Rhena Branch

Article / Updated 12-29-2021

Anxiety is a bully. And like most bullies, the more you let it shove you around, the pushier it gets. The principle of facing your fears until your anxiety reduces is one of the cornerstones of Cognitive Behavioral Therapy (CBT). Get to know the nature of anxiety and to identify the ways in which it pushes you about. Fundamentally, you can beat anxiety, like any bully, by standing up to it. Acquiring anti-anxiety attitudes Your thoughts are what count, because your feelings are influenced greatly by how you think. Feeling anxious increases the chance of you experiencing anxiety-provoking thoughts. Anxious thoughts can increase anxious feelings, and so a vicious cycle can develop. You can help yourself to face your fears by adopting the attitudes we outline in this section. Thinking realistically about the probability of bad events If you have any kind of anxiety problem, you probably spend a lot of time worrying about bad things that may happen to you or your loved ones. The more you focus your attention on negative events and worry about bad things being just around the corner, the more likely you are going to believe that they’ll actually happen. Proving for sure that bad events won’t happen isn’t that easy, with or without a crystal ball, but you can acknowledge that you tend to overestimate the probability of bad things happening. Adjust your thinking appropriately to counterbalance for this tendency. Counterbalancing your attitude is a lot like riding a bike with the handlebars offset to the left — to steer straight, you need to pull the handlebars to the right, otherwise, you keep veering off to the left. If you tend to always imagine the worst, straighten out your thinking by deliberately assuming that things are likely to be okay. Avoiding extreme thinking Telling yourself that things are awful, horrible, terrible or "the end of the world" only turns up the anxiety heat. Remind yourself that few things are really that dreadful, and instead, rate events more accurately as bad, unfortunate, inconvenient, or unpleasant, but not "the end of the world." Extreme thinking leads to extreme emotional reactions. When you mislabel a negative event as horrible, you make yourself overly anxious about unpleasant but relatively non-extreme events, such as minor public embarrassment. Taking the fear out of fear When people say things like "Don’t worry, it’s just anxiety," the word just implies — wrongly — that anxiety is a mild experience. Anxiety can, in fact, be a very profound experience, with strong bodily and mental sensations. Some anxious people misinterpret these intense physical symptoms as dangerous or as signs of impending peril. Common misreadings include assuming that a nauseous feeling means that you’re about to be sick, or thinking that you’re going crazy because your surroundings feel "unreal." If you have concerns about your physical sensations you may consider seeing your family doctor prior to deliberately confronting your fears. Your doctor may then be able to advise you as to whether deliberately increasing your anxiety in the short term, in order to be free of it in the long term, is safe enough for you. It is rare for people to be advised against facing their fears. Understanding and accepting common sensations of anxiety can help you stop adding to your anxiety by misinterpreting normal sensations as dangerous. The figure below outlines some of the more common physical aspects of anxiety. Undoubtedly, anxiety is an unpleasant, sometimes extremely disturbing experience. However, evaluating your anxiety as "unbearable" or saying "I can’t stand it" only ramps up the emotional impact. Remind yourself that anxiety is hard to bear but not unbearable. It’s sometimes intense, but it’s temporary. Attacking anxiety with CBT The following are some key principles for targeting and destroying anxiety. Winning by not fighting Trying to control your anxiety can lead you to feeling more intensely anxious for longer. Many of our clients say to us, "Facing my fears makes sense, but what am I supposed to do while I’m feeling anxious?" The answer is . . . nothing. Well, sort of. Accepting and tolerating your anxiety when you’re deliberately confronting your fears is usually the most effective way of making sure that your anxiety passes quickly. If your anxiety is more generalized, try to relegate it to the back burner of your mind. Carry on with mundane everyday tasks and let the anxiety burn itself out. Try taking the attitude "I can still function and do what needs to be done in the day even with feelings of anxiety." The less you focus on it, the less your brain feels like it’s got another problem to solve, meaning it is less stressed. If you’re convinced that your anxiety won’t diminish by itself, even when you do nothing, test it out. Pick one anxiety-provoking situation that you normally withdraw from, such as using an elevator, traveling on a busy bus, standing in a crowded room, or eating alone in a cafe. Make yourself stay in the situation and just let your anxiety do its thing. Don’t do anything to try to stop the anxiety. Just stay where you are and do nothing other than feel anxious. Imagine the anxiety like waves crashing onto a beach and let the waves get smaller and smaller until they’re only a gentle ripple. Eventually, your anxiety will begin to ebb away. Defeating fear with 'FEAR' Perhaps the most reliable way of overcoming anxiety is the following maxim: FEAR — Face Everything And Recover. Supported by numerous clinical trials, and used daily all over the world, the principle of facing your fears until your anxiety reduces is one of the cornerstones of CBT. The process of deliberately confronting your fear and staying within the feared situation until your anxiety subsides is known as exposure or desensitisation. The process of getting used to something, like cold water in a swimming pool, is called habituation. The principle is to wait until your anxiety reduces noticeably before ending your session of exposure – usually between 20 minutes and one hour, but sometimes more. Repeatedly confronting your fears As the following figure shows, if you deliberately confront your fears, your anxiety becomes less severe and reduces more quickly with each exposure. The more exposures you experience, the better. When you first confront your fears, aim to repeat your exposures at least daily. Keeping your exposure challenging but not overwhelming When confronting your fears, aim for manageable exposure, so that you can successfully experience facing your fears and mastering them. If your exposures are overwhelming, you may end up resorting to escape, avoidance or safety behaviors. The flipside of choosing overwhelming exposures is taking things too gently, which can make your progress slow and demoralizing. Strive to strike a balance between the two extremes. If you set yourself only easy, gentle exposures, you risk reinforcing the erroneous idea that anxiety is unbearable and must be avoided. The point of exposure work is to prove to yourself that you can bear the discomfort associated with anxious feelings. Taking it step by step Avoid overwhelming or underchallenging yourself by using a graded hierarchy of feared or avoided situations. A graded hierarchy is a way of listing your fears from the mildest to the most severe. If you want to kill your fear, let it die of its own accord. You can use the following table to list people, places, situations, objects, animals, sensations, or whatever triggers your fear. Be sure to include situations that you tend to avoid. Rank these triggers in rough order of difficulty. Alongside