Cognitive behaviour therapy

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Post by Ruth Hennessy31 Aug 2012

Last week my workplace computer experienced problems and I discovered this article hadn't saved.

"NO! All that work gone! I can’t start again. I have too much to do and NOW the computer keeps freezing! %#@&! If I don’t get this done I will have to leave the country and move to Iceland where there is no beach and I like the beach . . ."

OK, I may have exaggerated the last bit. But you get the idea.

Did I sound panicked and annoyed? Well, I was. From a cognitive therapy point of view, I was ‘catastrophising’ — thinking along a theme of worse case scenarios in response to stress.

How did I deal with this stress? I whinged to a colleague. Their response? "How annoying, but I am sure you can remember what you wrote so it won’t take long to rewrite." Empathy and rationality. It was not the end of the world and I needn’t start packing for Iceland.

The more I focused on what I could do rather than what had happened, the more time I had to rewrite this article. And yes, it was a bit faster writing it AGAIN . . . (let it go, let it go).

I used cognitive behaviour techniques to address my ‘catastrophic’ thinking.

Cognitive Behaviour Therapy (CBT) is the most widely practised, evidence-based psychological treatment. It is used to treat everything from depression, anxiety and bipolar to eating disorders, chronic pain and alcohol and drug dependence.

While it may be delivered in different forms and levels, the fundamental strategies are always the same. CBT proposes that how we think about a situation and what we do have a significant influence on how we feel.

About one in four people will experience depression. There is no single cause of depression and it is generally viewed as a mix of genetic, chemical and environmental factors. One environmental factor might be how we have learnt to cope with life’s difficulties. Sometimes we can even see how this came about, e.g., "My mother used alcohol to numb pain. I use alcohol similarly."

Numerous studies have shown that people who experience depression have negative and unhelpful thoughts about themselves, the world and the future e.g., "I am unworthy, the world is terrible and the future looks hopeless." These negative thinking patterns are probably both a symptom of depression and an underlying vulnerability that predisposes someone to depressive episodes.

For example, if you think "I am a failure" this might trigger emotions of sadness or hopelessness. These emotions then motivate behaviours such as withdrawal and inactivity which then make you feel tired and irritable and shape more ongoing negative thinking. In this way, depression reinforces and maintains itself and can lead to what is called the vicious cycle of depression.

CBT suggests that we can learn to change our negative thinking and related behaviour toward feeling better.

While particular thinking patterns place people at risk of developing depression, CBT uses techniques to target these vulnerabilities, and one of these is called cognitive restructuring.

The objective in cognitive restructuring is to challenge this unhelpful thinking and to develop more realistic ways of thinking. It involves testing your negative assumptions and the way you might exaggerate your difficulties. In CBT, people are taught to identify and review unrealistic beliefs , e.g., what is the evidence both for and against my beliefs? What are some other perspectives?

Another source of change in CBT is behaviour experimentation. CBT logic suggests that if we behave differently we will feel differently. So, people are simply encouraged to do things differently. For example, research is clear about the benefits of activity in treating depression. In fact, the lift in mood you get with exercise is as good as any antidepressant. This is not only because of the feel-good chemicals we release during exercise but also the shift in focus we experience. We focus on the activity, not on our unhappiness and feel satisfaction at doing something healthy.

Here are a couple of snapshots of CBT at work:

PETER says he "hates being gay" because "all gay men are shallow as they are only after sex". He can easily find examples to support his beliefs — media, internet sites, unwanted approaches, etc. He feels angry at himself (for "being gay"), at the gay world (for "being shallow") and sadness at the thought of "being alone because I am different".

Peter responds defensively and angrily in social situations.

However, he says he wants to be less angry so he agrees to try doing the opposite of scowling and to practise acting/mimicking feeling less angry. Although he feels like he is grimacing, he plasters a smile on his face.

He also agrees to actively look for examples contrary to his beliefs. He discovers he can easily find examples of non-sex-seeking/non-shallow gay men if he stops logging onto internet sites and looks elsewhere.

Peter is surprised to find these strategies help lift his mood.

Energised, he agrees to attend a gay men’s yoga group and develops a friendship. Although his friend pursues him for sex, their shared interests and intellect encourage the friendship. By engaging in less isolating viewpoints and behaviours, Peter feels less angry and alone.

MARTIN has a (non-HIV related) degenerative neurological disease that leads to loss in physical movement and he has begun to struggle with anxiety.

Any physical mishap and his mind races with alarm: "Is my disease getting worse? Is this the downhill slope?"

Visions of potential future incapacity overwhelm him and he feels helpless. Daily experiences are becoming unpleasant.

Cognitive restructuring suggests he answer his own fears, test their truth and deal with the answers. So, he sees his specialist regularly and his brain scans show no significant change. He is reminded that everyone will fumble at times.

Upon reflection, Martin decides that many fumbles are probably a normal part of ageing rather than a sign of deterioration; and that he can accept a fumble as just a fumble and not have to add any fearful meanings and generate panic.

It was also suggested that his future-based thinking was encouraging him to live his prognosis prematurely. The rational mind recognises the present moment as the only place we can act . . . so, he agrees to practise bringing his attention to the present.

The following are Martin’s words and are a wonderful example of a resilient focus.

"I was noticing some pretty normal stuff-ups for a man of a certain age, but given my prognosis, I was letting these little annoyances cloud my thinking. I was seeing them as the arbiters of the fate I will have to face. It is early days yet, but rather than thinking about what may be going to happen somewhere down the track, I find myself practising bringing myself back to the moment. I walk most mornings and enjoy so many little things on these excursions. I used to take these moments for granted. But these are the simple things of life . . . and in the end they are the fabric of our life."

Ruth Hennessy is a Senior Clinical Psychologist and the Psychology Unit Manager at the Albion Centre in Sydney. She has extensive experience counselling people with HIV and training healthcare workers in the sector both here and overseas.