(after "cognitive behavioural therapy for dummies")

PART I: INTRODUCING CBT BASICS

Acting out

• one scenario, many possible reactions
• e.g. parter is mean:
  • "he has no right" (anger)
  • "he doesn't love me" (depression)
  • "i don't deserve this" (hurt)
  • "i must've done something wrong" (guilt)
  • "he's losing interest" (anxiety)
  • "he probably has a reason" (shame)

ABC/DE

• ✔ do write them down
• ✖ do not get into a vicious circle (event changes feelings change behaviour change world change event)
• The form:
  • A ctivating Event / Trigger
  • B eliefs, thoughts, and attitudes about A
  • C onsequences of A and B on your emotions and behaviours
  • D ispute (question and examine) B and generate alternatives
  • E ffect of alternative thoughts and beliefs
• How to fill it out:
  • C Write down the emotions you're feeling.
  • C Write down your actions and behavious.
  • A Write down what triggered your feelings.
  • B Write down your thoughts and beliefs.
  • B Write down your thinking errors. (More see below)
  • D Write down alternatives for unhelpful thoughts in B.
  • E Write down how you feel now and how you are going to act.
• Examples: whole form
  • C Anger, anxiety, depression, envy, guilt, hurt, jealousy, shame
  • C Avoidance, isolation, aggression, escaping, procrastination
  • A An event, a thought, a person, a memory, an emotion
  • B "I'm useless", "i should know better", "i'm not normal"
  • B Thinking errors →☁
  • D Alternative thoughts →☀
  • E Concern, annoyance, sadness, remorse, disappointment

Behaving like a Scientist

• Theories:
  • 1. Write down your prediction / theory
  • 2. Search for at least one alternative theory
  • It's always to good to have opposing theories
  • One theory is always: "I only think that ..."
  • Use your theories for an experiment
• Theories Example:
  • 1. My boss doesn't like me at all.
  • 2. My boss isn't friendly in the mornings, to everyone.
  • My boss is only nice to employees he knows very well.
  • I only think that he doesn't like me.
• Experiments:
  • 1. Describe your problem. (Include 'safety behaviours'!)
  • 2. Formulate your predictions/theories
  • 3. Execute the experiment (multiple times)
  • 4. Examine the results
• Experiment Example:
  • 1. Petra avoids doing her hobbies because she doesn't feel like doing them because of her depression.
  • 2. Petra says "Even if I begin doing something, it won't be fun."
  • 3. Petra begins to do something anyways.
  • 4. Petra realises that it wasn't as much fun as it used to be, but it was better than doing nothing.
• "Safety behaviours":
  • things you do to try to prevent your feared catastrophe
  • examples: not talking in a social situation

Refocusing and Retraining your Awareness

• Task Concentration
  • ... involves paying less attention to what's going on inside of you and more attention to what's happening outside of you.
  • If you have a task to do: (eg. listening, talking) concentrate on the task, not yourself
  • If you have no task to do: (e.g. waiting) concentrate on the environment, not yourself
  • Train this first in non-threatening and then in threatening situations. Tip: Imagine you are acting as an eyewitness for the police. Concentrate on all your senses.
  • Example: Eating out alone: Stop worrying about whether you look stupid. Eat slowly, observe other people.
• Mindfulness
  • ... is the art of being present in the moment, without passing judgement about your experience.
  • How to: Observe what's going on around you, in your mind, and in your body without doing anything. Just be aware. Or: Try to look at everything through 'fresh eyes' (= as if you've never seen it before).
  • Train of thought: Watch your thoughts and feelings (trains) pass by without hopping onto them.

PART II: DEFINING PROBLEMS AND SETTING GOALS

Identifying Emotions

• Giving emotions a name
• Healthy and Unhealthy Emotions
  • Feelings have a context (interaction of thoughts; actions; attention focus; memory; ...). The context distinguishes between healthy and unhealthy emotions.
  • Anxiety becomes Concern, Depression becomes Sadness, and so on. See all here.
  • thinking. Unhealthy emotions can spring from rigid, demand-based thinking (eg. "other people have to be nice to me!" ). Healthy emotions spring from flexible, preference-based thinking (eg. "i prefer others to be nice to me, but they are not bound to do so." ).
  • behaving. Healthy negative emotions are accompanied by largely constructive behaviours (eg. solving problems ), whereas unhealthy feelings usually go hand-in-hand with self-defeating behavious (e.g. drinking alcohol )
  • focusing. If you're having an unhealthy emotion, your mind is likely to focus on catastrophic possibilites in the future based on the primary event.
  • physical sensations. Only distinguishable in intensity and length, not type. (eg. butterflies in the stomach can be good and bad )
• Feelings about Feelings (Meta-emotions)
  • example: being ashamed of being depressed
  • Meta-emotions can prevent you from dealing with your primary emotional problems.
• Unhealthy positive feelings
  • It's nice to be happy. But unhealthy positive emotions can make you vulnerable to unhealthy negative feelings.
  • example: You "must get" the approvol of your boss, and you do. You are very happy. But "must get" is demand-based thinking (which is bad).

