Cognitive-Behavioural Therapy

The basic tenet of Cognitive Behavioural Therapy, or CBT, is that what you think affects the way you feel. That is to say, if you think depressive thoughts then you will feel depressed. Conversely, if you manage to stop yourself thinking these thoughts, then your depression will lift.

As a psychiatrist using CBT techniques, my first step is to look for unhelpful patterns of thinking with my clients. Depressed people often think in particular ways that are very different from non-depressed people. These ways of thinking are called – in CBT language – “thinking errors”. Thinking errors help to cause and then maintain depression.

Numerous different thinking errors have been identified by CBT therapists over the years, and particular kinds of errors seem to predispose to particular psychological problems. In my experience as a therapist, the most common errors found in depression are “All-or-Nothing” thinking, “Mental Filtering”, “Disqualifying the Positive”, and “Personalising”.

“All-or-Nothing” thinking (also known in CBT circles as “Black-or-White” thinking) emphasises extremes and ignores the fact that most things in life are shades of grey rather than absolutes. For example, a person thinking in this way may play one poor game of tennis and then decide that he’s totally useless and give up forever. Or she may miss one yoga class and tell herself that as she’s fallen behind, there’s no point in going back. “All-or-Nothing” thinking sets very rigid rules for a person to live by – rules that, if broken (as they almost inevitably are!) can lead to the abandonment of enjoyable and worthwhile activities, and predispose the person to depression.

“Mental Filtering” is the term applied to the thinking patterns of people who “see” the world in a depressive way. People with this thinking error are biased in what they take notice of, and what they later remember. They will tend to notice (or, in CBT parlance, “attend”) to objects, people, or events that “fit-in” or confirm their previously held beliefs. For example, a depressed person who thinks that the world is an unpleasant place to live is more likely to remember the sad news stories as compared to a non-depressed person. A depressed person who thinks that they’re unlikeable will take extra notice of possible sleights from others. CBT theory posits that such mental filtering reinforces a person’s depression.

A closely related thinking error is termed “Disqualifying the Positive”. As well as focusing on the negative features of the world (and themselves), depressed people will often actively ignore (or “disqualify”) evidence to the contrary. A depressed person may well recall the person at the party who ignored them, but he will forget or downplay the others who chatted to him for hours. If a CBT therapist asked them about this, he will often say things like “oh, they just felt sorry for me”, thereby turning a positive interaction into something very different.

“Personalising” is the term given to a type of thinking that places the person at the centre of events. Such a view of the universe places a huge burden on the persons shoulders – they can feel responsible for all the bad things that happen. You may be “Personalising” when you feel guilty about not being able to help an unemployed friend keep his house, or when reading about climate change due to our Western way of living. There are factors beyond your control and for which you should not take responsibility. If you do, then CBT hypothesises that you will experience feelings of guilt, shame, and ultimately depression.

The above is a brief review of the common thinking errors that I have come across during the course of my work as a therapist in Edinburgh. Identifying such errors with the client is a first step on the way to identifying other, healthier, ways of thinking.

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for further information on psychological problems and CBT.

Cognitive therapy is first and foremost a psychotherapeutic approach which attempts to influence human behaviours and dysfunctional emotions. The methodology behind cognitive therapy is to analyse negative emotions and identify inaccurate and dysfunctional behaviours. The method is both goal-oriented and well-organised.

The theory behind this method was formed as a result of merging the works of Aaron T. Beck and Albert Ellis. The two theories that were merged to create this method were behaviour theory and cognitive theory. It is therefore now known as Cognitive Behavioural Theory (CBT). Albert Ellis first originated rational therapy which was a main step in the development of CBT. Aaron T. Buck was inspired by Ellis’ work and this led him to develop cognitive therapy.

In the beginning both of these theories were compared and there was an attempt made to determine which one was the best approach. However they were merged instead into one to form CBT. The creation of this joint theory has led to the development of successful treatments for panic disorders. CBT is also very good for the treatment of issues including: personality complexes, anxiety, mood, and substance abuse. Other psychotic issues can also benefit from CBT and it has been used to reduce some criminal behaviour as well.

