Cognitive Therapy Basics

Having worked with a variety of people who have panic attacks on a regular basis in my practice in St Albans, I have found that a large number of them also are outgoing, happy- go -lucky individuals at other times during their day to day life. Many of them are the “clown” or entertainer when in a social setting, or work in sales, for example. For many of them, there are very few people around them who are aware of their panic attacks and would never suspect a thing, because they just do not seem to be the “sort of person” to suffer from such a problem.
There are many different techniques that can be used to help those who suffer from panic attacks, and some therapies work better on some people than others. Personally, as a therapist based in St Albans, I find EFT, Hypnosis and some NLP techniques such as anchoring are usually helpful to know, as it is likely that one of these skills will be suitable for the client. However, in the situation described above, where the person has this dichotomous character (”sometimes I feel very calm and extroverted, other times I feel blind panic”) it is worth exploring the NLP technique known as a parts integration.
A “Parts problem” occurs when there is a significant emotional event that occurs, or a serious of mild emotional events that occur in which a client has failed to enforce a boundary. What is meant by boundary enforcement is context dependent- sometimes we fail to say “no, I don’t want to…” and do something against our will. Sometimes we do not or are not able to enforce physical boundaries. Sometimes our boundaries are violated because we are too young, or too trusting to be able to speak up and say what we really want or feel.
Imagine that all of the negative emotion related to that memory, are stored in your system. But rather than having those negative feelings floating all over your nervous system, your body houses them all together within a boundary, (in the same way that it might do with the poison from a cyst or blister for example.) The boundary with the negative emotion inside is called a part, and it is apart from the rest of the nervous system.
Whenever the nervous system “gets word from the outside” by seeing, hearing, feeling, recalling (and to a certain degree even tasting or smelling) some kind of trigger that relates to that parts existence; the part springs into action. This will have the effect of the person feeling all of the emotions, experiencing all of the behavior and reacting with all of the characteristics associated with that parts existence without regard for the “normal” behavior and character of that person.
Let say for example that the behavior associated with that part is “blind panic.” It would go some way to explain the incongruence that the person who is usually confident experiences- “sometimes I’m really confident, sometimes I’m panicking about something insignificant…”
A parts integration works by establishing the highest intentions of both parts (the panic part and the confident part.) The highest intentions are almost always the same as each other and are simply using different behaviors in order to be met. Once they have been established as the same, and positive, the problem part can find new empowering ways of being met and the two parts can be re-integrated. This is a truly magic technique to witness.

Hypnose (or hypnosis) has been accepted for a long period of time as a mental state which is very similar to sleep. Induced by suggestion, this practice has allowed therapists and other specialists to enter ones subconscious. Today, we know much more facts about hypnosis and hypnotherapy. There is no more room for controversies or prejudice, given how useful hypnose really is.If you are curious about finding out more about this subject, then you should definitely keep on reading. You will be informed about how powerful can suggestions be for a person who is about to be hypnotized, but also how important is to be genuinely relaxed before the hypnose session. The Internet is also a pretty good source of information, with hundreds of specialized websites tackling this very interesting subject. It all depends on how much are you interested in finding out.There is another fascinating fact about hypnose. Even though most people prefer going to a trained hypnotist for a session, there are probably just as many who induce this mental state by themselves. Self-induced hypnose is practiced by people from various corners of the world, starting with a state of relaxation and different suggestions. This is the only way to reach the subconscious mind and experience a unique state where peripheral consciousness is reduced to a very low level.Being under hypnose means that all of your senses will be modified. Memories might be brought back to you. You might experience new thoughts or old emotions. No one can tell for certain what is going to happen while you are hypnotized. Interesting experiments have been made to demonstrate that hypnose can be used to cure various medical conditions, including spastic colon or different skin conditions. In some cases, it has been proved that hypnosis might be used instead of substance-induced anesthesia. As the number of people suffering from different phobias increased, hypnose started to be perceived as one possible treatment. It did not take too long for hypnosis to enter the list of recommended treatments. Nowadays, fobi and other anxiety disorders are successfully treated with hypnose sessions. While they are under the state of hypnosis, phobic persons are instructed to recall any event or situation that may have triggered their fobi. They use their experience to relate these events or happenings to the predispositions of the person. Using all of this information, one might provide the person suffering from a certain phobia with very important suggestions.There are millions of people out there who have been diagnosed as suffering from fobi. Some are afraid of how they will deal in social situations, thus having what is known as a social phobia. Others are terrified of spiders, dogs or flying. Many people will not even dare to go on an elevator or sit on the top of a building, being scared of heights. When such fears prevent them from functioning normally, the term of fobi can be definitely used. Fortunately, there are different types of treatment out there and not only hypnose. Cognitive behavioral therapy is starting to become more and more popular, offering incredible results.Suffering from a fobi can make you change your life. Do not take such a turn and seek out for help. Use the Internet to discover more information about different phobias, search for ways to overcome your fears. Talk with a therapist about your fobi, learn about self-induced hypnosis and you will be alright in no time!

