© WHO Collaborating Centre COGNITIVE BEHAVIOURAL THERAPY INTRODUCTION.

© WHO Collaborating Centre

COGNITIVE COGNITIVE BEHAVIOURAL BEHAVIOURAL

THERAPYTHERAPY

INTRODUCTIONINTRODUCTION


CBT INTRODUCTIONCBT INTRODUCTION

• Concept

• History

• Basic concepts


ConceptConcept

• COGNITIVE-thoughts, beliefs

• BEHAVIOURAL-behavioural modification to influence link between problem, thought and behaviour

• THERAPY-structured approach used to overcome disorder


WHY USE CBTWHY USE CBT

• Highlights how irrational thoughts influence feelings and behaviour

• Helps us change to achieve our life goals

• Evidence based

• NICE Recommended.


HISTORY OF CBTHISTORY OF CBT

• PAVLOV-emotional responses can be conditioned. Dogs given food when bell rung. After repetition, dogs salivate in response to bell alone.

• LAW OF EFFECT-if a behaviour is consistently rewarded, it is likely to recur– Positive reinforcement eg praise– Negative reinforcement eg not being told off.


HISTORY OF CBT 2. HISTORY OF CBT 2.

• BECK 1960s– Link between self talk and feelings– Described negative internal dialogue as

automatic thoughts or hot thoughts, to describe thoughts laden with negative emotions

– People not always aware, but if they learn to identify them, they can change them


HISTORY OF CBT 3HISTORY OF CBT 3

• BECK THEORY– It is not a particular situation or event that

directly causes us problem feelings but the meaning we attach to the situation-our “self talk”

– Originates in childhood experiences which become core beliefs or rules for living

– Sometimes they are helpful and sometimes they are not.


BASIC PREMISE OF CBTBASIC PREMISE OF CBT

• Our thoughts produce our feelings

• What you think about a situation triggers certain feelings –mental and physical

• There is no such thing as a negative or positive event-our reaction is caused by the meaning we attach to the event, whether consciously or unconsciously.


TYPES OF PROBLEMSTYPES OF PROBLEMS

• Practical problems– Obstacles that prevent us reaching our goals eg bank

problem means no money in the account– It is real, no matter how we react to it

• Emotional problems– Our reaction to a perceived problem– Eg how we feel about the bank problem

• Imagined problems– We think a practical problem exists when it does not– Eg bank can solve problem immediately


NEGATIVE THINKINGNEGATIVE THINKING

• A pattern of negative thinking produces a problem cycle of emotions

• The way to break the cycle is to – recognise that the negative thoughts are not

inevitable, correct or natural– Recognise negative thought patterns– Set up new habits


MAKING THE THOUGHT AND MAKING THE THOUGHT AND FEELING LINKFEELING LINK

• ABC MODEL– ACTIVATING EVENT– BELIEFS – CONSEQUENCES


ABC ModelABC Model

• Activating event– What you are AWARE of –situation , event, problem– may be present or in future, or in memory

• Beliefs– Automatic negative, toxic beliefs and thoughts, which

include your unconscious rules, values, principles for self, others and world. Self talk determines the meaning you attach to the event.

• Consequences– Emotions, physical feelings, actions and behaviour


BeliefsBeliefs

• They are often hidden, and unconscious because we have had them so long

• Known as automatic or reflex thoughts• Automatic negative thoughts can be useful

– Eg useful to brake automatically if obstacle in front

• But can be irrational and destructive – Eg if neighbour frowns, it means he is going to

hurt me.


THOUGHTSTHOUGHTS

• Internal memory of a past event

• Internal image of a future event

• Your rule about how you “should “ appear and behave.

• May happen in a ten thousandth of a second..so we may not be aware , and think the feeling directly followed the event , rather than the intervening thought.