each trigger, rate your anticipated level of anxiety on the good old 0-to-10 scale. Voila! You have a graded hierarchy. After you have confronted your fear, rate the actual level of anxiety or discomfort you experienced. Then, tailor your next exposure session accordingly. Most situations are not as bad as you expect them to be. In the unlikely event that the reality is worse than your expectations, you may need to devise more manageable exposures for the next few steps and work your way up the hierarchy more gradually. Jumping in at the deep end Although we caution about striking a balance between under- and overchallenging yourself, jumping in with both feet does have its benefits. The sooner you can face your biggest fears, the sooner you can master them. Consider whether you can climb to the top of your hierarchy straight away. Graded exposure is a means to an end. Going straight to your worst-feared situation without resorting to safety behaviors can help you get rapid results, as long as you stick with the exposure long enough to discover that nothing terrible happens. Shedding safety behaviors You can overcome anxiety by turning your anxiety upside-down. The best way to make your anxiety go away is to invite it to do its own thing. The things you do to reduce your fear in the short term are often the very things that start you feeling anxious in the first place. Recording your fear-fighting Keep a record of your work against fear so you can check out your progress and make further plans. Your record can include the following: The length of your exposure session Ratings of your anxiety at the beginning, middle, and end of your exposure session A record helps you see whether you’re sticking with your program long enough for your fear to subside. If your fear doesn’t seem to be reducing, make sure that you’re still trying hard enough to reduce your fear by getting rid of those safety behaviors. Overriding common anxieties with CBT The following outlines the application of CBT for some common anxiety problems. The CBT principles that we introduce you to here are the very best bet for overcoming most anxiety problems. First, define what you’re doing to keep your anxiety alive in your thinking, and alive in your behavior. Then, start to catch your unhelpful thoughts and generate alternatives, and test them out in reality. Understanding where you focus your attention, and retraining your attention, can also be hugely helpful. Socking it to social anxiety Attack social anxiety (excessive fear of negative evaluation by other people) by drawing up a list of your feared and avoided social situations and the safety behaviors you tend to carry out. Hang on to the idea that you can accept yourself even if other people don’t like you. Be more flexible about how witty, novel, and entertaining you have to be. Systematically test out your predictions about people thinking negatively about you — how do people act when you don’t try so hard to perform? Refocus your attention on the world around you and the people you interact with, rather than on yourself. Once you’ve left the social situation, resist the tendency to play your social encounters back in your mind. Waging war on worry To wage war on your excessive worry, resist the temptation to try to solve every problem in advance of it happening. Try to live with doubt and realize that the most important thing is not what you specifically worry about but how you manage your worrying thoughts. Overcoming worry is the art of allowing thoughts to enter your mind without trying to "sort them out" or push them away. Pounding on panic Panic attacks are intense bursts of anxiety in the absence of real danger and can often seem to come out of the blue. Panic attacks often have very strong physical sensations, such as nausea, heart palpitations, a feeling of shortness of breath, choking, dizziness, and hot sweats. Panic sets in when people mistake these physical sensations as dangerous and get into a vicious cycle because these misinterpretations lead to more anxiety, leading to more physical sensations. Put panic out of your life by deliberately triggering off panic sensations. Enter situations you’ve been avoiding and resist using safety behaviors. Realize, for example, that feeling dizzy doesn’t cause you to collapse, so you don’t need to sit down, and that other uncomfortable sensations of anxiety will pass without harming you. Carry out a behavioral experiment to specifically test out whether your own feared catastrophes come true as a consequence of a panic attack. Assaulting agoraphobia What is agoraphobia? Georgina was afraid to travel far from her home or from familiar places she felt safe in, which are common characteristics of agoraphobia. She feared losing control of her bowels and soiling herself. She had become virtually housebound and relied heavily on her husband to drive her around. She learned about the nature of anxiety and developed the theory that, although she may feel like she is going to soil herself, her sensations are due largely to anxiety and she will be able to "hold on." To gain confidence and overcome agoraphobia, develop a hierarchy of your avoided situations and begin to face them, and stay in them until your anxiety reduces. This may include driving progressively longer distances alone, using public transport and walking around in unfamiliar places. At the same time, work hard to drop your safety behaviors so you can discover that nothing terrible happens if you do become anxious or panicky, and ride it out. Dealing with post-traumatic stress disorder Post-traumatic stress disorder (PTSD) can develop after being involved in (or witnessing) an accident, assault, or other extremely threatening or distressing event. The symptoms of PTSD include being easily startled, feeling irritable and anxious, memories of the event intruding into your waking day, having nightmares about the event, or feeling emotionally numb. If you have PTSD, you may be sustaining your distress by misunderstanding your normal feelings of distress in response to the event, trying to avoid triggers that activate memories of the event or trying too hard to keep yourself safe. To combat PTSD, remind yourself that memories of a traumatic event intruding into your mind and feelings of distress are normal reactions to trauma. Allowing memories to enter your mind and spending time thinking about them is part of processing traumatic events, and a crucial part of recovery. Many people find that deliberately confronting triggers or writing out a detailed first-person account can be helpful. At the same time it’s important to reduce any excessive safety precautions you may have begun to take. Depending on the nature of your trauma and the severity of your symptoms, your best bet may be to seek a CBT therapist with expertise in treating PTSD. A trained therapist can help you ground yourself after exposures and be alongside you as you confront disturbing memories. Don’t hesitate to get professional help with what may now feel overwhelming. Hitting back at fear of heights Begin to attack a fear of heights by carrying out a survey among your friends about the kind of feelings that they have when standing at the edge of a cliff or at the top of a tall building. You’ll probably discover that your sensation of being unwillingly drawn over the edge is very common. Most people, however, just interpret this feeling as a normal reaction. Put this new understanding into action to gain more confidence about being in high places. Work through a hierarchy of entering increasingly tall buildings, looking over bridges and climbing to the top of high cliffs.

