CBT Self Help Course Step 2

Continued from Step 1

Printable PDF: Step2

See also: The Decider Skills for Self Help online course

The documents linked from the bottom of each page are intended to be an integral part of this course, and should not be omitted - the worksheet documents are included in the downloadable Steps linked above.

Use the Self Help mp3 downloads to strengthen therapy or as a stand-alone technique.

In Step 1, we looked at vicious cycles and learned how thoughts, feelings and behaviours are linked and each one affects the others.

If we use the depression example from that page, we see that on waking in the morning, 'Dave' had thoughts that included "There's no point", and "I'll only mess up again". If we think those thoughts and believe them, there is every chance that we are going to feel depressed. If we think those thoughts and feel depressed, then it's likely that we would be sorely tempted to pull the covers over our head and stay in bed.

How does doing that affect the way Dave feels and thinks? Hmm. Staying in bed might mean that his thoughts get carried away and he continues to think that way, making him feel even worse, and even more likely to stay in bed. A vicious cycle.

Vicious Cycle of Depression VIDEO

DEPRESSION
Depression can happen to anyone - and does happen to one in four of us over our lifetimes. Different factors that make it more likely to happen, include biological make-up, upbringing, or reaction to life events. What keeps it going though, is how we deal with those things. The way we think and what we do affects the way we feel.

Depression is often accompanied by other feelings such as guilt, shame, anger and anxiety.

Thoughts
People who are depressed tend to think very negatively about themselves, the future and the world around them. It can be like seeing life through "gloomy specs".

- Everything is hopeless - nothing can change
- I'm useless, worthless
- It's all my fault
- The world is a terrible place - everything goes wrong

We can dwell on these thoughts repeatedly, mulling over things, asking ourselves why, thinking regretful things about the past, what we should or shouldn't have done.

Physical Sensations

- Tiredness, fatigue, lethargy
- Difficulty concentrating or remembering
- Sleep changes (sleep more or less)
- Eating changes (eat more or less)
- Lose interest in hobbies, activities, sex

Behaviours
Because of the tiredness, difficulty sleeping and eating, and negative style of thinking, we tend to do less and less. We stop doing the things we used to do and enjoy. It could get so bad that we can't even go to work, or do things at home. We want to stay in bed, or stay at home doing very little. We might isolate ourselves from friends and family.

ANXIETY
Anxiety is the body's way of responding to being in danger. Adrenaline is rushed into our bloodstream to enable us to run away or fight. This happens whether the danger is real, or whether we believe the danger is there when actually there is none. It is the body's alarm and survival mechanism. Primitive man wouldn't have survived for long without this life-saving response.

It works so well, that it often kicks in when it's not needed - when the danger is in our heads rather than in reality. We think we're in danger, so that's enough to trigger the system to go, go, go! People who get anxious tend to get into scanning mode - where they're constantly on the lookout for danger, hyper-alert to any of the signals, and make it more likely that the alarm system will be activated.

Thoughts
- I'm in danger right now
- The worst possible scenario is going to happen
- I won't be able to cope with it

Physical Sensations The Adrenaline Response
When there is real, or we believe there is a real, threat or danger, our bodies' automatic survival mechanism kicks in very quickly. This helps energise us to fight or run away ('fight or flight response'). We will notice lots of physical sensations, which might include:

Heart racing - This helps to take the blood to where it is most needed - his legs so that he can run faster (flight); his arms so that he can hit out (FIGHT); his lungs to increase his stamina. At the same time blood is taken from the places it is not needed for example fingers, toes and skin. These changes cause tingling coldness and numbness.
Breathing gets faster - This helps the bloodstream to carry oxygen to the arms, legs and lungs. This will give him more power. The side effects may include chest pain, breathlessness and a choking feeling. As there is a slight drop in the blood and oxygen being sent to the brain he may feel dizzy or light headed, he may experience blurred vision.
Muscles tense and prepare - The large skeletal muscles tense and create power, this may cause pain, aching and shaking.
Sweating - Sweating helps to cool the muscles and the body. It helps to stop them from overheating. Sweating can also make us more slippery to our enemies!
Pupils dilate - This lets more light into his eyes so his overall vision improves. Side effects may include sensitivity to light or spots before his eyes.
Digestive system slows down - These are not important while in danger and so are slowed down then the saved energy goes to where it is most needed. Side effects may include nausea, butterflies and a dry mouth.
More alert - He will be concentrating on looking for danger, much less able to concentrate on anything else. He will be waiting for something to happen. This is the basis of the way we worry.