Beliefs and thoughtsBeliefs and thoughts

• Our thoughts arise from our beliefs

• Beliefs determine the meaning we ascribe to an event

• A belief about yourself can trigger an onslaught of automatic thoughts when you encounter an event/situation

• Negative thoughts are habitual, automatic, but we may think of them as facts


Beliefs tend to Beliefs tend to

• Be about you and how you view your identity– Eg I am a lazy person

• Be about other people eg he doesn’t like me• Stop you from taking action eg I cant show

my emotions• Make you take action eg I need to be nice to

people or they wont like me


Beliefs and facts Beliefs and facts

• Are very different

• A belief is an opinion you hold about yourself, or other people ,or the world

• It may be supported by evidence, but that doesn’t make it true

• To change your irrational beliefs you must first identify them

• Ask yourself, in order to have this reaction to the event, what would I have to believe.


FeelingsFeelings

• Distinguish between unproductive and productive feelings

• Unproductive feelings (negative, uncomfortable, toxic) lead to ineffective behaviour

• Learned and can be controlled


Symptom stressSymptom stress

• Not just situation /event that can cause negative emotions

• Some people feel bad about the fact that they feel bad– Afraid of being anxious– Depressed about being depressed– Anxious about being afraid– Depressed about having a problem– Afraid they will always have problems


EXAMPLE OF A NEGATIVE EXAMPLE OF A NEGATIVE ABC PATTERNABC PATTERN

• activating event/what you are aware of– Boyfriend tells you he wants to end

relationship because he has found someone else

• Beliefs-meaning you give situation and automatic thoughts-this proves I am unlovable and other people are better than me

• Physical reaction-you feel sick and cry.


GROUP EXERCISEGROUP EXERCISE

• Take 5 minutes to produce example of negative ABC pattern in workplace


POSITIVE ABC PATTERNPOSITIVE ABC PATTERN• Activating event

– Boyfriend tells you he wants to end it because he has found someone else

• Beliefs-meaning you give the situation-– My boyfriend does not appreciate me, we are very

different, – this is just proof of incompatibility,– it is good we are both moving on, – it will free me up to meet someone else with whom I can

have a better relationship

• Consequence-calmness with some sense of loss or relief.



• Take 5 minutes to produce example of positive ABC pattern


Identifying faulty thinkingIdentifying faulty thinking

• Faulty thinking causes us to interpret memories and thoughts about future in a negative way, resulting in negative emotions


All or nothing thinkingAll or nothing thinking

• Viewing things in black and white terms, or everything or nothing, instead of seeing a middle way. – Eg our relationship is totally spoilt now– She is fat– I am not perfect– It’s a complete waste of time trying to give up

smoking– Men are all untrustworthy– There is no point me saving money-I am rubbish at

saving


Problems with all or nothing Problems with all or nothing thinkingthinking

• Interferes with goals

• More likely to give up after a setback

• May interpret a single piece of evidence as an ongoing pattern

• Perfectionism invites failure..very few things in real life are able to be 100%

• May interpret minscule shortfall as failure


Examples of all or nothing Examples of all or nothing thinkingthinking

• You want to lose weight, you set a goal to lose 10kg, but after 3 days of sticking to diet you eat slice of cake…with all or nothing thinking, you think diet is now totally ruined and give up. If you accept middle way of thinking, “it was just slice of cake” , you carry on afterwards with diet.


How to challenge all or nothing How to challenge all or nothing thinkingthinking

• Allow for a middle ground in your thinking

• Accept idea of failure as feedback rather than as total end

• Instead of either/or, how about both/and

• as well “can’t” , use “yet”.

• Stop being a perfectionist

• Recognise the 80/20 rule…if you achieve 80% you are doing very well.


Examples of all or nothing Examples of all or nothing thinkingthinking

• Class to give examples


OvergeneralisationOvergeneralisation

• Make sweeping judgment and interpret single event as never ending pattern

• Language clues– Always– Never– Everybody– Nobody– The world– All– none


LISTEN TO YOUR LANGUAGELISTEN TO YOUR LANGUAGE

• I NEVER meet people I like• I ALWAYS draw the short straw• I ALWAYS get sacked eventually• My friends ALWAYS end up rejecting me• I will ALWAYS be lonely• EVERYONE is better than me at everything• ALL people who live in towns take drugs• She NEVER hears what I am saying.


