Cognitive Therapy Basics

Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.

In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health. 

 Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”

 Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.” 

Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain

The following ideas are some guidelines for managing pain more effectively

·         Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?

·         Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish

·         Use various activities to refocus away from your pain. Dwelling on pain makes it more    painful. Stretching, music, swimming, meditation, and other activities are important

·         Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management

·         Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments

·         Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.

Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.

In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health. 

 Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”

 Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.” 

Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain

The following ideas are some guidelines for managing pain more effectively

·         Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?

·         Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish

·         Use various activities to refocus away from your pain. Dwelling on pain makes it more    painful. Stretching, music, swimming, meditation, and other activities are important

·         Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management

·         Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments

·         Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.

Sometimes people ask me why I spend so much time on what generates panic attacks. My usual response is, beyond my natural curiosity, I simply don’t see how one can manage something if one doesn’t fully understand just what that something is. And, at least to me, a complete understanding has to include insight into genesis. I mean, if you were experiencing chronic chest pain, wouldn’t you want to know what was causing it? And let’s no forget that knowing why something happens leads to more efficacious management strategies and techniques.

I have always placed emphasis on both the psychological and physical contributors to panic attacks. But, in this article I’d like to stick with the psychological and address two theories of treatment. Needless to say, there are many floating about; however, I’d like to briefly discuss the psychoanalytic and cognitive points of view with regard to the generation of panic attacks.

Psychoanalytic

A psychoanalyst would likely submit the generation of panic attacks goes back to infancy and childhood. They would, however, acknowledge that panic attacks may also occur as a result of assorted cues in the present, such as the fear of having a panic attack in a situation where one recently occurred. For the record, an attack occurring within this context could either be situationally-bound or situationally-predisposed. The psychoanalysts consider both conscious and unconscious panic triggers as representations of intense early life wishes and fears. So, panic attacks, in large part, occur in response to cues associated with long past psychological and biological threats to one’s existence. By the way, these cues are based in retained themes of intensely feared eventualities such as castration, separation, and parental disapproval.

Cognitive

A cognitivist would likely submit that a panic attack is a manifestation of an intense feeling of helplessness in the face of intense danger. The vicious cycle of panic, which we know all too well, is generated and sustained by combining the very real terror of vulnerability with one’s traditional distorted thought and feeling responses. Within the context of human genetic predisposition, which from a phylogenetic perspective leans toward the anxious for purposes of survival, it naturally flows that these thought and feeling responses appear to be designed to produce the belief that out-of-control internal distress can lead to grave danger, even disaster. Doesn’t it make sense that it’s this dynamic that so often generates the intense need to seek a caregiver for immediate assistance? I mean, at this point all bets on reason and logic are absolutely off as our primal instincts take over. And then all sorts of physical symptoms arrive on the scene because our mind really believes we’re in imminent danger, and it’s getting us ready to fight the good fight. And the snowball just rolls on down the hill from there.

Finally, the cognitivists would likely submit that though panic attacks are often thought of as spontaneous, some sort of event had to have tripped the trigger. Who knows, the culprit may have been a sudden physiological change; say, feeling faint upon standing, sensing a rapid or palpitating heart beat, or detecting a shortened breath. The thought is that events such as these, in the absence of reason, are interpreted as indicators of immediate physiological danger. And, boom, off to the races we go.

It’s my belief that, individually, both the psychoanalytic and cognitive angles hold great merit. But, for my money a combination of the two is truly the ticket. I mean, so okay, according to the cognitivists a physiological change, such as a shortened breath, may trip the panic trigger. Well that’s great; however, I’d like to know what existed unconsciously that led to the perception that that shortened breath was a signal of coming catastrophe. Hmmm.

As always, the more we understand about our circumstances, the better we become at managing them.

Fibromyalgia syndrome (FMS) is the medical terminology used to represent a complex clinical disorder of symptoms characterized by soft tissue pain, stiffness, and altered deep pain threshold with psychological fallout.  It can mimic or accompany symptoms of joint injury, but it is not an arthritic or neurological condition.  The disorder affects between 3 to 6 million people – or as many as one in 50 Americans.  About 80 and 90 percent of those diagnosed with fibromyalgia are women. 

There is usually an emotional overlay of depression and anxiety that affects the sufferer.  There are numerous reasons why this is true.  Many within the medical community have discounted fibromyalgia as a bona fide disease.  Patients have been told that they are over-dramatizing their pain and that the stiffness or soreness has been psychologically induced.  Others have been told that the condition was fabricated for attention or perceived by health providers as feigned helplessness.  These assertions from medical experts make patients with FMS feel ignored, mistrusted, alone and without support.  Patients often turn to self-blame, which fuels the pain cycle.The pain and symptoms of fibromyalgia are real and have a definite physical basis. There is no known cause for fibromyalgia.  Some researchers have speculated that physical trauma or viral influences have triggered FMS syndrome in many patients.  There are no known abnormalities in the muscle tissue of fibromyalgia patients that would account for the disease.