Article / Updated 12-28-2021

Cognitive behavioral therapy – more commonly referred to as CBT – focuses on the way people think and act to help them with their emotional and behavioral problems. Many of the effective CBT practices we discuss in this book should seem like everyday good sense. In our opinion, CBT does have some very straightforward and clear principles and is a largely sensible and practical approach to helping people overcome problems. However, human beings don’t always act according to sensible principles, and most people find that simple solutions can be very difficult to put into practice sometimes. CBT can maximize on your common sense and help you to do the healthy things that you may sometimes do naturally and unthinkingly in a deliberate and self-enhancing way on a regular basis. Scientifically-tested methods The effectiveness of CBT for various psychological problems has been researched more extensively than any other psychotherapeutic approach. CBT’s reputation as a highly effective treatment is based on continued research. Several studies reveal that CBT is more effective than medication alone for the treatment of anxiety and depression. As a result of research like this, briefer and more intense treatment methods have been developed for particular anxiety disorders, such as panic, anxiety in social settings, or feeling worried all the time. As scientific research of CBT continues, more is being discovered about which aspects of the treatment are most useful for different types of people and which therapeutic interventions work best with different types of problems. Research shows that people who engage in CBT for various types of problems — in particular, for anxiety and depression — stay well for longer. This means that people treated with CBT relapse less often than those treated with other forms of psychotherapy, or those who take medication only. This positive result is likely due in part to the educational aspects of CBT — people who have CBT receive a lot of information that they can use to become their own therapists. More and more physicians and psychiatrists refer their patients for CBT to help them overcome a wide range of problems, with good results. These problems include the following: Addiction Anger problems Anxiety Body dysmorphic disorder Body image problems Chronic fatigue syndrome Chronic pain Depression Eating disorders Gender identity and sexuality issues Obsessive-compulsive disorder Panic disorder Personality disorders Phobias Post-traumatic stress disorder Psychotic disorders Relationship problems Social anxiety CBT skills and techniques can be applied to most types of psychological difficulties, so give them a try, whether or not your particular problem is specifically discussed in this article. Understanding CBT Cognitive behavioral therapy is a school of psychotherapy that aims to help people overcome their emotional problems. Cognitive means mental processes like thinking. The word cognitive refers to everything that goes on in your mind including dreams, memories, images, thoughts, and attention. Behavior refers to everything that you do. This includes what you say, how you try to solve problems, how you act, and avoidance. Behavior refers to both action and inaction; for example, biting your tongue instead of speaking your mind is still a behavior, even though you are trying not to do something. Therapy is a word used to describe a systematic approach to combating a problem, illness, or irregular condition. A central concept in CBT is that you feel the way you think. Therefore, CBT works on the principle that you can live more happily and productively if you’re thinking in healthy ways. Combining science, philosophy, and behavior CBT is a powerful treatment because it combines scientific, philosophical, and behavioral aspects into one comprehensive approach to understanding and overcoming common psychological problems. Getting scientific. CBT is scientific not only in the sense that it has been tested and developed through numerous scientific studies, but also in the sense that it encourages clients to become more like scientists. For example, during CBT, you may develop the ability to treat your thoughts as theories and hunches about reality to be tested (what scientists call hypotheses) rather than as facts. Getting philosophical. CBT recognizes that people hold values and beliefs about themselves, the world, and other people. One of the aims of CBT is to help people develop flexible, non-extreme, and self-helping beliefs that help them adapt to reality and pursue their goals. Your problems are not all just in your mind. Although CBT places great emphasis on thoughts and behavior as powerful areas to target for change and development, it also places your thoughts and behaviors within a context. CBT recognizes that you’re influenced by what’s going on around you and that your environment makes a contribution toward the way you think, feel, and act. However, CBT maintains that you can make a difference in the way you feel by changing unhelpful ways of thinking and behaving — even if you can’t change your environment. Incidentally, your environment in the context of CBT, includes other people and the way they behave toward you. Your living situation, your culture, workplace dynamics, or financial concerns are also features of your larger environment. Getting active. As the name suggests, CBT strongly emphasizes behavior. Many CBT techniques involve changing the way you think and feel by modifying the way you behave. Examples include gradually becoming more active if you’re depressed and lethargic, or facing your fears step by step if you’re anxious. CBT also places emphasis on where you focus your attention. Mental behaviors, such as worrying and chewing over negative events, can be helped by learning to focus your attention in a more helpful direction. Progressing from problems to goals A defining characteristic of CBT is that it gives you the tools to develop a focused approach. CBT aims to help you move from defined emotional and behavioral problems toward your goals of how you’d like to feel and behave. Thus, CBT is a goal-directed, systematic, problem-solving approach to emotional problems. Making the thought–feeling link Like many people, you may assume that if something happens to you, the event makes you feel a certain way. For example, if your partner treats you inconsiderately, you may conclude that she makes you angry. You may further deduce that her inconsiderate behavior makes you behave in a particular manner, such as sulking or refusing to speak to her for hours (possibly even days; people can sulk for a very long time!). We illustrate this common (but incorrect) causal relationship with the following formula. In this equation, the A stands for a real or actual event — such as being rejected or losing your job. It also stands for an activating event that may or may not have happened. It could be a prediction about the future, such as, "I’m going to get the sack," or a memory of a past rejection, such as "Hilary will dump me just like Judith did ten years ago." C stands for consequence, which means the way you feel and behave in response to an actual or activating event. A (actual or activating event) = C (emotional and behavioral consequence) CBT encourages you to understand that your thinking or beliefs lie between the event and your ultimate feelings and actions. Your thoughts, your beliefs, and the meanings that you give to an event produce your emotional and behavioral responses. So, in CBT terms, your partner does not make you angry and sulky. Rather, your partner behaves inconsiderately, and you assign a meaning to her behavior, such as "She’s doing this deliberately