. I call this “shop open” and “shop shut” body language. Regularly monitor yourself to see whether you are giving off approachable “shop open” body language or unfriendly “shop closed” body language. Shop open body language consists of:

smiling, making eye contact, shoulders back etc

Sadly, when we are shy or feel anxious socially, our thoughts tend to be anxious in nature and this affects our body language negatively. What ends up happening is known as a self fulfilling prophecy – the very thing we fear comes true. If you feel anxious, try focusing on something external instead of  focusing on yourself. This is a great trick to lessen anxiety  in social situations. Focus on others, find out more about them…

In the future, remind yourself to give off “shop open” body language and you will immediately see a change in how people treat you and communicate with you.

Mandy X

Is my thinking normal?

 

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Is my thinking normal?

This is a question we all ask ourselves at times. I know I have had moments where I have questioned my sanity and wondered if I have completely lost the plot. This is usually as a result of some overwhelming emotional experience. I find when emotions are involved, my thoughts tend to be far less rational.

If you would like to test out your thoughts, try the Dysfunctional Attitudes Scale:

This questionnaire lists different attitudes or beliefs which people sometimes hold. Read each statement carefully and decide how much you agree or disagree with the statement. For each of the attitudes, indicate to the left of the item the number that best describes how you think. Be sure to choose only one answer for each attitude. Because people are different, there is no right answer or wrong answer to these statements.

To decide whether a given attitude is typical of your way of looking at things, simply keep in mind what you are like most of the time.

1 = Totally agree 2 = Agree very much 3 = Agree slightly 4 = Neutral 5 = Disagree slightly 6 = Disagree very much 7 = Totally disagree _____

1. It is difficult to be happy unless one is good looking, intelligent, rich, and creative. _____

2. Happiness is more a matter of my attitude towards myself than the way other people feel about me. _____

3. People will probably think less of me if I make a mistake. _____

4. If I do not do well all the time, people will not respect me. _____

5. Taking even a small risk is foolish because the loss is likely to be a disaster. _____

6. It is possible to gain another person’s respect without being especially talented at anything. _____

7. I cannot be happy unless most people I know admire me. _____

8. If a person asks for help, it is a sign of weakness. _____

9. If I do not do as well as other people, it means I am a weak person. _____

10. If I fail at my work, then I am a failure as a person. _____

11. If you cannot do something well, there is little point in doing it at all. _____

12. Making mistakes is fine because I can learn from them. _____

13. If someone disagrees with me, it probably indicates he does not like me. _____

14. If I fail partly, it is as bad as being a complete failure. _____

15. If other people know what you are really like, they will think less of you. _____

16. I am nothing if a person I love doesn’t love me. _____

17. One can get pleasure from an activity regardless of the end result _____

18. People should have a chance to succeed before doing anything. Revised date (4 October 2006) 56 _____

19. My value as a person depends greatly on what others think of me. _____

20. If I don’t set the highest standards for myself, I am likely to end up a second-rate person. _____

21. If I am to be a worthwhile person, I must be the best in at least one way. _____

22. People who have good ideas are better than those who do not. _____

23. I should be upset if I make a mistake. _____

24. My own opinions of myself are more important than others’ opinions of me. _____

25. To be a good, moral, worthwhile person I must help everyone who needs it. _____

26. If I ask a question, it makes me look stupid. _____

27. It is awful to be put down by people important to you. _____

28. If you don’t have other people to lean on, you are going to be sad. _____

29. I can reach important goals without pushing myself. _____

30. It is possible for a person to be scolded and not get upset. _____

31. I cannot trust other people because they might be cruel to me. _____

32. If others dislike you, you cannot be happy. _____

33. It is best to give up your own interests in order to please other people. _____

34. My happiness depends more on other people than it does on me. _____

35. I do not need the approval of other people in order to be happy. _____

36. If a person avoids problems, the problems tend to go away. _____

37. I can be happy even if I miss out on many of the good things in life. _____

38. What other people think about me is very important. _____

39. Being alone leads to unhappiness. _____

40. I can find happiness without being loved by another person._______

Dysfunctional Attitude Scale (DAS)    Author: Arlene Weissman

The DAS is a 40-item questionnaire that is designed to identify and measure cognitive distortions (irrational thinking), particularly distortions that may relate to or cause depression.

