CBT for anxiety, depression, relationships, and much more
Welcome to the first part of my new Open Access course “Cognitive Behavioural Therapy with a Twist”. This is aimed at anyone struggling with psychological difficulties who would like and could benefit from a self-help course*. People who search for anxiety therapy, depression therapy, or are interested to learn more about anxiety disorders, low mood and trauma could start here.
CBT is an evidence-based psychological therapy that has been shown to be helpful for many mental health concerns. In this course I am introducing some modifications that I have found helpful over the years.
This course will be updated every two weeks on Sundays.
In part 1 you will learn:
- Why negative thinking is at the heart of much psychological distress.
- The importance of learning to notice our thoughts
Why do we feel pain
People who come to my psychology clinic in Kensington or see me for online counselling, complain of difficulties in one or more of these three areas:
I’m not good enough
I may have a serious illness
People don’t respect me
Avoid social situations
Swear at people
The first principle of CBT is that situations trouble us because of our thoughts about these situations. What our minds say. The meaning we give to events.
For example, different people could have a different thought in the following situation
You have just won the lottery
“At least my financial worries are gone”
“People will be asking me for money all the time now”
“I don’t really deserve this when so many other people suffer”
“Others may feel envious and dislike me”
“How can I be sure that a new partner will be with me because of me”
“Now I have to worry about making good use of my fortune”
Thoughts lead to emotions:
“At least my financial worries are gone” –> Joy
“People will be asking me for money all the time now” –> Anxiety
“I don’t really deserve this when so many other people suffer” –> Guilt
Emotions lead to behaviours:
Anxiety –> we might avoid certain situations.
Guilt –> we might overcompensate (e.g. people pleasing).
As we have negative thoughts that we believe, we will feel the corresponding emotions. This is what pain is and it is inevitable, because of the way human minds work. But why do some of us struggle so much?
Why do we suffer or "adding insult to injury"
The second principle of CBT is that how we respond to our thoughts (or more precisely the emotions that the thoughts lead to) makes the difference between pain and suffering.
Our behaviours can affect what we think next. A behaviour can initiate a new “chain” of thoughts/emotions/behaviours:
“I am useless” –> Shame –> Stay in bed
So you wake up in the morning and think that you are no good and can’t do anything right. No doubt a really painful thought. You feel deeply ashamed about this. But, what would be the outcome of the behaviour “stay in bed”?
It may lead to further thoughts/emotions/behaviours. You may think:
“I did not get anything done today”
Then the emotion comes as well. Probably more shame. This may lead to other unhelpful behaviours in order to cope with the emotion. Drinking some alcohol might be an example:
“I didn’t get anything done today” –> Shame –> Drink alcohol
This new behaviour “drink alcohol” can keep pain going. The next day may be even worse. Now you have a hangover.
“I am such a lost cause, I won’t get anything done today” –> Shame –> Stay in bed
We are back where we started. The pain has now turned to suffering.
Suffering is being caught in a vicious cycle. This last example above is helpful in showing us that:
What this means is that negative thoughts (through the emotions they evoke and the behaviours that we deploy to manage the emotions) can lead to vicious cycles and keep themselves going.
In CBT we do not look that much into why we have these thoughts, but what keeps them going and how we break the vicious cycle. CBT focuses on thoughts (the C of CBT) and behaviours (the B of CBT). Why not emotions? Because if you think “I am useless” and you BELIEVE it, you WILL feel sadness. Emotions will be dealt on a later post, but it might be enough to say:
If we respond to our thoughts and behaviours in a helpful way, the emotions will often pass on their own. Pain may not deteriorate into suffering.
CBT often starts with working out more helpful behaviours, especially for people who are very depressed. E.g. “get up and make some breakfast”. Break the cycle, by changing the behaviour. It sounds simple, but it can often take a lot of work. However, if we can really see how we get into difficulty by having a model such as this, it might make it easier to motivate ourselves to behave differently.
