The basic tenet of Cognitive Behavioural Therapy, or CBT, is that what you think affects the way you feel. That is to say, if you think depressive thoughts then you will feel depressed. Conversely, if you manage to stop yourself thinking these thoughts, then your depression will lift.

As a Psychiatrist in Edinburgh I use CBT techniques extensively. My first step is to look for unhelpful patterns of thinking with my clients. Depressed people often think in particular ways that are very different from non-depressed people. These ways of thinking are called – in CBT language – “thinking errors”. Thinking errors help to cause and then maintain depression.

Numerous different thinking errors have been identified by CBT therapists over the years, and particular kinds of errors seem to predispose to particular psychological problems. In my experience as a Psychiatrist, the most common errors found in depression are “All-or-Nothing” thinking, “Mental Filtering”, “Disqualifying the Positive”, and “Personalising”.

“All-or-Nothing” thinking (also known in CBT circles as “Black-or-White” thinking) emphasises extremes and ignores the fact that most things in life are shades of grey rather than absolutes. For example, a person thinking in this way may play one poor game of tennis and then decide that he’s totally useless and give up forever. Or she may miss one yoga class and tell herself that as she’s fallen behind, there’s no point in going back. “All-or-Nothing” thinking sets very rigid rules for a person to live by – rules that, if broken (as they almost inevitably are!) can lead to the abandonment of enjoyable and worthwhile activities, and predispose the person to depression.

“Mental Filtering” is the term applied to the thinking patterns of people who “see” the world in a depressive way. People with this thinking error are biased in what they take notice of, and what they later remember. They will tend to notice (or, in CBT parlance, “attend”) to objects, people, or events that “fit-in” or confirm their previously held beliefs. For example, a depressed person who thinks that the world is an unpleasant place to live is more likely to remember the sad news stories as compared to a non-depressed person. A depressed person who thinks that they’re unlikeable will take extra notice of possible sleights from others. CBT theory posits that such mental filtering reinforces a person’s depression.

A closely related thinking error is termed “Disqualifying the Positive”. As well as focusing on the negative features of the world (and themselves), depressed people will often actively ignore (or “disqualify”) evidence to the contrary. A depressed person may well recall the person at the party who ignored them, but he will forget or downplay the others who chatted to him for hours. If a CBT therapist asked them about this, he will often say things like “oh, they just felt sorry for me”, thereby turning a positive interaction into something very different.

“Personalising” is the term given to a type of thinking that places the person at the centre of events. Such a view of the universe places a huge burden on the persons shoulders – they can feel responsible for all the bad things that happen. You may be “Personalising” when you feel guilty about not being able to help an unemployed friend keep his house, or when reading about climate change due to our Western way of living. There are factors beyond your control and for which you should not take responsibility. If you do, then CBT hypothesises that you will experience feelings of guilt, shame, and ultimately depression.

The above is a brief review of the common thinking errors that I have come across during the course of my work as a Psychiatrist in Edinburgh. Identifying such errors with the client is a first step on the way to identifying other, healthier, ways of thinking.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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Cognitive Behavioral Therapy, or CBT, is an effective psychological treatment for psychological and emotional problems. As a psychiatrist in Edinburgh I use CBT techniques to treat depression, and I see a lot of clients feeling low and unhappy. They often ask me if I think they’re depressed, and what has caused them to feel like this. These questions have prompted me to write this short account.

The term “depression” means different things to different people. To psychiatrists, “depression” is synonymous with “clinical depression”, a mental illness with a set of (numerous and rather loosely drawn) symptoms and it’s own clinical course and prognosis. To most of the rest of us, “depression” simply means feeling very low.

Depression, in either sense of the term, is common. Statistics vary as to just how common it is, but a figure in the range of 50% for “life-long” risk of clinical depression is common. This means that most of us have a 1 in 2 chance of experiencing clinical depression in our lifetimes. Similarly, at any one time, between 10% and 20% of the adult population fulfil the criteria for clinical depression. These figures have been rising for many years now, and it is expected that they will continue to increase in the future. It can seem as if the world (particularly the industrialized part of it) is suffering an epidemic of depression.

The causes of such widespread and increasing frequency of depression are unclear and depend to a great extent on who you ask! What follows is a very brief summary of the main contenders.

Many psychiatrists (and the pharmaceutical companies) focus on genetic and biochemical factors in depression – they emphasize the apparent hereditary nature of depression and the response of depression to antidepressants and Electro-Convulsive Therapy (ECT). They see depression as a physical disease of the brain.

In contrast, other researchers and workers (such as Social Theorists and Social Workers) emphasize the role of society and the immediate environment in causing depression. They hypothesize that a stressful living environment and detrimental social situation can cause depression. They point to differences in the rates of depression between different social groups (there are significantly higher rates of depression and suicide in lower socio-economic groups) as evidence of this environmental impact. Such a view issues in a very different set of “treatment” recommendations – not antidepressant tablets but socio-economic help such as improved housing and employment opportunities.

Finally , Cognitive Behavioral Therapy (or CBT) focuses on the individuals thinking as a potential cause of depression. The theory is that people prone to depression tend to habitually think in particular “depressive” ways, and when these people experience adverse events (or even simply believe that something bad has happened), then they are at great risk of becoming depressed. An example of a “depressive” thinking habit is “negative filtering”, where a person will “see” or “count” only the unpleasant or bad things she experiences, and discount the good ones. A CBT therapist would call this pattern of thinking a “Thinking Error”. Thinking in this way can make the world will seem threatening and yourself seem persecuted – and it’s a small step from here to feeling depressed. A CBT therapist aims to help the person identify and change their “depressive” thinking habits.

As noted previously, the causes of depression are not known – we have some good hypotheses, but psychological and emotional problems are notoriously difficult to research and reach a definitive conclusion. And there are many more hypotheses out there – ranging from viral theories of depression to sunlight deprivation to dietary deficiencies.

