Cognitive Therapy Basics

During my work with clients either through Online Mindfulness Therapy Skype sessions or in the office, I find that one of the central problems most people have is that they do not know how to focus inwardly and create a quiet, safe space in which they can engage with their inner emotional suffering. We develop a plethora of secondary reactions of avoidance, resistance or plain resignation. We busy ourselves in activities, anything to avoid facing the inner reality of our anxiety or depression. We talk about our problems, analyze them, and try to fix things through will power and positive thinking, which are all fine in themselves, but only if they come out of a foundation of stillness and inner listening. The problem is that we do not take the time to cultivate this inner relationship, and that’s like trying to fix a problem without knowing all the facts, and that is never a good strategy. We need to learn the art of being still and completely present with the anxiety, depression, traumatic memory or other upset; in short we need to learn the art of listening within. Everyone knows the importance of listening without, to a friend or child needing our attention and support. Well this very same attitude is needed within if we want to bring about healing. This is the prime work of Mindfulness Meditation Therapy: learning to form a relationship based on listening, openness and being completely present with your emotions, and in therapy-teaching sessions, you will be taught how to do this in great detail.

Therapy begins the moment a client establishes a mindfulness-based relationship with his or her emotional reactions, and in fact therapy can almost be defined as the process of cultivating the art of inner listening until it becomes the natural response to suffering. Why is this so important? The attitude of listening and being totally present for our experience has many extraordinary effects, and all of them bring benefit. At the most fundamental level, listening is the process in which we stop reacting and start experiencing. This is what is described as the development of “presence,” and this is one of the chief characteristics of mindfulness: being fully present for whatever you are experiencing, without the interference of thinking or further reacting to what you are experiencing. In fact mindfulness can be described as “engaged-presence.” It is that quality of acute listening and openness to experience coupled by a willingness to engage and face our experience, including the painful and disagreeable thoughts and emotions.

As a therapist, my primary mission is to help my client establish this engaged-presence of mindfulness with his or her suffering. Mindfulness teaches us how to tune in to our core emotions, and as we do that, we create a space around the pain that I call the “therapeutic space of mindfulness.” Reactivity tends to close and contract the mind making it fearful and angry, neither of which helps the healing process. Mindfulness tends to open and expand conscious awareness, and literally makes room in which tight and contracted emotional states can begin to move, unfold and differentiate. In summary: Reactivity inhibits change; mindfulness facilitates change, and this is one of the basic principles of mindfulness psychology.

Mindfulness of our emotions is not the same as acting out the emotion and it is not wallowing in feeling bad. It is the process of literally “sitting” with the emotion: nothing to do, nowhere to go, nothing to fix, just being 100% present with the emotion as an object to observe and investigate with care. This shift in relationship from subjective reactivity, in which we are continually hijacked by our emotions, to an objective relationship, in which we can be with our emotions in a state of inner silence, has an immensely powerful healing effect. It literally creates a space in which the emotion can change from within. So, if you feel overwhelmed by anxiety, fear, worry, guilt or depression, then Mindfulness Meditation Therapy will be of great value to you.

One woman described how she saw herself as being a victim of incessant worrying and anxiety. She had tried several forms of talking therapy, but the anxiety persisted. When I asked her what color the anxiety-emotion was, she seemed puzzled. Apparently, in all her previous therapy sessions no one had asked her to look inside and see what was actually there. Talking about emotions is never as effective as actually looking at them directly. After a couple of sessions of MMT she established an inner mindfulness-based relationship with the anxiety-emotion and immediately noticed that it had a black color and had a hard, tight form. Now, for the first time, she had something tangible to work with, and after several more sessions of simply creating a therapeutic mindfulness space around the black object, it spontaneously began to soften and loosen up, eventually taking on a new color and changing in many other ways. The constricted emotional energy was being released during this process of direct inner experiencing and this led to profound transformation at the core. Out of this change at the core feeling level, her beliefs and thinking also changed and she no longer felt a victim of compulsive worrying. She readily found new solutions and more positive perspectives on things, and all this arose as a consequence of first learning to be present with her worry-thoughts through mindfulness training.

