Cognitive Therapy Basics

People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work.
People with GAD cannot get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They are unable relax, startle easily and have difficulty concentrating.
Physical symptoms that often accompany the anxiety include, but are not limited to, fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath and hot flashes.
GAD affects about 6.8 million Americans and about twice as many women as men. It comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.
It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.
Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. It is commonly treated with medication an/or cognitive-behavioral therapy.
Treatment of Anxiety Disorders
Anxiety disorders are typically treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the persons preference.
Before treatment, a doctor must conduct a careful diagnostic evaluation to determine whether the symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder must be identified, as well as any coexisting conditions, such as depression or substance abuse.
Sometimes alcoholism, depression or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
People with anxiety disorders who have already received treatment should tell their current doctor about that treatment.
If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether it was ever increased or decreased, what side effects occurred and whether the treatment helped them significantly. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions and how much the therapy helped.
Often people believe that they have failed at treatment or that the treatment did not work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations before they find the one that works for them.
Medications
Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy, often from a psychologist. The principal medications used to treat anxiety disorders are antidepressants, anti-anxiety drugs and beta-blockers which control some of the physical symptoms.
With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.
Antidepressants
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.
SSRIs
Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil) and citalopram (Celexa) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. These drugs are also used to treat panic disorder when it occurs in combination with OCD, social phobia or depression.
Venlafaxine (Effexor), a drug closely related to the SSRIs, is also used to treat GAD. These medications are started at low doses and gradually increased until they cause side effects or produce a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time, however.
Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another medication.
Tricyclics
Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased.
They sometimes cause dizziness, drowsiness, dry mouth and weight gain, which can usually be corrected by changing the dosage or switching to another medication.
Tricyclics include imipramine (Tofranil), which is prescribed for panic disorder and GAD and clomipramine (Anafranil), which is the only tricyclic antidepressant useful for treating OCD.
MAOIs
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications and the ones most commonly prescribed for anxiety are phenelzine (Nardil), followed by tranylcypromine (Parnate) and isocarboxazid (Marplan), which are useful in treating panic disorder and social phobia.
People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil, Motrin and Tylenol, cold and allergy medications and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure.
MAOIs can also react with SSRIs to produce a serious condition called serotonin syndrome, which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm and other potentially life-threatening conditions.
Anti-Anxiety Drugs
High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can develop a tolerance to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol or who become dependent on medication easily.
One exception to this rule, however, is people with panic disorder, who can take benzodiazepines for up to a year without harm. Clonazepam (Klonopin) is used for social phobia and GAD, lorazepam (Ativan) is helpful for panic disorder and alprazolam (Xanax) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.
Buspirone (Buspar), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Psychotherapy
Psychotherapy involves talking with a trained mental health professional, such as a psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears and the behavioral part helps people change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes.
People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened.
People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face.
Group therapy is particularly effective for social phobia. Often homework is assigned for participants to complete between sessions.
There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.
Taking Medications
Before taking medication for an anxiety disorder:
1. Ask your doctor to tell you about the effects and side effects of the drug.
2. Tell your doctor about any alternative therapies or over-the-counter medications you are using.
3. Ask your doctor when and how the medication should be stopped. Some drugs cannot be stopped abruptly but must be tapered off slowly under a doctors supervision.
4. Work with your doctor to determine which medication is right for you and what dosage is best.
5. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
How to Get Help for Anxiety Disorders
If you think you have an anxiety disorder, the first person you should see is a psychologist, psychiatrist or your family doctor. It must be determined whether the symptoms that alarm you are due to an anxiety disorder, another medical condition or both.
If an anxiety disorder is diagnosed, the next step is usually contracting with a mental health professional to provide treatment. The practitioners who are most helpful with anxiety disorders are psychologists and therapists who have training in cognitive-behavioral therapy and/or behavioral therapy and who are open to using medication if it is needed.
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere.
Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder.
Remember that once you start on medication, it is important not to stop taking it abruptly.
Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur. Make sure you talk to the doctor who prescribed your medication before you stop taking it.
If you are having trouble with side effects, it is possible that they can be eliminated by adjusting how much medication you take and when you take it.
Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out.
If you do not have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.
Ways to Make Treatment More Effective
Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common.
Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a psychologist or other mental health professional. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of their therapy.
There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs and even some over-the-counter cold medications can aggravate anxiety disorders, they should be avoided.
Check with your physician or pharmacist before taking any additional medications. Also, the family is very important in ones recovery. Ideally, the family should be supportive and should not trivialize the disorder or demand improvement without treatment.