to upset me, and she absolutely should not do this," thus making yourself angry and sulky. In the next formula, B stands for your beliefs about the event and the meanings you give to it. A (actual or activating event) + B (beliefs and meanings about the event) = C (emotional and behavioral consequence) This is the formula or equation that CBT uses to make sense of your emotional problems. Emphasizing the meanings you attach to events The meaning you attach to any sort of event influences the emotional responses you have to that event. Positive events normally lead to positive feelings of happiness or excitement, whereas negative events typically lead to negative feelings like sadness or anxiety. However, the meanings you attach to certain types of negative events may not be wholly accurate, realistic, or helpful. Sometimes, your thinking may lead you to assign extreme meanings to events, leaving you feeling disturbed. For instance, Tilda meets up with a nice man that she’s contacted via a dating app. She quite likes him on their first date and hopes he’ll contact her for a second meeting. Unfortunately, he doesn’t. After two weeks of eagerly checking her phone, Tilda gives up and becomes depressed. The fact that the chap failed to ask Tilda out again contributes to her feeling bad. But what really leads to her acute depressed feelings is the meaning she’s derived from his apparent rejection, namely, "This proves I’m old, unattractive, past it, and unwanted. I’ll be a sad singleton for the rest of my life." As Tilda’s example shows, drawing extreme conclusions about yourself (and others, and the world at large) based on singular experiences can turn a bad distressing situation into a deeply disturbing one. Psychologists use the word disturbed to describe emotional responses that are unhelpful and cause significant discomfort to you. In CBT terminology, disturbed means that an emotional or behavioral response is hindering rather than helping you to adapt and cope with a negative event. For example, if a potential girlfriend rejects you after the first date (event), you may think, "This proves I’m unlikeable and undesirable," (meaning) and feel depressed (emotion). CBT involves identifying thoughts, beliefs, and meanings that are activated when you’re feeling emotionally disturbed. If you assign less extreme, more helpful, more accurate meanings to negative events, you are likely to experience less extreme, less disturbing emotional and behavioral responses. Thus, on being rejected after the first date (event), you could think, "I guess that person didn’t like me that much; oh well — they’re not the one for me" (meaning) and feel disappointment (emotion). You can help yourself to figure out whether or not the meanings you’re giving to a specific negative event are causing you disturbance by answering the following questions: Is the meaning I’m giving to this event unduly extreme? Am I taking a fairly simple event and deriving very harsh conclusions about myself (and/or others and/or the future) from it? Am I drawing global conclusions from this singular event? Am I deciding that this one event defines me totally, or that this specific situation indicates the course of my entire future? Is the meaning I’m assigning to this event loaded against me? Does this meaning lead me to feel better or worse about myself? Is it spurring me on to further goal-directed action or leading me to give in and curl up? If your answer to these questions is largely ‘yes’, then you probably are disturbing yourself needlessly about a negative event. The situation may well be negative, but your thinking is making it even worse. Acting out The ways you think and feel also largely determine the way you act. If you feel depressed, you’re likely to withdraw and isolate yourself. If you’re anxious, you may avoid situations that you find threatening or dangerous. Your behaviors can be problematic for you in many ways, such as the following: Self-destructive behaviors, such as excessive drinking or using drugs to quell anxiety, can cause direct physical harm. Isolating and mood-depressing behaviors, such as staying in bed all day or not seeing your friends, increase your sense of isolation and maintain your low mood. Avoidance behaviors, such as avoiding situations you perceive as threatening (attending a social outing, using a lift, speaking in public), deprive you of the opportunity to confront and overcome your fears. The ABCs of CBT When you start to get an understanding of your emotional difficulties, CBT encourages you to break down a specific problem you have using the ABC format, in which A is the activating event. An activating event means a real external event that has occurred, a future event that you anticipate occurring or an internal event in your mind, such as an image, memory or dream. The A is often referred to as your "trigger." B represents your beliefs, thoughts, personal rules, the demands you make (on yourself, the world and other people) and the meanings that you attach to external and internal events. C represents the consequences, including your emotions, behaviors, and physical sensations that accompany different emotions. This figure shows the ABC parts of a problem in picture form. Writing down your problem in ABC form — a central CBT technique — helps you differentiate among your thoughts, feelings, behaviors, and the trigger event. Consider the ABC formulations of two common emotional problems, anxiety and depression. The ABC of anxiety may look like this: A: You imagine failing a job interview. B: You believe, "I’ve got to make sure that I don’t mess up this interview; otherwise, I’ll prove that I’m a failure." C: You experience anxiety (emotion), butterflies in your stomach (physical sensation), and drinking to calm your nerves (behavior). The ABC of depression may look like this: A: You fail a job interview. B: You believe, "I should’ve done better. This means that I’m a failure." C: You experience depression (emotion), loss of appetite (physical sensation), staying in bed and avoiding the outside world, and drinking to quell your depressed feelings (behavior). You can use these examples to guide you when you are filling in an ABC form on your own problems. Doing so will help ensure that you record the actual facts of the event under A, your thoughts about the event under B, and how you feel and act under C. Developing a really clear ABC of your problem can make it much easier for you to realize how your thoughts at B lead to your emotional/behavioral responses at C. Characterizing CBT Here’s a quick reference list of key characteristics of CBT: Emphasizes the role of the personal meanings that you give to events in determining your emotional responses. Was developed through extensive scientific evaluation. Focuses more on how your problems are being maintained rather than on searching for a single root cause of the problem. Offers practical advice and tools for overcoming common emotional problems. Holds the view that you can change and develop by thinking things through and by trying out new ideas and strategies. Can address material from your past if doing so can help you to understand and change the way you’re thinking and acting now. Shows you that some of the strategies you’re using to cope with your emotional problems are actually maintaining those problems. Strives to normalize your emotions, physical sensations, and thoughts rather than to persuade you that they’re clues to "hidden" problems. Recognizes that you may develop emotional problems about your emotional problems — for example, feeling ashamed about being depressed. Highlights learning techniques and maximizes self-help so that, ultimately, you can become your own therapist.