The items contained on the DAS are based on Beck’s cognitive therapy model and present 7 major value systems: Approval, Love, Achievement, Perfectionism, Entitlement, Omnipotence, and Autonomy.

Scoring: Any items that are missing, assign a zero. To obtain the overall score, simply add the score on all items (ranging from 1 to 7). When no items are omitted, scores on the DAS range from 40 to 280. Lower scores represent more adaptive beliefs and fewer cognitive distortions.

The higher your score, the more likely it is that your thinking is working against you and creating anxiety and depression. Be more aware of your thoughts and get into the habit of challenging their validity. Not every thought we think is true or is valid.

Mandy X

 

 

 

How to face your fears

 

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How to face your fears

What are you afraid of? Do you avoid relationships because you fear rejection? Do you avoid job interviews as you worry you will fail? Fear is everywhere but it’s mostly in our minds. I know that seems a contradiction but it is only when you face your fears that you will realise that fear exists mainly in our minds.

We have a choice about how we want to view things in life. We can see the world as a scary place where others can’t be trusted and people are out to get us, or we can accept that parts of life are like that but we can still carry on and live life without allowing self limiting beliefs to limit our opportunities.

When you face your fears, you break down the huge threat that exists in your mind (eg. I will never be able to do that, that person is better than me, no one will ever love me, I am not good enough to do that, I will embarrass myself, no one understands me, I am the only one who is alone etc) and you build up confidence in your ability to cope with the tough times and your fears.

How to face your fears

Make a list of the things you fear. For example: talking to a stranger, opening up to your partner, going to the gym, etc

Rate each fear out of ten. Ten being the most stressful, one being the least stressful.

Example: Speaking to someone on the phone  2/10

Go shopping when there’s lots of people          4/10

Speak to a stranger                                               6/10

Ask my boss for a raise                                        7/10

Being assertive with a friend                               9/10

Telling my partner how I really feel                    10/10

Start with the lowest rated fears and begin working your way up. It’s all about baby steps. The more you face your fears the less you will fear them. Either, the worst won’t happen as you probably worry about and even if it doesn’t go well, you will be challenging the fearful thoughts and showing yourself that you can still cope.

Each step requires repetition so do each one regularly. The more you do it the less it will create fear for you. The less we fear the more opportunities we get in life.

If you think you would find it difficult to try the above steps on your own, speak to a Cognitive Behavioural therapist who can help you through the process. I have done it and it works!

Mandy X

 

How to decatastrophise

 

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How to decatastrophise

We’ve all been there – something triggers us and we end up catastrophising and imagining the absolute worst case scenario. We make mountains out of molehills. Try out the techniques in this blog post to decatastrophise and get back to normality. One thought can sometimes spiral out of control and before we know it we have become homeless, bankrupt, single /and/or have imagined ourselves on our deathbed. Learn to deal with anxiety and stress in a calmer way and enjoy a less stressful life.

Steps to decatastrophise

Specify the catastrophic consequence clearly:

This has to be as specific as possible. “What if something bad happens?” is too vague.

Here are a few good examples:

What if my health never gets better?

What if my partner leaves me?

Losing my job

Change any “what if” statements into concrete declarations of fact:

Examples: My health will never get better

My partner will leave me

I will lose my job

Challenge the truth/validity of your statement:

Ask yourself if anything bad has ever happened before. Ask yourself how often this might happen or whether it is very likely to happen. Also ask yourself whether there is any clear evidence to suggest that your worry will come true.

Ask yourself what a friend might say if you told them about your worry. Are there any reasons to doubt your worry coming true?

Examples: My health is bad right now but I have been ill before and improved. The doctor said I had a good prognosis.

My relationship is going through a rough patch but that doesn’t mean my partner is thinking of leaving me. My partner has given me no indication that they might leave me.

I might be performing worse at work but losing my job is a big jump. Perhaps I am jumping to conclusions. There is no evidence that I am about to be fired.

Come up with three positive alternative statements:

My health will probably get better. I’m at my worst now – even if I don’t fully recover I’m likely to get better than I am now.

My relationship will survive this tricky patch

My job will still be there tomorrow

Remember that thoughts are not facts and there are times when we allow our thoughts to get the better of us and cause us great distress. Use the above exercise to restore calm to your mind and see things from a different perspective.

Mandy X