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February 2012

MessageFrom the Clinical Director

How to deal with Negative Thoughts

How to assess and change them Page 3 & 4

Diagnosis CornerWhat do the doctors look for? Page 6

Testimonial of RecoveryElspeth page 7

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MessageFrom the Clinical Director

The demands on each of us are increasing and the days are not getting longer. The guilt placed on the city dweller to improve ones mind is constant. Bookings to the latest private viewing at a gallery, eat at the latest opening of a new restaurant to name a few activities that are carried out to defend against the criticism and keeps us busy. But have we lost our way and go through the motions and have forgotten to enjoy the process, and instead look to the end result? The city is full of distractions and can cater all tastes and desires. But do we need our time to be filled or can we use what is available to us now to bring calm and enjoyment in the simple pleasures. There is a whole array of pleasures around us but they may initially look absurd for us to comprehend the usefulness of such simplicity.

Have you ever being on holiday and taken 101 pictures of a mosaic that was very interesting at the time but when you collect pictures from the developer most of the photos end up in the bin. It is at these moments that senses were engaged in the moment and then we click away on the camera. Well lets try this now and go for a walk at lunchtime and act as if you are the tourist and have just arrived and develop the curiosity to smell, taste, look, touch and hear what is around. In Cognitive Behavioural Therapy this is called the Tourist exercise. Think about the wind brushing upon the face, the sound of twigs breaking underneath the feet. Look up and around and make a mental note of what you notice and describe it. You may need to ‘just do’ the exercise before the motivation kicks in.

2CBT in the City Ltd Registered company in UK:6709268. CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited 2012

People who are depressed typically think in a biased negative way. They have negative views of themselves (eg I’m no good), the world (eg Life has no meaning) and the future (eg I will always feel this way). People who are anxious typically think in a catastrophic way (eg I am going to die), the world (eg The World is unsafe) and the future (eg I will never cope). As you progress in therapy, you will learn to identify other patterns of thinking that affect the way you feel such as extreme anger, jealousy, envy, shame, embarrassment and other emotions.

Automatic negative thoughts are the most basic form of thoughts. We are not trained to identify them. In the course of therapy,

one of the most important aspects of therapy is to identify these automatic thoughts. They have several characteristics which are:

Automatic – they just pop into your head without any effort on your part

Distorted – they do not fit in with all the factsUnhelpful – they keep you feeling the extreme feelings that

you experience, make it difficult to change and stop you getting what you want out of life

Plausible – you accept them as facts and it does not occur to you to question themInvoluntary – you do not choose to have them and they can

be very difficult to switch off.

These thoughts can trap you in a vicious circle and maintain the way you feel. For example, the more depressed you become the more automatic negative thoughts you have and the more you believe them and this in turn makes you feel more depressed. The main goal of Cognitive Behaviour Therapy is to help you break out of this vicious circle by helping you develop the skills in dealing with these negative automatic thoughts.

Overcoming the problemIn the sessions, the therapist will help you identify what

triggers (A = activating events) your negative thoughts (B =

beliefs) and link in with the way they make you feel and behave (C = consequences). It is important to start to learn to identify your negative automatic thoughts and how to deal with them.

Initially you may find it not easy to identify your automatic thoughts and deal with them. Challenging automatic negative thoughts is like any other skill and it takes time and regular practice to be able to do it with ease. Your therapist will highlight the importance of dealing with negative automatic thoughts. Don’t be discouraged if you have difficulties. In sessions, your therapist will help you to identify them and you will be set these as your homework so you will have opportunities to practise on your own. The more you do, the easier it gets and challenging your automatic negative thoughts will become natural to you.

The first step in challenging your automatic negative thoughts is to become aware of your thoughts and of their effects on you.

These thoughts have an effect on you and make you feel bad, anxious, sad, depressed, hopeless, guilty and angry. Instead of becoming overwhelmed by these emotions, you can learn to use them as a cue for action. Notice when your mood changes for the worst and look back at what was running through your mind at the moment. Over the course of a few days, you will become more sensitive to changes in your feelings and to the thoughts that spark them off. You may find that the same thoughts (and beliefs) occur again and again.

How to do itThe best way to become aware of your automatic thoughts

is to write them down as soon as they occur. You can do this on the ABC Form.

Step 1Write down the emotion you experienced at C

(Consequences) eg, anxiety, depression, guilt, hurt, shame, anger, jealousy. Rate the intensity of your feeling 0 – 100%.

Step 2Write down you actions at C, eg escape, becoming

withdrawn, aggression, reassurance seeking, taking drugs, avoidance, safety behaviour etc.

how to deal with negative automatic thoughts lets start with assessing them....

Pit Stop Exercise

PS

4CBT in the City Ltd Registered company in UK:6709268. CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited 2012

Step 3-Write down what triggered off your thoughts and feelings in the column marked A (Activating Event). Activating Events can be past, present or future events. Places, memories, people objects, images and physical sensations can all be Activating Events.

Step 4-Write down your negative automatic thoughts and beliefs about A. This should include your perceptions of the situation and what it meant to you.

Step 5-Dispute D your negative thoughts and beliefs. Use the questions at the bottom of the ABC Form to help you. Label the thinking error for each distorted thought and belief.