On a daily basis, we are bombarded by commercials that tout the virtues of sleeping pills. We are constantly reassured that sleeping pills are getting better: Lunesta, Ambien and Sonata cause fewer side effects than their predecessors. But the fact remains that sleeping pills continue to have side effects. Just take a look at the prescribing information in any sleeping pill box. There is always the inadvertent portion on common side effects. Worse still, things like sleep-eating and sleep-driving are not listed there. Rosemary Eckley, a graphic artist in New London, Wis., said she thought she was sleeping well on Ambien but woke to find her wrist broken, apparently in a fall while sleepwalking, she wrote in an e-mail exchange.Also, they don’t greatly improve sleep for the average person. The National Institutes of Health found that viewed as a group, these sleeping pills reduced the average time to go to sleep 12.8 minutes, and increased total sleep time 11.4 minutes compared with fake pills. So what then are the existing insomnia treatments without side effects? Overall, they are called non-pharmacologic insomnia treatments. These include hypnotherapy, cognitive behavioral therapy, relaxation therapy and brainwave entrainment.1. HypnotherapyHypnotherapy has been well documented for its effective use with conditions such as depression and pain. As for insomnia, a meta-analysis showed that when combined with psychotherapy, 70% of patients have shown greater improvement compared with those on psychotherapy alone.The plus point with hypnotherapy is you can eventually be taught to self-treat and so gain a sense of control. This would give you the ability to stay insomnia free. However, just be mindful that not everyone can be hypnotized i.e. some people have persistently low hypnotizability as measured by the Hypnotic Induction Profile.2. Cognitive Behavioral Therapy (CBT)It is based on the idea that how you think affects the way you feel and behave. It involves techniques to change your negative thoughts about sleep (cognition) so you will stop sabotaging good shut-eye (behavior).A recent study conducted by Harvard Medical School’s Gregg Jacobs found that CBT worked better than sleeping pills both in the short term and the long term. Volunteers only received four half-hour sessions of CBT, plus a follow-up phone call that led to sleep improvements that persisted even after treatment was stopped. As few as two sessions have been shown to produce results. Unfortunately, there are very few CBT practitioners specializing in sleep. However, nurses and psychology grad students can be easily trained to provide CBT. And there is a growing lay literature designed to help people try it for themselves.3. Relaxation TherapyThis includes muscle relaxation, biofeedback, imagery training through meditation and thought stopping. Professionals, who specialize in instructing these techniques, can be found in some healthcare centers, support communities and even cancer centers. The best part is you can accomplish some of these techniques on your own. You may find deep breathing, stretching, meditation or prayer to be relaxing. A warm bath, warm glass of milk or cup of chamomile tea at bedtime can help to induce a restful state. Avoid alcohol although it may cause initial tiredness, it usually leads to fragmented sleep.4. Brainwave EntrainmentMany professionals in psychology and neurology have used this technology to train, empower and treat people for a wide variety of issues including insomnia. Research has shown that brainwaves can be stimulated to actually change a person’s current state. Hence, this is achieved through sound pulses that gently guide your brain to produce more of the brainwave frequencies associated with sleep.Your brain is re-trained to sleep deeply and naturally eventually foregoing the soundtracks. So, coupled with sleep hygiene or basic CBT, all you need to do is listen to some soundtracks. However, this isn’t for everyone as it involves brainwave stimulation. People who are epileptic, prone to seizures, pregnant or wearing a pacemaker would have to give this a pass. In summary, the good news is that studies have reported about 70 to 80% of the patients treated benefited from these insomnia treatments Just remember one thing: best results are obtained when you combine any of them. There is absolutely not one magic treatment for all.