Cheat Sheet / Updated 08-12-2021

Cognitive behavioral therapy (CBT) can help you understand how the way you think about yourself and situations in your life impacts your emotions and actions. Learning to form different and more productive perspectives on life can help you feel and act in self-enhancing ways. This commonly involves pushing through anxiety or low mood, challenging negative thoughts, establishing and pursuing viable goals, and looking after your physical self along the way.

Article / Updated 08-11-2021

Psychological problems are no more mysterious than physical ones. In the recent past (and even today) people often viewed mental health problems as a sign of intrinsic character flaws. If your body has a problem, that’s understandable, but if your mind has a problem, then something must be wrong with the whole of you. Not true. Mind and body aren’t separate entities; you’re no more to blame for psychological problems than for physical problems. The points in this article highlight and bust many myths surrounding mental health. Some contradict one another, yet people often find that they hold more than one conflicting negative idea at the same time! If you are embarking on cognitive behavioral therapy (CBT), good for you! Getting help for mental health issues or behaviors is nothing to be ashamed about; in fact, congratulations on working toward a healthier you. Psychological problems mean you’re weak When you’re depressed or suffering from anxiety or panic (to name but a few), you’re in a diminished state; you’re ill or are in a weakened state. Would you consider yourself weak for having a bout of flu or epilepsy? Probably (and hopefully) not. Weakened through illness doesn’t equal weak as an overall person. Similarly, mental strength doesn’t equal mental health. Many resilient people who pride themselves as "copers" find periods of poor mental health particularly hard to accept. Even people with jobs that require tremendous mental fortitude such as parents, teachers, nurses, surgeons, firemen, paramedics, the military, performers and athletes can and do suffer periods of mental illness. So, if someone tells you that she’s never had any psychological problems in her life, it doesn’t mean that she’s stronger than you; it means that she’s either extraordinarily fortunate or lying. I should be able to get better on my own Should you, though? This monster myth dances a damaging duo with the one in the preceding section. Shame about mental ill health leads to secrecy and tends to keep people suffering in silence for a long time. We may be writing a self-help book, but that’s only one way to get better. Mental health professionals exist because everyone needs help to overcome problems; you can’t always do it all by yourself. There’s no virtue in suffering needlessly, so get help sooner rather than later. Mental health is an either/or issue Like your physical body, your mind is ever vulnerable to injury or illness. A very bad episode in your life such as a trauma can leave you psychologically injured. You need proper care to repair. Protracted periods of stress can wear you down and leave you open to a nasty bout of depression. Even if you suffer from a chronic mental health disorder like bipolar disorder, you’re not always mentally unwell. With the appropriate medication and treatment, you can lead a stable life much the same as someone suffering from epilepsy or diabetes. Therefore, nobody is ever either completely mentally well or unwell; everyone experiences both in a lifetime. You get better all at once Recovery from depression or anxiety takes time. Everyone’s journey is different; how quickly and consistently you start to improve depends on a host of factors, including how severely unwell you were to start with. Be patient with yourself, and don’t give up if you have a setback. Setbacks are a normal part of recovery, and you often can learn from them. Pacing yourself — being realistic about goals — is important. A good CBT therapist helps motivate you and rein you in if you’re expecting too much of yourself. Even after you’re beginning to see the light flickering at the end of the proverbial tunnel, remember that you’re convalescing. Keep treating yourself compassionately and be aware of your limitations until you’re well and truly back on your feet. The drugs don’t work; they just make you worse Many people recover from common mental health problems without needing psychiatric medication. Some need medication for only a short period of time, perhaps to aid sleep, alleviate anxiety symptoms or readjust depleted levels of serotonin via an antidepressant. Most of the psychiatric medications prescribed by your doctor have relatively minor side effects and aren’t dependency forming or addictive. Doctors should be mindful of limiting the number of prescriptions given, do standard medication reviews and inform you of any potential side effects so you know what to expect. Your doctor should also consult you about stopping medications and give you a gradual reduction regime to curtail any possible withdrawal effects. The large majority of individuals we treat have no major difficulties going on or coming off medication. A lot of scaremongering goes on out there about everyday psychiatric medications, and it isn’t doing sufferers much service. If you go online to research a drug, stick to very reputable websites and avoid opinion-based anecdotal forums. Research into the efficacy and safety of drugs can be confusing and misleadingly represented in the media, so be skeptical about what you hear. For many people, the drugs do work; for others, medication isn’t something they can afford to do without. Conditions like bipolar, forms of psychosis, and severe obsessive compulsive disorder (OCD) or body dysmorphic disorder (BDD) require carefully considered medications or combinations of medications to be successfully managed. Speak to a registered psychologist or psychiatrist if you’re in need of a professional