Cognitive Behavioural Therapy Made Simple: 10 Strategies for Managing Anxiety, Depression, Anger, Panic and Worry (Sheldon Press)

by Seth J. Gillihan

The main strategy to break negative thought patterns is to compare our thoughts to reality.

FOLLOW THE FACTS The following series of steps will allow you to identify possible errors in your thinking. Step 1: Look for evidence that supports your thought

Step 2: Look for evidence that does not support your thought

Step 3: Look for possible errors in your thinking

Step 4: Identify a more accurate and helpful way of seeing the situation

Step 5: Notice and record any effects of the new thought on your feelings and behaviours

For now, I invite you to take the following action steps: 1 Pay attention for clues that negative automatic thoughts may be at work (e.g., a sudden drop in mood). 2 Practice recording negative automatic thoughts using the form here. 3 Follow the downward arrow technique as needed to drill down to your actual distressing thoughts.

4 Once you feel comfortable with identifying your thoughts, use the five-step plan to start testing them for accuracy. 5 As you gain experience catching and clarifying your thoughts, begin to do so in the moment, without writing things down. 6 Return to the full written technique as needed for more challenging thoughts or to tune up your practice.

You can find a copy of this form online at CallistoMediaBooks.com/CBTMadeSimple.

Once you’ve identified your core beliefs and written them down in your journal, how do you go about changing them?

You can find a copy of this form online at CallistoMediaBooks.com/CBTMadeSimple

Lead with the positive When we begin to learn how our minds react in certain situations, we can predict our automatic thoughts.

Situation: Giving a presentation Relevant Core Belief: I’m unlikable More Realistic Core Belief: Most people who know me really seem to like me.

You can find a copy of this form online at CallistoMediaBooks.com/CBTMadeSimple

it’s important to write down the plan for dealing with your anticipated thoughts. It may be most convenient to write your plan on an index card or, as Dr. Judith Beck calls it, a “coping card.”

Chapter Summary and Homework In this chapter, we built on the practices from chapter 4 as we identified and challenged core beliefs. We saw how these beliefs do double duty, as they not only lead to negative automatic thoughts but also create a mental filter that can interfere with our ability to evaluate those automatic thoughts objectively. It’s not easy to alter our core beliefs, and doing so takes persistent practice. Plan to be patient with yourself as you modify these deeply held beliefs. The homework for this chapter includes multiple techniques for identifying and changing your core beliefs: 1 Note recurrent themes in your negative automatic thoughts. 2 Use the downward arrow technique to explore the meaning of your automatic thoughts. 3 Review aspects of your past that may have shaped your core beliefs. 4 Test past and current evidence that may or may not support your core beliefs. 5 Practice leading with the positive in situations that are likely to trigger automatic thoughts related to your core beliefs. 6 Keep a daily record of three things that went well, and why. 7 And finally, over time you can shift toward simply shrugging off inaccurate thoughts and continuing on your way.

1 The mind focuses on things other than what is happening right now.

2 The mind continually evaluates our reality as good or bad.

The second core feature of mindful awareness is acceptance, which means opening to our experience as it unfolds.

MBCT includes elements of traditional CBT for depression and integrates training in mindfulness to protect against relapse.

As the name suggests, it emphasizes acceptance of our experience in the service of committing to action that supports our values.

Act

The most common formal mindfulness technique is sitting meditation.

Other common types of meditation can entail a focus on bodily sensations (body scan meditation), ambient sounds, or wishes of health and contentment toward ourselves and others (loving-kindness meditation).

Formal practices also include more active exercises like yoga and tai chi.

meditation is simply refinding our focus as many times as we lose it.

There are many ways to meditate. Here’s a simple plan to get started: 1 Practice meditation when you’re able to stay awake and alert. 2 Find a quiet place where you won’t be disturbed, and remove possible distractions like your phone. 3 Choose a comfortable seat on the floor, in a chair, or anywhere else. If you sit on the floor, you can raise your hips with a blanket or a yoga block if that’s more comfortable. 4 Close your eyes if you wish, or keep them open and fixed on the floor a few feet in front of you.

5 Practice with or without a recording; set a timer if you do it without. Five minutes is a good starting point. Keep the timer out of sight. 6 Begin to notice the sensations of breathing, paying attention to them for the full length of your inhalation and exhalation. 7 Bring your attention back to the breath each time you realize your mind has wandered. 8 There are many apps and free online meditations available if you prefer a guided meditation. Aura and Insight Timer, for example, are free meditation apps available for iOS and Android systems.

As you’re practicing mindful awareness in your own daily activities, keep the following principles in mind: 1 Focus your attention on your sensory experiences (sights, sounds, etc.) as well as your thoughts, feelings, and bodily sensations. 2 Open to what is happening in the moment, allowing your experience to be as it is rather than resisting. 3 Bring a “beginner’s mind” to the activity, as though it’s the first time you’ve ever done or witnessed it. Let go of preconceived expectations of how it will be.

4 Allow the experience to take as long as it takes, rather than trying to rush through it to the next thing. 5 Notice the urge to grab on to aspects of the experience you like and push away the parts you don’t. 6 Allow thoughts to come and go, recognizing that they are just thoughts. Practice neither getting lost in the thoughts nor resisting them, but simply letting them flow.

Chapter Summary and Homework In this chapter, we explored the powerful and far-reaching effects of simply being fully in our experience with greater openness. Formal practices like yoga and meditation complement moments of mindfulness in our everyday activities. We also saw how these practices have been integrated with CBT and shown to effectively treat many conditions. If you’re working on behavioural activation and/or changing your thoughts, mindfulness principles dovetail perfectly with those practices. Subsequent chapters will include practices from all three pillars of CBT. It’s normal to have misgivings about mindfulness, which often are based on false impressions of what the practice is about. If you’re ready to try mindfulness for the first time or want to deepen your practice, I invite you to take the following steps: 1 Begin to notice what your mind is up to during your day. Is it focused on the past, the present, the future? Is it opening to your experience or resisting? Take care to just notice, letting go as much as possible of judging what your mind is doing. 2 Choose a small number of activities to practice mindful awareness during your day, using the six principles presented in this chapter. 3 Begin a meditation practice. If meditation is brand new to you, start with just a few minutes a day. The Resources section at the back of this book provides links to free guided meditations. 4 Reading books on mindfulness can reinforce the concepts from this chapter a...

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Chapter Summary and Homework In this chapter, we considered why we procrastinate, which generally has to do with fear of doing something badly or finding it unpleasant. Negative reinforcement and maladaptive thoughts also lead us to postpone doing our tasks. The Think Act Be framework presents many strategies for beating procrastination. On their own each of these strategies may have a small effect. For example, research has shown that by itself, rewarding ourselves for productivity provides only a small advantage. By combining these approaches, we increase our odds of success. It will take trial and error to discover what works best for you. With practice, we can develop new habits to replace the ones that promoted procrastination. If you’re determined to push through procrastination, here’s a plan to get started: 1 Consider carefully how procrastination is affecting your life. 2 Identify a task you’ve been meaning to do or one you habitually struggle to do promptly, that you will plan to work on this week. 3 Choose one or two strategies from each of the domains (Think, Act, Be) to help you complete your task. Take care not to choose so many strategies that it becomes unmanageable and counterproductive. 4 Keep track of your progress and what is helpful. 5 Use additional techniques as necessary. 6 Maintain a list of techniques to rely on as needed. 7 Apply what works for you to other areas where you tend to procrastinate. And, in case it doesn’t go without saying, enjoy th...

Fear happens in the presence of whatever scares the person. • In contrast, anxiety involves an imagined threat that may or may not materialize. • Worry is a specific type of anxiety in which we repeatedly think about feared outcomes in situations involving uncertainty.

For example, we would say that Peter worried that he might encounter a dog as he walked to work, felt anxious when he saw a dog across the street, and experienced intense fear when a large dog ran toward him in the park.

we can practice more relaxed breathing: 1 Breathe in gently for a count of two. 2 Exhale slowly to a count of five. 3 Pause after you exhale for a three-count. 4 Repeat from step 1 for 5 to 10 minutes, one to two times per day.

these steps to conquer your fears: 1 Create a list of ways to face your fears. Include items on your list that vary in difficulty. Be as creative as you can to come up with a variety of situations that would trigger your fear. 2 Rate how difficult each one would be. Make your best guess about how much distress you would feel in each situation; a 0–10 scale tends to work well, but use a different scale if you prefer. See the example that follows. 3 Arrange your items in descending order of difficulty. This ordered list of exposure ideas is called your “hierarchy.” You might build your hierarchy in a spreadsheet to make it easy to work with. As you review your list, do you notice any big gaps in your numbers, like a jump from a 2 to a 7? If so, look for ways to modify your items to make them easier or harder so you can add intermediate items. For example, doing a difficult activity with a loved one can make it more manageable, and can facilitate a transition to doing it on your own.

ACTIVITY DISCOMFORT LEVEL (0–10)

4 Plan and complete your initial exposures. Choose an item from your hierarchy and schedule a specific time to do it. It’s best to choose one of low to moderate difficulty—easy enough that you’ll be setting yourself up for success, and hard enough that you’ll feel good about having done it.

5 Continue working up your hierarchy. Repeat each activity until it starts to feel more manageable. The exposure sessions should be close enough together that the new learning builds on itself; for example, daily practice will be better than weekly. Keep in mind, though, that closer together is not always better, as four exposure sessions on the same day are probably not as effective as four consecutive days of exposure.

Chapter Summary and Homework Fear can direct our lives in many ways if we let it. In this chapter, we reviewed some of the common anxiety conditions and other ways anxiety can color our experience. We also covered many strategies from the Think Act Be framework for reclaiming your life from overwhelming anxiety and fear. These individual strategies work well together—for example, practicing acceptance of our feared outcome while we do exposure, and testing our predictions for how we expect it to go. By following a systematic program for exposure, we can transform our determination to conquer our fears into real progress. When you’re ready to face your fears, here are ways to get started: 1 Complete a CBT diagram of your fears, identifying your relevant thoughts, feelings, and behaviours and their relationships. 2 Look for subtle ways that fear affects you that aren’t immediately apparent. 3 Choose strategies from the Think, Act, and Be categories to practice in the coming days. 4 If you have specific fears that lend themselves well to exposure therapy, begin with step 1 and work consistently through the plan. 5 Balance the tough work of facing your fear with consistent self-care (see chapter 10). Being good to yourself will help you through this process. CHAPTER

Just as we saw with anxiety, anger becomes a problem when we experience it to such a degree that its costs outweigh its benefits.

In the following practice we use the body and the breath as vehicles to manage unresolved anger. 1. Begin with a few moments of basic breath meditation (see here). Feel your body and any sensations that are present from your toes to your head. 2. Picture as vividly as possible the circumstances that led to your anger, opening to the emotions they provoke. 3. Notice where the anger expresses itself in the body—for example, a clenched jaw or a knot in the stomach. Breathe with these physical manifestations of anger. Bring compassion to your experience, making room for the emotion. Let it be what it is. Take care not to resist the feelings or criticize yourself for the reactions you’re having. 4. Practice being the witness of your own experience, observing your emotions without becoming completely entangled in them. If you struggle to take the role of observer, that’s OK, too—it’s easy to get wrapped up in anger. If at any point you feel overwhelmed with emotion, gently direct the attention to the breath until the grip of anger loosens. 5. Continue to breathe with the physical sensations for as long as you like, noticing how emotions change over time. When the intensity of the anger has abated, bring the attention back to the breath before opening your eyes. Notice how you feel.

Chapter Summary and Homework Uncontrolled anger can lead to conflict, aggression, and even violence. In this chapter, we examined the factors that lead to excessive anger and described ways to manage it. Keep in mind that the goal is not to banish anger from our lives. Instead, we can learn to keep it in check. Things to practice from this chapter include: 1 Complete a diagram for a specific situation that made you angry to learn more about your own experience of anger. 2 Use a thought record to capture and examine some of your anger-related thoughts for a situation that comes up. 3 Begin to note situations in which you’d like to practice managing your anger. 4 Choose one or two techniques from the Think, Act, and Be categories to start practicing. 5 Write down how each technique works for you, and add new ones as needed. 6 Refer to your list of strategies often to remind yourself of the best ways for you to manage your anger.

National Sleep Foundation recommend seven to nine hours of sleep per night for most adults (seven to eight for older adults).

cognitive behavioural therapy for insomnia (CBT-I).

Going to bed and getting up at the same time every day • Planning to be in bed only for the amount of time you’re actually able to sleep • Using the bed for sleeping only (sex is an exception) to strengthen the “bed equals sleep” association • Getting out of bed if you’re having a hard time sleeping to break the link between bed and being anxious about not sleeping • Challenging unhelpful thoughts about sleep (e.g., catastrophizing about how terrible the next day will be due to bad sleep) • Practicing relaxation to counteract the tension and anxiety that typically go along with insomnia • Practicing mindful awareness and acceptance to interrupt sleep-related worries and to let go of efforts to force yourself asleep • Following other practices that promote good sleep, like limiting caffeine intake (especially after lunchtime); making the bedroom cool, dark, and quiet; keeping electronics out of the bedroom; and exercising regularly • Avoiding napping in general, which can make it harder to sleep well at night • Having a winding-down routine that signals your body and brain that bedtime is approaching (e.g., gently stretching, reading for pleasure, or drinking a cup of herbal tea) If

new mental health field called nutritional psychiatry/psychology.