Illustration of (Some) CBT Concepts

Overview

Cognitive Behavioral Therapy (CBT) is the strongest, research-backed therapeutic approach in the treatment of anxiety and, additionally, to be very effective for a whole host of other mental health issues. It is based on the framework that emotions, thoughts, and body sensations/physical behavior are at three points of a triangle and intervening on one of the points will result in changes the other two.

TEDx Talk: Feeling Good presented by David Burns, MD – In this YouTube video, David Burns, MD, a well known researcher, clinician, and educator introduces the power of CBT in his warm, humorous and down-to-earth way.

Concepts

“Automatic Thoughts”
Automatic thoughts are a core concept of CBT.  They are our brain’s running interior dialogue or self-talk that narrates our life without us even really being aware of that it’s happening until we choose to pay attention to them.  If your thoughts frequently contain “thought errors” that are biased to being negative ones, they are very likely to be increasing the level of anxiety or depression that you feel necessarily .  These thoughts are habits that reflect the way we interpret things that we do, experience, or even how we view the world.  The thing about habits is that, with some work, they can be shifted or changed.  When you increase awareness of what your automatic thoughts are, you can start to challenge them and then, ultimately, reduce their effect on your perceptions and your mood. When working with children, negative automatic thoughts that affect them this can sometimes be referred to as a “brain bully.”

  • An animated video that talks about automatic thoughts and gives an overview of some of the typical “thought errors” that people might have. Read More >

Thought Errors/Cognitive Distortions

“Focus on the Negative”
Focusing on the negative is known in CBT as a cognitive distortion or “thought error” that can increase the level of anxiety or depression that you feel.  The human brain is drawn to negatives but it skews our perception of people and the world around us.  With the easy access to negativity in the media, including the internet, it can be more and more challenging to pull our minds away and, instead, choose to focus on the wealth of positive things in our lives.  However, the research shows that with practice we can get better at recognizing when we are focusing on only the negative aspects of something and then consciously remind ourselves of all of the positives in the situation instead.

  • A playful animated video that illustrates this idea. Read More >
  • TED talk that gives a more scientific explanation of how our brains seem to stay stuck on negative information, and how to get unstuck.  Read More >
  • Story time! At least that’s what our brain is doing when we are experiencing fear for something that might happen in the future. Check out this TED talk and learn more. Hmmm…why might this knowledge be important? Read More >

Healing Yoga

Update: 12/16/2018  I just learned that Healing Yoga is closing it’s doors.  However, I have decided to leave this article up so that people know that there is such a thing as a yoga/therapy blend that can be very powerful treatment, especially for folks with PTSD.  If you are reading this and know of another local resource that offers this type of treatment, please let me know~ Andrea

I’ve written a little about how yoga is an activity that has benefits for for everyone is beneficial for just about everyone.  Healing Yoga (Douglassville, PA) takes it one step farther.  Recommended to me by a colleague, the instructor, Dorian Abel is a licensed professional  counselor who is skilled at incorporating her professional expertise into some of her yoga classes.  However, even basic yoga classes should provide wonderful ways to develop skills that benefit a person’s mental well-being.  As I write this segment (July ’16), in comparison to prices for yoga classes at other locations that I’ve looked at in the area, her prices are quite reasonable.  The individual session fee is definitely more expensive but my suggestion would be, if you are considering that option but are concerned about the expense, it might be possible to do it once as a consultation and then work to incorporate what you learn into your yoga class experience, on your own.

Yoga

Yoga is good for the body AND the mind. In addition to the obvious health benefits of regular exercise, a good yoga instructor creates an environment that promotes:

  • A sense of serenity and acceptance for who you are in the moment.
  • Guidance for how you can recognize when your “monkey mind” is swinging from thought to thought with the worries of the day and gently turn your attention back to the present moment and the feeling of your nourishing breath
  • Feeling comfortable in your own skin.
  • Increasing confidence as your strength and flexibility grows.

There is a TON of research that strongly supports using yoga to assist with the treatment of: anxiety (including Post Traumatic Stress Disorder); depression; ADHD; sleep problems; substance abuse, anger issues, and schizophrenia (when done in conjunction with medication).  It’s an activity that can be modified for people of any age, from 2 to 102, and you can take with you anywhere you go! There are even some instructors that have training in both mental health therapy and yoga and can customize the work to really target anxiety and trauma specifically, teaching you how to be comfortable in your own body again.

Personally, my ability to use relaxation breathing as a skill in my daily life has never left me, even though I haven’t done a class for almost 10 years.  One day, when my life gets a bit simpler, I fully intend to return to the benefits of a more regular, devoted yoga practice.  In the meantime, I remind myself the words of wisdom of one of my former instructors, “Even one sun salutation is a yoga practice.”

Article: Not Hungry in the Morning - Dr. Kristen Allott, Naturopathic Physician

Nutrition is the cornerstone of good mental health.  This is why it’s one of the first things I talk with my clients about when they start to work with me.  Nobody is perfect, least of all me, but the more conscious we are about making sure to eat at least three meals a day, plus a few healthy snacks, the easier it will be for our mood to be calm and comfortable and out energy level to be active.