Suffice to say that, given our current level of knowledge, it seems wise to accept that there are likely to be many causes of depression, either working alone or in tandem. Indeed, most Mental Health Practitioners use a “multi-factorial” model of mental illness that has room for physical, environmental (social) and psychological factors. The treatments offered for depression should (but, unfortunately, frequently don’t) reflect this complexity. In particular, there remains a paucity of psychological treatments available on the NHS. Many clients that I see privately as a Psychiatrist in Edinburgh have been unwilling to wait months before getting help.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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The theory of Cognitive Behavioural Therapy, or CBT, is that emotions are closely linked to cognition. Put more simply, CBT says that “the way you think affects the way you feel”. People who think anxious thoughts will end up feeling anxious.

As a therapist in Edinburgh a significant proportion of my clients suffer from anxiety. Edinburgh is a beautiful city and a wonderful place to live, but as in any urban environment, individuals can start to feel stressed out and anxious. Thus it is important for me to help each client to become familiar with their own ways of thinking, and to help them to identify ways in which their thinking patterns may be contributing to their emotional problems.

A CBT therapist has a term for patterns of thinking that can lead to emotional problems – they are called “Thinking Errors”. Many different types of thinking error have been identified over the years, but what follows is a brief summary of those errors that I have seen as a therapist in Edinburgh when working with people suffering from anxiety.

“Catastrophising” is a thinking error frequently found in anxious people. In fact, I’m sure we’ve all done it ourselves at some point! When someone catastrophises they automatically “assume the worst”. A message to call back the boss is taken to mean that you’re going to be sacked, a clunking noise in your car means that the engine is about to fall to bits, and a pain in the chest is the beginnings of a heart attack. CBT hypothesises that habitually thinking like this will lead to long-term problems with anxiety.

Another common thinking error seen in people with anxiety is called “Mind-Reading”. As the name suggests, a person who’s exhibiting this thinking error will believe that they know (absolutely know) what people are thinking about them. This belief will often go contrary to what the other person says and does, and is almost always pessimistic in nature. For instance, if the CBT therapist yawns (heaven forbid!) during a session, the client will know that the CBT therapist is bored or fed up with them – even if the therapist apologises and explains that her young daughter is teething and kept her awake last night. Or if the person gets invited to a dinner party, they will know that they’re only invited along to make up the seating numbers. Thinking in this way can make life one long series of possible sleights and put-downs, leading to increased anxiety and excessive monitoring of those around you.

“Crystal-Ball Reading” is a third common thinking error in anxiety. People thinking in this way know what is going to happen in the future. And, lo and behold, it’s bad! The bus will definitely be running late, they will definitely fail the interview, and they will absolutely make a fool of themselves at the works party. Not a pleasant way to think. And certainly not a good way to prepare for an interview (or even a party!). CBT encourages people to “keep it real” – there’s enough strife out there without looking into the future for extra!

These three thinking errors are those that I’ve found most frequently in anxious people whilst working as a therapist in Edinburgh, although I doubt that they’re exclusive to East Coast Scots!

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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Obsessive Compulsive Disorder (OCD) is a common psychological condition that I see frequently in my work as a therapist in Edinburgh. A diagnosis of OCD is made when a person shows the two key features of obsessions and compulsions. An obsession is a persistent thought, image, or urge that seems to enter the mind from nowhere and causes significant distress. Compulsions are things done again and again in response to an obsession or obsessions, in an attempt to reduce the stress. Compulsions are usually physical acts (such as washing the hands excessively or repeatedly checking door locks), but they can also be mental acts.

As a therapist in Edinburgh I see a lot of clients suffering from OCD, and I am frequently asked what causes it. Unfortunately the causes of OCD are not known for sure, but there are some likely culprits and I give a brief summary of these in this article.

Genetic factors seem likely to play some role in a person developing OCD. If you have a “first-order” relative with OCD (that is, a parent or sibling has OCD), then your chance of developing OCD yourself is in the region of 5%. However, it should be noted that OCD affects about 1% of the general adult population in the West, so an increased risk is present but it certainly isn’t enormous.

Subtle abnormalities in the brain have also been put forward as causes of OCD, but this has not been well supported by the research to date. Brain scans do not show any structural abnormality, and the more recent “functional” scan results (e.g. showing high frontal lobe activity) probably reveal the brain’s response to OCD, rather than being the cause of OCD.

It has been hypothesised that a key element underlying OCD is a relative lack of the neurochemical serotonin in certain parts of the brain. The only evidence for this has been the fact that OCD seems to respond (at least sometimes) to the SSRI class of antidepressants (SSRI meaning Selective Serotonin Reuptake Inhibitor – these drugs increase the amount of serotonin in the brain). Obviously the fact that some condition improves when a medicine is taken does not mean that the medication is acting on the cause of the condition. If you break your leg and are in severe pain, morphine will reduce the pain but it will have no affect on the cause of that pain!

One of the more interesting theories about the causes of OCD has been related to sufferer’s memories. This theory postulated that OCD sufferer’s may have poor memories and that is why they repeat their compulsions so frequently! In reality, OCD sufferer’s memories are fine but they don’t seem to trust them as well as other people do.

A final focus of research in OCD has been the apparent “triggering” of the condition. OCD commonly starts in the late teens and early twenties, and often seems to follow on from some form of emotional, psychological or physical stress. Common stresses include pregnancy and childbirth, physical violence, bullying, bereavement, or even the change of job or role at home. Whilst such “triggers” are common, they are not ubiquitous and a significant minority of people I see as a therapist in Edinburgh develop OCD without any identifiable stress.