Both Cognitive Behavioural Hypnotherapy and Cognitive Behavioural Therapy are recognised by many therapists and clinicians as being powerful goal-directed therapies .  Substantial empirical research supports this fact. The cognitive behavioural approach is to focus on the root of emotional disturbance  –  our thinking. Cognitive Behavioural Hypnotherapy is a methodology whereby hypnosis is integrated into the  Cognitive Behavioural Therapy.

What is a cognitive and behavioural approach?

The cognitive and behavioural approach is based on the philosophy that our own thinking determines how we respond to any situation we encounter.  Our thinking, our feelings and our behaviour are interdependent.  The ability to recognise the interdependency of thinking, feeling and behaviour, together with the acceptance of emotional responsibility, is the core of our emotional wellbeing and can also contribute significantly to our physical health.

Every day we face events which can contribute to our emotional responses; however, they do not cause the response.  In fact, it is inconsequential as to whether an event is real or imaginary.  We are not “disturbed “or “upset” by events themselves, rather, it is how we have learned to react to them. If events were responsible for our reactions then we would all react in the same way to any given event.  The reaction which coincides with an event is a consequence of what we choose to believe about the event.

More about events

An event might be a person, a place, an occurrence, a world disaster, an illness or a rejection, and our emotional response to such an event is within our control.  In other words, each of us is responsible for our own emotional reaction to an event; this responsibility is not shared with others.  Likewise, we are not accountable for the emotional responses sustained by other people to events which result from our actions or behaviour, even if our behaviour may have been a contributing trigger.  How often have you heard statements such as: “Missing a deadline makes me feel awful “, “The state of the world depresses me”, “Bad driving drives me mad” , “She makes me so angry”  or, “Public Speaking scares me”?  The fact is that none of these events make you feel anything. However, these events can trigger thoughts, and it is these thoughts which can result in either healthy or unhealthy emotions or symptoms. Our beliefs about certain events can be rational, healthy and flexible or they may be irrational, unhealthy and inflexible.  Cognitive Behavioural Therapy focuses on irrational, unhealthy and inflexible beliefs which may result in a myriad of unhealthy consequences, (for example anger, depression, anxiety, headaches, eating problems, IBS and unhealthy behaviours).

Missing a deadline by itself does not make you feel awful.  However, your belief that missing a deadline is something which must not happen might be the reason you feel “awful “.  Missing a deadline is an event which has a trigger that activates an unhealthy/irrational belief you are holding. Likewise, the state of the world and bad driving do not make you do or feel anything. They are events which have a trigger that activates unhealthy /irrational beliefs.

It is a fact of life that bad, sometimes very bad, things do happen; life can be very difficult, uncomfortable and unfair.  The manner in which we perceive these negative events determines our response.  It is important to recognise that the approach which assumes that you have responsibility for your emotional responses neither condones “ badness “  nor suggests that we have responsibility for “badness “ which may take place.  However, this approach does presuppose that we have a choice about how we respond to events in our lives, irrespective of their perceived “goodness” or “badness”.

Whether your feelings or behaviour in response to an event in your life are appropriate or inappropriate depends on whether the belief triggered by the event is a healthy or unhealthy belief.

More about beliefs

Our beliefs can be healthy or unhealthy.  A healthy belief is realistic, rational, appropriate and flexible. An unhealthy belief is unrealistic, irrational, inappropriate and rigid. It is the unhealthy beliefs which give rise to unhealthy consequences, for example anger, jealousy, guilt, anxiety, depression,  low self-esteem and self-worth, obsessions , self pity, world pity, behavioural problems (such as eating issues, excessive drinking and avoidance), physical problems (such headaches and IBS) and much more.

In accordance with the philosophy of cognitive behavioural therapy, unhealthy beliefs are a consequence of having rigid rules about how we would like life to occur.  Our strong  preferences  as to how we would like life to be have developed  into irrational, rigid and dogmatic demands which we believe must be met; if not, we  become disturbed  in ways such as described above.

