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Cognitive Behavioural Therapy in Bristol and Bath A more detailed look at what it's all about.... What is Cognitive
Behavioural Therapy (CBT)? Cognition (to cognise) means “to possess knowledge or information about”. Re-cognise therefore means to know again. In practice the word cognition is also used to mean “to think” or to perceive (in a certain way). The way you cognise something is the way you perceive (or know) it. Cognitive Behavioural Therapy therefore is a therapy based on cognition (knowing) and behaviour. Human beings can think, feel, and behave irrationally and inflexibly. Here, the word “inflexibly” doesn’t imply being difficult or awkward, but refers to perceiving in a fixed way, without the possibility of using alternative perspectives. Having irrational beliefs, thoughts, and feelings can lead us to perceive the world through negatively skewed fixed perceptual filters and the resulting distorted cognition can make us feel (mistakenly) awful about ourselves, the world, and other people. In the same way that we can see things through “rose tinted spectacles” when we’re overly optimistic, we can also see things as being more threatening than they really are if our perceptual filters are negatively focused or distorted. Irrational and inflexible thinking creates disturbance at the emotional and mental level, because perceiving negatively means we find the World threatening, and this can inappropriately activate our fight and flight mechanism. This emotional and mental disturbance can lead to symptoms of anxiety, depression, anger, sexual dysfunction, phobias, social anxiety, loss of confidence, fear of the World, low self esteem, perfectionism, irritation, jealousy, obsession, compulsion, impatience with others….the list goes on. Cognitive Behavioural Therapy might be thought of at core then as learning how to be aware of anxiety causing perceptions and how then to use this awareness to maintain ongoing positive mental hygiene, thus reducing anxiety and all its associated symptoms. Once learned, it will be with you as a strategy for life. How does negative
perception cause emotional disturbance? How does CBT
work? The Insights Paraphrased, Albert Ellis’s insights (part of the foundation of CBT) state the following: The Therapy Characterised by
using the words "always" or "never". This one
creates feelings of being consistently defeated and creates a
negative feeling about the World, Self, and Others. It is RARELY
based on FACT. To overcome over-generalisation we look for
exceptions to these internal assertions. This filter
involves filtering out whatever doesn’t “fit” ones beliefs,
and looking ONLY for evidence that supports your way of seeing
things, even if that’s purely negative. Usually this means
dwelling on a single negative detail and excluding all else! Discounting the
positive Catastrophising Minimisation Emotional
reasoning I FEEL it therefore it MUST be true. Feelings are facts and to hell with the truth! Inflexible language. Should, must, ought
to, have to etc statements – Musterbatory or "Mind
Menace" language. When you say something “should” be a certain way, you are guaranteed to feel disturbed when it’s not! The same goes for have to, ought to, must etc. This language can be directed towards yourself and is even more powerfully disturbing when directed towards the world or others! “Should” is the surest way to ensure you don’t. “Should” is also the surest way to get someone else into a defensive stance. “Shoulds” can be easily replaced with “I’d prefer”, or “I’d like to”. Stop “shoulding” all over yourself! Can’t is pretty inflexible too! Negative
labelling This refers to labelling self or others as exclusively negative. So rather than knowing that no-one is perfect we can over-generalise a person’s behaviour or thinking as bad and label that person a failure or a jerk. This is inflexible thinking and can be directed towards self, creating terrible feelings of low self worth! Personalisation
and blame A big one in CBT. We personalise that which is often out of our control. When an event happens that is beyond our control (illness. missed opportunities etc) we blame ourselves. This makes you feel rotten about yourself! Perfectionism can often fall into this category. Blame is the
opposite of course where we are unwilling to assume responsibility
for our lives and behaviour and thus never arrive at a place of
healing because how can we heal it if we don’t own it? Blaming
also makes you mad at everyone else (creates anger) and blocks
solutions in a big way! The History of
CBT Although CBT has been influenced by Buddhism and Science alike through the years, perhaps the most interesting individual historical contributors are Marcus Aurelius, Epictetus, and Immanuel Kant. Marcus Aurelis (121-180AD) was a Roman Emperor. He was the author of a classic philosophical text called “Meditations”. Centrally he is quoted as saying “If you are distressed by anything external, the pain is not due to the thing itself but to your own estimate of it; and this you have the power to revoke at any moment”. This idea that we can choose how to respond to situations and events is of course front and centre to CBT. Epictetus (55-135AD) was a slave and endured great hardship. His “master” would often torture him and on one occasion, during a leg twisting torture session, Epictetus warned his master that the leg would break. The message was not heeded and the leg broke, leaving Epictetus lame. Epictetus is quoted: “Some things are up to us and some things are not. Our opinions are up to us, and our impulses, desires, aversions – in short, whatever is our own doing. Our bodies are not up to us, nor are our possessions, our reputations….that is, whatever is not our own doing” Although this message is perhaps less relevant to most people’s situation today, the central theme, that being that there are factors in life beyond our control such as other people, and their opinions, remains highly relevant to CBT. In essence there are many things we can’t control in life, but he notes we can choose to control how we respond to those things. Immanuel Kant (1724-1804) – Immanuel Kant basically proposed that objectivity (the real world) is ultimately imperceptible to the individual. He explained that all experience is filtered through subjective filters, named schema. This also is central to CBT. In understanding that what we experience is an “interpretation” of events rather than a “fact”, we can easily find our way back to the CBT based understanding that what we “feel” (our filtered interpretation) about something doesn’t always match the “facts” of the situation. The Process.