So, in summary, the cause or causes of OCD remain obscure and more research needs to be done. However, even without definite causes being known, there are well-researched and effective treatments for OCD. As mentioned above, SSRI drugs are commonly used to help OCD sufferers, but the most effective treatment is Cognitive Behavioural Therapy, or CBT. This is the treatment of choice recommended by NICE (the Institute of Clinical Excellence – a Government body that advises clinicians about the safety and efficacy of different treatments for illness). Please see my other articles for more information about CBT in Edinburgh.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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Cognitive Behavioural Therapy, or CBT, is a an effective psychotherapy for a wide range of emotional problems. The theory underlying CBT is that our thoughts directly affect the way we feel – if we think in depressed ways then we will feel depressed. As such, a primary aim for a CBT therapist is to help a client recognise when they’re thinking in unhelpful ways. This article is a brief overview of one method of doing exactly this. I’ll use the example of someone suffering from social anxiety, a common problem amongst people I work with as a Psychiatrist and therapist in Edinburgh.

The first step for the client is to start “recording their thoughts” when they feel anxious – that is, writing down (in brief sentences) what’s going through their head. This may sound a little strange at first, but it really is an essential part of the CBT method. Ideally the client should stop and write down what they’re thinking at the moment they’re thinking it, but writing it down at the end of the day is also acceptable. They should write down everything they were thinking of – this will usually produce quite a list of thoughts and statements and beliefs. In addition, the client should note both how they felt (physically and emotionally) and the situation in which these feelings occurred.

In my example, the client would record that the situation was a social gathering of work colleagues after work. His heart was racing, he felt hot and sweaty, and he was a little light-headed (physical feelings). He described his emotional feeling as “very anxious”. Afterwards, when back at home, he wrote down the following thoughts that he remembered having at the time: “I don’t know anyone very well”, “I’ve got body odour”, “They’re all friends”, “This place is too busy”, “I hate these things”, “I want to go home”, “I’m going to faint and make a fool of myself”, “I’ve got to get out of here”

This list of thoughts that he has recorded is a list of what a CBT therapist would call “Negative Automatic Thoughts”. They’re “Negative” in that they tend to hinder the person’s motivation and ability to engage with activities, and contribute to emotional problems. They’re “Automatic” in that they seem to occur “just like that”, popping into the person’s head as if from nowhere. Indeed, unless the person specifically focuses his attention on what he’s thinking – as in the thought-recording exercise – they may pass unnoticed. All that the person would then be aware of is a sudden feeling of anxiety and a desire to leave the situation.

These Negative Automatic Thoughts (or NATs) cause emotional problems (in this case, social anxiety). Thinking in this way triggers the “Fight or Flight” response to perceived threat, leading to the physical symptoms of anxiety such as a racing heart and nausea. If the person didn’t have these NATs (i.e. he didn’t think thoughts such as “I’m going to faint”) then the “Fight or Flight” response would not kick-in. No physical symptoms of anxiety would result, and he would be free to enjoy the social do.

Having identified the client’s NATs, the next step is to find alternative, more helpful ways of thinking about the situation. This is best done by examining the NATs for their rationality or “truthfulness”. A CBT therapist (along with the client) does this by conducting a “trial” for a particular NAT. In this example I will take the NAT “I’m going to faint and make a fool of myself” – this NAT was described by the client as the most distressing thought (in CBT parlance, this would be called the “Hot Thought”).

In a trial, evidence is presented “for” and “against” the party concerned. It’s the same in a trial for Negative Automatic Thoughts. So what evidence is there that the statement “I’m going to faint and make a fool of myself” is true? Very little – the client felt physically unpleasant and was anxious. And the evidence that says the thought is false? Much greater – he didn’t actually faint, he’s never actually fainted in all the times when he’s felt anxious, and it’s a well known fear of people experiencing anxiety that they will faint. And besides, there seems little evidence to suggest that even if he did faint, his colleagues would be anything other than concerned about him.

The verdict? That his NAT “I’m going to faint and make a fool of myself” is irrational and false.

Next, it’s time to identify an alternative thought that does actually fit with the evidence. How about “My heart is racing and I feel uncomfortable because I’m anxious, but I won’t faint and my anxiety will pass with time”? This seems a more accurate statement of the situation, and is clearly less likely to exacerbate his anxiety symptoms. Thinking in this way will reduce his anxiety and enable him to stay out longer with his colleagues, which in turn will help to reduce his anxiety.

Cognitive Behavioural Therapy (CBT) says that “we feel the way we think”. An important first step in the recovery from emotional problems is to learn to identify and challenge our irrational thoughts (or “NATs”). As a Psychiatrist and therapist in Edinburgh I have found this to be an effective (and surprisingly quick) way of relieving some of the burden of difficulties such as depression and anxiety. But it is just a first step, and most clients will benefit from a more in-depth CBT approach that addresses not just their Negative Automatic Thoughts but also their Negative Core Beliefs. Please see my other articles on this subject.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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Please note that this is a “follow-on” article. It is best read after my articles “Cognitive Behavioural Therapy (CBT) and Negative Core Beliefs (NCBs) – Causes” and “Cognitive Behavioural Therapy (CBT) and Negative Core Beliefs (NCBs) – Identification”.

What can be done about Negative Core Beliefs? There are several options open to a CBT Therapist, but in my experience as a Psychiatrist and Therapist in Edinburgh I find that the following method is particularly effective.

Firstly, the method is to challenge these Negative Core Beliefs, in much the same way that a CBT Therapist would challenge a person’s Negative Automatic Thoughts. The CBT Therapist and the client can look for evidence that the Negative Core Belief is true, and then look for evidence that it is false. The client is then in a position to make a reasoned judgement as to whether it is rational and healthy to continue holding their Negative Core Belief. If they don’t think it’s rational, then they can begin to look for alternative beliefs that better explain the evidence.

An example of this method might be challenging a client’s Negative Core Belief that “People are dangerous”. Evidence in favour of this belief might be that they had unpleasant and frightening experiences growing up – perhaps their father was abusive, or they were severely bullied at school. Experiences as an adult may also play a role – the overbearing boss at work, or the “friend” who turns out to be rather two-faced etc. Evidence against the belief that “People are Dangerous” could include the fact that their mother and grandparents were kind and loving, and that she had a few friends at school who were supportive. Perhaps most of her work colleagues now are nice and trustworthy, and the boss is renowned for being unpleasant and cantankerous to everyone.

