Month: September 2018

robintre

Cognitive Behavioural therapy (CBT)

I am not going to attempt to do justice to the ‘big’ models and how they inform the work I do. Part of your ‘safe experimenting’, may be to research these areas for yourself, and in your own way.

I am making mention of some key models simply to stimulate you in creating your own experimental designs, and to foster your curiosity.

CBT has had a long and chequered history, emerging in the 21st century as something of a ‘flavour of the year’, particularly in those institutions needing to administer mass programmes to help people under stress, e.g. The National Health Service (NHS) here in the UK.

Initially a harsh and rather impoverished model having no truck with our ‘inner world’,. modern CBT is more willing to address the ‘black box’ that is our inner experience. It still tends to be ‘manualised’ as training programmes have felt the need to create an identifiable minimum standard of service.  That might be important when those administering CBT programmes are drawn from many walks of life – some heavily influenced by psychology and other therapists with limited psychological education.

It is not difficult to criticise the ‘manualised’ approach (mini-experiment: take a moment to consider how you would create your own criticism).  Plenty of practitioners have moved away from it and I’d like to think this process will continue. Where CBT does help is in:

  • identifying how and what to record about our own actions, thoughts and feelings.
  • structuring therapy and ‘homework’ exercises to generate evidence to encourage us to change.
  • creating a positive attitude to collecting and recording evidence so that change appears to be manageable, and not as some daunting and discouraging obstacle.
  • seeking out the resources we need to sustain the change process.
  • understand the change process at a knowledge level and helping us see beyond ‘knowledge’ into ‘action’.

… and, above all else, CBT challenging the ways we think about things.

In my view, the key notion is that modern CBT recognises that we are often unaware of our feelings –  at a time when we are beginning to realise that decisions all have an emotion component. Emotions impact on our beliefs and it is easy to be unaware of the way in which our beliefs shape our actions.

There are many other ways in which CBT might help you in the design and implementation of safe experiments.  The orginator of aspects of CBT, Aaron Beck, set up his own Institute and on its web page you will find a CBT approach to recording and acting on small victories and small defeats:

https://beckinstitute.org/wp-content/uploads/2015/10/4-Guide-to-self-therapy-sessions.pdf

Why not tell me about your experiences of what worked for you at:

robintrewartha@btinternet.com

and help me to tell others!

Return to:

Models informing therapy

Welcome to Find Your Nudge

How to give yourself a nudge

robintre

Blind Spots

There is a problem with the method I recommend. It places a lot of responsibility on you to decide the direction of change and how to go about it bit-by-bit.

Therapy has thrived as a profession because individuals possess blind spots that make it difficult to direct your own therapy. Many people have reported the benefits of having some-one around to help them complete the therapeutic journey.

You may well have doubted your own judgment as you examined the results of some of your experiments and wondered what to do next. All along I’ve encouraged you to seek a consultation when this happened.

However, there is still more you can do to develop your own self-awareness and to extend the benefits of the ‘safe experiment’. There are ‘doors’ that will help you along and there are others that need to be pushed opened.

You will need to experiment differently as you approach the different ‘doors’. What do I mean by this? Try this:

Consider an issue in your life: a new one or one you already have worked on. Jot it down somewhere in the briefest detail.

  • it is likely to be concerned with the way you are thinking,  behaving or feeling. I’m including ‘financial’ matters under ‘behaving’, for present purposes.
  • would you say you are some-one more dogged by your thoughts, or behaviour or feelings?  If so, then one of the three is likely to dominate. This dominant one becomes your ‘target door’: your response to it requires some attention now.
  • according to your personality, you will have an ‘open door’ more available to you –  one of the remaining ‘doors’ will be approached with some confidence, but …….
  • the remaining ‘door’ – – either your thoughts, or behaviour or feelings – will be your trap door;  the door most likely to trip you up.

Now, how will this category of ‘doors’ help with safe experiments?

It provides an opportunity to focus our attention on a ‘target’ using the skills already available to you. The ‘open door’ provides an initial way in.

The aim is to reduce the traps right in front of us or to offer us a warning about the things we might miss.

That all sounds rather vague so let’s make up some examples.

An individual becomes more and more aware that his checking behaviour, say, door locking, gets in the way of a quality life; it wastes time. That person is trapped by his behaviour. He is good at thinking; his thoughts are full of “did I check or not“. On this analysis, the man will focus safe experiments on the ‘middle’, ‘feeling door’.  He reacts to the anxiety he experiences when regularly checking.

Only by acknowledging ‘worry’ can we make a plan to address it. It is very easy to return to ‘did I check or not‘, again and again, a thought that stimulates the unacknowledged worry. This disrupts the alternative, less-used action/behaviour pathway – the one that promotes planning and the impulse to see the plan in action.

The initial experiments are likely to focus on affect regulation and his observations of the changing levels of anxiety feelings using the SUD scales. This may lead, through practice,  to actions and behaviours that prove more useful; making us more aware and sensitive to other aspects of our existence.

What about another individual – a woman – who finds it difficult to say ‘boo to a goose’? she demonstrates withdrawal in company; her behaviour, the open door, is passive avoidance of company.  Her thoughts provide the trap door that reinforce her actions – ‘I wouldn’t do that if I were you’  ideas, so again, the target door is ‘feeling’. By devising experiments that attend to her feelings, and the changing levels of her SUDS, this woman may learn to improve her self-confidence and manage her feelings differently.

Often, these changed responses will encourage different thoughts such as self-affirmation: “even though I am feeling anxious, I can deeply and completely accept myself ” and she may be more able to act differently when meeting people.