Identifying Problems in Solutions

• Bad solutions you might use:
  • Avoiding situations that you fear or that provoke anxiety
  • Concealing aspects of yourself that cause you shame
  • Putting of dealing with problems or tasks until you feel like it / like it's the right time
  • Alcohol, drugs, sleep
  • Frequent requests for reassurance
  • Repeated checking behaviours
  • Superstitious rituals
  • Trying to influence others (eg. to avoid sth.)
• Worrying
  • Convince yourself that exessive worrying doesn't prevent feared events from happening or prepare you for dealing with bad things. (Because it doesn't.)
• Avoiding something makes it happen
  • eg. trying too hard to say the right thing makes you talk slowly
• Your Vicious Flower (example)
  • 1. Write down your trigger (event, ...).
  • 2. In a circle, write down your key thoughts
  • 3. In four patels around the circle, write: Emotions, behaviours, physical sensations, attention focus
  • Try to change your emotions, behaviours and attention focus to help you better. Note that you mostly can't change your physical sensations, but you can learn to tolerate them.

Setting your sights on Goals

• SPORT
  • Specific (eg. "i want to be sad instead of depressed when ... happens")
  • Positive (eg. "gain confidence" instead of "be less scared")
  • Observable (think: when can you tell that you achieved your goal?)
  • Realistic (eg. not "i want to be happy that [something bad] happened")
  • Time (set a time frame)
• Problem & Goal Statements
  • I feel <emotion> about <situation> and <behaviour>
  • To feel <emotion> about <situation> and to <behaviour>
• Inspiration and Motivation
  • Role models who have characteristics you want to have
  • Inspirational stories of people overcoming something
  • Images and metaphors
  • Provers, quoates, and icons
  • Record your progress: At regular intervals (eg. 2 weeks, not less than 1 week) evaluate the intensity of your emotional problem and how much it interferes with your life, and rate how close you are to achieving your goal (which you have written down with SPORT)
• Cost-benefit analysis
  • Focus on the benefit of change! (The solution might be negative in short-term but positive in the long-term!)
  • Write down behaviours, emotions, thoughts, attitudes, beliefs, and options to solve a practical problem. Evaluate the pros and cons: in short-term, long-term, for yourself, for other people. (example)
  • Tip: Write in pairs (Feelings: advantages, disadvantes. Behaviours: ... etc)

PART III: PUTTING CBT INTO ACTION

Facing Fear

• FEAR
  • = Face Everything and Recover
  • Deliberately confront your fear and stay in that situation till your anxiety subsides
  • Keep your exposure challenging but not overwhelming
  • Write a table with: Feared Trigger, Anticpated Anxiety, and (after facing the trigger) Actual Anxiety
  • Repeat confrontations and keep writing them down in the table

Deconstructing Depression

• Am I depressed?
  • If for the past month, you’ve felt down, lacked energy, been pessimistic or hopeless about the future, and lost interest or enjoyment in doing things, if you’ve also had difficulty concentrating, had a poor appetite, been waking early, and experienced a low mood, anxious thoughts or feelings of dread in the morning, then you’re even likely to be diagnosed with depression.
  • Symptom list
• Things that fuel depression:
  • Rumination (a repititive, cyclical process of negative thinking, going over past problems, asking yourself unanswerable questions)
  • Inactivity (not doing day-to-day tasks, staying in bed, not going out)
  • Social withdrawal (avoiding to see people)
  • Procrastination (avoiding specific tasks that you have to do)
  • Shame and Guilt (about being depressed)
  • Hopelessness (thinking that the situation will never improve)
• Try to do the opposites of the things above. A few tips:
  • Keep a daily timetable
  • Recognize your rumination and stop it (more about unhelpful thoughts and refocusing in PART I)
  • 1. Define your problem, 2. brainstorm solutions, 3. evaluate solutions (select the most realistic, list pros and cons), 4. try out the solution, 5. review
• How to sleep well
  • Get some exercise (but not to close to your bed time)
  • Establish a schedule, and avoid daytime naps
  • Avoid lying in bed awake
  • Establish a bedtime routine
  • Don't drink caffeine
  • Make your bedroom cosy (smells, nice bed sheets, remove clutter)
• Recognice your feelings of hopelessness about the future as a symptom of depression, not a fact.

Overcoming Obsessions

• Stop obsessions by either:
  • Reducing (or stopping) a ritual
  • Increasing a ritual
• Tips
  • Tolerate uncertainty, because it isn't the problem, because everyone has it but not everyone is obsessed with something
  • Trust your own judgement
  • Treat your thoughts as nothing more than thoughts (they won't trigger an event, change the past/future, it doesn't give you responsibility, etc)
  • Don't try too hard: Don't use internal criteria (your feelings, what you think is 'right') but external criteria (what you can see being right or at least okay)

PART IV: LOOKING BACKWARDS AND MOVING FORWARDS

PART V: THE PART OF TENS