A CBT therapist aims to help people suffering from emotional problems [...]]]> Cognitive Behavioural Therapy (CBT) is an effective psychotherapy
for a wide range of emotional and psychological problems. The basic tenet of CBT is that our emotions are affected by our cognitions. To put it another way – the way we think affects the way we feel.

A CBT therapist aims to help people suffering from emotional problems by helping them to identify the ways in which their thinking may be causing their problem. A first step in CBT is therefore the identification of “Negative Automatic Thoughts” (or “NATs” for short) – these are the thoughts that accompany unpleasant or unhelpful emotions such as depression or anxiety.

A closely related aim of the CBT therapist is the identification of so-called “Thinking Errors”. These are habitual (and unhelpful) ways a person has of thinking about themselves, others, and the world around them. These thinking errors will often twist or distort experiences, acting to make the person seem a failure, others as hostile, and the world as dangerous or unpleasant.

The identification of NATs and related Thinking Errors is half the battle in CBT – once a person is aware of their unhelpful thoughts and mental habits they can then choose to think in more rational, healthy ways. A CBT therapist can guide them through this (fairly straightforward) process.

As a Psychiatrist and therapist working in Edinburgh I use CBT techniques extensively. Some of my clients are quite happy with the results they get from simply challenging their NATs and Thinking Errors – they feel much better and have no desire to delve further. However, the majority of clients are keen to “get to the bottom” of why they had their emotional problems in the first place. I tend to encourage this further work as it helps to reinforce the progress made to date and, in my opinion, helps to prevent the client from relapsing at some future date.

This further work involves a search for “Negative Core Beliefs” (or “NCBs”). These are the unhelpful beliefs that a person has had throughout their later childhood and adult life. They are core components of the person’s personality and they are the root cause of the person’s Thinking Errors and ultimately their NATs. If a CBT therapist can help a person to change their Negative Core Beliefs (or, more realistically, find more rational and healthier alternatives), then the person’s Thinking Errors and NATs will diminish, and their emotional problems will lessen (usually!).

A difficulty with NCBs is that a person is rarely aware of them. Even when someone is competent at identifying NATs and Thinking Errors, the cause of these problems may be hidden. But we can use NATs and Thinking Errors as clues.

In my experience as a Psychiatrist in Edinburgh I have found two techniques of most benefit in the search for the NCBs of my clients.

Firstly, there is the method of “Repeated Questioning”. I ask the client what a particular NAT he has identified means to him – he will give an answer, and I then ask him what that answer means to him. He will give a second answer, and I then ask him what that second answer means to him, and so on. Within a short space of time, the client ends up with a global statement that can’t be taken any further. This is a Negative Core Belief. It’s probably best demonstrated with an example:

Client: “There’s loads of litter around Edinburgh” (He’s angry)
CBT Therapist: “What does that mean?”
Client: “That I’m the only one who cares about it”
CBT Therapist: “What does it mean if you’re the only one who cares about it?”
Client: “People don’t care about things that aren’t their personal property”
CBT Therapist: “And what does it mean if people only care about their own stuff?”
Client: “People are only out for themselves”

(“People are only out for themselves”. This is the client’s Negative Core Belief – a global statement that is uncompromising and will clearly influence the way he views and interacts with others in other areas of life, not simply littering!)

A second method of identifying Negative Core Beliefs is to look for the “themes” that run throughout a persons many NATs and Thinking Errors. Such themes may be “I’m a failure” or “There’s no point to life” (very common in depression), or perhaps “The world’s a dangerous place to live” (common in anxiety conditions).

Once a client’s Negative Core Beliefs have been identified, the CBT therapist will (along with the client) try and explore alternative and more rational ways of thinking about the self, others, and the world in general.

What can be done about Negative Core Beliefs? There are several options open to a CBT Therapist, but [...]]]> 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.

The theory behind this method was formed as a result of merging the works of [...]]]> Cognitive therapy is first and foremost a psychotherapeutic approach which attempts to influence human behaviours and dysfunctional emotions. The methodology behind cognitive therapy is to analyse negative emotions and identify inaccurate and dysfunctional behaviours. The method is both goal-oriented and well-organised.