Mindfulness meditation is like “mental massage” in which we bring warmth and healing energy to those hard, reactive places within, and with each gentle touch, suffering begins to respond by healing itself from within. In the Online Mindfulness Therapy Course, I teach clients how to do this “mindfulness massage” so that they can practice the art of inner healing at the core level and learn a totally different way of being with the many challenges of their lives. The problem is seldom in the challenges, disappointments and issues, but almost always in the way that we react to these events. Mindfulness teaches us how to maintain balance and to avoid becoming reactive. We learn to replace reactivity with responsiveness, based on mindfulness rather than blind compulsion. That is the path that heals suffering in our heart and in our relationships. In fact, many of my clients use the mindfulness skills that they learn to heal the compulsive patterns of reactivity and arguing that destroys personal relationships. It all begins by learning the art of true listening based on mindfulness and engaged-presence.

Besides face-to-face Mindfulness Psychotherapy sessions, Dr Peter Strong offers the ever-popular Online Psychotherapy and Counseling service, in which he teaches clients specific strategies for working with emotional stress through a combination of email correspondence and Skype sessions. Peter also offers teaching seminars for groups, and companies with an interest in stress management. If you want to learn Mindfulness Meditation, you can do this through email correspondence and Skype. Visit http://www.mindfulnessmeditationtherapy.com

Your email enquiries are welcome.

If you have found this article useful and would like to support the work of Dr Strong and Mindfulness Meditation Therapy, please consider making a donation through PayPal by visiting my website and reading the additional articles on Mindfulness Meditation Therapy. A donation button is located under the articles on Blog/Articles.

http://www.google.com

There has been a growing interest in Online Therapy using email, correspondence and live video conferencing using Skype or similar free services. The convenience of this approach for the client is very apparent: The client can take control of the process, paying only for the time that he or she wants to pay for. The client can have his session at a time that is convenient to him, and can take the time to compose his email questions and feedback at his leisure, instead of feeling pressured to perform during a traditional session. Of course, not having to take time off work to drive to a therapist’s office is always a plus. Generally the cost for online sessions is much lower too since the therapist doesn’t have to pay for office space. Generally, it is well recognized that if you make therapy more accessible and more convenient, then people will be more likely to stick with it, and this is always a major factor in the successful outcome of psychotherapy.

What about effectiveness?

Well, in a clinical study published in the Lancet in August, 2009, Online Therapy, via instant messaging, resulted in a significant recovery rate for patients suffering from depression. The treatment method used was Online Cognitive Behavioral Therapy (CBT).

In general online therapy works best when clients are offered specific strategies with which they can experiment at home. Techniques such as CBT, Neuro-Linguistic Programming (NLP), Mindfulness-based Psychotherapy (http://www.mindfulnessmeditationtherapy.com) are particularly appropriate.

The very process of writing down your thoughts in an email is an immensely powerful tool for helping you develop a more objective relationship with emotions, which can be very abstract and difficult to verbalize. This is why journaling has long been encouraged in many schools of psychotherapy. Then taking the bold step of sharing this with another person is also very empowering for most people. Some people are good at doing this face-to-face, but many actually feel intimidated and need more time to formulate the right words, without a therapist pressing them for content.

The online approach can also be good for the therapist, because he or she can take time to design the right strategies to offer the client and not feel pressured to provide a solution on the spot.

Is Online Therapy a substitute for face-to-face sessions?

No, probably not, but it is clearly an excellent addition, and provides an alternative for those who don’t feel comfortable with traditional therapy sessions, or are unable to attend such sessions. It may be particularly useful for those suffering from social anxiety or agoraphobia. One thing is for certain: the internet has become a major part of most people’s lives, and we should develop the extraordinary potential of the World Wide Web for bringing people together to promote healing.

Internet Psychotherapy and Counseling provides a vehicle that will allow many more people to connect and find wise counsel for working with their emotional issues than is possible through in-person sessions alone.

In my work in online counselling, mostly by email, I am always pleased to see how clients become more empowered through the process. Recently, I helped a person in South Africa, who was struggling with anxiety following a recent personal trauma. It was a joy to see his emails in the morning and then take the time to suggest the next exercise to practice to help him resolve his inner pain. We never met in person and probably never will, but nevertheless, I have been able to help heal his inner trauma, and that is immensely satisfying to me as an online therapist as it was to him as an online client.