Problems with Problems with overgeneralisationovergeneralisation

• Suggests a situation is inflexible or final –it disempowers you by implying you don’t have the ability to change anything

• Overgeneralisation causes prejudice – eg all young people are badly behaved


HOW TO CHALLENGE HOW TO CHALLENGE OVERGENERALISATIONSOVERGENERALISATIONS

• Be specific in your descriptions

• Be open minded

• Question the words that overgeneralise– Eg never-has there been a time when she

heard you


Examples of overgeneralisationExamples of overgeneralisation

• Class to give examples of over generalisation


MENTAL FILTERINGMENTAL FILTERING

• Singling out and focussing on the negative aspects of the experience.

• Means by which we unconsciously filter information from the world to make it fit with a preconceived notion.


EXAMPLES OF MENTAL EXAMPLES OF MENTAL FILTERINGFILTERING

• You think “I am stupid”. You ignore any evidence that counteracts this idea even though there are many examples of things you do to a high standard

• You think “ My life is all terrible” Yet if asked to list the positive and negative aspects of your life you can come up with more positives than negatives

• A separating couple think “My partner is a horrible mean person. They never used to be like this. Why did they change.” they ignore all the good things about the person they once fell in love with.


PROBLEMS WITH MENTAL PROBLEMS WITH MENTAL FILTERINGFILTERING

• Being blinkered eg being in love-just see the good things, then later see the rest and think person has changed but it is just that they have stopped filtering

• Disqualifying the positive-so focussed on the negative that you don’t see the positive

• Leaping to conclusions-coming to conclusion too quickly


HOW TO CHALLENGE HOW TO CHALLENGE MENTAL FILTERINGMENTAL FILTERING

• Pay attention to sweeping statements

• Hunt for contradictory evidence-could you be wrong, look at all aspects

• Propose a new belief-you don’t have to believe it yet, but allow it as a possibility and look for evidence to support it, then reconsider your beliefs


MIND READINGMIND READING

• We presume we can read what another person is thinking and then we act on our assumption

• We tend to project on to others our own way of thinking

• We project what we most fear• No room for doubt, instead of thinking that

the person may think this, we think they definitely think this.


EXAMPLES OF MIND EXAMPLES OF MIND READINGREADING

• woman goes on blind date-she has been on several before but it is his first. She talks all time while he is quiet . She assumes he is not interested because she talked too much. In fact he is interested but shy. He thinks she will

follow up with him if she is interested.• Man called to meeting with boss. When he begins talking

he notices boss frown…he thinks boss disapproves, but in fact boss is worrying that his parking meter is running out.

• Woman bumps into old school friend..he says he will call but doesn’t, so next time she sees him she ignores him. In fact, he had a family crisis and forgot.


PROBLEMS WITH MIND PROBLEMS WITH MIND READINGREADING

• You cant read another persons mind

• Jumping to conclusions, and acting on asssumption of what others are thinking

• Reading minds is a waste of time-respond to how they act, rather than how they might be thinking


HOW TO CHALLENGE MIND HOW TO CHALLENGE MIND READINGREADING

• Challenge your negative assumptions

• Communicate rather than leap to a conclusion-if you don’t like the way someone is behaving, instead of assuming you know the reasons, talk to them. Find out why instead of guessing.

• Think of possible alternative reasons


FORTUNE TELLINGFORTUNE TELLING

• You leap to conclusions by thinking you know what is going to happen– Eg you are asked on a skiing trip. You predict

you would be bad at skiiing, so refuse, and then bemoan fact you don’t do interesting things.


PROBLEMS WITH FORTUNE PROBLEMS WITH FORTUNE TELLINGTELLING

• Predicting the future can lead to a self fulfilling prophecy– Eg if you are convinced a girlfriend is about to

end a relationship, you start to behave differently, so she gets unhappy and does in fact end the relationship

– Eg you think you will fail maths exam so you don’t bother to revise properly

• Negative fortune telling stops you taking action


HOW TO CHALLENGE HOW TO CHALLENGE FORTUNE TELLINGFORTUNE TELLING

• Avoid leaping to conclusions– You don’t own a crystal ball. Recognise that

you predictions might be true but that isnt the same as definitely true, which in turn means they might be wrong