After analysing negative emotions and identifying inaccurate and dysfunctional behaviour, CBT seeks to replace these harmful influences with more realistic and positive ones. Some of the therapeutic systems which make up CBT are: cognitive therapy, rational emotive behaviour therapy and multi modal theory. Techniques included in these systems include keeping a record of negative feelings, thoughts, behaviour and beliefs and learning how to accurately identify them. These techniques are practiced by the patients themselves under the monitoring of a therapist. CBT can help stabilize mood and treat conditions like bipolar disorder.

If there is a phobia of social situations, the same theory and methods are used however they are modified slightly for use in a group setting.

Clients can also use software programs to practice CBT. These programs can serve as an alternative to a face-to-face meeting with a therapist. If a therapist is unavailable, this means that a patient can still get the guidance and the counselling that they need. Some people who suffer from depression and loss may feel too afraid or may hesitate in talking to a person about their problems. In these cases CBT software may be the best solution in these cases.

Some of the main conditions which are treated by CBT include insomnia, mental disorders, mood disorders and panic disorders. With the help of a therapist, a client may also do some behavioural experiments in order to see how and if this would help them improve their quality of life.

CBT is also used with children and adolescents. There has been some remarkable work done in this area by Mark Reinikie and his colleagues. The “Friends Program” that was started by Paula Barrette is also a part of the CBT approach. The World Health Organization has recognized that this program is the best for the treatment of anxiety in children.

CBT is very similar to the “Scientist Practitioner Model” where the clinical practice and research work is done from a scientific perspective. This method places an emphasis on measurement.

There are some non-CBT therapists who criticize its methodology. Some further information on CBT (including some of the criticisms) includes:

It is important to realize that the effects of cognitive behavioural therapy will not be felt overnight. It can take considerable time and effort from the patient and the therapist in order to replace psychotic or negative behaviours.

Have you ever wondered how your thoughts and emotions have affected your behaviour? Or whether thoughts and behaviour are inter-related? Is it possible that what you think consciously or unconsciously can actually influence your life and even the lives of those around you?

Often the problems that we face in our lives are because of negative or faulty thought patterns that manifest themselves in our day to day behaviours and we are unable to recognise it. Thus we are trapped in the vicious circle of negative thoughts leading to negative behaviours which again causes negative thoughts. So how do we correct these faulty thought patterns and make life better? The answer lies in Cognitive Behaviour Therapy.

Cognitive Behaviour Therapy is a form of psychotherapy which emphasizes the importance of thinking and how it affects our emotions and actions. It is based on the idea that our thoughts influence our actions, our moods, our feelings and our emotions. External things like people, situations, and the environment are not the cause of our problems. Thus if you correct your way of thinking and make a change in yourself you can cope better with the same people and situations and function better in the same environment.

Cognitive Behaviour Therapy is one of the shortest forms of therapy available, in terms of time and effective results. An average of 16 sessions or lesser is required depending on the problem. The whole therapy process is structured and goal-oriented.  The therapist and the client collaborate on the goal of the therapy, and the decision to terminate the therapy when it has been achieved. What makes it very effective is the fact that each session has a goal which is decided by the therapist and the client. They have to work on the techniques in that session to reach an outcome, and proceed likewise in each subsequent session. Therefore in each session the therapist guides the client towards his goal by teaching him alternative or new ways to think and behave to achieve what they want.

Often our behaviours and thoughts are learnt, so we need to unlearn the faulty thought patterns and relearn the correct thought and behaviours. The therapist educates and aids in this process. Once the person understands why and how he is doing a particular action the sooner he can change it and learn a new action. This can be a time-consuming process thus we have a feature unique to Cognitive Behaviour Therapy, known as the Homework to speed it up. At the end of each session the therapist assigns the client to practice the techniques taught in the session and give some additional reading and exercises to be done. This helps in reaching the goal faster.

Empirical evidence has shown this therapy to be effective in problems ranging from Anxiety, Depression, Eating Disorders, Stress, Marital problems, Relationships etc. So Cognitive Behaviour Therapy is an effective therapy to solve your problems by yourself, make a change and enhance the quality of your life.

Your first panic attack should be a learning experience that will help you control attacks in the future. Sometimes people with a panic attack go to the emergency room thinking they are having a heart attack as the symptoms are similar and come on suddenly. You’ll feel things like sudden periods of extreme fear, anxiety, shortness of breath, dizziness, trembling, rapid heart beat, hyperventilation, tingling sensation, nausea, etc. When they learn that it was a panic attack and knowing the difference they can start taking control of their future attacks. This is important because often a panic attack will keep you from even functioning. Panic attacks are caused by many physical, mental and emotional triggers. Genetics may play a part and females are more apt to get them than men. Allergies or sensitivities to food, drink or chemicals can trigger an attack along with memories or trauma. Alcohol and drug can also cause panic attacks and disorders. Serious and upsetting experiences along with everyday events could trigger an attack. Panic disorder may lead to “situational avoidance,” where the sufferer feels they have to avoid every place or situation in where attack has occurred and might not even leave their house which could be a very serious disruption to a normal life. Control subjects were less likely to have panic attacks then patients with panic disorders after both drank a high amount of caffeine, according to results of a small study by Isabella Nascimento, MD, and colleagues at the Federal University of Rio de Janeiro, in Brazil. People who had went to a doctor for treatment told me that they were usually told they should avoid caffeine in colas, coffee, chocolate and teaI’ve talked with several people who gave me the following natural treatments they have used to cure or avoid panic attacks without using medicine. Deep Breathing One of the best forms of panic attack relief is to simply take deep, slow breaths to prevent hyperventilation. By getting hyperventilation under control you avoid things such as the dizziness and lightheadedness which happens because there is too much oxygen being taken to the brain at one time. Exercise This appears to be a one of the best ways of dealing with a panic attack once it’s started. An adrenaline rush usually accompanies an attack and the exercise can bleed it off according to people who use it. Aroma therapy After listening to a number of people talk about using aroma therapy to combat panic attacks it appears there are two schools of thought. The first swears by using smells that bring back pleasant memories, such as baby powder, certain flowers, farm animals or barbecuing. The others said that aromas from essential oils or candles were the best. Meditation This is a way that several people said helped them from having attacks or by being able to stop them once they started. Think happy thoughts or take your mind off your problem Others told me that once an attack started they tried to empty their mind of anything but pleasant things that they had done in the past and it appeared to help them. They also said taking your mind off the attack with things like counting backwards from one hundred was helpful. The above ways are used by ordinary people to cure or get over a panic attack. In some cases they just can’t do it themselves and need professional help. Below is some information on several different natural methods used to cure people with panic disorders. Getting Professional Help Hypnosis Diane Ulicsni, director of The Hypnosis Center in Lake Oswego, Ore., suffered from chronic panic attacks for many years. She finally found relief through hypnosis and is now a board certified hypnotherapist. She says that hypnosis — recognized by the American Medical Association since 1958 as a form of treatment — is one approach that is non-drug and can greatly ease or even cure panic attacks. Laugh your panic attacks away? That’s a good strategy, says Steve Sultanoff, PHD, a clinical psychologist in Irvine, Calif., and past president of the American Association for Therapeutic Humor. He uses humor visualization with his panic attack patients, telling them to imagine themselves in a situation where they’ve laughed uncontrollably. When they have a panic situation, they are able to return to the picture of themselves laughing. Cognitive Behavorial Therapy James D Herbert, PHD, associate professor of clinical psychology at MCP Hahnemann University in Philadelphia, says that cognitive behavioral therapy is his choice for treating panic disorders. Cognitive-behavior therapy is made up of two parts: One is to identify and modify the thinking patterns that produces anxiety (cognitive therapy), and lessening anxiety by exposing the patient to fearful scenarios (behavior therapy). If you suffer from panic attacks try some of the treatments listed above. They have worked for people I talked with and maybe they’ll work for you too. Sources Natural Panic Attack Treatments http://www.webmd.com/balance/features/natural-panic-attack-treatments?page=1 James D Herbert, PHD http://www.academyofct.org/Library/InfoManage/Guide.asp?FolderID=153&SessionID=

Cognitive Behavioural Therapy, or CBT, is an effective psychological treatment for a wide range of psychological and emotional problems. As a psychiatrist based in Edinburgh who uses CBT techniques, I see a lot of clients suffering from depression. A prominent feature of their symptom profile is the presence of “Depressive Ruminations”.

The term “rumination” relates to a repeated cycle of activity – in the case of cows (”ruminants”), this means chewing the cud! In CBT circles, ruminations are the repeated, seemingly endless, “stuck” ways of thinking seen in certain psychological conditions. It is particularly common in depression.

There can be many “themes” to an individuals ruminations, but the most common is a search for some sort of answer to questions such as “Why am I feeling like this?” or “What could I have done to avoid this?”. Another common theme is one of remorse or regret – “If only I had done (whatever) differently I wouldn’t be in this position now” or “I’ve ruined my life”. Depressive ruminations about the future are also seen – “Everything’s going to go wrong”. Ruminations often incorporate what a CBT therapist would call “Thinking Errors”.

What does it feel like to ruminate? Well, I’m sure we’ve all done it at one time or another! It’s like trying to solve an unsolvable riddle – you just go round and round inside your head, examining the same old “clues”, time and time again. If only you’d done this, or said that, or had this, or not had that. You convince yourself that there’s an answer, and that when you find it then you’ll be fine. But of course there is no “answer”. People can ruminate for hours in severe cases, but up to an hour is more usual.

How do you know when you’re ruminating? Because you’ve stopped doing everything else! You haven’t turned the page of your book for the past 20 minutes, or you’re standing in the kitchen with a dishcloth in your hands, gazing off into space. If someone asks you what you’ve been thinking, you can bet it’s the same old depressive thoughts that you’ve been carrying around for ages.

Is there a problem with ruminating? Well, yes. It differs from other forms of thought such as problem-solving, or reflecting, or remembering, in two ways. Firstly, most people find it rather unpleasant. The same old worries getting churned up again and again are bound to make us feel sad or anxious. Secondly, rumination tends to worsen (or at least maintain) depression – if you focus on how bad you feel and how hopeless (you feel) your situation is, then you will ignore opportunities for change.

CBT theory sees depressive ruminations as a major obstacle to recovery from depression, and as such it is important for clients to learn how to deal with them. There are a range of techniques, but the ones I favour as a therapist in Edinburgh are both simple and effective (and almost common sense!).

If you realise you are ruminating, then now’s the time to do something energetic. It’s hard to ruminate when you’re out on a run, or swimming, or doing press-ups. The pain tends to get in the way! Or, if you’re not the exercise type, try refocusing your attention. Focus (really focus hard!) on some aspect of your surroundings – a picture on the wall, a tree, the cat – and examine it for detail, noting each and every irregularity and shade of colour. Pretend that you’re a famous artist and that you’re going to paint the most brilliant, detailed, lifelike picture ever! Really focusing on things outside of you (meaning “outside of your head”!) helps to dislodge your thinking from ruminative patterns. A final tactic – one that some clients swear by and others can’t get the hang of at all – is to “stand-back” (”in your head”, as it were!) and let your thoughts simply churn away to themselves, whilst acknowledging them as pointless symptoms of your depression. By letting them “get on with it”, and refusing to “play with them”, you disarm them of their depression-causing capability – eventually they’ll get bored and go away!

The above techniques are those that I’ve found most effective working as a CBT therapist in Edinburgh. There are a number of other methods out there in the literature, and I don’t claim that these work for everybody. A good thing about the CBT ethos is that it shies away from doctrinal doings – there’s no “You have to do it this way or else!” in CBT. So the bottom line is, use whatever method you find helps you the most, and say “Goodbye!” to those unpleasant ruminations!

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.

Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.

In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health. 

 Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”

 Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.” 

Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain

The following ideas are some guidelines for managing pain more effectively

·         Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?