It’s not unusual, when I start to discuss this with my clients, for folks to tell me, “Well, I’m really not hungry in the morning.”  Because breakfast so strongly sets the tone for our bodies for the rest of the day (because of chemical processes that need to be fueled in the morning, as well as other things), this is an issue that we need to tackle together.

In her article, Dr. Allott teaches us about why you actually aren’t feeling hunger, even though your body really does need more food.  And, while she explains it in the context of breakfast, this is true for any time that our glucose level (“blood sugar”) goes low and kicks off a process in our liver that taps into our body’s emergency reserves.

PS – While you are on her site, you may want to explore.  She has TONS of free resources available that really help to illustrate the connection between nutrition and mood.

Stages of Change

Once upon a time there were two researchers, Prochaska & DiClemente. (If you can’t already tell, I’m in a bit of a silly mood at the moment.) They were smart people who did research and read other people’s research and put it all together back in 1983 to come up with their Stages of Change model. This model is used heavily in the treatment of addictions but can also be applied to things like the treatment of anxiety and depression…or almost anything really, where change is involved. What they so wisely realized, when it came to making a change in one’s life, was that in addition to understanding the human mind and what can help it to change, you also need to be aware of the person’s readiness to actually do the work to make the change that they are looking for. The stages are Pre-Contemplation (when you don’t even have the desire to make a change), Contemplation (when you recognize that there is a problem and you are starting to consider if you want to make a change), Preparation (when you are starting to gather the resources and information you might need to help you make this change), Action (actively working on making the change happen), and Maintenance (you’ve made the change and can finally start to not work so hard on it, but there may still be some things you need to do to keep this positive change in place).

The Stages of Change model can help us to be patient with ourselves. It can help us to recognize how really ready we (or someone we care about) might actually be to make a significant change in our life. And, it can help us to realize what steps we can take to get ourselves closer to being ready to make this change. There is a therapeutic approach, Motivational Interviewing, that is also heavily rooted in the treatment of addictions but that can be applied in all sorts of other places. Motivational Interviewing is a technique that helps therapists, parents, even friends, to be accepting of the stage of change that a person is in at this moment, and being able to work with them (rather than battle with them) to explore small steps that they might feel comfortable with doing that will get them closer to being ready for change. (I plan to make a post on that at some point but for now, I leave you with doing an internet search.)

Below is an illustration of these stages. I like this illustration in particular because it’s drawn with a spiral rather than in a linear way. This is because there are no rules about the actual order we need to go in as we head towards change. And, sometimes, we even go backwards to an “earlier” level.

Crime Victims’ Center of Chester County

The Crime Victims’ Center of Chester County, Inc. provides free and confidential services to victims and their family members/significant others who reside in or were victimized in Chester County, Pennsylvania.  They make the cold and unwelcome world of the court system feel knowable and as effective as possible by practically, and sometimes literally, holding your hand every step of the way.  Additionally, free counseling and even money towards expenses that have resulted from being a victim are also available.

Since I originally wrote this post, I have now had personal experience with this organization and I can’t say enough good things about them.  If you are the victim of a crime, they should be the second place, that you call, after the police/FBI. Even if you are unsure or don’t want to formally report your the crime to the authorities, CVC is there for you, 24-hours/day.

CVC, also known as the Rape Crisis Council of Chester County, Inc., is the designated Sexual Assault Center for Chester County. CVC provides services to victims of all types of crime and violence including, but not limited to: rape, sexual assault, incest, sexual harassment, child abuse, elder abuse, homicide, assault, robbery, identity theft, drunk driving, stalking, and bullying.

Tip: If you don’t live in Chester County, your county will have a crime victims’ center too, but perhaps by a different name.  A quick Google search should be able to help you locate the one in your area.

Shyness and Social Anxiety Workbook: Proven, Step-by-Step Techniques for Overcoming your Fear by Martin M. Antony PhD and Richard Swinson MD FRCPC FRCP

shyness n social anxiety wkbkI recommend using this book when working with adults and some teens who have high levels of shyness and social anxiety.  In a clear, and easy to read fashion, this book takes you step-by-step through the process of learning about how cognitive behavioral therapy (CBT) views shyness and social anxiety and is a powerful tool in overcoming how these thoughts and feelings can hold you back from living your life in a way that you are comfortable and happy with.  CBT is a therapeutic philosophy and a large body of scientific research strongly supports CBT as the foremost treatment of social anxiety.

I do think that most people would still need a therapist to be guiding them through the process because for the individual working to learn these skills and challenging themselves to try new things, it can take a lot of energy.  When a therapist is coaching you in the sidelines (and celebrating your successes with you), it frees you up to devote all of your energy towards growing.  However, over time, these are skills that you will learn and can take with you forever.  Once you understand how it works and how powerful it is, you will be able to use this approach to tackle any similar issues that should come up for you in the future.