• Your future can be different from your past

• Take account of all the evidence

• Go outside your comfort zone


CATASTROPHISINGCATASTROPHISING

• You take a smallish situation and blow it out of all proportion so you imagine all sorts of dreadful things happening

• Magnify importance of problems you have caused or achievements of others

• Minimise the importance of your achievements


EXAMPLES OF EXAMPLES OF CATASTROPHISINGCATASTROPHISING

• You spill something on our clothes just before you go to a party and assume everyone will mock you

• Your girlfriend fails to turn up for a date, and you assume it is her way of telling you the relationship is over or perhaps she has been run over

• You magnify a personal shortcoming. “I’ve put on 3kg, I am fat, I cant meet my friends”

• You minimise a positive attribute.


PROBLEMS WITH PROBLEMS WITH CATASTROPHISINGCATASTROPHISING

• You assume the worst possible result

• The smallest disagreement becomes the end of the relationship

• A mistake becomes a great failure

• A shortcoming becomes your whole identity


HOW TO CHALLENGE HOW TO CHALLENGE CATASTROPHISINGCATASTROPHISING

• Get some perspective-what does it matter?• What resources do you have to change attitude eg

people, personal qualities , to prevent it escalating and becoming self fulfilling prophecy

• Do your personal shortcomings really affect the bigger picture

• Experiment• Remember you have learned and changed before –you

can do it again


EMOTIONAL REASONINGEMOTIONAL REASONING

• You assume your negative emotions reflect the way things are

• This can set up a negative cycle of escalating negativity or possimism

• Eg you are tired, and you think your colleagues are being very unhelpful, when in fact they are same as usual, and it is just your fatigue which is making you think they are unhelpful


PROBLEMS WITH PROBLEMS WITH EMOTIONAL REASONINGEMOTIONAL REASONING

• Emotions are not facts-if you rely on emotions to be your guide, it takes you away from the facts– eg just because you feel jealous, does not mean you

need to be jealous

• Emotions can be triggered by physical tiredness –dangerous to interpret emotions as being necessarily triggered by one particular event


HOW TO CHALLENGE HOW TO CHALLENGE EMOTIONAL REASONINGEMOTIONAL REASONING

• Identify your emotional reasoning-separate the feeling from the cause you think you have identified

– Eg I am depressed because she hasn’t rung me, and so if I am depressed it means she doesn’t love me. Recognise instead that your feelings are triggered by your emotional state , and not the facts of the situation.

• Notice the difference between your normal perspective and your perspective when you are tired.

• Get perspective after the event-after you have let go of the peak of the emotion, think about it again-how do you view it now.


LABELLING AND LABELLING AND MISLABELLINGMISLABELLING

• Using inaccurate and emotive language to describe an event

• It limits our thinking about ourselves or other people

• If the label is all we see, then we stop looking at the facts


LANGUAGE CLUESLANGUAGE CLUES

• I am just so stupid, fat, unattractive

• Hes just an alcoholic

• Shes a typical estate agent/lawyer

• I am a person who always makes mistakes

• He is a horrible person-he always forgets to call

• It’s a dangerous world out there.


EXAMPLES OF LABELLINGEXAMPLES OF LABELLING

• You fail your first driving test-you label yourself a failure

• You fall over at a party, and someone laughs. You label them as a horrible person and don’t make an effort to be friends

• You hear about a robbery in your area, and label you area as a dangerous place.


PROBLEMS WITH LABELLINGPROBLEMS WITH LABELLING

• Labelling yourself as useless or as stupid may cause you to beat yourself up emotionally

• Labelling others may cause you to have negative feelings towards them

• Labelling the world around you in a negative way may stop you taking risks


HOW TO CHALLENGE HOW TO CHALLENGE LABELLINGLABELLING

• Remember that you are fallible – A mistake doesn’t make someone stupid– The danger of labelling someone even with

their job is that it might lead you to erroneous assumptions eg he is a lawyer so he must be rubbish at plumbing

• Consider other aspects of a situation or person


SHOULD, MUST, OUGHT, SHOULD, MUST, OUGHT, HAVE TOHAVE TO

• He should help me, he’s my son

• I must do that job, I have no choice

• I have to have respect

• You must not steal money

• I have to work hard, I don’t have a choice


PROBLEMS WITH SHOULD PROBLEMS WITH SHOULD THINKINGTHINKING

• Rigid and moralistic rules-limit flexibility of action and thought

• Guilt, resentment, frustration and anger-causes us to point finger at someone

• Its not magic-the shop should sell bread, why isn’t it here. If you don’t recognise that circumstances can change, you end up felling angry.