·         Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish

·         Use various activities to refocus away from your pain. Dwelling on pain makes it more    painful. Stretching, music, swimming, meditation, and other activities are important

·         Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management

·         Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments

·         Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.

Cognitive-behavioral therapy (CBT) tries to reduce a person’s misconceptions about sleep, as well as teach more positive sleep behaviors. The therapy consists of talking with a therapist (alone or with a group) to address your beliefs, assumptions and behaviors regarding sleep, and is often used in conjunction with stimulus control, sleep restriction and good sleep hygiene. Several studies have shown that CBT is an effective way of treating insomnia and that the therapy can reduce the number of long term medical issues associated with insomnia. Cognitive behavioral therapy addresses a person’s beliefs about sleep and helps replace negative or unhelpful behaviors with positive ones. The significance of one’s thinking about sleep is often underestimated. Sleep problems which start as isolated incidents can become chronic because of mental hang-ups.How we think about sleep can play an important role in how we deal with sleep difficulties. For this reason, an essential part of your sleep treatment involves identifying your thoughts about sleep that tend to make sleeping more difficult and replacing these thoughts with more helpful thinking. One technique for examining your thinking is to treat your thoughts as scientific hypotheses or ideas. You may have had certain beliefs about your sleep for a long time. At this time you are being asked to consider alternative beliefs and determine which of these beliefs is best supported by the information available to you. As you pay attention to your thinking about sleep and consider alternatives, you will probably notice two issues to address:1.    The more important it is to get a good night’s sleep, the less you sleep. Believing that a poor night’s sleep is a disaster only generates more anxiety and worry about your sleep. Challenge this thinking and consider alternative thoughts that reduce the importance of sleeping on the rest of your life (i.e. “It’s no big deal”, “I’ll be a little tired and cranky tomorrow but nothing I can’t handle.”). 2.    The more you try to control your sleep, the less you sleep. Sleep is a natural body response. Telling yourself that you must sleep and trying to force yourself to sleep only puts pressure on you and makes your sleep worse. Focusing on what you can control (sleep habits, schedule, when you are in or out of bed) and letting go of what you can not control will allow falling asleep and staying asleep to happen naturally. Now that you’ve become aware of the thoughts that make your sleep worse and have considered alternative ways of thinking, the next step is to practice these new thoughts. This challenging of new thoughts replacing old thoughts will take some effort because our thoughts are typically automatic and we are not accustomed to deliberately noticing them. Scheduling a time each day to examine the ways you think about your sleeping will be helpful in getting you to notice and challenge any maladaptive thought patterns. It is important to do this on a regular basis, as it can be easy to fall into old thought habits if you are not actively monitoring your thoughts. Like any new skill, it is important to practice it. Keep a diary of your sleep-related thoughts and your ideas on how to think differently. Once you have become accustomed to examining your thoughts, you will find that this is an excellent skill that will prove useful for helping you to approach your sleeping difficulties differently as well as for learning a healthier approach to other life problems as well.

The basic hypothesis of Cognitive Behavioural Therapy, or CBT, is that our emotions are greatly influenced by our cognitions. Or, put in plain English, “we feel what we think”.

Anger is, of course, a very common emotion and as such is not necessarily a problem. Getting angry occasionally can be entirely appropriate – I think we can all empathise with people who are angry because their car’s been stolen or someone’s spreading rumours about them. But anger can get out of hand – either through becoming too frequent or becoming too intense – and this certainly can be a problem.

And with today’s lifestyles anger can seem to be on the rise. Whether or not it is (in reality) increasing, there is certainly plenty anger-related crime reported in the media, perhaps the most obvious being the notion of “Road-Rage”. As a psychiatrist in Edinburgh I see plenty of clients that have some difficulty in controlling their anger. Often the anger appears situational – often being related to a stressful working enviroment – but it can be more generalised as well. And yes, I have seen people with “road-rage”. Even a beautiful city like Edinburgh can’t avoid the rush-hour jams (especially not since the tram-works started…)

When anger is causing an individual problems (in their relationships, occupation, or with the police etc), CBT therapists will often call it “dysfunctional”. The causes of dysfunctional anger – like any other emotional problem such as depression or anxiety – can usually be traced back to the way a person thinks. In CBT parlance, a person exhibiting dysfunctional anger will often show particular “Thinking Errors” that predispose him to anger.