The theory behind this method was formed as a result of merging the works of Aaron T. Beck and Albert Ellis. The two theories that were merged to create this method were behaviour theory and cognitive theory. It is therefore now known as Cognitive Behavioural Theory (CBT). Albert Ellis first originated rational therapy which was a main step in the development of CBT. Aaron T. Buck was inspired by Ellis’ work and this led him to develop cognitive therapy.

In the beginning both of these theories were compared and there was an attempt made to determine which one was the best approach. However they were merged instead into one to form CBT. The creation of this joint theory has led to the development of successful treatments for panic disorders. CBT is also very good for the treatment of issues including: personality complexes, anxiety, mood, and substance abuse. Other psychotic issues can also benefit from CBT and it has been used to reduce some criminal behaviour as well.

After analysing negative emotions and identifying inaccurate and dysfunctional behaviour, CBT seeks to replace these harmful influences with more realistic and positive ones. Some of the therapeutic systems which make up CBT are: cognitive therapy, rational emotive behaviour therapy and multi modal theory. Techniques included in these systems include keeping a record of negative feelings, thoughts, behaviour and beliefs and learning how to accurately identify them. These techniques are practiced by the patients themselves under the monitoring of a therapist. CBT can help stabilize mood and treat conditions like bipolar disorder.

If there is a phobia of social situations, the same theory and methods are used however they are modified slightly for use in a group setting.

Clients can also use software programs to practice CBT. These programs can serve as an alternative to a face-to-face meeting with a therapist. If a therapist is unavailable, this means that a patient can still get the guidance and the counselling that they need. Some people who suffer from depression and loss may feel too afraid or may hesitate in talking to a person about their problems. In these cases CBT software may be the best solution in these cases.

Some of the main conditions which are treated by CBT include insomnia, mental disorders, mood disorders and panic disorders. With the help of a therapist, a client may also do some behavioural experiments in order to see how and if this would help them improve their quality of life.

CBT is also used with children and adolescents. There has been some remarkable work done in this area by Mark Reinikie and his colleagues. The “Friends Program” that was started by Paula Barrette is also a part of the CBT approach. The World Health Organization has recognized that this program is the best for the treatment of anxiety in children.

CBT is very similar to the “Scientist Practitioner Model” where the clinical practice and research work is done from a scientific perspective. This method places an emphasis on measurement.

There are some non-CBT therapists who criticize its methodology. Some further information on CBT (including some of the criticisms) includes:
• The amount of research and published literature on CBT may give the impression that other, less documented forms of therapy are somehow inferior or sub-standard.
• People who undergo any form of therapy will, in theory, show some signs of improvement. Therefore, the number of people who are showing improvement may not be related to any extra level of effectiveness of CBT
• CBT is effective in the treatment of anxiety disorders. Studies do show that someone with one of these disorders may show much more improvement than someone with the same disorder who used a different method of therapy
• CBT provides a valuable level of relief from depression and other mood disorders
• Several analyses show that CBT is good at treating mental disorders. Recently, CBT has become well-known for its effectiveness in correctional settings. It can reduce criminal behaviour and CBT programs have been started in many different prisons and jails.
• Patients will show gradual improvement over the course of the therapy sessions. It is this continual level of improvement that has caused it to become well known in comparison with other therapy methods. Some disorders may show up again during the course of therapy but this is decreased by consistent and regular therapeutic sessions

It is important to realize that the effects of cognitive behavioural therapy will not be felt overnight. It can take considerable time and effort from the patient and the therapist in order to replace psychotic or negative behaviours.

2. Fortunetelling: You predict the future negatively: Things will get worse, or there is danger ahead. “I won’t get that job.”

3. [...]]]> A Guide for Patients
1. Catastrophizing: You believe that what has happened or will happen will be so awful and unbearable that you won’t be able to stand it. “It would be terrible if I failed.”

2. Fortunetelling: You predict the future negatively: Things will get worse, or there is danger ahead. “I won’t get that job.”

3. Mind reading: You assume that you know what people think without having sufficient evidence of their thoughts. “He thinks I’m an idiot.”

4. Labeling: You assign global negative traits to yourself and others. “I’m undesirable,” or “He’s a rotten person.”

5. Negative filtering: You focus almost exclusively on the negatives and seldom notice the positives. “Look at all of the people who don’t like me.”

6. Discounting positives: You claim that the positive things you or others do are trivial. “That’s what wives are supposed to do—so it doesn’t count when she’s nice to me,” or “Those successes were easy, so they don’t matter.”

7. Overgeneralizing: You perceive a global pattern of negatives on the basis of a single incident. “This generally happens to me. I seem to fail at a lot of things.”

8. Dichotomous thinking: You view events or people in all-or-nothing terms. “I get rejected by everyone,” or “It was a complete waste of time.”

9. Shoulds: You interpret events in terms of how things should be, rather than simply focusing on what is. “I should do well. If I don’t, then I’m a failure.”

10. Blaming: You focus on the other person as the source of your negative feelings, and you refuse to take responsibility for changing yourself. “She’s to blame for the way I feel now,” or “My parents
caused all my problems.”

11. Personalizing: You attribute a disproportionate amount of the blame to yourself for negative events, and you fail to see that certain events are also caused by others. “The marriage ended because I failed.”

12. Unfair comparisons: You interpret events in terms of standards that are unrealistic—for example, you focus primarily on others who do better than you and find yourself inferior in the comparison.
“She’s more successful than I am,” or “Others did better than I did on the test.”

13. Regret orientation: You focus on the idea that you could have done better in the past, rather on what you can do better now. “I could have had a better job if I had tried,” or “I shouldn’t have said that.”

14. What if?: You keep asking a series of questions about “what if” something happens, and you fail to be satisfied with any of the answers. “Yeah, but what if I get anxious?” or “What if I can’t catch my breath?”

15. Emotional reasoning: You let your feelings guide your interpretation of reality. “I feel depressed; therefore, my marriage is not working out.”

16. Inability to disconfirm: You reject any evidence or arguments that might contradict your negative thoughts. For example, when you have the thought “I’m unlovable,” you reject as irrelevant any evidence that people like you. Consequently, your thought cannot be refuted. “That’s not the real issue. There are deeper problems. There are other factors.”

17. Judgment focus: You view yourself, others, and events in terms of evaluations as good–bad or superior–inferior, rather than simply describing, accepting, or understanding. You are continually
measuring yourself and others according to arbitrary standards, and finding that you and others fall short. You are focused on the judgments of others as well as your own judgments of yourself. “I didn’t perform well in college,” or “If I take up tennis, I won’t do well,” or “Look how successful she is. I’m not successful.”

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Often the people that I see for Cognitive Behaviour [...]]]> Cognitive Behaviour Therapy (CBT) can be useful in helping people to overcome shyness and social anxiety. I have found that seemingly confident people often present for treatment because they are fed up with dreading social events and feeling tense during situations that are supposed to be enjoyable.

Often the people that I see for Cognitive Behaviour Therapy (CBT) have problems with social anxiety aren’t stereotypical wallflowers. They have professional jobs and often large, busy social networks. So why do they feel nervous and self-doubting inside? There is no straight answer to this question. It is usually due to a mixture of factors.

The role of Cognitive Behaviour Therapy (CBT) isn’t delving into the past, rather it’s to gain insight into what the person does psychologically and behaviourally that maintains their social anxiety now in the present.

However, as the person with the aid of their therapist develops a formulation of their problem, factors will be considered such as significant experiences from childhood and parenting. Often, its possible to see that experiences from childhood (and they don’t necessarily have to be hugely traumatic to have an impact) relate to the persons experience in the present. We know this because the person will often remember and visualise such memories in difficult situations in the present.

The good news is that now that you’re an adult and you have more resources and knowledge then when you were a child. This means that you can start to use these resources to make changes to the psychological and behaviour factors that exacerbate social anxiety. Cognitive Behaviour Therapy teaches you how to do this.

Cognitive Behaviour Therapy Edinburgh, will teach you about the link between events, thoughts, moods, feelings, behaviour and outcomes. You will learn how to reveal the distorted thinking and ways of processing information that prolong your problem.

People who experience social anxiety often have a automatic inner critic feeding them negative biased information about themselves. This feedback is often just outside of awareness that you don’t notice it or is so authoritative that it is taken as the truth. Via cognitive behaviour therapy Edinburgh, you will learn to challenge and consider the evidence for and against your thoughts. You don’t have to accept them.

You will also learn about the core beliefs and assumptions that you hold about yourself, other people at the world at large and how these relate to your anxiety. Once you know what they are you can set about the process of discarding those that you no longer need and working on new adaptive empowering beliefs.

Cognitive Behaviour Therapy will also help you to move towards accepting yourself as you are and to care less about what others think. Your therapist can help you uncover how you measure your self-worth. CBT therapists work from the assumption that its not possible or sensible to try to measure our self-worth. Human beings are far too complex, where would we start?
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According to the study, conducted by individuals from Virginia Commonwealth University and the University of Miami Miller School of Medicine, scientists divided injured [...]]]> Scientists recently discovered that a therapy treatment known as Oxycyte, which may be able to ‘improve cognitive recovery’ to help traumatic brain injury (TBI) patients, according to an October 2008 issue of Neurosurgery.

According to the study, conducted by individuals from Virginia Commonwealth University and the University of Miami Miller School of Medicine, scientists divided injured animals into two groups, with one group receiving high doses of Oxycyte and 100 percent oxygen and another group receiving low doses of Oxycyte with 100 percent oxygen, while a control group received saline.

The researchers found that both groups that received either low or high doses of the treatment had ?significant improvement in ability to learn and function in a standard maze when compared with injured saline control animals.? While the studies are reporting positive and life-altering affects from the drug, scientists believe additional studies are necessary before the drug should be administered to TBI victims on the market.

Cognitive Repair and TBI

The National Institute on Deafness and Other Communication Disorders (NIDCD) reported that approximately 200,000 individuals die each year from brain-injury related incidents. However, millions more suffer from TBI as well as TBI side effects including cognitive and communications disorders.

THe NIDCD described the following as cognitive and communication impairments associated with a brain injury:


* delirium

* 
 multi-infarct dementia

* 
 amnestic disorders

* 
 Alzheimer?s disease

While cognitive communication disorders are a large part of a TBI incident, the American Speech-Language Hearing Association (ASHA) has found that with intervention services and additional treatments, such as the Oxycyte, there may be a way to provide positive rehabilitation. According to ASHA, speech pathologists will work with a TBI victim on the following steps to improve the lingering brain injury side effects.

* Evaluation of cognitive communications disorders in various contexts.

* 
 Determine appropriate combination of intervention approaches such as skill training, counseling, process-specific training, metacognitive approaches, etc., while also taking into account support from friends, family.

* 
 Cooperate with others on intervention collaboration processes.

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Additional Traumatic Brain Injury Side Effects

Unfortunately, there are a plethora of common side effects often associated with a brain injury diagnosis. Some of the most common TBI side effects include the following, according to the National Institute of Neurological Disorders and Stroke (NINDS);

* lightheadedness

* 
 seizure

* 
 dizziness

* 
 slurred speech

* 
 continual headache

* 
 inability to awaken from sleep

* 
 repeated vomiting or nausea

* 
 dilation of one or both pupils of the eyes

* 
 weakness, numbness in extremities

* 
 loss of coordination

* 
 confusion

* 
 restlessness

* 
 agitation

Living With a Brain Injury

Living with a traumatic brain injury can be a difficult illness and can often lead an individual to feeling hopeless or having severely dismal feelings and a poor outlook on life; however, there are an array of treatment options and therapy groups that can assist a brain injured victim.