• It’s your choice. I have to g to work-actually you dont.


HOW TO CHALLENGE HOW TO CHALLENGE SHOULDSHOULD

• Recognise rules as preferences• Accept current reality-frees you up t respond to

the circumstances as they are rather than as you think they should be

• Deal with your anger-anger serves no useful purpose other than to alert us to our personal rules. If you look at things calmly, can then decide on best course of action

• Change your “have to” to “choosing to”• Change irrational shoulds to wishes


Change irrational shoulds to Change irrational shoulds to wisheswishes

• Gives you more flexibility for movement in your response to a situation– she shouldn’t speak to me like that– I wish she would speak to me with more respect but

at the moment she doesn’t. What can I do to encourage her to speak to me in a different way

– I should have done that job better– I wish I had done that job better but I didn’t, What

could I do next time to get a better result. How could I prepare differently.


PERSONALISATION AND PERSONALISATION AND BLAMEBLAME

• When you personalise, you inaccurately see yourself as the cause of some negative external event or blame someone or something else for a situation they have not caused or only partly caused– my husband is stressed. It must be because

of me– If I had been a good mother, my son would

not have got divorced.


PROBLEMS WITH PROBLEMS WITH PERSONALISATION AND BLAMEPERSONALISATION AND BLAME

• Anger and resentment towards others-if you think a situation has been caused 100% by someone else it will create blame.

• Guilt


HOW TO CHALLENGE HOW TO CHALLENGE PERSONALISATION AND BLAMEPERSONALISATION AND BLAME

• Gather information– Often personalisation and blame rooted in misinformation or lack

of information– Makes people jump to conclusions– Usually conflict caused by miscommunication

• Recognise the world does not revolve round you– Other people have their own motivations, view of world and

responsibilities– You are not the core of the world around which verything

revolves– This absolves you of any need to be cause of everything around

you


CONFUSING WANT TO WITH CONFUSING WANT TO WITH NEED TONEED TO

• Needs=food, water, air• Wants=everything else

– Love, being liked,– Attention– Education– Money, an easy life, possessions– Respect, self esteem– Health, – Success– Rights


PROBLEMS WITH NEED PROBLEMS WITH NEED STATEMENTSSTATEMENTS

• Anger, anxiety and resentment– Your partner tells you he doesn’t love/respect

you. If you “need” this from them, you will be angry

– The train ius late. If you need it to be on time, you will panic


CHALLENGING NEED CHALLENGING NEED STATEMENTSSTATEMENTS

• Change need statements to “want to’s “– Recognise difference, and change the statement

• Will you live– Will I live without this?– If you can survive as a human being, it is a want.– Even if person kills themselves, it is not the lack of the

want that did it, it is the person deciding.• Change your “cant stand it” to “wants”

– “Cant stand it” is another way of expressing “need to”. It assumes you don’t have a choice when you do.


Worrying as a preventative Worrying as a preventative measuremeasure

• Magical thinking– If I worry about the train being late, it will be

on time– If I think about the airline losing my bags and

plan for the possibility, it wont happen


PROBLEMS WITH WORRYING PROBLEMS WITH WORRYING AS PREVENTATIVE.AS PREVENTATIVE.

• False actions– Thinking obsessively about future may make

you think you are taking actions towards better outcome when in fact doing nothing

• Voodoo talisman thinking– Negative thoughts cannot cause a positive

outcome. If you just worry rather than take action, you are not doing anything useful. Just using worry as a talisman to prevent you from coming to harm.


CHALLENGING WORRYING CHALLENGING WORRYING AS PREVENTATIVEAS PREVENTATIVE

• Replace worries with actions– worry is a false protector. Cannot stop bad

things from happening or make good things happen. But taking action can have positive result.

• Gather information– Find out if fear is false or true, and take

decisive action.