Anyone who has ever had a panic attack knows how life stopping these events can feel. A panic attack can seriously hurt your quality of life by causing you become terrified of a repeat episode. This terror is just another negative side effect of panic attacks, and you should learn to think of it as such so that you can get on with your life without the constant fear of a panic attack hanging over your head. Worrying about having a panic attack all the time might even cause you to trigger panic attacks later.

Panic attacks feel a lot like heart attacks. A panic attack might cause your heart to race, and it might cause you to become short of breath. You might find that you feel dizzy or light headed, and they are characterized with the feeling of life or death importance. It is not uncommon to believe that you are dying or about to die when you are having a panic attack. Fortunately for sufferers, they are usually not of a long duration, and will stop when they have run their course, usually a few minutes, or when the cause of the panic is removed.

If you are terrified that you might have another panic attack, you may just end up cutting yourself off from everything in order to avoid having another. You might hide from the world, or otherwise separate yourself from the friends and family who might otherwise be able to help you. If this sounds familiar to you, then you need to consider seeking professional help to empower you to dispel the threat of panic attacks that hangs over your head.

You may also be able to help yourself by avoiding the situations that cause you to have your panic attacks in the first place. One of the biggest causes of panic attacks is stress, and if you are constantly in stressful situation, then you will be at a much higher risk for panic attacks in the future. This stress is not necessarily the stress that comes over a few days over a particular event; panic attacks are triggered by constant stress over a period of months or sometimes even longer. This stress is often too much for people to bear, and even if we do not realize that, our bodies do, and they rebel.

Panic attacks can also be caused by certain situations. If you get a panic attack every time you are running late, or stuck in traffic, or going over a bridge, then you need to make sure to avoid those situations to prevent these same events from triggering more panic attacks in the future. You can take a different route to work, leave early, and avoid roads that you know will be snarled with traffic or even head to a local place for dinner after work before facing the drive home.

If you practice avoiding panic attacks and chart where you were, what you were doing, and how you felt immediately prior to each panic attack, then you can use this information to avoid the things that trigger you. You may be able to save yourself a lot of trouble with your mental and even your physical health later down the road.

Panic attacks do not just feel remarkably like heart attacks; recent studies have linked experiencing panic attacks with an increased likelihood of actually having a heart attack later. Keep your odds low and keep your stress levels down to avoid panic attacks and to remain as healthy as possible. No one likes to suffer, and panic attacks certainly fall into the category of suffering.

If you are at risk for panic attacks or you have had them in the past, then you should examine the past causes of your panic attacks so that you can help yourself to avoid similar situations in the future. You should also get in contact with your doctor to find out if you may need medication or therapy to help you take charge of your life and get away from the panic attacks. It can be difficult to determine exactly the best means of preventing panic attacks, but you may get better results when pairing the practice of avoiding triggers with medication to help you feel calmer. A therapist can also help you learn mental tricks to help you ride through the panic attacks without completely losing your cool the next time you feel one coming on.