With evidence of this sort compiled both “for” and “against” the belief, the client can weigh it up and make a judgment. In this particular case, the evidence may seem roughly evenly balanced both “for” and “against”. In which case the client may decide not to totally reject their original belief, but modify it somewhat. They may decide that the statement: “Some people are dangerous, but some aren’t” is a better description of the evidence. Learning to live with this new modified belief will almost certainly lead to the client having less emotional problems.

However, this is easier said than done. After all, your Negative Core Beliefs have been with you a long time – they can seem like an integral part of who you are, and as such, you can’t just “turn them off” like that. They’re well-trodden paths that can feel very comfortable and familiar, even if (in the long run) they cause you a lot of problems.

What a CBT Therapist may suggest is that rather than trying to actively eliminate your Negative Core Belief, it can be more productive to focus your attention on actively cultivating your new, alternative Core Belief. In my experience as a therapist in Edinburgh, one of the most powerful ways that a client can employ in order to start thinking in newer, healthier ways is to start behaving as if they already truly believed the new Core Belief. That is, to make a conscious decision to act in accordance with their new belief. In the example given, the client will act as if they already believed the new core belief “Some people are dangerous but some aren’t”. They will (quite consciously and deliberately) assume that people are not always dangerous and act in accordance with this (e.g. smile, be friendly, trusting etc), and make a conscious note of the results of such behaviour. Ordinarily the results will be pleasant, positive, and re-inforcing of the new belief. By repeating this behaviour day-in and day-out it will become second-nature, and the client will, deep down, really start to believe their new Core Belief. No longer will they see all other people as inevitably dangerous, and their instinctive initial responses to others will reveal a mature and trusting attitude.

This CBT technique of acting “As-If” is a very powerful way of inculcating real sustainable changes in your Core Beliefs. As a Therapist in Edinburgh I always encourage my clients to use this method in their day to day lives, in addition to keeping a close eye on any Negative Automatic Thoughts or Thinking Errors they may be having. Emotional problems tend to be very resilient to change, so you need to be on their case at all times to prevent relapse.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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Cognitive Behavioural Therapy (or CBT) is an effective treatment for a wide range of psychological and emotional problems. The underlying theory of CBT is that our emotions are affected by our cognitions – put another way, “We feel what we think”. As a Psychiatrist and Therapist in Edinburgh I use CBT techniques extensively in the treatment of common problems such as depression, anxiety, and obsessive compulsive disorder (OCD).

CBT views emotional problems as the result of unhealthy and irrational thinking. It employs terms such as Negative Automatic Thoughts and Thinking Errors to describe the different ways in which unhealthy thinking can cause emotional problems. Having identified these unhealthy thinking habits, CBT also provides us with the tools to develop alternative, healthier ways of thinking about ourselves and the world around us. By thinking in a more balanced way we will feel better emotionally. Please see my articles on Negative Automatic Thoughts and Thinking Errors for a more detailed explanation of the above methods.

However, Negative Automatic Thoughts and Thinking Errors are not the whole picture. Many people will wonder why they have such ways of thinking when other people don’t. CBT uses the term Negative Core Belief to describe the fundamental root cause or causes of a person’s emotional difficulties.

A Negative Core Belief (or NCB) is a strongly held, intrinsic belief that a person holds about either themselves, others, or the world in general. Frequently people will have NCBs about all 3 categories. NCBs are usually an integral part of a person’s personality – so much so that they’re often blissfully unaware that they even have such a thing. One of my other articles on NCBs outlines ways that people can identify their NCBs – this article will focus on their causes.

Negative Core Beliefs arise most commonly during childhood and adolescence. This period would seem critical in the development of a person’s personality – it is the time when they first form opinions about themselves, others and the world around them. In lay terms, we are “impressionable” in our younger years.

If our experiences during these years are generally positive and empowering, then we are likely to develop healthy Core Beliefs. If we have loving parents, a pleasant and supportive schooling experience, and are lucky enough to have good friends when we are growing up etc, then we are very likely to see ourselves, others, and the world in general in a positive light. We may end up with Core Beliefs such as “I’m a generally nice person” or “People are usually OK”.

Unfortunately, this is not the case for everyone. Children grow up in violent or abusive households, children are bullied at school, children are ostracised by their peers – all these experiences can have a detrimental effect on a person’s core beliefs. Even seemingly minor experiences – perhaps having “pushy” parents or over-critical teachers – can influence our views of the world. Negative Core Beliefs are the result of such an environment, examples of such beliefs being “I’m bad” or “People are aggressive”.

It can seem reasonable (even logical) that a child forms these beliefs. After all, they’re young and have limited alternative experiences to compare. If your father is aggressive, or your teacher critical, then it can easily seem like every adult is aggressive or critical. Also, these people are powerful figures in your early life – role models – and you are likely to believe what they say. A father saying “You’re bad” or a teacher calling you “Useless” is, as far as you can see, the truth. You begin to believe that these are undeniable facts about yourself, facts that obvious to everyone.

These beliefs are the conclusions that are formed in a child’s mind based on his or her limited experience. You only have your parents judge how all parents are, and you only meet a certain number of teachers and schoolmates in your formative years. As a child, your view of the entire world is based on these few contacts and experiences.

The Core Beliefs we form as a child and adolescent tend to persist throughout our adult lives. This is not a problem if they are healthy, but Negative Core Beliefs predispose the individual to emotional difficulties. If you go through life believing, deep down, that you’re a bad person or a failure, then you’re prone to seeing much of your adult experiences in these terms. If a loved one is upset then you feel guilty even if it wasn’t your fault, or the passing comment by a boss can seem like the end of the world. Negative Core Beliefs are the cause of Negative Automatic Thoughts and Thinking Errors – and these are the causes of emotional difficulties.

Finding the cause of a clients Negative Core Beliefs is an important step in the treatment of their emotional problems. Please see my other articles on the Identification and Treatment of Negative Core beliefs.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

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The emotion (or “feeling”) of anger is a complex combination of physical sensations, cognitions (or thoughts), and behaviours.