IRRATIONAL DEFINITIONSIRRATIONAL DEFINITIONS

• He doesn’t give me presents or pay for me when we go out, so he doesn’t love me

• I am a failure because my class mates have all gone on to have better careers than me

• I would have to be able to have children to be a success as a woman

• My child never tidies up so he is lazy


PROBLEMS WITH PROBLEMS WITH IRRATIONAL DEFINITIONSIRRATIONAL DEFINITIONS

• Self defeating– Rigid– Leave us little room for complexity of life– Don’t take into account human reactions– Leave us little room to be flexible in response

to situation


HOW TO CHALLENGE HOW TO CHALLENGE IRRATIONAL DEFINITIONSIRRATIONAL DEFINITIONS

• Recognise your core beliefs and assess whether they work for you– Listen to your language and challenge your rigid

definitions– Many of them lead to all or nothing, good/bad

approach to life

• Replace black and white thinking with sometimes thinking– Change I am not a success to I am a normal

human being.


PROJECTIONPROJECTION

• A form of mind reading– Assumption that the beliefs and thoughts we

hold must also be held by others , – and that therefore their actions ought to be

the same in similar circumstances


EXAMPLES OF PROJECTIONEXAMPLES OF PROJECTION

• I am fat and therefore unattractive. Society believes fat people are ugly so it is obvious that men will not find me desirable.

• I wouldn’t hand in money if I found it in the street. It is likely other people wouldn’t either

• My friends and I always gossip.Its normal, isnt it• I might be tenpted to lie, so others probably will

too.


PROBLEMS WITH PROBLEMS WITH PROJECTIONPROJECTION

• Different models of the world– Each of us has a different way of looking at

the world, formed by differing beliefs and values.

– If you project and your self view is negative, you will project negatively on to others.


HOW TO CHALLENGE HOW TO CHALLENGE PROJECTIONPROJECTION

• Remember your assumption may be a projection

• If you gossip, it doesn’t mean others will gossip about you

• Ask yourself, am I just thinking that they will think like that because I would tend to think like that in the same circumstances


HOPELESS/HELPLESS HOPELESS/HELPLESS THINKINGTHINKING

• Assumes a problem exisits, infomration has been gathered but a solution cannot be found; therefore a solution does not exist and cannot exist in the future.

• Sometimes the helpless thinker has adopted someone else’s strong view as a core belief.


EXAMPLES OF HOPELESS EXAMPLES OF HOPELESS THINKINGTHINKING

• Ill never be a success

• I will never get married

• Other people do well but never do.


PROBLEMS WITH HOPELESS PROBLEMS WITH HOPELESS THINKINGTHINKING

• Unconscious assumptions of failure– We start in life thinking we can do anything– Then we learn we cant– Becomes unconscious assumption of failure

• Anger– Sometimes helpless thinking causes people to

give up– Giving up too early can cause helpless feeling– Then feel angry and frustrated.


HOW TO CHALLENGE HOW TO CHALLENGE HELPLESS THINKINGHELPLESS THINKING

• Question the experts– An expert is not necessarily right– Research and look for options and

opportunities– Use logic to analyse alternatives

• View setbacks as feedback

• Remember that you are unique.– Just because no-one else has achieved this

doesn’t mean you cant.


TOO MUCH/TOO LITTLE TOO MUCH/TOO LITTLE THINKINGTHINKING

• Makes assumption you will fail because you have too much/too little..– Im too stupid– Im too unattractive– He is too fat– She is too dirty– He doesn’t wash enough– She eats too much.


PROBLEMS WITH TOO PROBLEMS WITH TOO MUCH/TOO LITTLE THINKINGMUCH/TOO LITTLE THINKING

• Loss of goal– someone who talks in too much or too little

terms has lost their goal– if you can identify the goal, then can start

looking at self view as a practical problem that has solution


HOW TO CHALLENGE TOO HOW TO CHALLENGE TOO MUCH/TOO LITTLE THINKINGMUCH/TOO LITTLE THINKING

• Ask question for what purpose.– I am too stupid to get the degree I want– as soon as have goal, potentially have means

of achieving it– eg set study timetable


CONFUSING “NOT ABLE” CONFUSING “NOT ABLE” WITH “WON’T”.WITH “WON’T”.