Step 6-For EACH of the original thoughts and beliefs at B, generate a balanced and realistic response. Write them down in the D column.

Step 7-Re-rate the original emotion you noted down at C and put this down at E (Effect of alternative thoughts and beliefs).

Step 8-Write down at E, a plan for a more constructive behaviour in the future. This might be a different way of managing a situation or an experiment to test out a thought. Try to be as clear and specific as you can.

There may be times when you cannot identify any thoughts or images as such. If so, then ask yourself what the meaning of the situation is. What does it tell you about yourself, the situation and your future? This may give you a clue as to why the situation is so depressing or what is making you angry, anxious etc. An argument, for instance, might mean to you that a relationship may be at an end with somebody or even that you may never be able to have a proper relationship with anyone.

In the course of therapy, your therapist will help you develop other skills as the downward arrow to help you identify beliefs and meanings attached to situations. That is why it is important to complete your ABC Forms.

Common problems in recording negative thoughtsIdeally, it is best to record your thoughts and feelings

immediately they occur. But of course, this is not always possible.

It would be difficult to record your thoughts in the middle of a meeting. In this instance, it is often useful to record the thoughts on a piece of paper. Set aside time each day to do your ABC Forms, say, 30 minutes each evening to complete your homework. Run through an action replay and recall as much detail as possible of what happened, what was the situation (A), what your thoughts were (B), what you were feeling and your behaviour (C).

Beware of excuses that keep you from focusing on your thoughts and feelings. Often people say “I will do it later” or “It’s better to forget all about it”. You may find that you may be unwilling to face the thoughts. Perhaps you are afraid they will overwhelm you or think that they are stupid. It is quite natural for you to avoid thinking through unpleasant experiences but doing so is the best way to combat your depression, anxiety, anger etc. If you find yourself making excuses, this is probably because you hit upon something important so make yourself write it down. You can divert yourself by engaging in distraction (alcohol, drugs etc) but this won’t help you deal with your problems as the thoughts won’t go away.

As your mood improves, you will find that you have less of a focus and attention towards the automatic negative thoughts. It is still useful to continue to work on these thoughts as it will provide you with practice on how to deal with these thoughts.

Should your mood deteriorate or become anxious, you have the tool to deal with it before it becomes unmanageable. The ABC Forms should be kept as they are useful in helping you deal with your automotive negative thoughts when your mood becomes low and help you challenge your thoughts. As your mood improves, you can strengthen your disputes by adding to them.

PSPit Stop Exercise

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Compulsive Hoarding (or Pathological Hoarding or Disposophobia) is the excessive acquisition of possessions (and failure to use or discard them), even if the items are worthless, hazardous, or unsanitary. Compulsive Hoarding impairs mobility and interferes with basic activities, including cooking, cleaning, hygiene, sanitation, and sleeping

Characteristics

A. Persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions*  B. This difficulty is due to strong urges to save items and/or distress associated with discarding C. The symptoms result in the accumulation of a large number of possessions that fill up and clutter active living areas of the home or workplace to the extent that their intended use is no longer possible. If all living areas are uncluttered, it is only because of the interventions of third parties (e.g., family members, cleaners, authorities) D. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others) E. The Hoarding Symptoms are not due to a general medical condition (e.g., brain injury, cerebrovascular disease). F. The Hoarding Symptoms are not restricted to the symptoms of another mental disorder (e.g., hoarding due to obsessions in Obsessive-Compulsive Disorder (OCD), decreased energy in Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autism Spectrum Disorder, food storing in Prader-Willi Syndrome)

*Specify if: With Excessive Acquisition: If symptoms are accompanied by excessive collecting or buying or stealing of items that are not needed or for which there is no available space

*Specify whether Hoarding beliefs and behaviors are currently characterized by: Good or fair insight: Recognizes thatHoarding-Related Beliefs and Behaviors(pertaining to difficulty discarding items, clutter, or excessive acquisition) are problematic. Poor insight: Mostly convinced that Hoarding-Related Beliefs and Behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary. Absent insight: Completely convinced that Hoarding-Related Beliefs and Behaviors (pertaining to difficulty discarding items, clutter, or excessive acquisition) are not problematic despite evidence to the contrary

Compulsive HoardingWhat do the doctors look for?

DCdiagnosis corner

cognitive behaviour therapy made a difference!....the human conditionBy Elspeth

I did not realise that I was suffering from OCD until I met with Matt. I knew it was anxiety but I had not told anyone about my intrusive and unwanted thoughts. They would just pop in and I hated myself for having them. I would wait for all my housemates to go to sleep before I went to bed. I had frightening images of me walking around with a knife and killing all that were dear to me.

I threw out knives in the bin and I started to eat sandwiches rather than make a meal. I would ensure that my routine was in place before going to sleep. I would set up traps so that if I did wake up and harm anyone then I would trip up over things hoping that this would stop me.

Matt help me see through using CBT that these were just thoughts and that I did not have to be a prisoner to them. I am now able to cook meals using sharp knives, go to bed early and at any time, have a relationship! and more importantly enjoy life.

7CBT in the City Ltd Registered company in UK:6709268. CBT in the City is a registered Trademark copyright 2010 and all work produced and published is the property of CBT in the City Ltd. Any reproduction is prohibited 2012

Testimonial of Recovery

TR

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