As a therapist, I don’t use this book alone.  I supplement it with concrete, scientifically grounded information about relaxation breathingGrowth Mindset as well as other customized handouts and tally sheets for homework.

Panic Attacks Part 1: What is Panic & Why We Need It

Businessman scared under table of Bear. frightened business man under work board. Wild Animal. Boss fear office desk. To hide from angry grizzly. Vector illustration

Panic is a normal, necessary physical response to the brain perceiving a significant threat.  It involves the release of a hormone that you are likely familiar with, adrenaline.  Adrenaline’s job is to tell the body to make chemical changes in the body so that the body is physically primed to either fight or flee/run away, from the threat.  These can be things such as:

  • Rapid heartbeat
  • Short, shallow breaths
  • Paling or flushing (can switch between both)
  • Digestion slows down or stops (becomes a low priority for your body)
  • Constriction of blood vessels in many parts of the body…including the BRAIN (which interferes with your ability to think logically)
  • Dilation of blood vessels for muscles (so they are ready for action)
  • Take energy from stored nutrients to fuel muscles
  • Dilation of pupils
  • Temporary loss of hearing
  • Tunnel vision (loss of peripheral vision)
  • Physical shaking

For an illustration of this, you can check here.

Back in the day of the caveman, the people who didn’t have a panic response were much less likely to survive because their bodies were not as prepared to deal with a physical threat.  Our body’s ability to quickly maximize all of our resources for survival is a critical aspect not only of humans but all animal species.  Yet, in our Western culture, many of us are fortunate that our safety is not regularly threatened in a physical way. Instead, because our brain does not recognize a difference between a physical threat and emotional threat, in a modern society a panic response can often be triggered by things such as fear of embarrassment or fear that a bridge might collapse.  Or, perhaps you do have experience with your physical safety being at risk and now, your body is in hyper-vigilant mode and looking for danger at every corner.

The problem here is that our body’s physical readiness to fight or run won’t help us to not be embarrassed. Nor will it help us cross a perfectly well-maintained bridge or walk around the corner in a typically safe neighborhood.  Instead, that physical response can feel scary itself and physically uncomfortable if we don’t do anything to burn off that energy and bring our body back to calm.  Additionally, increasing our breathing rate without making use of the extra oxygen we are taking in creates a chemical imbalance between the oxygen and carbon dioxide levels of our body that adds to our feelings of physical discomfort.  (Psychology Tools has a nice information sheet with some more details about this.)

So, what can we do if we start to physically panic about a possible emotional threat?  Check out the next article in this series!


Remaining articles in this series:


Panic Attacks Part 2: The Antidote to Panic - Relaxation Breathing


Previous article in this series:

Relaxation breathing is the antidote to panic.  Literally.  It is impossible to be truly breathing in a relaxed way and to be experiencing a full-blown panic attack at the same time.  This is because relaxation breathing helps to reset our body chemistry to a “normal” state and bring it out of panic.  If you haven’t read it yet, the previous article in this series, Panic Attacks Part 1: What is Panic & Why We Need It, you might want to check it out.

Some people may tell you that there is a “right way” to do relaxation breathing. In my opinion, if you try the “right way” and you find it to be really annoying and just plain won’t do it, then clearly that is not the right way for you. Generally, the recommendation is that you are breathing out for a longer count than you are breathing in and that you are taking in air by expanding your belly muscles, not your chest muscles.

My recommendation is that you find something that feels comfortable for you and go with that approach.  No matter which approach you choose, the most important thing is that you practice relaxation breathing every day when you are already calm. I cannot stress this point enough. When your body is in panic mode, learning a new skill is not something that your brain is going to be very good at. So if you’re heading into a panic attack and you haven’t been practicing your relaxation breathing, don’t be surprised if it doesn’t work to help you return to calm…yet.

Regardless of the breathing technique that you decide to use, I recommend that you practice your relaxation breathing during a time that you are already relatively calm and relaxed, for five minutes at a time, a minimum of 1-2 times every day, with one of those times being at night when you are lying down to fall asleep.  The main goal is to be able to clear your mind of all thought and just focus on the sensation of your breath going in and out of your body.  Or, you can add some sort of positive phrase that you can repeat to yourself if it helps.  (For example: “Breathe in calm.  Breathe out fear,” but it could be anything so long as you interpret it as positive and relaxing.)

Below is a video that describes square breathing and then, below that, a few other informational links.  The video is geared towards kids but you can use whatever imagery you like, and, who doesn’t enjoy the smell of fresh baked cookies??  (You’ll understand that last comment when you watch the video.)



Additional Breathing Information:

  • Another take on square breathing, including a printable that you can download and customize.
  • Diaphragmatic breathing, also known as “belly breathing,” which can be blended with square breathing if you’d like.

If you have a smart phone, there are also plenty of free apps that you can download to help coach you through relaxation breathing.  Here are two that I’ve had experience with:

  • Breathe2Relax – availabe on iPhone and Android (I recommend adjusting the default settings to what is comfortable for you.)
  • Centered – available on iPhone only 🙁

Remaining articles in this series: