Cognitive Therapy Basics

Fear is an innate feeling of danger to a risky or threatening situation. In event of danger or risk, there would be an adrenaline rush into our body muscles so that we can react defensively to protect ourselves in the survival fight. The brain would decide on the better reaction of whether to fight for our survival or to run and hide away from the danger called fight or flight reaction. This emotion is natural instinct of humans and has evolved and ingrained in our daily lives. For some people, there are cases where the state of emotional fear lingers for so long that it cannot be eliminated as a result of the fight or flight reaction that results in what is known as panic attacks.
Panic attacks are an exaggerated condition due to fear. While some fear is healthy, in panic attacks there is an overwhelming amount of fear. The panic attack can come into our lives with no warning at all. There may be no logical reason why we can get into a state of panic, however once a panic attack occurs it is very intense and there is nothing that we can do about it.
Several physical symptoms of panic attacks can be identified which include heart racing, pounding or skipping heartbeat, tightness or discomfort in chest region, choking sensation, sweatiness, shaking and trembling, butterflies and nausea, hot flashes or chills, numbness in certain parts of the body, erratic breathing or shortness of breath, dizziness, light-headedness and so forth. The psychological emotions felt by these victims can be very damaging and frightening that they, who suffer panic attacks, can feel that they are dying or losing their minds. Things seem unreal to them or may even feel that they are detached from their bodies while some are so fearful that they must escape and flee the situation altogether.
In fact, the symptoms mentioned above are the sensations and feelings that one experiences whenever they are facing impending threats or dangers. As reinstated earlier, these symptoms occur to sufferers of panic attacks in circumstances without presence of danger even in safe environment and under no logical explanation. There is no surprise at all that the panic attack can occur even when the victim is at sleep.
Panic attacks cannot or difficult to stop when it attacks and they normally happen without any potential signals or predictions. This is because the excessive level of hormones imbalances and adrenalines that flood the body and muscles causes such extreme terror and desperation that are so beyond the grasp of the actual situation. It is therefore not only necessary but compulsory to attempt to control the exaggerated emotions of fear using different appropriate means of treatments.
The suffering of panic attacks is very dreadful and agonizing according to many victims of the panic attacks. The feelings of extreme fear and overwhelming terror are very intense that they feel like eternity once the attack starts to kick in.
Terror, to the normal people living normal lives, is part and parcel of our lives and the evolution. To victims of panic attacks, they are constantly and relentlessly facing the fear and terror everyday of their lives. There are a great variety of treatment techniques and therapies available in the marketplace for curing the panic attack and disorder. Do not give up on yourself and start visiting professionals to seek treatment and get rid of the panic attack forever for your lifetime.

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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.

Exposure therapy is suggested to be one of the best ways to overcome your anxiety. To master something in life it is necessary first to think about it, and then actually practice doing it. Remember when you first started to learn how to drive. The more you practiced the better you became. This is the basis of exposure therapy. You actually need to go into the situation and think about it in a different way, implement the other skills and knowledge you have to mange your anxiety, and then reflect on how it went.

There is a word of caution here. Some research suggests ‘facing the fear and doing it anyway’. For some people this may work however for others it doesn’t. Learning the skills and techniques of cognitive therapy and educating yourself on where your anxiety is actually coming from in the first place, prior to exposing yourself to the situation, can often have better outcomes as you can feel more in control before you enter the situation, rather than going in feeling absolutely terrified.

When you feel anxious, it is suggested that you go through it firstly in your mind (realistic thinking/skills of cognitive therapy), and secondly, put yourself in the situation that you fear. This part is called exposure therapy.

In general, exposure therapy with response prevention is probably one of the most effective treatments. It’s a fairly straightforward type of treatment. Some people have already begun it on their own – in a way.

Exposure therapy is what it sounds like, exposing the person to whatever it is that causes their fear. The process usually begins by gradually introducing the patient to the feared situation and works towards helping them develop constructive responses to their fear. For example, a patient with severe arachnophobia (a fear of spiders) may begin by talking about “creatures with eight legs” and end up being able to sweep spiders away when they see one.

The therapy is very systematic. You first write down the situations with spiders that scare you and then categorize them from least frightening to most frightening. You will also have to learn an effective relaxation technique to employ when in these situations.

The next step is to imagine coping with the situations at the lowest levels on your list while engaging in relaxation. Gradually, the anxiety will subside. You stay at the same level until the anxiety provoked by the stimulus becomes tolerable. Then you move on to the next level and you work your way up to the top of the hierarchy. These exercises can be done in imagery as well as in reality.

The final step is gradual exposure. This is done without relaxation. With a trusted person’s guidance, you expose yourself to real phobic situations. Again, you proceed step by step, from the least to the most frightening, and remain in the situation until the anxiety subsides.

You can involve pictures of spiders in your exposure therapy when you practice the exposure steps. Starting with a picture of a spider can be a very non-threatening way to at least be able to look at the spider and imagine how you will cope when it’s the real thing!