Behaviours

Avoiding people or places
Not going out
Going to certain places at certain times, e.g. shopping at smaller shops, at less busy times
Only going with someone else
Escape, leave early
Go to the feared situation, but use coping behaviours to get you through: examples include: self talk, holding a drink, smoking more, fiddling with clothes or handbag, avoiding eye contact with others, having an escape plan, medication. These are called 'safety behaviours'.
Safety behaviours can also help to keep your anxiety going. Whilst you depend on them to help you cope, you don't get to find out that without them, the anxiety would reduce and go away on it's own.
Whilst avoiding people or situations might help you feel better at that time, it doesn't make your anxiety any better over a longer period. If you're frightened that your anxiety will make you pass out or vomit in the supermarket aisle, you won't find out that won't actually happen, because you don't go. So the belief that it will happen remains, along with the anxiety.

Vicious Cycle Of Anxiety

Vicious Cycle of Anxiety - video

We all feel anxious some times. A certain amount of anxiety helps us to be more alert and focused. For example just prior to an exam, a few exam nerves have a positive effect - motivating us, helping us focus our thoughts on the job in hand, making us more alert. Too much anxiety, or constantly being anxious, is unhealthy and detrimental to our lives and relationships.

ANGER
Anger is a result of thinking that we have been unfairly treated or disrespected, or that others have broken or fallen short of our rules, standards or expectations, and we won't stand for it.Thinking this way leads us to feel angry, which stimulates the body's adrenaline response which is our body's way of helping us to cope with either fighting, or running away ('fight or flight' response). We respond to those thoughts and feelings, by acting, or feeling an urge to act, in threatening or aggressive ways.

Thoughts
- I'm being treated unfairly
- I'm being disrespected
- They're breaking a rule or standard
- I won't stand for it

Physical Sensations - The Adrenaline Response
When there is real, or we believe there is a real, threat or danger, our bodies' automatic survival mechanism kicks in very quickly. This helps energise us to fight or run away ('fight or flight response'). We will notice lots of physical sensations, which might include:

heart racing or pounding - enabling good blood supply around our bodies breathing quickly - allowing more oxygen around the body
tense muscles - a state of readiness to fight or flee
shaking
hot, sweating
light-headed
stomach churning or butterflies
fist or teeth clenching

Behaviours
- staring & facial expression
- aggressive body posture
- attack
- hit out (or urge to hit out)
- argue
- shout
- run or storm away
- don't talk
- sulk

The Angry Cycle

Vicious Cycle Of Anger VIDEO

We all feel angry some times. Some people tend to become angry easily (a "short fuse"), and some have problems controlling their anger. Anger has consequences, and they often involve hurting other people - more usually their feelings, but sometimes physically. Anger can cause problems in our personal lives, and affect work and study. After an angry outburst, we can think very critically of ourselves and our actions, leading us to feel guilty, ashamed and lower our mood, which might result in our withdrawing from others, not wanting to do anything (see depression cycle).

Summary
In CBT, we aim to break those cycles by changing something - what we think or what we do. We might start by looking at what might be easiest to change. Perhaps in this case, it might be easiest to change what we do.

How would Dave, in the first example above, have felt if he had got up anyway, in spite of how he was feeling. Maybe ate some breakfast, had a shower, got dressed, then perhaps went out for a walk. How would that affect his depression? What would that do to the way he was thinking?

It's very likely that his mood would have improved, and that he would have started to think a little more realistically. He might have even enjoyed his day, or got a sense of achievement from having done something.

Emotions: A summary of particular emotions and their associated thoughts, body reactions and behaviours.

If you have a problem other than depression, anxiety or anger, then you can read the information given in these information sheets, and then continue the course:

Stress or webpage
Low self-esteem or webpage
Chronic pain / fatigue or webpage
Paranoia, Delusions &/or voices or webpage
Substance misuse or webpage
Bulimia or binge eating or webpage
Anorexia or webpage
Bipolar or webpage
Insomnia
Anxiety
Depression
Anger

Specific Anxiety Disorders:

VICIOUS COGS
Have a look at what you've written down on your vicious cycle worksheets of examples of distressing situations (Step 1 practice). What links can you see between what you think and what you do, and how they affect the way you feel?

In order to make effective positive change, it is essential to look at the factors which help to keep the problem going. Once we've identified those factors, we can then target each factor and start to make positive changes.

Using the example of a simple clockwork mechanism, we can see how the smaller cogs keep the large central cog turning. If there's a problem with any of the cogs, then the whole mechanism will grind to a halt.

We can therefore use this process to help us deal with our mental health problem. If our main problem is "anxiety", then we can write "anxiety" inside the large central cog. Then we can identify each factor than helps keep the anxiety going.

In order to reduce and deal with the anxiety, we need to target and make positive helpful changes in each of those smaller cogs.

EXAMPLE COGS

Vicious Cogs Of Anxiety