Peter Strong, PhD is a scientist and Psychotherapist, based in Boulder, Colorado, who specializes in Mindfulness Meditation Therapy and NLP to treat anxiety, depression, phobias, grief, and post-traumatic stress. He specializes in Online Psychotherapy and teaches individuals and couples strategies for overcoming emotional problems. Visit

http://www.mindfulnessmeditationtherapy.com

Email enquiries welcome.



http://www.google.com

Behaviour Therapy (CBT) and its techniques can be useful to help people who are distressed by worrying about health. Health anxiety refers to a psychological condition where the person intensely worries about their health. As a result they feel distressed and find that these worries get in the way of daily life.

Often people who have health anxiety fear that common symptoms indicate they have a serious illness, despite tests and feedback from their GP to the contrary. Common symptoms include: headaches, numbness, aches and pains, dizziness, palpitations, chest pain, increased heart beat, sweating, feeling cold and shivery and feeling foggy headed.

This list of symptoms is not exhaustive. I am an occupational therapist and I work with people using Cognitive Behaviour Therapy, Edinburgh. Specific examples, of people I have treated with health anxiety include a middle-aged man who felt “fuggy headed” and worried this may mean that there was something seriously wrong such as a brain tumour or with his heart and a young woman who would sometimes hear a buzz or ringing in her ear as she was falling off to sleep and worried that this meant she was going mad and would soon start to hear voices.

In both these examples, each of the people I was working with using Cognitive Behaviour Therapy, Edinburgh, has visited their GP numerous times for reassurance. The man had also paid to have several private tests via his private health insurer. All the examinations and tests had concluded that these people were not suffering from anything other than anxiety about their health.

This is good news, because it is possible to learn the strategies to manage and reduce health anxiety via Cognitive Behaviour Therapy. This involves first understanding the link between how you think about symptoms, how this makes you feel emotionally and physically and then what you do to cope with these emotions and physical body changes.

What is common in the people I work with is that the things they do to cope with their health anxiety, actually has the opposite effect and often exacerbates or prolongs the problem. The ways of thinking that increase health anxiety includes misinterpreting normal body sensations as something serious and doubting ability to cope with a serious illness. When people misinterpret symptoms as something serious they will feel anxious as a result this will trigger the stress response. When the stress response is triggered you will feel changes in your body that include most of the symptoms from the list above.

Behaviours that increase health anxiety include a biased focused on checking your body for any signs of illness, disease or changes. Commonly people I have worked with will monitor themselves excessively and ask themselves “How am I feeling now” and look for signs. Other behaviours includes seeking reassurance from healthcare professionals, family and friends, spending vast amounts of time on the internet or reading literature in order to find out about illnesses, avoiding anything that will trigger off their anxiety such as TV programmes about health or avoid activities that increase symptoms. For example, avoiding physical activity and exercise that leads to increased heart rate.

If any of these thinking styles and behaviours sound familiar to you, then it would be advisable to speak to your GP about Cognitive Behaviour Therapy. I have found Cognitive Behaviour Therapy, Edinburgh a very useful approach for helping people get their lives back from worrying!



http://www.google.com

Cognitive Behavioural Therapy (CBT) is an effective psychotherapy for a wide range of emotional and psychological problems. The basic tenet of CBT is that our emotions are affected by our cognitions. To put it another way – the way we think affects the way we feel.

A CBT therapist aims to help people suffering from emotional problems by helping them to identify the ways in which their thinking may be causing their problem. A first step in CBT is therefore the identification of “Negative Automatic Thoughts” (or “NATs” for short) – these are the thoughts that accompany unpleasant or unhelpful emotions such as depression or anxiety.

A closely related aim of the CBT therapist is the identification of so-called “Thinking Errors”. These are habitual (and unhelpful) ways a person has of thinking about themselves, others, and the world around them. These thinking errors will often twist or distort experiences, acting to make the person seem a failure, others as hostile, and the world as dangerous or unpleasant.

The identification of NATs and related Thinking Errors is half the battle in CBT – once a person is aware of their unhelpful thoughts and mental habits they can then choose to think in more rational, healthy ways. A CBT therapist can guide them through this (fairly straightforward) process.

As a Psychiatrist and therapist working in Edinburgh I use CBT techniques extensively. Some of my clients are quite happy with the results they get from simply challenging their NATs and Thinking Errors – they feel much better and have no desire to delve further. However, the majority of clients are keen to “get to the bottom” of why they had their emotional problems in the first place. I tend to encourage this further work as it helps to reinforce the progress made to date and, in my opinion, helps to prevent the client from relapsing at some future date.

This further work involves a search for “Negative Core Beliefs” (or “NCBs”). These are the unhelpful beliefs that a person has had throughout their later childhood and adult life. They are core components of the person’s personality and they are the root cause of the person’s Thinking Errors and ultimately their NATs. If a CBT therapist can help a person to change their Negative Core Beliefs (or, more realistically, find more rational and healthier alternatives), then the person’s Thinking Errors and NATs will diminish, and their emotional problems will lessen (usually!).

A difficulty with NCBs is that a person is rarely aware of them. Even when someone is competent at identifying NATs and Thinking Errors, the cause of these problems may be hidden. But we can use NATs and Thinking Errors as clues.

In my experience as a Psychiatrist in Edinburgh I have found two techniques of most benefit in the search for the NCBs of my clients.

Firstly, there is the method of “Repeated Questioning”. I ask the client what a particular NAT he has identified means to him – he will give an answer, and I then ask him what that answer means to him. He will give a second answer, and I then ask him what that second answer means to him, and so on. Within a short space of time, the client ends up with a global statement that can’t be taken any further. This is a Negative Core Belief. It’s probably best demonstrated with an example:

Client:                                    “There’s loads of litter around Edinburgh” (He’s angry)

CBT Therapist:            “What does that mean?”

Client:                                    “That I’m the only one who cares about it”

CBT Therapist:            “What does it mean if you’re the only one who cares about it?”

Client:            “People don’t care about things that aren’t their personal property”

CBT Therapist:            “And what does it mean if people only care about their own stuff?”

Client:                                    “People are only out for themselves”

(”People are only out for themselves”. This is the client’s Negative Core Belief – a global statement that is uncompromising and will clearly influence the way he views and interacts with others in other areas of life, not simply littering!)

A second method of identifying Negative Core Beliefs is to look for the “themes” that run throughout a persons many NATs and Thinking Errors. Such themes may be “I’m a failure” or “There’s no point to life” (very common in depression), or perhaps “The world’s a dangerous place to live” (common in anxiety conditions).

Once a client’s Negative Core Beliefs have been identified, the CBT therapist will (along with the client) try and explore alternative and more rational ways of thinking about the self, others, and the world in general. This is where real, sustained recovery from emotional problems is made and I will discuss this in a follow-up article entitled “Cognitive Behavioural Therapy (CBT) and Negative Core Beliefs (NCBs) – Treatment”.

Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He makes extensive use of CBT techniques to treat problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for further information about psychological problems and CBT.



http://www.google.com

The theory of Cognitive Behavioural Therapy, or CBT, is that emotions are closely linkedto cognition. Put more simply, CBT says that “the way you think affects the way you feel”. People who think anxious thoughts will end up feeling anxious.

As a psychiatrist in Edinburgh a significant proportion of my clients suffer from anxiety. Edinburgh is a beautiful city and a wonderful place to live, but as in any urban enviroment, individuals can start to feel stressed out and anxious. Thus it is important for me to help each client to become familiar with their own ways of thinking, and to help them to identify ways in which their thinking patterns may be contributing to their emotional problems.

A CBT therapist has a term for patterns of thinking that can lead to emotional problems – they are called “Thinking Errors”. Many different types of thinking error have been identified over the years, but what follows is a brief summary of those errors that I have seen as a therapist in Edinburgh when working with people suffering from anxiety.

“Catastrophising” is a thinking error frequently found in anxious people. In fact, I’m sure we’ve all done it ourselves at some point! When someone catastrophises they automatically “assume the worst”. A message to call back the boss is taken to mean that you’re going to be sacked, a clunking noise in your car means that the engine is about to fall to bits, and a pain in the chest is the beginnings of a heart attack. CBT hypothesises that habitually thinking like this will lead to long-term problems with anxiety.

Another common thinking error seen in people with anxiety is called “Mind-Reading”. As the name suggests, a person who’s exhibiting this thinking error will believe that they know (absolutely know) what people are thinking about them. This belief will often go contrary to what the other person says and does, and is almost always pessimistic in nature. For instance, if the CBT therapist yawns (heaven forbid!) during a session, the client will know that the CBT therapist is bored or fed up with them – even if the therapist apologises and explains that her young daughter is teething and kept her awake last night. Or if the person gets invited to a dinner party, they will know that they’re only invited along to make up the seating numbers. Thinking in this way can make life one long series of possible sleights and put-downs, leading to increased anxiety and excessive monitoring of those around you.

“Crystal-Ball Reading” is a third common thinking error in anxiety. People thinking in this way know what is going to happen in the future. And, lo and behold, it’s bad! The bus will definitely be running late, they will definitely fail the interview, and they will absolutely make a fool of themselves at the works party. Not a pleasant way to think. And certainly not a good way to prepare for an interview (or even a party!). CBT encourages people to “keep it real” – there’s enough strife out there without looking into the future for extra!

These three thinking errors are those that I’ve found most frequently in anxious people whilst working as a therapist in Edinburgh, although I doubt that they’re exclusive to East Coast Scots!

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.



http://www.google.com

Also known as manic depression, bipolar disorder is a mental ailment that occurs due to several factors like biological, neurological, environmental and emotional. It is featured by very frequent mood swings or cycling among extreme emotions like mania, depression, and normal behavior of the patient.

While there are several treatment options available for bipolar disorder, the most commonly used option is a combination of therapy & medication.

However, not all patients can be put under the same drill. The cases that involve a history of drug abuses, cannot be put to medication, else it could land up in a great risk. Also, it is hard to find that mood swings occurred due to bipolar disorder or drugs and say if the extent o bipolar disorder was not too much in the body, the medications would end up harming the patient quite severely. Also as a basic fact the patients move to medication only when no other resort is found.

In such special cases where medications are not the right choice, CBT comes in to being. The Cognitive Behavioral Therapy popularly known as or CBT is a sort of a therapy that is used to assist the patients in recognizing the exact triggers & causes of their depressive & manic states. Then the patients are made to learn the techniques so as to avoid the triggers & henceforth and cope up with the symptoms during the episodes. 70% of bipolar I disorder patients are made to undergo the CBT experience, especially those when one or a few episodes have taken place with in 4 years of initiating the CBT treatment.

CBT treatment to cope with bipolar disorder is used to accomplish two major goals. These are:

i. To recognize the manic episodes prior to their becoming uncontrollable & making a conscious change in how one reacts to these episodes.

ii. To learn the techniques, thoughts, reactions & behaviors that would help them offset the depression.

With the various activities & techniques prescribed by the expert therapists, these goals are achieved quite effectively.

Under CBT, the effectiveness of the treatment of the bipolar disorder mainly rests in the hands of the patient, as he/she is allotted homework like – performing some exercises, reading, etc. These are focused on helping the patient understand his/her condition and to help them learn the methods to cope with the situation.

The steps to conduct CBT are as follows:

1. Making a Contract with the Patient

Initializing CBT, you need to make a treatment contract with your patient. In this treatment you draw a definite plan of treatment for the patient and he/she agrees to follow the same. This also includes the patient’s promise to do all his homework complete taking all assignments seriously. The patient in this contract also ensures that he/she would take any & all the prescribed medication just as directed. This is a crucial step towards CBT as this process largely depends on the patient’s desire to cope with the bipolar disorder and his/her sense of responsibility towards the same.

2. Recording the Mood Swings

In the second step, CBT involves monitoring and grading the moods of the patient. For this the doctor gives the patients several worksheets that the patient fills in regularly. In these sheets the patient records his/her moods for the day. They also file the other important details like for how many hours did they sleep, the level of anxiety, & the level of irritability they felt. Especially the patients of Bipolar II Disorder must record all these details daily as in that case the mood cycles very frequently.

3. Patient does the Homework

Once the therapist is able to understand the mood cycles of the patient of bipolar disorder, the next step in CBT is for the patient. Here the therapist gives some reading material to the patient for him/her to understand exactly how our thoughts effect our emotions. This is done by the patient filling in the worksheets and once he/she understands the drill, they would be able to practice through altering their thoughts in far more rational way. Their emotions then become very rational, thereby decreasing the number & severity of the depressive & manic episodes.

4. Recognizing the Triggers

Further, you must be able to know the triggers in the case you are curing. Triggers are the basically any emotional or physical clicks that arouse a depressive or a manic episode like emotions, thoughts, times of the year, situations, environments, events, etc. Once the patient starts understanding and recognizing their triggers, he/she would then be able to learn to avoid them entirely, henceforth decreasing the severity & number of the depressive & manic episodes.

All in all, CBT is quite an effective method of treatment for the bipolar disorder patients. In case you think that you need this therapy, contact your doctor or therapist before it gets too late!



http://www.google.com