The physical sensations associated with anger are well known. A racing heart, feeling short of breath, a dry mouth, butterflies in the stomach, trembling limbs, feeling hot and flushed etc. These may sound familiar – they are very similar to the physical sensations that occur in anxiety. This is unsurprising – it is the same physiological mechanism that underlies both emotions. Anger is the “Fight” component of the “Fight or Flight” response to perceived danger.

The physical sensations of both anger and anxiety are driven by hormones released by the adrenal glands (small pockets of tissue situated above the kidneys). These adrenal glands secrete adrenalin into the blood which rapidly disperses around the body. It is adrenalin that acts on the body to prepare it to either fight or run away by increasing the heart (“racing heart”) and breathing rate (“short of breath and dry mouth”), raising the blood pressure (“feeling hot and flushed”), tensing the muscles (“trembling limbs”) etc.

Common thoughts associated with anger include “He can’t say/do that to me!” or “It’s not fair!”

Behavioural manifestations of anger include clenching the fists, grinding the jaw and invading another’s personal space.

It is very important to realise that all these 3 components interact and feed-back to one another, causing either an increase or decrease in the feeling of anger. For instance, if you’re angry and you let yourself behave angrily – shouting and screaming for instance – you’re body will secrete more adrenalin, thus increasing further the sensations of anger.

Anger per se isn’t a problem – it is an emotion that has benefits in certain situations. The “anger” seen in animals when they’re threatened or fighting over territory or mating rights is clearly a survival strategy. A passive, mild-mannered tiger isn’t likely to live very long!

Fortunately for most human beings we no longer have to physically fight to survive, eat or find a partner. This makes a lot of our anger redundant. However, the “Fight or Flight” response has developed in us (and most animals) over millions of years so we will continue to get angry for the foreseeable future. This can cause us and others around us problems.

I’m not suggesting that we try and eliminate anger from our lives, but if we think it’s causing us or others problems, we can try to moderate it and make it less damaging. Ideally we can make it work for us rather than against us.

CBT approaches anger by focusing on the thought processes associated with anger. The theory is that since our thoughts are a fundamental component of anger (along with physical sensations and behaviours), if we can moderate these angry thoughts we can moderate the other two components as well via the feedback mechanism.

Often it is our thoughts – our interpretations of events – that trigger the anger response in the first place. If we can develop a more balanced and rational interpretation of the world around us, we can nip the anger response in the bud. A good example of this is our response to criticism. If we interpret all criticism as a spiteful attack on us as a person, then we will get angry. If we are able to adopt a more balanced, rational view of criticism, we may feel disappointed but we will avoid getting “hot under the collar”. We may even be able to see that sometimes our critic is right!

Another technique to moderate our anger is too think more flexibly. We’ve all seen toddlers and young children throw tantrums – they can be apoplectic with rage! Often this seems to be a result of immature, inflexible thinking – young children like to have (and make up) rules that must never, absolutely never, be broken, either by themselves or (especially) by others. Oh, the scenes of horror witnessed at children’s parties when a child has “broken” the rules of a game!

Unfortunately, many of us adults continue with inflexible, never-to-be-broken rules to life. This is a problem if you want to avoid screaming and rolling around on the ground whilst wearing a suit. Examples of adult rules are “No-one must ever be rude to me”, “Life must not be unfair to me”, and (my favourite) “Other people must drive as well and courteously as I do”.

There are many problems with these rules. First and foremost of which is that they’re not really “rules” at all – they’re your preferences. There is no law against people being rude to you, or life being unfair, or people not letting you out at junctions. You’d prefer it were otherwise, but that’s all it is – your preference. As it turns out, most people are usually polite and drive decently, and the world may not be totally unfair after all, but there will always be exceptions. You can’t control these exceptions, and by having such rigid rules you’re setting yourself up for a lot of anger in your life. Try thinking along the lines of “I prefer it when things go my way, but sometimes they won’t and I can accept and deal with that”.

This leads to another technique for moderating anger – moderating the language we use. I don’t simply mean avoiding swearing etc, but something more subtle than that, relating to both the words we use internally and externally. Language is a powerful thing – after all, our thoughts are made up of words (we a few pictures thrown in) – and we can use it to our advantage. So if something we don’t like has occurred – someone’s bumped our car in the car park – we can choose how to frame this event in language. We can think “I’d like it if they hadn’t done that, they might have been more careful, this will cause me some inconvenience and expense” OR we can think “He’s done this deliberately! He was probably drunk! How can this happen, today of all days!” One way of thinking uses moderate terms, the other uses extremes. Same event but different thinking responses. It’s clear which response is not only makes this hassle more bearable, but also leads naturally on to sorting the hassle with a minimum of fuss.

Thinking more flexibly also involves accepting people – including yourself – as fallible human beings, capable of making mistakes and doing wrong. And yet despite these faults, they (and you) still possess dignity and are worthy of respect. This also means that we will accept that other people can have differing opinions and views and, even if we don’t agree with them, we’re not going to make ourselves angry trying to make them admit that they’re wrong! Also, we’re not going to label others (or yourself) as “nasty” or “useless” or “selfish” etc on the basis of one or two events or conversations. Everyone can, and probably has, been all of these things (and others) at some time in their lives, and probably on more than one occasion! If you label someone then not only are you being wholly inaccurate about a complex and changing human being, but you are also likely to interpret anything they do in the future on the basis of that label. If a “nasty” person coughs whilst you’re giving a talk then obviously they’ve done it deliberately to annoy you. Cue the anger response!

A final way to moderate anger makes use of the interactions between thoughts, sensations and behaviours in a slightly different way. Rather than focusing on the thinking processes, this technique encourages you to focus on your behaviour. By moderating your behaviour you will provide “negative feedback” (also called “inhibitory feedback”) to the anger response system, dampening down it’s effects. So when you next feel very angry, rather than stomp around, shouting, shaking your fists and being intimidating, try taking slow deep breaths, relaxing your hands, talking at a normal volume and at a normal rate etc. This calm behaviour will send the message “Things are OK” back to your body, causing the secretion of adrenalin to tail off and stop, thereby reducing and eliminating the physical sensations of anger. Interestingly, behaving like you’re calm also works on your thoughts. So calm, measured behaviour leads to a calm body and mind.

