Cognitive Behaviour Therapy Vicious Cycles by Getselfhelp.co.uk Cognitive Behaviour Therapy or CBT looks at the links between thoughts feelings and behaviors, how you think about yourself, the world and other people, which is generally result of earlier experiences in life. CBT tends to focus on the here and now and although therapy helps to make sense of the past and understand the way it has shaped your life and that's really important to do, CBT mainly looks at ways to improve your current situation and future. CBT says there is a trigger or a situation that we think about. So we have thoughts in reaction to the trigger or situation, and as a result of those thoughts we feel an emotion, and we have some physical sensations, and as a result of those thoughts and feelings we behave, we react in a certain way. We tend to think that in response to an event we feel emotion or behave in a certain way. Epictetus, a Greek-born Roman slave in the first century, said "Men are disturbed not by things but by the view they take of them", so he's saying, and CBT agrees, that it's not the event which causes our emotions and behavior response, but it is the meaning or the thoughts ABOUT the event which causes us to feel and behave in a certain way. For example in the middle of the night, you might hear a loud crash. So if you think "oh gosh that intruder might come and hurt me", you're going to feel frightened. If you think "my son's drunk again", then you might feel angry or annoyed. Or if you think "the cat's knocked over that biscuit tin again" then that might feel okay, or perhaps mildly annoyed, and if you think "oh gosh my clumsy daughter is home safe" then you're going to feel relieved. It's the same event, the same situation, but the different meanings that we give it, lead to different emotions. So we can make sense of our emotions using vicious cycle diagrams, looking at the thoughts, feelings and behaviours, and trying to make changes. The vicious cycle of anxiety. There is a trigger, whatever that trigger is. It might be a thought, it might be a feeling, it might be an external event. With anxiety, thoughts are generally "something bad is going to happen" and "i'm not going to be able to cope!" It's very future focused and catastrophic. We tend to think the worst possible thing is going to happen, and if anybody has those thoughts and believes those thoughts, they will feel anxious, terrified, panic-stricken. The body's alarm system is going to be activated, and we're going to feel that adrenaline response, tense, heart racing, breathing fast, shaky, hot, sweaty, and all those things really unpleasant feelings which seemed to confirm that: "Something bad really is happening!" We're going to want to get rid of these feelings. We want to stop these feelings. So we tend to do these things.... we avoid or escape. So we might avoid situations where we are likely to feel anxious, or if we find ourselves in a situation where we suddenly feel anxious, we're going to want to escape in order to stop the thoughts, stop the feelings. So we might not go out, we might avoid going to the party at the weekend, we might make excuses, we might try to leave early, or we use what we call safety behaviours - things that help us cope in that situation. So if I did go to the party I might hide away in the corner and drink more for instance, and if I keep doing these things, if I keep avoiding those situations, that's going to reinforce the negative thoughts that I have, and so we're going to stay in that anxious cycle, and we're going to get caught up and that's what we mean by a vicious cycle. It seems like we can't escape from it, but in CBT we can learn to escape and break that cycle. Vicious cycle of depression or sadness. Eeyore is a very good example, very slowed down, he thinks very negatively, a gloomy outlook, no energy, doesn't want to do anything. Depression is a lot like that. Depression might creep up on us over a long time, it might also be some trigger or event or thought that dips our mood. Thoughts tend to be very negative, very gloomy. It's like wearing really dark gloomy specs. Very self-critical - we tend to be really down on ourselves. And we think "What's the point?" quite hopeless about the future. "No one likes me". And anybody that thinks these thoughts and believes these thoughts are going to feel sad and depressed. Energy will drop, we'll feel tired, no motivation, not interested in doing anything, and just slow down. And if we're thinking and feeling that way, then we're going to withdraw and isolate ourselves. We're going to stay home, not do much. We're going to cut ourselves off from other people, not go out and just drop all the fun stuff. And if we stay home and cut ourselves off from other people, how does that affect the way we think? How does that affect the way we feel? So again we get caught up in this downward spiral that we feel we can't escape from, we can't break out from. The vicious cycle of anger. In response to a trigger, thoughts with anger, tend to be "it's unfair!" "this isn't right!", there is some injustice and "I must do something about it", "I must right this wrong!" So we feel angry, and we get that same adrenaline response that we do when we are anxious, but this time it's not about running away and avoiding - it's about attacking, giving us the resources that we need to right this wrong. We get this urge to hit out, to make a noise, to shout, we make ourselves look bigger. Or it might be quite low key and just sarcastic and that sort of thing, and if we keep responding in that same, then nothing is going to change. The vicious cycle of stress. All these emotions are normal and normal responses to thoughts. Everybody feels anxious and the emotions have a purpose. It's good to feel anxious sometimes, it gets us away from danger. The trouble iss sometimes our mind tricks us into thinking there is danger when there really is none. This is cycle of stress. Everybody gets stressed at times. Stress is about - too many demands being made on us and we don't have the resources to cope. So in response to a trigger, we tend to think there's too much to do, there's not enough time, it's out of control, I can't cope! So we feel very stressed. We get that drip feed of adrenaline and cortisol, the stress hormone, which results in these horrible physical feelings all the time with tense, headaches, forgetful, and all that sort of thing. So what do we do? Well if we haven't got enough time, then we might try and make more time at work in order to try and fit in everything we've got to do. Or we might think I can't cope in going to work at all, and just stay home. You might avoid and put things off, lots of different things. You might sleep more, or sleep less, drink more, smoke more, shout, argue, spend less family time. It affects us in all different ways and if we don't make any changes in the way we think, and the way we behave, then nothing is going to change. So we need to understand our vicious cycle to help us to make positive changes. We need to break the cycle and we can break the cycle by thinking differently - by changing the way we think, and doing differently - changing the way we behave. if we go back to the vicious cycle of anxiety, we can break this cycle by thinking differently. That will include learning to challenge our thoughts, not believing our thoughts, learning not to pay attention to our thoughts, and learning skills that will help us do those things. That is going to have an impact on the way you feel and if we also change our behaviours, so instead of avoiding or escaping, we'll make a plan to gradually DO those things and to stick with them rather than escape. We need to start small and build up, so start with little things. Make a plan and learn and use coping skills to help you cope with those situations, and every time you go into that anxiety provoking situation, the first time you could be very anxious, the second time you're not going to be quite so anxious, because you're starting to learn that actually it wasn't so bad as what I thought it would be, and the next time you go again you won't be quite so anxious, and each time the anxiety will reduce, and it will go away quicker too. So if we think differently and do differently then you're going to feel very differently. You are going to be feeling much less anxious and more confident in yourself. And for depression ... With depression we start to make those changes in the behaviours, because that's what the evidence says works most quickly, most effectively. We change what we do, so rather than withdraw and isolate ourselves, we need to start to go out more, do more of the activities I enjoy or used to enjoy. Connect with other people, or rather than cutting ourselves off, start to make those connections again. Spending time with other people. Gentle exercise. Exercise is an amazing mood enhancer. Now it all feels like a big ask at the at the beginning, but start with the five-minute rule. Go for a walk for five minutes. Commit to that. After five minutes, you can ask yourself Is this helping? How am I feeling? Do I want to carry on? Or actually is that enough for today? You can learn coping skills that will help you do those things, and then you can also learn to challenge your thoughts, change the way you think. Not just challenge, but learn not to believe everything your thoughts say. Learn to not pay attention to your thoughts all the time. Start to notice the positives. When were depressed we tend to focus on all the negatives, on the past. We ruminate and ruminate, and get caught up in horrible things, but we can start to notice the ok stuff and the good stuff. You can learn skills again that will help you do this. So if you're thinking differently, and acting differently, that's going to have an enormous impact on the way you feel. Your mood will lift, your energy will increase, and the more you your mood lifts, your energy increases, you're going to do more, you're going to be thinking differently, and so your new positive cycle is going to develop even more. so visit the webpage at www.get.gg/problems.htm then click on the name of the problem whether it's depression or anxiety or stress or anger or any of the individual anxiety disorders such as OCD or panic, and then follow the self-help guide. Follow those steps. You can download lots of worksheets and information leaflets from there. You can find further self-help resources on www.get.gg or getselfhelp.co.uk - it's the same website You can download self-help mp3 downloads from selfhelpmp3.co.uk and there are some for depression, anger, anxiety, or some mindfulness. All different kinds of mp3's. You can ask your health professional about practical and fun CBT skills - you can find out more from www.thedecider.org.uk and visit the website www.get.gg
