CBT for anxiety, depression, relationships, and much more
Welcome to the third part of my 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 need help with anxiety, depression, trauma, relationships may like to start here.
If you haven’t already, please read Part 1 by clicking here.
Last week I promised we would continue by introducing behaviours and bringing thoughts/emotions/behaviours together in what psychologists call a “psychological formulation”: a psychological snapshot that helps us figure out where we can intervene to address a psychological problem.
Let us start with behaviours.
So far we have been working on the connection between thoughts and emotions. We have been practising exploring our thoughts and trying to arrive at a root thought which explains the emotion we experience during a given situation. We learnt how to use the “downward arrow technique” to go from the thought that is in our minds to the thought that is linked to the emotion we feel. Let’s take an example from Melissa. In the last two weeks she noted the following thought:
What: checking for messages to see if Abela has replied (Melissa and Abela had gone on a first date on Saturday)
Where: in my bedroom.
When: Monday morning
Who: by myself
Melissa was feeling sad. Next to “sad” she noted the thought: “she doesn’t want to see me again”. She then asked: “what does it mean about me if she doesn’t want to see me again?”
She then wrote “I’m not partner material”. If that was true what would happen next? “I will never find anyone”. And then? “I will always be alone”.
Melissa was feeling sad partly because she thought she would not see Abela again, but also, and perhaps mostly, because she believed that she would always be alone. So far we have:
“I will always be alone” -> Sadness
Today we will look at what happens next. We can ask the question: what do I do in response to this sadness? Do I do anything to make myself feel better? Do I try anything to not feel the emotion?
In this case, Melissa decides to sign out of the dating app she is using. She is afraid she will feel like this again.
In CBT we call this a “safety behaviour”. It means that we do something on the defensive, in order to change our emotional experience, get rid of feelings, or prevent something from happening again.
Other examples of safety behaviours:
-Procrastinating because doing something is anxiety provoking
-Checking for symptoms to prevent being surprised by an illness
-Taking a video of myself locking the door, because I can’t trust myself
-Wearing a lot of makeup so people cannot see that I blush in social situations
-Avoid going to certain places because I may have a panic attack
Once we have identified what we do in a situation that affects us emotionally, we can ask:
-Behaving in this way, is it less likely, more likely, or as likely that I will have the same thought again?
In our example, Melissa responds “more likely”. If she stops using her dating app it is more likely that she will have the thought “I will always be alone again”. It is also more likely that she will behave in a way that will make it even more likely to continue thinking in this way.
Breaking the cycle
In CBT we call a situation like this a “vicious cycle”. The reason is that safety behaviours are very likely to keep the negative thoughts coming. We usually feel it is very risky to behave differently. You have to keep in mind that we may have learned to behave in particular ways from an early age, and that back then these behaviours may have been adaptive. In the case of severely traumatic childhoods these behaviours may have kept us sane and alive. You also have to keep in mind that most of time we act on auto-pilot. We are rarely aware of what we are doing or how it may affects us adversely.
However, if we have a formulation like this we can begin to see, maybe for the first time, how we can get in the way of ourselves and what we may need to do to have better experiences.
What could Melissa do in this situation? She can work on either the thoughts or the behaviours. Sometimes it might be enough to encourage herself to carry on dating and be kind to herself when things do not work out. Often she may need to take some extra steps, which is what we will look at in the next part: challenging the negative thoughts and coming up with more balanced and realistic thoughts.
Plan for weeks 5 and 6
By now, you will likely have accumulated a quite a few examples of thoughts (including root thoughts) and emotions, in specific situations (described with the 4Ws). What I would like to invite you is:
(a) Try and write the behaviour that followed in each case (whenever you can remember) or do this over the next two weeks with new examples.
(b) See if there is anything you can do differently. In other words try a new behaviour. Don’t worry about doing it perfectly. It doesn’t have to be anything big. It might not even be anything you can do right there and then, but something you commit doing differently in the future.
For Melissa, it might be try the dating app again in a couple of days. At the same time, what can Melissa do with the feeling of sadness? Emotions often tend to pass on their own if we do not behave in ways that bring about thoughts that fuel the sadness. At the same time, Melissa may get in touch with a mate and arrange a meetup after work so she has something to look forward to. In a situation like this there is the danger, for example, of withdrawing socially because we feel low. This can actually prevent us from some emotional recharge with the people close to us, functioning in the same way to keep our mood low and us more likely to behave in ways that will bring about more negative thoughts.
See you in two weeks for some thought challenging!
*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.email@example.com. We can then sit down together and look at what you struggle with in depth.