The most obvious dysfunctional behaviors you will be helped to eliminate are panicking at the first sign of trouble, indulging a pessimism that seems to have a life of its own, using irrational stubborn behavior and having a mindset of HAVING to be right!
Some other defense mechanisms to avoid include blaming others, losing your temper, talking more than listening and using mind-altering substances to reduce anxiety.
It will take work and deliberate effort to remove them from your life but if you do not work on changing these behaviors now you will be prolonging your treatment time.
If you would like more rapidly successful therapy, develop a chart to monitor your progress in reducing these behaviors and work it seriously. Counseling and therapy are often associated with a person who is troubled but intelligent and desirous of enhancing his or her quality of life.
The IQs of those entering therapy are sometimes much higher than those who do not. Similarly, counseling for adults can be easier than for teens; the latter have dysfunctional ways of coping of which they are unaware and sometimes their ability to reflect on their emotions is limited or seems overwhelming.
In some serious cases, patients have to take anti-depressant or anti-anxiety medication along with their counseling and psychotherapy. The most popular kind of counseling today is called cognitive-behavioral.
This type of therapy can sometimes achieve positive results in 3 to 6 months. Patients are taught to become aware of their subconscious thoughts that cause painful feelings or behavioral symptoms.
Also, reviewing your familys history of problems can speed things up by helping you to become even more aware of thoughts and behaviors that have been passed down from generation to generation in your family. Some of your resulting insights will be startling.
How about a technique that could help you replace the family symptoms with more constructive behavior? Sound good? Well, cognitive re-structuring will help you with that.
This technique inventories the subconscious thought patterns you received inadvertently from your family that cause your rage, depression and anxiety to rear their ugly heads. The therapist helps you to discover these unhealthy thought patterns and helps you to almost magically transform them so that your rage, anxiety and depression are eliminated.
This counseling technique is also safe, because it is drug-free and when used by a professional counselor, it virtually has no side effects. Writing your thoughts down two or three times a day, then discussing them with your counselor or psychologist can help minimize and re-shape, if not eliminate, these unhealthy thinking patterns and the anxiety that is caused by them.
Also, practicing time-tested relaxation exercises can help if you are having serious anxiety problems, such as panic attacks or irrational fears. It is likely that genes can play a not insignificant role in the development of your vulnerability to episodes of anxiety or depression.
Some researchers believe that there are certain genes that affect a persons likelihood of developing emotional problems. Some believe that the connection is how certain people metabolize various chemicals and hormones that are related to emotional reactivity; rates and efficiency of their metabolism may be impaired in these people, causing more emotional discomfort.
Stress is clearly related to anxiety and is something that cannot be avoided. It is an everyday circumstance and may arise in any given situation.
Though the link between severe stress and heart attack is established, other dysfunctional behaviors have recently been linked to it: chronic rage and anger.
Although the relationship is somewhat hazy, researchers are learning more about it.
One theory is that anger causes the bodys nervous and circulatory systems to prepare to fight danger, causing blood vessels to constrict, blood pressure to increase and the heart to work harder. This might cause cardiac stress which would be sufficient to lead to a heart attack.

“A narrative or story is anything told or recounted; more narrowly, something told or recounted in the form of a causally-linked set of events; account; tale, the telling of a happening or connected series of happenings, whether true or fictitious” (Denning, 2006).

Your life is a narrative, counted and recounted from many different perspectives, and by diverse people. There are settings, themes, characters and plots – just like in any movie, book, historical account or legendary fable.

In this article we review the approach of Narrative Therapy and how it can be effectively used by counsellors to assist individuals improve their lives.Fundamentals of Narrative Therapy

The Narrative Therapy is an approach to counselling that centres people as the experts in their own lives. This therapy intends to view problems as separate entities to people, assuming that the individual’s set of skills, experience and mindset will assist him/her reduce the influence of problems throughout life. This therapeutic approach intends to place the individual in both the protagonist and author roles: switching the view from a narrow perspective to a systemic and more flexible stance.

Systemic and flexible stance? Yes. The aim is to help clients realise what forces are influencing their lives and to focus on the positive aspects of the ‘play’. In many events of our lives, we tend to focus on particular things and ignore others. Analysing our lives as a play, or a system, helps us understand the different forces and roles that are influencing our behaviour. This in turn gives us flexibility to invoke the necessary changes for improvement.

“The products of our narrative schemes are ubiquitous in our lives: they fill our cultural and social environment. We create narrative descriptions for ourselves and for others about our own past actions, and we develop storied accounts that give sense to the behavior of others. We also use the narrative scheme to inform our decisions by constructing imaginative “what if” scenarios. On the receiving end, we are constantly confronted with stories during our conversations and encounters with the written and visual media. We are told fairy tales as children, and read and discuss stories at school.” (Polkinghorne, 1988)

Merging a familiar set of events (one’s life) to a familiar structure (a narrative story) is a useful strategy. The emotional, cognitive and spiritual perspectives of a person are usually combined in order to derive meaning to an event. In many instances, one or two perspectives will prevail over the other(s), and this will depend upon the particular scenario and the individual’s personality traits.

As an example, we can compare the perspective of two people who have different levels of emotional intelligence. According to Coleman (1998) “intellectual and emotional intelligence express the activity of different parts of the brain. The intellect is based solely on the workings of the neocortex, the more recently evolved layers at the top of the brain. The emotional centers are lower in the brain, in the more ancient subcortex.” Thus, individuals that are more ‘emotionally intelligent’ will draw different conclusions, and behave differently in certain situations.

This is only an example of possible disparities in perception and decision-making. It is the protagonist responding to the setting, the characters, the theme and plot.Techniques and Objectives

“The techniques that narrative therapists use have to do with the telling of the story. They may examine the story and look for other ways to tell it differently or to understand it in other ways. In doing so, they find it helpful to put the problem outside of the individual, thus externalizing it. They look for unique outcomes: positive events that are in contrast to a problem-saturated story.” (Sharf, 2004)

Externalising the Problem

In Narrative Therapy the problem becomes the antagonist of the story. Certain behaviours are based on particular ‘unhealthy’ or ‘undesired’ characteristics – such as lack of patience, aggressiveness, etc. Thus, they are approached as not a part of the client but as an opposing force which needs to be ‘defeated’. An example would be a child that has a very bad temperament and tends to be aggressive to other kids at school and his parents. The child might feel guilty for his temperament and blame it on himself (“I don’t know… it is the way I am…”). The counsellor will work with him towards isolating that undesired trait (aggressiveness) and placing it as an external trait – not a characteristic of the individual.

This strategy helps clients re-construct their own stories in a way which will reduce the incidence of the problem in order to eliminate negative outcomes and reinforce personal development and achievement. The protagonist becomes the author and re-writes the story constructively.

Unique Outcomes

If a story is full of problems and negative events, the counsellor will attempt to identify the exceptional positive outcomes. When exploring unique positive outcomes in the story, the counsellor will assist the client in redeveloping the narrative with a focus on those unique outcomes. This assists the client in empowering him/herself by creating a notion that those unique outcomes can prevail over the problems. Think about this analogy: you are a novel writer. You were given a novel to review and publish the way you prefer. You have read it and found it generally poor, but there were some interesting ideas which you liked. You selected these ideas, and re-write the novel around them. You can make a flawed story become a bestseller.

Alternative Narratives

The focus of Narrative Therapy is to explore the strengths and positive aspects of an individual through his or her narrative. Therefore, the main objective of this therapeutic approach is to improve the person’s perspective internally (reflective) and externally (towards the world and others). Alternative narratives are a simple way to relate to this concept. This technique works in combination with unique outcomes. How? The individual will reconstruct a personal story using unique outcomes, therefore, focusing on the positive aspects of a previous story in order to achieve a desired outcome. This process is based on the premise that any person can continually and actively re-author their own life.

By creating alternative perspectives on a narrative (or event within the narrative) the counsellor is able to assist the client in bringing about a new narrative which will help combat the ‘problems’. This is similar to Cognitive Behavioural Therapy as it aims to create a positive perspective of an event.Boundaries of Narrative Therapy

Despite being a widely used approach, particularly when combined with other therapeutic approaches, Narrative Therapy has certain boundaries or limitations. In many occasions, diverse clients may expect the therapist to act as the expert, instead of having to ‘conduct’ the conversation themselves. For this reason, Narrative Therapy can be challenging when the individual is not articulate. Lack of confidence, intellectual capacity and other issues could also undermine the expression of the individual through a narrative.

Another common boundary of Narrative Therapy is the lack of recipe, agenda or formula. This approach is grounded in a philosophical framework, and sometimes can become a particularly subjective or widely interpretative process.The Leading Role

The most important aspect of Narrative Therapy is to empower the client. Placing the client as an expert, and understanding his/her story instead of attempting to predict it, indicates the therapist’s mindset. The idea is to emphasise the therapeutic relationship, in particular the therapist’s attitudes. This standpoint encompasses many of the important aspects of good interpersonal communication, such as: demonstration of care, interest, respectful curiosity, openness, empathy, and fascination.

Once this collaborative relationship has been established, the counsellor and the client can move forward and work on how to improve the outcomes of the narrative:

“Once upon a time… there was an optimistic, content and productive person…”

References:

Coleman, D. (1998). Working with Emotional Intelligence. (1st Ed.). London: Bloomsbury Publishing.

Denning, S. (2004). Steve Denning: The website for business and organizational storytelling. (www.stevedenning.com/What_story.html)

Polkinghorne, D. (1988). Narrative Knowing and the Human Sciences. Albany N.Y.: State University of New York Press

Sharf, R. (2004). Theories of Psychotherapy & Counselling. (3rd Ed.). Pacific Grove, CA: Thomson Learning.Subscribe to our FREE eZine.

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Emotional stress is someth ing that we all experience when we have to cope with the many demands and responsibilities of home and work. Stress can be defined as an intense emotional and physiological reaction to a situation or the mental representation of a situation as a memory or anticipation. Chronic stress is produced when stress reactions do not resolve themselves and become habitual. The sustained physiological effects of chronic stress can have a serious effect on the body and lead to an increased risk of disease. The psychological effects of chronic stress produce fatigue, poor concentration and an impaired ability to perform tasks, which leads to more stress. Stress produces a general feeling of helplessness and negativity, both of which reinforce the stress reactions. This produces a lack of vitality, enthusiasm and creativity and many people describe chronic stress as a heavy blackness that covers everything and in its severe form, chronic stress leads to depression. Chronic stress can result in an increased chance of accidents as well as reducing work performance. Chronic stress also reduces our listening and learning skills and this reduces the quality of communication in our personal relationships and family.

It is well recognized that stress reactions are learned and originate from the influence of our own mental outlook and from belief patterns acquired from our parents, family and culture. Stress always contains both an objective component and a subjective component and in most situations, it is the habitual subjective emotional reactivity that generates the emotional tension and physiological characteristics of stress. There is pain and there is suffering. Pain is the objective component that is often inevitable or unavoidable, but suffering is a subjective reaction that we generate and add to the pain. The Buddha described this subjective suffering as dukkha and not surprisingly, mindfulness, which is one of the central teachings of the Buddha, was and continues to be very relevant for working with and resolving emotional stress.

The other major source of stress comes from unresolved traumas that result from physical injury, assault, domestic abuse and violence. In general this kind of trauma-related stress results from experiences and associated emotional reactions that we cannot process, because they are outside of our normal range of experience. These unresolved wounds become repressed and submerge into the subconscious mind where they continue to simmer and generate a generalized anxiety. This is described as post-traumatic stress disorder (PTSD). Occasionally, in severe cases of PTSD resulting from war or other intense situations, the stress reactions will erupt as nightmares and flashbacks in which the individual re-lives the trauma.

Whatever the source of the stress reactions, it is important to understand that each reaction has an internal structure in the form of negative thoughts and beliefs and associated emotional energy that gives power to these thoughts. It is often very helpful to examine these negative thoughts and try to change them. This is the approach taken in Cognitive Behavioral Therapy. Another approach is to change the emotional energy that empowers the thoughts and beliefs, because without this compulsive charge, the beliefs will have no power to generate stress. This is the approach taken in MMT. Through careful attention and investigation of the emotion through mindfulness, we can uncover the internal structure of the emotion and discover what needs to change. As the structure changes, so does the emotion. Resolve this and you will neutralize the stress reactions.

OVERCOMING STRESS REACTIONS: THE FOUR Rs

Stress is generated by habitual emotional reactions to external events and internal beliefs. These patterns of negative thinking can be changed by the application of the four Rs, which are the primary focus of MMT. These are: RECOGNITION, REFRAMING, RELATIONSHIP, RESOLUTION.

RECOGNITION

All habitual emotional reactions rely on two key elements: ignorance and emotional energy. The first task in MMT is to learn to recognize our stress reactions as they arise in stressful situations. We train ourselves to watch very carefully for any impulse to react. This counteracts the automatic and mechanical part of what makes reactions habitual. The maxim of MMT is that all change begins with mindfulness and mindful-recognition is the first and most important step. You know what pushes your buttons. It might be in your personal relationships with your partner or with your children or perhaps with your parents. One of the most important steps you can take on the path of self-transformation is to take the initiative to examine what stressors cause you to react and to learn to recognize your impulse to react. This is very empowering and changes your attitude from being a victim to being a warrior. For most of the time, most of us react out of habit and have no awareness of what is happening while it is happening. We are simply seduced into the same automatic patterns of reactive thinking over and over again. Clearly, the first step is to break this pattern of ignorance and know what is happening as it happens. This is the fundamental first part of mindfulness. Mindfulness means to be present for experience as it is unfolding.

REFRAMING

Now you are learning to recognize anger reactions, disappointment and frustration reactions, fear and anxiety reactions as they arise in real-time. This new awareness can be very transformational by itself by simply making you conscious of what you are doing. It is a truth that what you don’t see is what has the greatest power over you. Awakening to what is happening is therefore the first step to change.

The next step that paves the way for transformi ng the emotional energy that powers stress reactivity is to change your relationship to the emotion. Our usual response is to say I am angry or I am afraid or I am upset and we literally become the emotion. Contrast this to saying I notice anger/fear/upset in me. Now the emotion becomes reduced to an object, not me, that I can relate to with mindfulness. This simple reframing of how we perceive an emotional reaction – as me or as an object that has arisen in me is itself transformational.

RELATIONSHIP

However, what keeps a reaction alive is the associated emotional charge, without which the reaction would have no power to cause stress. MMT teaches us how to form a non-reactive relationship, the Mindfulness Based Relationship, with this underlying emotional energy that compels us to react. This is the RELATIONSHIP phase of MMT.

The mindfulness relationship is very important. This is where we allow ourselves to open our awareness and investigate the emotional energy, which is quite different to our usual reactions of ignorance, avoidance or aversion. We choose to be fully present with the inner feelings behind the stress reactions, rather than getting sucked into the content and story line. Just as in personal relationships, it is the quality of our PRESENCE, our ability to listen with an open mind and heart that is most important. Now we are learning to cultivate this same presence for our inner emotional stress. The nature of the mind is such that if you allow things to change, they inevitably will. If you allow things to change and unfold into this safe spaciousness of the mindfulness-based relationship, things will change in a beneficial direction that will transform and resolve the inner conflict and pain. It is the habitual reactivity that stops this natural healing and as we learn to disengage from the patterns of reactivity we create the right conditions in which emotional tension will resolve itself.

RESOLUTION

Mindfulness creates a therapeutic space that allows the emotion to unfold and undergo transformation. If you give it space it will change. This is one of the great discoveries made by the Buddha, 2500 years ago and which we are rediscovering today. It is not what we do that matters as much as how we relate to our emotional stress. When this relationship is based on the receptivity and openness of mindfulness, then we create the best possible conditions in which emotional tension can resolve itself.

Resolution can be understood as the process in which a stress producing emotion like anger or anxiety or disappointment undergoes a process of unfolding and differentiation. When we investigate anger with mindfulness, we begin to see that the anger is actually an assembly of more subtle content – the inner structure – in the form of feelings, memories, sensations and often some form of inner imagery that pulls all these parts together into the form of an emotion. The anger differentiates into feelings of sadness, emptiness, fear. With intense stress reactions resulting from trauma, we will likely notice vivid inner imagery. It is by uncovering the internal structure of the emotions and associated imagery that change becomes possible and mindfulness provides one of the best ways of cultivating a safe relationship with painful content by teaching you how to stay present and avoid becoming reactive to what you are uncovering.

Through becoming conscious of the inner structure of the emotions that power our stress reactions, the emotional energy will change and resolve. Without this emotional power, there is nothing to sustain the emotional reactions and life-long patterns of stress producing reactivity begin to dissolve, leaving you free from their compulsive grip. Like the petals of a lotus bud that were previously held and constrained so tightly, the mind begins to explore a new freedom with all its possibilities and choices. This is the freedom that the Buddha talked about and that is possible for all of us to discover through the practice of mindfulness. MMT teaches you how to apply mindfulness to resolve your patterns of habitual reactivity so that you can realize your full potential and enjoy your life and relationships to the full.

Peter Strong, PhD is a scientist and Buddhist psychotherapist who specializes in the study of mindfulness and its application in Mindfulness Meditation Therapy. Peter teaches mindfulness meditation (vipassana) and works with individuals and couples using Mindfulness Meditation Therapy for resolving difficult emotional problems including anxiety, depression, phobias, grief and trauma and the management of anger and stress. Besides face-to-face work, Peter also works with individuals and couples online via email and web conferencing. To learn more visit http://www.mindfulnessmeditationtherapy.com/

Email enquiries welcome.

Before understanding what therapy is about, one must first understand what the word means. As is the case with many medical terms, therapy was derived from a Greek term and is the attempt of treating a problem a patient is diagnosed with. In plain and simple terms, therapy means treatment. Treatment can take the form of certain prescriptions or exercises, depending on the problem.

What are the specific forms that therapy can take? Believe it or not, there are so many types of therapy a person could easily write a book on it. There are therapies that deal with both mental and physical issues. Therapies that deal with the psychological aspect include art therapy, behavioral therapy, cognitive analytical therapy, cognitive behavioral therapy, counseling, and occupational therapy.

Art therapy is what some patients may participate in to find a better understanding of their self and who they truly are. Behavioral therapy is often used in cases where people suffer from phobias. In this case, the medical professional will help the patient change how they feel about certain things by changing what the patient normally does. Cognitive analytical therapy is where the professional helps the patient work out what happened in the past and help the patient to start moving forward in their lives without being held back by a past incident. Cognitive behavioral therapy focuses on the negative thoughts and how they can affect the patient. The professional then helps the patient find a way to pick out those thoughts and focus on them in order to bring out more positive thinking. Counseling is what many people will go through in order to work out their difficulties and emotions. Occupational therapy is where the professional will get the patient involved in some useful activity that works on building the patient’s self confidence, and then work through what is causing them difficulties.

Therapies that deal with the physical aspect include geriatric therapy, neurological therapy, orthopedic therapy, and pediatric therapy. Geriatric therapy deals more with older people as they go through the normal aging process. As these people age, they can develop problems such as arthritis or cancer that can often be helped by geriatric therapy. It can help an older person increase their mobility and reduce any pain they might be suffering. Neurological therapy is often used on people who have suffered a brain or spinal injury, or suffer from diseases such as Alzheimer’s. Orthopedic therapy deals with people who have received an injury to any of their bone structure, or for helping people who have been through orthopedic surgery. Pediatric therapy is what is used to detect early signs of health problems. Pediatric therapy also focuses on helping children who suffer from a number of different disorders such as spinal bifida and cerebral palsy.

Depending on the problem, there is probably a specific type of therapy for it. While the therapies mentioned above don’t really mention medication, some therapeutic programs do combine the therapy with a prescription to help the patient through treatment. These are only a few of the vast number of different therapies out there. It changes from patient to patient as a result of their particular situation and condition, as well as who the professional is and what they feel would be in the patient’s best interest. New therapies also continue to be developed every day as more is found out about diseases and sicknesses that affect the human population.