Most people that have anger problems show “Inflexible Thinking”. That is, they live by a varying number of rules that they’ve set for themselves and for others. These rules may not even be obvious to the person, but when they’re broken they will feel intensely angry. An example of a rule might include “People must always drive as well and as courteously as me”. Obviously it would be nice if everyone did drive like you, but they’re not going to, so you’re in for a lot of rule-breaking and hence a lot of anger! A CBT therapist would help the individual to identify this unhelpful rule, and help the person develop a more flexible way of thinking.

Having “Poor Frustration Tolerance” is another feature of dysfunctional anger. People can convince themselves that they can’t stand any discomfort and inconvenience at all, no matter what it is or what the possible benefits in the long run might be. You may really want to see Madonna in concert, but the queue for tickets is “too long” and you “can’t stand” queuing anyway. So you leave in a huff, and then kick yourself repeatedly over the next few weeks as your friends get more and more excited over the upcoming gig! A CBT therapist can help you learn to “frame” inconveniences and discomfort in a less emotive way, increasing your tolerance levels and lessening your self-defeating anger.

People with dysfunctional anger are often in the habit of “Labelling” others. That is, they are in the habit of describing (both to themselves and others) people or situations in just a few words – often just one! So a job is “irritating” and a work colleague “annoying”. Whilst such a way of thinking and talking scores points for brevity, it must surely be inaccurate – is every aspect of the job “irritating”? Is the work colleague always, 100% “annoying?” Probably not. By labelling situations and people in such a way you can predispose yourself to anger problems as these situations and people are always in your “bad books”, regardless of what they do. So a minor slip up here or there and you’re primed to jump down their throats. A CBT therapist will endeavour to help you regard other people and situations as more complex than this, allowing them (and you) room for error without causing anger.

The above thinking errors are those that I’ve most commonly encountered whilst working as a therapist in Edinburgh. CBT is an effective psychological treatment for a whole host of psychological and emotional problems, ranging from Anorexia to Trichotillomania.

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for further information about psychological problems and CBT.

Changing the way you think in order to improve the way you feel, forms the basis of cognitive approaches to mental-wellbeing. Cognitive therapies recognise that our thoughts can affect our understanding of the outside world. Depressed people (i.e. people that practice depressed thoughts!) experience the world in a different way to others. For example, they may perceive colours less vibrantly, food can seem bland and unpleasant, and safe everyday situations can seem threatening. They often predict bad outcomes from actions and events where others would expect positive consequences. A depressed persons world is likely to be experienced significantly differently to a happy person’s. However, to an observer their circumstances could appear the same.
Cognitive therapy and related approaches such as NLP (neuro-linguistic-programming) are very effective at helping people recognise the thinking habits behind problems such as depression, anxiety, panic disorders and phobias. There are many cognitive techniques for testing negative thinking patterns and developing new more adaptive ways of thinking. If you are considering cognitive therapy, expect to commit to homework tasks and regular practise of these techniques.
Negative thoughts are usually fairly easily identifiable with the help of a therapist. In order to bring about a more global change, it’s often necessary to go beyond the thoughts we have to the deeper levels of our cognition – our beliefs.
Most people rarely think about their beliefs, how they developed, their role in guiding your life or whether they are helpful and supportive.
That’s because our beliefs have often been with us for a very long time. Very often we develop them in childhood. For example, a child may learn that ‘dogs are dangerous’ or ‘dogs are friendly’, depending on his experiences related to dogs. As that child grows up, it is likely that he will become more flexible in his belief about dogs, able to judge individual dogs for friendliness or dangerousness. This happens in most areas of our lives, as the more rigid beliefs from childhood, evolve and become more flexible as we develop.
However, this is not always the case. Sometimes negative beliefs develop due to trauma or consistent negative interactions or early life experiences. These beliefs often remain fixed in adulthood even though they hold the person back or negatively impact on their lives. Often they are taken as the absolute truth.
Beliefs form the core of your identity. Holding beliefs about yourself, your world and others that are unconstructive and not necessarily true, can be bad news for your self-esteem. Beliefs influence on your emotional experience and behaviour by colouring how you see the world.
Every belief you have is a generalisation or simplified way of viewing the world. Generalisations by their very nature are distortions. Often when I see clients for therapy it is possible to find a distorted belief behind the problem. For example ‘I am worthless’ is a belief, which promotes depression.
Your beliefs can actually determine outcomes. This is because your beliefs effect what you focus on or pay attention too. So for example, if you focus on being un-likeable, your unconscious mind will be on the lookout for examples of people not liking you and will find various ways to bring this to your attention. Whilst this is going on, you are of course ignoring evidence that shows you are in fact liked by all sorts of people.
I practice NLP, CBT therapy in Hertfordshire and I am also a hypnotherapist, Hertfordshire. People often come to see me with difficulties, which can be traced back to limiting beliefs e.g. “I am unattractive”, “I am a bad person”. Of course, it is not always obvious to them that they are holding onto damaging beliefs about themselves and their world, which prevent them from growing and developing or doing things they want too.
NLP and CBT therapy and Hypnotherapy, Hertfordshire has proven methods for empowering people to challenge and even eradicate illogical beliefs. The result can mean seeing the world in new and fresh ways.