So now, you can probably begin to see how CBT works? The problem is that we are often in the habit of thinking in these distorted ways without conscious awareness of doing so. CBT uses many different techniques to bring a new awareness to these patterns. A discussion of the techniques used are beyond the scope of this article, but a central technique is to use a “Thought Record”. A thought record asks you to record exactly where you are, who you’re with, and what you are doing at the moment that your mood shifts from positive to negative, and then to write down your thoughts exactly as they occur at that moment. Having identified those central “disturbing, maladaptive” thoughts and beliefs, we can go about providing more adaptive perspectives. This process is collaborative, meaning that the therapist guides you towards a better understanding of how you may be distorting your perceptions and we work together then to create new more helpful perspectives that you can buy into with feeling. Alongside this, we work on core beliefs, because if a core belief is negative then it can create LOTS of negative thoughts in many different situations. A core belief that says essentially “I’m no good at anything” will affect everything you do negatively. Using thought records and other CBT tools, we can quickly trace back to the roots and find the core belief. There are many tools we use in CBT including (but not limited to): -
These processes give great structure to the process and allow us to evaluate our successes and accomplishments as we gain them, thus giving you increasing confidence and evidence in your ability to live from new beliefs and step into empowerment. Cognitive
Behavioural Hypnotherapy Cognitive Behavioural Hypnotherapy makes total sense! It always has to me. Firstly a few snippets of research for you: Smith et al. (1984)
pooled the results of 475 controlled studies into the efficacy of
different modes of therapy. The results showed that Cognitive
Behavioural Therapy, systematic desensitisation, and hypnotherapy
performed “better than average” in achieving therapeutic
improvement, where average was defined as the mean outcome of all
therapies studied. The international
journal of Clinical and Experimental Hypnosis 2007 conducted a study
of 84 depressed persons using 16 weekly treatments of CBH versus CBT
alone. The results showed that CBT combined with hypnotherapy
produced a greater improvement in anxiety by 5%, hopelessness by 8%
and depression by 6% than if CBT were used alone, demonstrating
clearly that CBH could be highly effective as a treatment model. The British Medical
Journal published studies in 2005 finding that in one study of 30
people presenting with severe IBS, that treatments using
hypnotherapy alongside CBT were more effective than in the
non-hypnotherapy control group. The 15 patients from the
hypnotherapy group were followed up over the next 18 months and it
was found that all patients had remained in remission. These results don’t surprise me at all. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. CBT is recommended by NICE as an effective evidence based therapeutic methodology. In plain English this means it’s mainstream (it is used within the NHS) and has been proven in trials as highly effective. The Royal College of Psychiatrists tell us: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx How effective is
CBT? §
It is one of the most effective treatments for conditions where
anxiety or depression is the main problem §
It is the most effective psychological treatment for moderate and
severe depression §
It is as effective as antidepressants for many types of depression In short then, CBT is effective, and research is showing, what we as practicing hypnotherapists have always known; that cognitive behavioural hypnotherapy is even more effective. Let’s have a look at why. Why Cognitive
Behavioural Hypnotherapy? We know that negative thinking arises from what are known as “Schema” or “Schemata” (plural schema). Schemata is the term used to describe the perceptual filters I have been talking about. Schemata are based on core beliefs. Hypnotherapy has always been about helping people to change their core beliefs by communicating directly with the unconscious mind. You can find plenty of information about this on my website, but essentially, we know that we can change core beliefs much more quickly and to a greater depth when we go straight to the source. That is to say, using hypnotherapy, we can communicate these more adaptive cognitions directly to the unconscious mind, thus bypassing the usual “resistance” of the conscious mind. The unconscious mind of course is where your core beliefs reside. This is the central computer from which all thinking, feeling, and behaviour springs. Since CBT is primarily a conscious mind technique, we have a major advantage when using CBT combined with hypnotherapy, because conscious mind adjustment is a slow process. It’s effective, and often necessary, but it’s like a drip feed when it comes to relaying information back to the unconscious. The message of change is only slowly absorbed when you work purely at the conscious mind level, and then only by persistence and repetition. Since hypnotherapy operates at a much more visceral (subconscious) level, we can amend belief systems quickly, and these belief systems are at the core of your thinking. Change the belief at the unconscious level and you simply FEEL, THINK, and BEHAVE differently. Therefore, whilst CBT can give great structure to