At other times CBT focuses on thinking first. In terms of this course, I believe that it makes more sense to start with this.
noticing negative thoughts
At the heart of CBT is the concept of “negative automatic thoughts”, or automatic thoughts in general. At any moment, if we pause and check in with ourselves, we might notice that there are sentence-like fragments about ourselves, others and the world being spoken in our minds. “I hate doing the dishes”. “My boss never appreciates how hard I work”. “I never thought I would like sushi”.
It takes practice to learn to notice these thoughts. They probably appear at different levels of awareness. Sometimes, we need to infer them from how we feel and how we behave.
One characteristic of automatic thoughts is the we experience them as facts.
Sometimes they are true.
Sometimes they contain a grain of truth.
Sometimes they are plain wrong.
But we always experience them as the truth.
One of the most important skills we can develop is that of noticing our thoughts. It’s what starts everything after all. Especially in emotionally charged situations.
Weeks 1 and 2 plan
For the next two weeks I invite you to do the following. Every time you experience a strong emotion (joy, excitement, contentment, pleasure, ecstasy, shame, guilt, sadness, anger) ask yourself:
What am I thinking?
What is my mind telling me?
What is running through my mind?
Take a few moments to notice. Then I’d like you to repeat back to yourself:
“My mind is telling me that…”.
“The thought that is going through my mind is…”
“The words I can hear right now are…”
“The story I am telling myself is that…”
“If my mind could speak right now, it would tell me that…”
You are doing 2 important things at once.
- Firstly, you are noticing your thoughts and therefore beginning to become more aware of what your emotions are about. For example, that feeling of anxiety earlier was about the possibility of your friends asking you for money after winning the lottery.
- Secondly, by playing them back to yourself, you are creating a tiny, teeny, little bit of distance from them. You are pausing and taking a look at the “truth” that you mind is giving you. Pausing for 5 seconds, standing back and looking at your thoughts (rather than reacting immediately) can sometimes be enough to prevent us from engaging in a familiar albeit unhelpful behaviour. It then opens up room for assessing these thoughts for how true or useful they might be.
Be like a news reporter who is trying to objectively report what they see. Simply report, don’t judge.
I would like you to do this for both weeks as often as you can and especially in emotionally charged situations.
In the second week, when you might getting the hang of this, I’d like you to start writing the thoughts down as you notice them. It can make a difference to see your thoughts on a piece of paper in front of you, creating even more distance from them. You may also begin to notice patterns in your negative thinking.
I also want you to write down the 4Ws:
Who am I with? (e.g. with my boss)
What am I doing? (discussing my recent project)
Where am I? (in my boss’ office)
When is this? (Wednesday morning)
In the end you should have an entry that includes (a) Emotion, (b)4Ws, (c) automatic thought.
In the second part we will begin to look at techniques to
- Analyse the thoughts further, to really grasp how they can evoke emotions
In the third part I will be helping you
- Understand why certain behaviours tend to follow painful emotions
- Start becoming an expert at tracing your specific vicious cycles and to consider where you can intervene in order to alleviate suffering.
As the course progresses we will be targeting some of the deeper layers of our psychology which can help us understand why we may be getting the negative thoughts that we do. In part 4 we will also start implementing change strategies. This may sound a little far off, but it is one of the modifications I was talking about. I think it is worthwhile to build solid foundations before starting to change yourself.
I look forward to sharing more with you.
*Please note that this course is not meant to be a substitute for professional help from a registered psychologist. I also cannot respond to any concerns you raise about yourself either in the comments section or conveyed to me by email or any other means . If you need more help, speak to your GP who can direct you to your local NHS service and you can get CBT for free. If you have some really scary thoughts about hurting yourself or someone else, please speak to your GP or, if you cannot wait, call Samaritans (call 116 23), go to your local A and E, or call 999 to request an ambulance. If you are already under NHS care reach out to your service and ask to speak to a duty worker if they have crisis options available. If you would like to see me for a course of CBT or another psychological therapy you are welcome to email me at Nikos.firstname.lastname@example.org. We can then sit down together and look at what you struggle with in depth.