opinion. Certain types of psychological disorders are glamorous Here’s one of the contradictions we talked about earlier in the chapter. On the one hand, people tend to view psychological illness as shameful, whilst on the other they romanticize some forms of disturbance. Have you ever heard someone describe herself as "a little OCD" because she likes a tidy house or is very organized? Or perhaps you know of someone who describes herself as having a "phobia" of something that she really just dislikes. To trivialize or romanticize any type of mental health problem this way is to minimize the profound suffering these disorders can cause. Of course, people use psychological terms in a colloquial sense and mean no harm by it. But for someone with true OCD that impacts her ability to work and maintain relationships, a flippant comment can be hard to swallow. Then you have the articles in the news about online sites that seem to promote or glamorize self-harm and eating disorders. A lot of serious misrepresentations and misunderstandings of mental health problems are floating around online, in film, on TV, and even among well-meaning health workers who may lack specific psychiatric training. Mental illness is no laughing matter, nor is it stylish to deliberately adopt or mimic selected symptoms. Some social media sites are making attempts to limit profiles that promote self-harm or eating disorders, but it’s still a work in progress. Mental illness is unpreventable; it’s just bad luck You can do a lot to keep your mind fit and well. Just as you watch your diet and exercise regularly to keep your body performing well, you can do a lot to keep your mind healthy. Happily, a lot of what you do to keep physically healthy also helps to keep you on an even psychological keel. Good food, a balanced lifestyle of work and play, plenty of rest and restorative sleep as well as fulfilling relationships all play important parts in your overall well-being. Many of the tips and strategies in this book are useful not just to pull yourself out of a slump but also to keep you running at optimal levels. You may not be able to prevent every physical or mental illness through conscientious care of your mind/body "machine;" indeed, that would be impossible! But you can take care to look after yourself during hard times, seek professional help at the first hint of relapse (if you’ve had psychological difficulties in the past) and embrace the types of healthy mental attitudes peppered throughout this book. Everyone can tell when a person has a mental illness Actually, it’s almost impossible to tell just by looking whether a person is depressed or anxious, has OCD or post-traumatic stress disorder (PTSD), or suffers panic attacks. Even psychosis isn’t immediately obvious and requires professional assessment. When people experience panic attacks in public, others often come to their aid thinking a physical explanation is to blame. Your best friend may not have a clue about how depressed you’re feeling. That’s why asking people in your life for support rather than hiding away because you feel vulnerable and exposed is important. Sharing your emotional and psychological problems for the first time can be difficult, but if you don’t, others who care about you may never guess. Your doctor may give you some measures to fill out that can help identify anxiety and low mood. But even a doctor needs you to give her basic information about how you’re feeling. Don’t wait for help to come; wave a metaphorical distress flag that others can’t miss. Having a mental illness means you’re dangerous Only very few individuals with far more severe and complex psychological disorders than those discussed in this book are ever a danger to others. Films hugely misrepresent mental disorders because it makes for good viewing; accuracy isn’t often the filmmakers’ main concern. You don’t go from having intrusive OCD thoughts or images to becoming a serial killer. Nor will your anxiety mount and mount until your mind eventually "breaks" and you’re no longer in control of your actions or are left a quivering wreck forever. The common psychological disorders in this book don’t change your value system or alter your moral compass. You’re not a risk to others just because you’re feeling bad. Yes, people sometimes engage in self-harm, misjudge risks or have thoughts of suicide when experiencing poor mental health. It’s important to tell someone close to you, your therapist, doctor, and any other professional involved in your care if you’re self-harming or feel the urge to do so. If you’re having thoughts of ending your life, seek support immediately, especially if you’ve developed a plan. We always advise behaving with an abundance of caution where any risk is concerned. That said, having dark thoughts about the point of life and the future is very common when depressed or battling with another type of disorder. People often have unpleasant thoughts and images about ending their lives that they worry they may impulsively act upon. Having thoughts about dying or death doesn’t mean you’re intent on suicide. However, it does mean that you’re feeling really awful. Seeking help will go on my medical record and hurt my future prospects If you get a formal diagnosis, it does go on your medical record, as does any medication you’re prescribed. You’ll be in good company, however, with the many thousands of others with some mental health issue on their records. Records are there to make sure you get the best treatment possible if you change doctors or have to go into hospital. Their intended purpose is to be helpful, not to be used as ammunition against you in the future. Most employers never see your full medical records. Also, the days of discrimination based on a history of psychological problems are over. Unfair treatment because of mental illness, past or present, is illegal. Know your rights; many charitable organizations offer legal advice, and some lawyers specialize in mental health cases.