The theory of Cognitive Behavioural Therapy, or CBT, is that emotions are closely linkedto cognition. Put more simply, CBT says that “the way you think affects the way you feel”. People who think anxious thoughts will end up feeling anxious.

As a psychiatrist in Edinburgh a significant proportion of my clients suffer from anxiety. Edinburgh is a beautiful city and a wonderful place to live, but as in any urban enviroment, individuals can start to feel stressed out and anxious. Thus it is important for me to help each client to become familiar with their own ways of thinking, and to help them to identify ways in which their thinking patterns may be contributing to their emotional problems.

A CBT therapist has a term for patterns of thinking that can lead to emotional problems – they are called “Thinking Errors”. Many different types of thinking error have been identified over the years, but what follows is a brief summary of those errors that I have seen as a therapist in Edinburgh when working with people suffering from anxiety.

“Catastrophising” is a thinking error frequently found in anxious people. In fact, I’m sure we’ve all done it ourselves at some point! When someone catastrophises they automatically “assume the worst”. A message to call back the boss is taken to mean that you’re going to be sacked, a clunking noise in your car means that the engine is about to fall to bits, and a pain in the chest is the beginnings of a heart attack. CBT hypothesises that habitually thinking like this will lead to long-term problems with anxiety.

Another common thinking error seen in people with anxiety is called “Mind-Reading”. As the name suggests, a person who’s exhibiting this thinking error will believe that they know (absolutely know) what people are thinking about them. This belief will often go contrary to what the other person says and does, and is almost always pessimistic in nature. For instance, if the CBT therapist yawns (heaven forbid!) during a session, the client will know that the CBT therapist is bored or fed up with them – even if the therapist apologises and explains that her young daughter is teething and kept her awake last night. Or if the person gets invited to a dinner party, they will know that they’re only invited along to make up the seating numbers. Thinking in this way can make life one long series of possible sleights and put-downs, leading to increased anxiety and excessive monitoring of those around you.

“Crystal-Ball Reading” is a third common thinking error in anxiety. People thinking in this way know what is going to happen in the future. And, lo and behold, it’s bad! The bus will definitely be running late, they will definitely fail the interview, and they will absolutely make a fool of themselves at the works party. Not a pleasant way to think. And certainly not a good way to prepare for an interview (or even a party!). CBT encourages people to “keep it real” – there’s enough strife out there without looking into the future for extra!

These three thinking errors are those that I’ve found most frequently in anxious people whilst working as a therapist in Edinburgh, although I doubt that they’re exclusive to East Coast Scots!

Dr Steve Last is a Psychiatrist who uses CBT techniques. He is based in Edinburgh. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.