Current research has focused on regions of the FMS patient’s brain and the susceptibility of certain brain locations to pain sensitivity.  The brain receives a pain signal from the muscles and stays in a state of alert.  For unknown reasons, the brain fails to let go of the pain signal and sets up a chronic pattern or pain syndrome.  The brain stays in a constant feedback loop, consisting of a system of amplified pain signals.

Recent brain scan research studies have shed new light on this disorder.  Results published in the May 2008 edition of the Journal of American College of Rheumatology shows that neuroscientists have been able to conduct scanning technology to areas of the brain affected by fibromyalgia.  Mild pressure on trigger points of the patient has produced measurable brain response in processing the sensation of pain.  The elevated response of pain in FMS patient’s brain scans was significantly different from those in the control group of the study.  This is one of several studies that validate the reality of fibromyalgia as a disorder affecting the brain’s response to muscular and neuropathic pain.  Hopefully, future studies will lead to new treatment options.

Currently, treatment options consist of the use of a multidisciplinary approach.  Medication management, physical therapy, meditation, exercise, alternative therapies, and cognitive-behavioral therapy are useful.  CBT is a valuable therapeutic treatment option for those suffering from pain syndromes.  One of the byproducts of pain can be the escalation of anxiety and depression.  Likewise, anxiety and depression can intensify the impact of pain and make it more debilitating.

Cognitive-behavioral therapy’s goal is to teach the FMS patient to embrace pain rather than fight it.  Cognitive distortions, such as magnification and “catastrophizing” need to be addressed so that patients learn to de-escalate fueling the pain process.  How one thinks about his pain affects its impact.  One can learn to rationally respond to pain by sayin

Cognitive-behavioral therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain.  This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior.  Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial.

Through the use of CBT, a therapist can provide the fibromyalgia patient with structured homework assignments that will help pain sufferers to experiment with new behaviors such as increased involvement and activities.  Motivating the client to set realistic goals for everyday functioning can be helpful.  Encouraging a multidisciplinary approach involving exercise, physical therapy, rehabilitation and pain management are essential.

Fibromyalgia patients fear that their disorder will cause them to lose the ability to function at work and at home.  Teaching patients to focus on what they can do rather than their limitations is important.  There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive.  Helping the patient and family to accept physical limitations is a necessary component to successful treatment.

Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms.  It is the goal of cognitive-behavioral therapy to assist the patient in coming to terms with his disorder and making plans to manage it.  This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it.

Have you ever wondered how your thoughts and emotions have affected your behaviour? Or whether thoughts and behaviour are inter-related? Is it possible that what you think consciously or unconsciously can actually influence your life and even the lives of those around you?

Often the problems that we face in our lives are because of negative or faulty thought patterns that manifest themselves in our day to day behaviours and we are unable to recognise it. Thus we are trapped in the vicious circle of negative thoughts leading to negative behaviours which again causes negative thoughts. So how do we correct these faulty thought patterns and make life better? The answer lies in Cognitive Behaviour Therapy.

Cognitive Behaviour Therapy is a form of psychotherapy which emphasizes the importance of thinking and how it affects our emotions and actions. It is based on the idea that our thoughts influence our actions, our moods, our feelings and our emotions. External things like people, situations, and the environment are not the cause of our problems. Thus if you correct your way of thinking and make a change in yourself you can cope better with the same people and situations and function better in the same environment.

Cognitive Behaviour Therapy is one of the shortest forms of therapy available, in terms of time and effective results. An average of 16 sessions or lesser is required depending on the problem. The whole therapy process is structured and goal-oriented.  The therapist and the client collaborate on the goal of the therapy, and the decision to terminate the therapy when it has been achieved. What makes it very effective is the fact that each session has a goal which is decided by the therapist and the client. They have to work on the techniques in that session to reach an outcome, and proceed likewise in each subsequent session. Therefore in each session the therapist guides the client towards his goal by teaching him alternative or new ways to think and behave to achieve what they want.

Often our behaviours and thoughts are learnt, so we need to unlearn the faulty thought patterns and relearn the correct thought and behaviours. The therapist educates and aids in this process. Once the person understands why and how he is doing a particular action the sooner he can change it and learn a new action. This can be a time-consuming process thus we have a feature unique to Cognitive Behaviour Therapy, known as the Homework to speed it up. At the end of each session the therapist assigns the client to practice the techniques taught in the session and give some additional reading and exercises to be done. This helps in reaching the goal faster.

Empirical evidence has shown this therapy to be effective in problems ranging from Anxiety, Depression, Eating Disorders, Stress, Marital problems, Relationships etc. So Cognitive Behaviour Therapy is an effective therapy to solve your problems by yourself, make a change and enhance the quality of your life.