Article / Updated 06-25-2021

If you are beginning thinking about Cognitive Behavioral Therapy (CBT), you need to examine openly whether your past experiences have led you to develop core beliefs that may be causing your current emotional difficulties. People are sometimes surprised to find out that CBT considers the past an important aspect of understanding one’s problems. Unlike traditional Freudian psychoanalysis, which focuses intensively on childhood relationships and experiences, CBT specifically investigates past experiences in order to see how these early events may still be affecting people in their present lives. What are core beliefs? Your core beliefs are ideas or philosophies that you hold very strongly and very deeply. These ideas are usually developed in childhood or early in adult life. Core beliefs aren’t always negative. Good experiences of life and of other people generally lead to the development of healthy ideas about yourself, other people and the world. Here, we deal with negative core beliefs because these are the types of belief that cause people’s emotional problems. Sometimes, the negative core beliefs that are formed during childhood can be reinforced by later experiences, which seem to confirm their validity. For example, one of Beth’s core beliefs is "I’m bad." She develops this belief to make sense of her father beating her for no real or obvious reason. Later, Beth has a few experiences of being punished unreasonably by teachers at school, which reinforce her belief in her "badness." Core beliefs are characteristically global and absolute, like Beth’s "I’m bad." People hold core beliefs to be 100 percent true under all conditions. You often form your core beliefs when you’re a child to help you make sense of your childhood experiences, and so you may never evaluate whether your core beliefs are the best way to make sense of your adult experiences. As an adult, you may continue to act, think, and feel as though the core beliefs of your childhood are still 100 percent true. Your core beliefs are called "core" because they’re your deeply held ideas and they’re at the very center of your belief system. Core beliefs give rise to rules, demands, or assumptions, which in turn, produce automatic thoughts (thoughts that seem to just pop into your head when you’re confronted with a situation). You can think of these three layers of beliefs as a dartboard with core beliefs as the bullseye. The following figure shows the interrelationship between the three layers and shows the assumptions and automatic thoughts that surround Beth’s core belief that she’s bad. The core beliefs dartboard and Beth’s dartboard, showing the three layers of beliefs Another way of describing a core belief is as a lens or filter through which you interpret all of the information you receive from other people and the world around you. Introducing the three camps of core beliefs Core beliefs fall into three main camps: Beliefs about yourself. Unhelpful negative core beliefs about yourself often have their roots in damaging early experiences. Being bullied or ostracized at school, or experiencing neglect, abuse or harsh criticism from caregivers, teachers or siblings can inform the way in which you understand yourself. For example, Beth’s experiences of physical abuse led her to form the core belief "I’m bad." Beliefs about other people. Negative core beliefs about others often develop as a result of traumatic incidents involving other people. A traumatic incident can mean personal harm inflicted on you by another person or witnessing harm being done to others. Negative core beliefs can also develop from repeated negative experiences with other people, such as teachers and parents. For example, because Beth’s father was violent and abusive towards her but also could be funny when he wanted to be, she developed a core belief that "people are dangerous and unpredictable." Beliefs about the world. People who’ve experienced trauma, lived with severe deprivation, or survived in harmful, insecure, unpredictable environments are prone to forming negative core beliefs about life and the world. Beth holds a core belief – that "the world is full of bad things" – which she developed as a result of her early home situation and events at school later on. Sometimes, core beliefs from all three camps are taught to you explicitly as a child. Your parents or caregivers may have given you their core beliefs. For example, you may have been taught that "life’s cruel and unfair" before you had any experiences that led you to form such a belief yourself. Seeing how your core beliefs interact Identifying core beliefs about yourself can help you to understand why you keep having the same problems. However, if you can also get to know your fundamental beliefs about other people and the world, you can build a fuller picture of why some situations distress you. For example, Beth may find being yelled at by her boss depressing because it fits with her core belief "I’m bad," but the experience also seems to confirm her belief that people are unpredictable and aggressive. Like many people, you may hold core beliefs that you’re unlovable, unworthy or inadequate — these beliefs are about your basic worth, goodness, or value. Or perhaps you hold beliefs about your capability to look after yourself or to cope with adversity — these beliefs are about how helpless or powerful you are in relation to other people and the world. Mahesh, for example, may believe "I’m helpless" because he’s experienced tragedy and a lot of bad luck. He may also hold beliefs that "the world is against me" and "other people are uncaring." Looking at these three beliefs together, you can see why Mahesh is feeling depressed. Detecting your core beliefs Because core beliefs are held deeply, you may not think of them or "hear" them as clear statements in your head. You’re probably much more aware of your negative automatic thoughts or your rules than you are of your core beliefs. Following, are methods you can use to really get to the root of your belief system. Following a downward arrow One technique to help you pinpoint your problematic core beliefs is the downward arrow method, which involves you identifying a situation that causes you to have an unhealthy negative emotion, such as depression or guilt. After you’ve identified a situation that brings up negative emotions, ask yourself what the situation means or says about you. Your first answer is probably your negative automatic thought (NAT). Keep asking yourself what your previous answer means or says about you until you reach a global, absolute statement, such as "other people are dangerous," or "I’m bad," in Beth’s case. For example, when Rashid uses the downward arrow method to work out why he feels so ashamed about failing a university entrance exam, he has this negative automatic thought: NAT: "I won’t get into any of the good universities." What does this NAT mean about me? "I’ve disappointed my parents again." What does disappointing my parents mean about me? "When I try to make my parents proud, I fail." What does failing mean about me? "I’m a failure." (Rashid’s core belief) You can use the same downward arrow technique to get to your core beliefs about other people and the world. Just keep asking yourself what your NAT means about others or the world. Ultimately, you can end up with a conclusive statement that is your core belief. The following is an example of how to do this, using the situation of being fired or laid off from a job: NAT: "None of my friends have been laid off; why has this happened to me?" What does this mean about the world? "Hard work and dedication don’t pay off." What does this mean about