The main problem with human beings and anger is that, for most of us, anger is no longer very useful. In our modern lives we mostly confront irritations and inconveniences rather than an enemy tribe or voracious wild animal. It is no longer appropriate for us to go red in the face and want to smash the place up. Using the techniques detailed above can help us to moderate our anger.

I say “moderate” and not “eliminate”. I think it is neither possible nor desirable to remove a fundamental emotion like anger from a human being. We need some level of anger to prompt us to act appropriately in situations where our interests are threatened. We may not be in physical danger, but getting angry can galvanise us to act when our bosses are giving us too great a workload or our government is curtailing our liberties.

But perhaps I should call not call this “anger” but “assertiveness”! (See above!)

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

Article Source: http://EzineArticles.com/

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Cognitive Behavioural Therapy, or CBT, views emotions as a complex mixture of these three different realms of human experience – cognitions (thoughts, mental images and memories), physical sensations, and behaviours. A depressed person will typically show depressive thinking (such as believing they’re a failure), feel depressed in a physical sense (like being tired all the time), and will behave in a depressed fashion (such as taking to their bed).

These three realms all interact and influence one another. For example, if someone habitually thinks in a depressive way, then they will begin to feel and act in a depressive way. Conversely, changing depressive thinking should diminish the feeling of depression, and consequently their depressive behaviours.

To understand how one can counter depressive thinking, it can be helpful to divide a persons cognitions (mental processes) into two categories – thought contents and thought patterns.

Thought content is familiar to us all – it’s simply what we’re thinking. It’s the answer to the question “A penny for your thoughts?” For instance, my thought content just now is what I’m going to write in this paragraph. Depressed people have depressive thought content – common themes include that they’re a failure, things are hopeless, the future’s bleak, they’re cursed by bad luck, they’re nasty or evil in some way etc.

Our thought patterns are less obvious to us, but they are still accessible. Our thought patterns are our ways of thinking (or our thinking habits) rather than what we actually think from minute to minute. They’re our ways of viewing our experience of ourselves, others, and the world around us. Depressed people will have thinking patterns that emphasise the bad and unpleasant aspects of their experience, and diminish or even totally negate the good aspects. For example, a depressed person is likely to remember unpleasant or embarrassing events from their past, and rarely recall the fun times they had.

The content of our thoughts will change rapidly as we go through our day, and will depend greatly on what we’re doing at the time. Our thought patterns are stable and can persist throughout our lives – unless we find that they’re causing us (or others) emotional problems and we want to change them! And it is our underlying thought patterns that ultimately determines what our thought content is. Depressive thought patterns produce depressive thought content (and then on to depressive sensations and behaviour).

CBT aims to improve depression by changing a person’s depressive thinking patterns and helping them develop more balanced, rational and helpful ways of thinking. This will (hopefully!) lead to less depressive thought content and therefore less feelings of depression.

The first step is for you to learn to identify your depressive thoughts. You do this by noting what you’re thinking about (your thought content) when you feel particularly distressed. This thought or thoughts (it can also be a mental image or memory) is what we call a Negative Automatic Thought, or NAT. You will need to monitor and record your NATs over a period of weeks. NATs are unpleasant but they are very useful to us – they allow us to identify your negative thinking patterns.

An example of a NAT might be if you suddenly get depressed or distressed when your partner makes a joke after you’ve miss-pronounced a word that you’re not familiar with. You may think “He’s always saying things like that. He thinks I’m stupid, and he’s right”. Now we will do two things with this NAT. We will want to examine it for depressive thinking patterns, and we will want to “challenge” it in order to test it’s truthfulness.

Firstly, we will examine it for typical depressive thinking patterns. These are ways of “looking at” things (yourself, others, and the world in general) that tend to generate depressive thought content. Common examples include “Negative Filtering” and “Discounting the Positive” – where a person will focus exclusively on the bad or unpleasant features of themselves, others or the world. Other examples are “Over-Generalising” (taking one comment or event as indicative of things in general), “Mind-Reading” (where you believe you know what someone is really thinking even if they deny it), “Catastrophising” (assuming the very worst in a given situation) and “Black or White Thinking” (assuming that something is either all-good or all-bad, and that there is no in-between these two extremes).

In the example NAT I gave earlier, we might say that there are several depressive thought patterns evident. I’d say the person was showing patterns of “Mind-Reading” (she knows what her partner really means), “Over-Generalising” (does he really say these things all the time?), and “Black or White Thinking” (he’s right and I am stupid).

Identifying these depressive thought patterns allows us to become our own critics – not of ourselves but of our thinking habits. It is common to find that a person will show the same few thinking habits again and again in all areas of life. By being aware that you are (for example) in the habit of Catastrophising and Mind-Reading means that you can pull yourself up when you find yourself doing it. The next time someone passes an ambiguous (to you at least) comment in your hearing, you will be able to take a moment to remind yourself that you tend to “Mind-Read”, and that you don’t actually know for sure what he or she means – the comment may not necessarily be bad, or even about you at all. And the next time you’re having a tough time at work, you’ll remember that you’re in the habit of “Catastrophising”, and that work won’t necessarily keep getting worse and worse. It may even improve! Such awareness of our thinking habits can protect us against developing emotional problems.

In addition to identifying our negative thought patterns, we will want to challenge the NATs themselves. We do this by holding a mock “trial” for these thoughts, where we ask ourselves to present real, hard evidence both for and against the truthfulness of the NAT. We usually find that the evidence stacks up against the NAT, showing it for what it really is – the unhappy product of depressive thinking patterns – not at all the rational, considered, “obvious” thought based on reality that it had been pretending to be!