The aim of cognitive behavioural therapy is not about changing your preferences! The aim is to help you to change your unhealthy thinking so that logically and emotionally you are able to accept: “just because I really want my preferences in life to be met, that does not mean they have to be met and that when life’s events are contrary to my desires and hopes it is not an indicator that life is awful, people are awful or that you are a failure and worthless and that you cannot cope”.

How does Cognitive Behavioural Hypnotherapy compare to Cognitive Behavioural Therapy?

While the philosophy behind cognitive behavioural hypnotherapy and cognitive behavioural therapy  is the same, hypnosis, which is a means of enhancing communication, can influence the effectiveness of the therapy.  Cognitive Behavioural Hypnotherapy simply involves the integration of hypnosis into the therapy.    Hypnosis and cognitive behavioural therapy are a powerful combination. Hypnosis enhances the effectiveness of therapy and also can bring about results in fewer sessions than might be needed otherwise. Read more about hypnothrapy here http://www.stephaniemaclennan.com/hypnotherapy.html

Cognitive Behavioural Therapy (CBT) is effective in helping people to overcome panic disorders. I use CBT at my practice in Edinburgh and have found it very useful in treating agoraphobia, particularly when used in conjunction with Neuro Linguistic Programming (NLP). This article details some of the ways in which CBT and NLP are used during NLP Edinburgh to help clients achieve freedom from agoraphobia.
1. Cognitive Therapy – At NLP and CBT Edinburgh, people are supported to identify and challenge information processing errors that maintain anxiety. Panic attacks and anxiety are initiated by unhelpful thinking. Thoughts alone do not cause anxiety, but believing negative thoughts does lead to anxiety. During CBT and NLP sessions, clients are supported to question the evidence for and against their interpretations.
2. Behavioural Therapy – This is the doing part of cognitive behaviour therapy and in the case of agoraphobia, the therapist will support you in identifying a hierarchy of goals related to going out. The therapist will be aiming for you to become desensitized to going out activities that you currently fear. The therapist accompanies you into the community where appropriate.
3. Learning cognitive strategies to master panic – clients that come for NLP and CBT Edinburgh are taught techniques to practice during homework tasks. You are supported in becoming effective at using these techniques when you are feeling panicky.
4. Practising – You will get out of therapy what you put in and mastering your panic will involve you carrying out practice in between sessions. Typical practice assignments include keeping a ‘Beating Panic’ Journal’, carrying out practice related to your ‘going out and about’ goal and creating a routine that involves empowering ‘calm’ activities. You will also be required to practice any coping techniques taught to you by the therapist, such as using your anchors (see below).
5. NLP Communication Model – Clients are taught NLP clean language techniques. This means learning to think and communicate with your self in a way that supports being safe, confident, and relaxed.
6. NLP Change Techniques – NLP, which is an understanding of how we code experience in our brain, has a range of techniques, which can be used to reduce or eradicate the intensity of remembered experiences. Its possible to take an unpleasant memory, examine how it is coded and then make changes so that it is no longer unpleasant and the emotion can just drain away. If you suffer from unpleasant memories or fears, an NLP therapist can help you deal with this, via submodality work. These treatments are available from my therapy practice, where I use NLP Edinburgh. You can also learn to be aware of the impact of how you code experience yourself.
7. Anchoring For Emotional Balance – Anchors are naturally occurring associations between an external stimulus and a behavioural or emotional response. They occur because the human mind constantly seeks to make sense of the environment by looking for patterns and associations between things. People learn to make negative associations between things. In the case of agoraphobia this may be associating going for a walk to the corner shop with fear and panic. NLP deliberately makes use of anchors in order to empower people to have control over their emotional states. There are specific NLP techniques in which a stimulus is used to trigger and link an emotional state. The stimulus is usually external and may be a sound or touch. Through these techniques it is possible to for an individual to build up a resource of positive emotional states, which they can access in any situation in which they need them. It is also possible to completely collapse negative anchors so that external stimuli that cause you negative emotional states will no longer be a problem.
These are just some of the ways that NLP and CBT Edinburgh can be effective at empowering people to overcome agoraphobia and other panic disorders.

A panic attack is a sudden feeling of extreme anxiety accompanied by significant physical symptoms such as trembling, sweating and shortness of breath. They are usually accompanied by an overwhelming fear of catastrophe – the person may feel they are dying or suffering a heart attack, or they may fear they are going mad. They can occur in response to specific situations (such as crowded areas) or spontaneously and with no obvious cause. They are usually short-lived (lasting a few minutes) but are so unpleasant that a person may live in fear of it happening again – in many cases, this will lead to the person avoiding situations that they think will trigger an attack (”avoidance behaviour”).
Panic attacks quite commonly accompany other anxiety conditions such as generalised anxiety and specific phobias (particularly Agoraphobia – the fear of open spaces). However they can occur outwith these other conditions – a study in 1994 found that 3 people in every 100 had experienced panic attacks alone.
Panic Disorder is the term used by Psychiatrists for those psychological conditions in which panic attacks predominate.
Psychological Symptoms of Panic Attacks
Intense anxiety
Fear of dying
Fear of losing control or going mad
Depersonalisation (the unpleasant feeling that you are not “real” or are detached from yourself)
Derealisation (the unpleasant feeling that your environment is “fake” or you are an “actor in a play”)
Physical Symptoms of Panic Attacks
Shortness of breath or feeling “smothered”
Choking
Palpitations (feeling the heart racing or beating irregularly)
Chest pain
Sweating
Dizziness or feeling faint
Nausea or abdominal discomfort
Flushing of the skin or feeling chilled
Trembling or shaking
The feeing of being unable to breath can lead to a compensatory increase in breathing rate (hyperventilation) by the person. This in turn can affect the body adversely, leading to both a worsening of the physical symptoms above and additional symptoms:
Physical Symptoms of Hyperventilation
Tinnitus (ringing in the ears)
Numbness or tingling sensations in the hands, feet and face
Headache
Weakness
Spasms of the hand and foot muscles
In a panic attack, people will usually experience at least 4 of the above symptoms, although most experience many more than this. For a diagnosis of Panic Disorder, the person will experience at least 4 panic attacks in a 4-week period, or experience significant fear of a further attack (and exhibit avoidance behaviour) for 4 weeks following a single episode.
Treatment
If the panic attacks are associated with other conditions such as generalised anxiety, phobia or depression, then the appropriate course of action is to address these underlying issues first – the panic attacks should subside as these other issues are resolved.
If the panic attacks are the main problem, then (as with most psychological problems) two courses of action are available – drug treatment and psychological therapies.
The drug treatment of panic attacks limited. Sedative drugs such as the Benzodiazepines (e.g. Diazepam (Valium)) are very effective in the short term, but are highly addictive and can lead to dependence. Further, when these drugs are withdrawn, a resurgence of the panic is likely. Antidepressants, particularly the Selective Serotonin Reuptake Inhibitors (SSRIs) such as Citalopram (Cipramil) and Paroxetine (Seroxat), are licensed for use in panic disorder. They can cause an initial worsening of symptoms when first taken, and can cause other side effects such as gastro-intestinal disturbance and sexual dysfunction. Drug treatments are not as effective as psychological therapies in these conditions.
NICE (National Institute for Clinical Excellence) recommends Cognitive Therapy for the treatment of panic attacks and panic disorder. Their research has shown it to be more effective than any drug treatments. Therapies such as Cognitive Behavioural Therapy (CBT) and Neuro-Linguistic Programming (NLP) involve the patient seeing a therapist on a one-to-one basis for hour-long sessions. The total treatment course is typically between 6 and 12 sessions, with one session a week. The therapies involve an explanation of the psychological and physical symptoms of panic attacks, and may involve the deliberate precipitation of a panic attack during a session. The aim is to reduce the fear associated with the physical symptoms – this fear is often a cause of the attacks itself and the associated avoidance behaviours. Once the fear of the panic attacks is reduced, the attacks themselves will lessen in frequency and severity and, hopefully, disappear altogether.
Despite the clear recommendations by NICE, the availability of Cognitive Therapy remains limited in the NHS. If your GP or local Mental Health Trust is unable to provide the appropriate treatment for your condition, they may be able to recommend a therapist in the private sector.