the world? "The world is unfair and cruel." (Core belief) Picking up clues from your dreaming and screaming Imagine your worst nightmare. Think of dream scenarios that wake you up screaming. Somewhere in these terrifying scenarios may be one or more of your core beliefs. Some examples of core beliefs that can show themselves in dreams and nightmares include the following: Drying up while speaking publicly Being rejected by your partner for another person Being criticized in front of work colleagues Getting lost in a foreign country Hurting someone’s feelings Doing something thoughtless and being confronted about it Letting down someone important in your life Being controlled by another person Being at someone else’s mercy Look for the similarities between your nightmare scenarios and situations that upset you in real life. Ask yourself what a dreaded dream situation may mean about yourself, about other people, or about the world. Keep considering what each of your answers means about yourself, others, or the world until you reach a core belief. Filling in the blanks Another method of eliciting your core beliefs is simply to fill in the blanks. Take a piece of paper, write the following, and fill in the blanks: I am ______________________________________________ Other people are ____________________________________ The world is ________________________________________ This method requires you to take almost a wild guess about what your core beliefs are. Ultimately, you’re in a better position than anyone else to take a guess, so the exercise is worth a shot. You can also review written work that you’ve done, which is a good technique for discovering your core beliefs. Going over what you’ve recorded enables you to refine, tweak, or alter your beliefs. Be sure to use language that represents how you truly speak to yourself. Core beliefs are very idiosyncratic. However you choose to articulate them is entirely up to you. The same is true of the healthy alternative beliefs you develop. Make sure that you put alternative beliefs into language that reflects your own unique way of speaking to yourself. The impact of core beliefs Core beliefs are your fundamental and enduring ways of perceiving and making sense of yourself, the world, and other people. Your core beliefs have been around since early in your life. These core beliefs are so typically ingrained and unconscious that you’re probably not aware of their impact on your emotions and behaviors. Spotting when you are acting according to old rules and beliefs People tend to behave according to the beliefs they hold about themselves, others and the world. To evaluate whether your core beliefs are unhealthy, you need to pay attention to your corresponding behaviors. Unhealthy core beliefs typically lead to problematic behaviors. For example, Milo believes that he’s unlovable and that other people cannot be trusted. Therefore, he tends to be passive with his girlfriends, to seek reassurance that they’re not about to leave him, and to become suspicious and jealous of their interactions with other men. Often, Milo’s girlfriends get fed up with his jealousy and insecurity and end the relationship. Because Milo operates according to his core belief about being unlovable, he behaves in ways that actually tend to drive his partners away from him. Milo doesn’t yet see that his core belief and corresponding insecurity is what causes problems in his relationships. Instead, Milo views each time a partner leaves him for someone else as further evidence that his core belief of "I’m unlovable" is true. Sybil believes that she mustn’t draw attention to herself because one of her core beliefs is "other people are aggressive." Therefore, she’s quiet in social situations and is reluctant to assert herself. Her avoidant, self-effacing behavior means that she doesn’t often get what she wants, which feeds her core belief "I’m unimportant." Sybil acts in accordance with her core belief that other people are aggressive and likely to turn on her and, subsequently, deprives herself of the opportunity to see that this is not always going to happen. If Sybil and Milo identify their negative core beliefs, they can begin to develop healthier new beliefs and behaviors that can yield better results. Understanding that unhealthy core beliefs make you prejudiced When you begin to examine your core beliefs, it may seem to you that everything in your life is conspiring to make your unhealthy core belief ring true. But more than likely, what's actually happening is your core belief is leading you to take a prejudiced view of all your experiences. Unhealthy beliefs, such as "I’m unlovable" and "other people are dangerous," distort the way in which you process information. Negative information that supports your unhealthy belief is let in. Positive information that contradicts the negative stuff is either rejected, or twisted to mean something negative in keeping with your unhealthy belief. The prejudice model in the following figure shows you how your unhealthy core beliefs can reject positive events that may contradict them. At the same time, your core beliefs can collect negative events that may support their validity. Your unhealthy core beliefs can also lead you to distort positive events into negative events so that they continue to make your beliefs seem true. The prejudice model illustrates how you sometimes distort positive information to fit in with your negative core beliefs. For example, here’s how Beth’s core belief "I’m bad" causes her to prejudice her experiences: Negative experience: Beth’s boss is angry about a missed deadline, affirming her belief that "I’m bad." Positive experience: Beth’s boss is happy about the quality of her report, which Beth distorts as "he’s only happy about this report because he's so used to all my other work being awful," further affirming her belief that "I’m bad." Beth also ignores smaller positive events that don’t support her belief that she’s bad, such as these: People seem to like her at work. Co-workers tell her that she’s conscientious at work. Her friends text her and invite her out. However, Beth is quick to take notice of smaller negative events that do seem to match up with her belief that she’s bad: Someone pushes her rudely on a busy train. Her boyfriend shouts at her during an argument. A work colleague doesn’t smile at her when she enters the office. Beth’s core belief of "I’m bad" acts as a filter through which all her experiences are interpreted. It basically stops her from re-evaluating herself as anything other than bad; it makes her prejudiced against herself. This is why identifying negative core beliefs and targeting them for change is so important!

Step by Step / Updated 06-18-2021

One of the central messages of cognitive behavioral therapy (CBT) is that your thoughts, your attitudes, and the beliefs you hold have a big effect on the way you interpret the world around you and on how you feel. So, if you’re feeling excessively bad, chances are that you’re thinking badly — or, at least, in an unhelpful way. Of course, you probably don’t intend to think in an unhelpful way, and no doubt you’re largely unaware that you do. Thinking errors are slips in thinking that everyone makes from time to time. Just as a poor signal stop your phone from functioning effectively, so thinking errors prevent you from making accurate assessments of your experiences. Thinking errors lead you to get the wrong end of the stick, jump to conclusions and assume the worst. Thinking errors get in the way of, or cause you to distort, the facts. However, you do have the ability to step back and take another look at the way you’re thinking and set yourself straight.