Taking the example given earlier, we’d look for evidence for and against the truthfulness of the statement “I am stupid” (I’d leave it up to them as to how they defined the term!). What sort of evidence does he or she have that supports the statement? Their partner (occasionally) says that they are. Does anyone else say it? Their boss? No. Their friends? No. Strangers in the street? No. So what about evidence against this statement? They finished school with some qualifications. Maybe they went to college afterwards. They’re quick witted and likeable. They can hold down a job. They can look after themselves. Drive a car. Even read and write… “Stupid” people would surely struggle with all of these things. The verdict – the thought “I am stupid” – is guilty of irrationality and is hereby sentenced to oblivion. It is replaced by the more realistic and helpful thought “My partner sometimes says I’m stupid, but he’s ignorant himself for saying that because it’s clear that I’m not!”. This thought certainly isn’t depressive.

So now, all being well, you will have learnt to identify and challenge your NATs and to recognise your depressive thinking patterns. You are able to think in a less depressed way, and you therefore feel and behave in a less depressed way.

But that’s not the whole story. Many people who experience emotional problems want to know why they have these difficulties. CBT can help here as well, allowing the individual to have a fuller understanding of themselves and their emotional lives.

CBT hypothesises that every one of us has a set of “Core Beliefs (CB)”. These are the fundamental views we have of ourselves, others, and the world at large and largely dictate our thought patterns, and hence our thought content. It seems likely that CBs are formed during our childhood and adolescence (and very occasionally in adulthood), and that the influence of our parents, siblings and schooling are critical. Positive and negative experiences during these years help to mould our CBs that can then (potentially) influence us for the rest of our lives.

Some CBs are beneficial. CBs such as “I can cope with most things” or “Others usually don’t mean me harm” or “The world is generally an OK place in which to live” are an excellent platform from which to launch into life. They have properties that make people very resistant to emotional problems. Of course bad or unpleasant things will happen to these people (or people they love), but their emotional response will be appropriate and not exaggerated or prolonged.

Most people who do have emotional problems have unhelpful or damaging CBs, and these issue in problematic thought patterns and NATs. Common examples of such CBs are “I’m a failure”, “I’m unattractive”, and “I’m nasty/evil”. CBT challenges such Core Beliefs in the same way as it challenges NATs – after all, the two are closely related. Successfully (and repeatedly) challenging unhelpful CBs will loosen their grip on your life, allowing more balanced and realistic CBs to replace them. This in turn makes it less likely for you to view life in unhelpful and problematic ways, and will reduce the occurrence of NATs. And this will make you feel less depressed.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

Article Source: http://EzineArticles.com/

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All of us feel anxious from time to time and in certain situations. It is a normal and natural emotion and can be useful as a stimulus to action. Unfortunately some of us feel excessively anxious in inappropriate situations, and this is not only unpleasant but can be a serious handicap in our lives.

Anxiety is part of the “Fight or Flight” response to perceived danger, a physiological reflex seen in a huge number of animals. This response physically prepares the animal to fight or run away from danger – it is a survival mechanism, and a very effective and successful one at that.

The basic physical mechanism underlying the response is a sudden release of the hormone adrenalin from the adrenal glands (situated on top of the kidneys). This hormone then rushes through the blood and around the body, acting on various organs and muscles to create the all too familiar physical sensations of anxiety – racing heart, breathlessness, dry mouth, flushed skin, dizziness, butterflies in the stomach, nausea, weak legs, trembling limbs etc. These sensations, which most people (but interestingly, not all!) find unpleasant and frightening, are actually side-effects of the body gearing up for fighting or running away. The racing heart pumps more blood to allow the muscles to work better, the fast breathing brings in more oxygen etc.

All of this is fine and good if your anxiety is based on a real physical threat – if you’ve got a lion taking a close interest in you, for example. Fortunately for most human beings, this would be an unusual event! Our “dangers” are rarely physical these days – they’re more likely to be the “danger” of failing an exam, or the “danger” of embarrassing yourself in front of others. Indeed, many of our “dangers” don’t even exist at all – they are purely in our heads. The “danger of perhaps, maybe, or what-if the lift breaks down and I’m stuck” or the “danger of my anxiety causing me to have a heart attack or pass out”.

Cognitive Behavioural Therapy (CBT) views anxiety (and all emotions) as the interaction of three areas of human experience – cognition (our thoughts and mental imagery), physical sensations (what we feel in or with our bodily senses such as feeling hot or short of breath), and behaviour (what we actually do with our bodies such as move in certain ways and interact with others and our environment).

These three areas – thoughts, sensations, behaviours – act together to make up an emotion. For example, when we feel anxious we will typically have certain anxious thoughts (“I’m going to collapse”, “I can’t stand it”), anxious sensations (nausea, wobbly legs) and anxious behaviours (we rush out of the room, we grab on to someone).

These three areas are linked to one-another in feed-back loops. This means that if our physical sensations of anxiety increase, then typically we will experience more frequent and pressing anxious thoughts, and the desire (indeed desperation) to engage in anxious behaviours will increase. This increase in anxious thoughts and behaviours then “loops” or “feeds-back” to increase our anxious physical sensations which then…well, you get the picture. A vicious cycle is set up where we simply get more and more anxious until (usually) we run away from whatever triggered the anxiety in the first place.

This sounds a problem, but actually this is great news! The fact that the three components of anxiety interact and affect one another allow us to “access” the system and change it for the better!

How do we do this? By targeting those areas of the system over which we have (at least some!) conscious control – our thoughts and our behaviours. We can, to a greater or lesser extent, control or decide what to think. And we can, to an even greater extent, control or decide how to behave. Contrast this with trying to control your heart rate or your blood pressure – much trickier (though I wouldn’t say impossible…)

The theory of CBT for anxiety is that by controlling and reducing my anxious thoughts and behaviours I can provide “negative (or inhibitory) feedback” to the system, causing my physical sensations of anxiety to reduce. A reduction in anxious physical sensations will decrease my anxious thoughts and behaviours, which will then, in turn, decrease my anxious physical sensations, and so on. We’ve set up the opposite of a “vicious cycle” (a “virtuous cycle”?) and our anxiety fades away.