the therapeutic process, hypnotherapy can help to deliver the necessary perceptual adjustments much more directly. In many ways then the two therapies compliment each other perfectly. Having access to both therapies also places us at a considerable advantage when it comes to addressing the individual components of a difficulty, which are often multileveled. A Fictional Case Study To understand how each approach can aid in a typical therapy let’s have a quick look at an example. Suppose Client A (Let’s call him Ben – he is pure fiction!), arrives with generalised anxiety. Upon further investigation we learn that Ben also has an irrational fear of balloons and spends a large part of every day working as a delivery driver worried that a child may turn the corner carrying a balloon. He also fears that one of the shops he delivers to may have inflated balloons on their premises. CBT could take care of this difficulty, but it would probably average at least three or four working sessions of graded exposure tasks, alongside continued adjustment of thinking and behaviour. With hypnotherapy, using NLP techniques, we would expect to be able to quickly desensitise and re-frame this difficulty in perhaps one or two sessions. We will usually create a more thorough recovery with this type of difficulty using hypnotherapy because an irrational fear of balloons is a subconscious mind response that will respond beautifully to the techniques hypnotherapists use to de-sensitise phobic templates. Separately, Ben also worries that the people in the shops he delivers to don’t like him. He is concerned that a customer might make a complaint about him and that he may lose his job as a result. Using CBT techniques we could have Ben record his thoughts each time he feels this way, and in so doing, we could then work together to examine the evidence for and against this possibility. With a rational objective evaluation we will discover that these feelings and thoughts are not supported by any strong evidence, but are in fact part of the anxiety pattern that Ben suffers with generally. Using CBT we would teach Ben to start behaving as though these perceptions are just intrusive negative thoughts and feelings instead of behaving as though they were a true reflection of reality. If we were to discover evidence that people were unpleasant to him, we would help him re-frame that as their problem, not his! Over time, Ben will gain his confidence and learn to notice that people are usually responding to him in positive ways which results in him being calmer and feeling better generally. We can use hypnotherapeutic mental rehearsal to have Ben imagine himself being calm at work, and we can create positive post-hypnotic suggestions that will be activated when he arrives at the delivery which help Ben to maintain his positive mood and walk with confidence etc. This new perspective and understanding sends a message back to that core belief that Ben does NOT endorse it. This also tells the brain that the negative belief is not true. It is only when we endorse these feelings that they remain true for us. When we dispute them they lose their power over us. Over time then the core beliefs adjust rather than Ben himself having to adjust (by remaining anxious) to the core beliefs. So, with this nicely black and white example (rarely are things quite as black and white in practice!) we can see why having access to both therapies helps and how each therapy can reinforce the other. CBT gives structure. Hypnotherapy quickly deals with subconscious mind resistance to assuming new perspectives. This process is highly flexible and can be used to address almost any emotional difficulty. What makes it particularly powerful is that it is structured and logical, whilst encouraging both subconscious and conscious mind adjustments, essentially covering all the bases. When the conscious mind and the subconscious mind are in agreement then there is no conflict and change can be surprisingly easy. About me and CBT I am primarily a hypnotherapist. During my career as a hypnotherapist I have always incorporated basic CBT understanding into my overall approach, so CBT is not new to me. However, I went on to undertake further formal training in CBT to extend my skills, earning my Diploma in Cognitive Behavioural Hypnotherapy. This diploma is accredited by the NCFE, an external national standards examination board to NVQ4 level. This is the equivalent of a higher national diploma (HND) or first year degree, and to earn this diploma you must demonstrate a high standard of competency. (Click here to learn what an NVQ is). CBT practitioners who offer CBT as their primary therapeutic model undertake extensive training purely in CBT, and are usually members of the associated CBT professional associations. For this reason we make the distinction that I am a Hypnotherapist with some formal CBT training rather than a CBT Therapist. Nonetheless, as I hope I have explained, CBT and hypnotherapy work beautifully together, and my formal CBT training means that I have a solid working knowledge of the principles and applications of CBT. As a general rule, I will take a hypno-therapeutic approach to most difficulties which incorporates CBT principles/application as standard where appropriate and helpful but if you prefer to use "pure" CBT (no hypnotherapy) then just let me know and we'll do so. If you would like some help with a difficulty, please do feel free to contact me for a free consultation.
Copyright John Crawford 2009. |