So much for the theory – what about the actual techniques and work involved? As you may have guessed, we can approach the problem of anxiety from two angles – we can tackle anxious thoughts and we can tackle anxious behaviours. In fact CBT therapists will usually tackle both simultaneously, though the emphasis may be more on thoughts than behaviour, or vice verse. In my experience, it is helpful to focus more on anxious thoughts when the anxiety is a result of thinking about a future event such as exams or an interview. On the other hand, tackling anxious behaviours is the priority in anxiety related to social situations, enclosed spaces or heights etc – situations that are easily replicated by the client and therapist.

Taking anxious thoughts first. People who experience severe and frequent bouts of anxiety often exhibit what CBT therapists call “Thinking Errors”. That is, their thoughts (and indeed their “ways of thinking”) are unrealistic and unhelpful, making their anxiety worse, and even being the initial cause of the anxiety in the first place.

Examples of common Thinking Errors in anxiety are “Fortune Telling” (thinking that you know what is going to happen in the future) and “Catastrophising” (assuming the worst possible scenario will come to pass): “I will fail the interview and never get a good job” or “I will pass out and my colleagues will laugh”. Thoughts like these will obviously increase a persons anxiety.

We tackle these thoughts by challenging them, questioning them, and asking them to back themselves up with evidence. It’s a Court of Law for these thoughts and they’re charged with Irrationality! How can you see into the future? How do you know that you will fail the interview? Have you always failed every interview you’ve ever done? or How do you know you will pass out? Have you passed out every other time you’ve been in that situation?

Or we can take a slightly different tack and question their assumptions of what will happen if things do in fact go poorly. What if you do happen to fail the interview? What will happen? Does everyone who fails an interview end up on the scrap heap? Is that what you’d tell a friend who’d failed an interview? or What if you do pass out? What will happen? Will your colleagues really laugh? Or will they be concerned for you?

By questioning our anxious thoughts we can stop simply assuming they’re right and begin to look for alternative ways of thinking about the situation. For example, you might remember that in fact you’ve always done pretty well in interviews in the past, or that a friend failed an interview for one job only to land an even better one a while later. So you might think instead that “Actually I’ve got a fair chance of doing OK in this interview, and even if I don’t get this job it’s not the end of the world”. This thought is not only more balanced and realistic, it will also diminish your anxiety.

Anxious behaviours are the behaviours that we consciously choose to do (or not to do!) as a result of our anxiety – they are NOT the physical sensations of anxiety (these aren’t under our immediate control). We engage in these behaviours in an attempt to reduce and alleviate our anxiety. There are two overlapping classes of anxiety-related behaviours. There are so-called “Safety Behaviours”, such as sitting down or grabbing hold of something when you feel anxious and dizzy. And there are “Avoidance Behaviours”, such as excluding yourself from social gatherings.

These behaviours seem to work in the short term – you’re fear of passing out diminishes, and you completely avoid the anxiety of the works do. But you’re storing up problems in the longer term. You’ll start to believe that you HAVE to sit down when you feel anxious or you WILL DEFINITELY pass-out, and the next time you’re invited to a social gathering you will be even more anxious.

Safety Behaviours prevent you from learning to cope with your anxious sensations, and Avoidance Behaviours prevent you from challenging your anxious thoughts.

There’s no denying that the physical sensations of anxiety can be unpleasant, but they are temporary and are not life-threatening. A racing heart, weak legs, nausea and light-headedness aren’t fatal. But they can feel certainly feel like it, so the way to prove to yourself that you won’t die or pass out or throw up or whatever it is you’re worried about, is to go out and get yourself some anxiety!

Deliberately putting yourself in your anxiety-provoking situations (crowded shop, tall building, whatever) is the first step to recovery. You can do this in a “graded” way (i.e. start with less busy shops or less tall buildings) before moving on to bigger challenges. Or you can “go in at the deep end” and expose yourself to your worst nightmare. And you just stay there – in the shop or observation deck – and you refuse to do any Safety Behaviours. If you feel dizzy then you feel dizzy, but you refuse to hold on to anything. If you feel nauseous, you just let yourself feel nauseous. Remember: these sensations are side effects of adrenalin and will not harm you. Many people even find them pleasurable – hence roller-coasters and bungee-jumping!

And then you just stay there some more. And some more. And then a bit more. Your anxiety will probably be huge to start with. You’ll get the whole lot – feeling sick, feeling faint, feeling that your chest will explode, your mind is mind racing, ” I’ve got to get out of here!”, your legs seeming about to take you away anyway etc. But if you just stick with it – not fighting it but just “experiencing it” – you’ll find things start to change. It can take anything from a few minutes to even an hour, but eventually your anxiety will wane. It’s almost as if you get bored with being anxious! Here you are, all het-up and ready to go, and nothings happening. Indeed, in a way, your body does get bored. After all there’s only so much adrenalin that your body can produce at any one time, and if it’s not really needed (i.e. your not running from a lion) then it’ll stop making it. And less adrenalin means less anxious physical sensations.

By staying in your anxiety-provoking situation you give yourself a chance to “habituate” to it – you have become used to it. This is an incredibly powerful thing to do. Not only have you faced up to your fears but you have proven to yourself that anxiety is bearable. Unpleasant, yes, but temporary and non-fatal. Your anxious thoughts about dying or passing out are shown to be wrong.

So what do you do now? Well, as you may have guessed, you go out and do it again. And again. And again. The more you enter into – AND STAY – in your anxiety-provoking situations, the better you’ll become at coping with your anxiety. You (and your body) will stop fearing these situations and, eventually, they will fail to produce any anxiety in you.

Dr Steve Last is a Psychiatrist and CBT Therapist working in Edinburgh. Please visit www.drstevelast.co.uk for further information on psychological problems and CBT.

Article Source: http://EzineArticles.com/

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