• I cant go on a blind date

• I cant say no to my boss

• I cant ask fr a slary increase

• I cant break up with my girlfriend

• I cant make presentations in front of an audience.


PROBLEMS WITH CONFUSING PROBLEMS WITH CONFUSING “NOT ABLE” WITH “WON’T”.“NOT ABLE” WITH “WON’T”.

• Fear, discomfort and anxiety– Eg not asking for a salary increase may result

in long term loss of money, but short term no loss of face if request refused.


HOW TO CHALLENGE CONFUSING HOW TO CHALLENGE CONFUSING

“NOT ABLE” WITH “WONT”“NOT ABLE” WITH “WONT”..• Learn how to do something new in a

comfortable way.

• Eg I feel uncomfortable giving presentations at the moment-what could I learn to make this a more enjoyable /comfortable experience.


ATTACHMENT TO ATTACHMENT TO IRRATIONAL IDEASIRRATIONAL IDEAS

• Assume something will cause a problem

• Someone in authority may have told them that a situation will lead to a problem outcome.


EXAMPLES OF ATTACHMENT EXAMPLES OF ATTACHMENT TO IRRATIONAL IDEASTO IRRATIONAL IDEAS

• Being obese• Being too thin• Becoming 50• Being bald• Having a large nose• Having small breasts• Being very tall or short• Having people dislike you• Being single• Getting grey hair young


Problems with attachment to Problems with attachment to irrational ideasirrational ideas

• When a person attached to an irrational idea, they assume it is an obstacle

• Eg I am too short, or I am 50 years old

• It becomes an excuse for not setting goals


HOW TO CHALLENGE HOW TO CHALLENGE IRRATIONAL IDEASIRRATIONAL IDEAS

• Find out the facts

• Where specifically has it been a problem

• Have you simply been to told that it is supposed to be a problem


THE FOUNDATION OF THE FOUNDATION OF CHANGECHANGE

• Identify what you don’t want any more-behaviour, feelings, automatic thoughts

• Identify new helpful thoughts

• Practice new habits-behaviour, feelings , thoughts.

• Accept some discomfort or disbelief with these new habits

• Continue to practise until unconscious and automatic


PRACTISE !PRACTISE !

• Change will only happen with practice

• Practice makes conscious change unconscious and permanent

• Can work on own or with a therapist


LEVELS OF CHANGE IN LEVELS OF CHANGE IN LEARNINGLEARNING

• Unconscious incompetence

• Conscious incompetence

• Conscious competence

• Unconscious incompetence.

• Eg reading


GENERAL GOAL SETTING GENERAL GOAL SETTING QUESTIONSQUESTIONS

• What do I want in my life

• What gives me pleasure and enjoyment

• What would I like to change

• What would I wish for instead


7 steps to create permanent 7 steps to create permanent changechange

• Assess your starting point-what do you want to change

• Set goals• Identify irrational thoughts and beliefs

– recognise that these thoughts and beliefs are creating unwanted feelings.

• Develop new rational thoughts as a replacement– Practice new way of thinking and refuse to entertain old

thoughts– Recognise that even though the new thoughts don’t feel

real, they may in the future


1. Assess where you are now.1. Assess where you are now.

• Write a problem list– I am constantly worried about my job– I am stressed because I have two small children– I am anxious that my wife will leave me as I am so

down all the time.– We are finding it more and more difficult to

communicate effectively– She is eating too much, and putting on weight and I

am not finding her attractive which isn’t helping our relationship


2. Set goals for therapy2. Set goals for therapy

• Turn the problems into goals– Eg I am afraid of flying– Into “ I want to fly happily without fear or

anxiety”


3. Get to know your faulty 3. Get to know your faulty thinking patterns and beliefsthinking patterns and beliefs

• Baby elephants struggle at chain, and need strong chains

• Adult elephants can be controlled by weak chains, because they learned when young that they couldn’t break free.

• Need to break the chains!


4. Begin to develop new rational 4. Begin to develop new rational beliefsbeliefs

• Dispute and disprove the thoughts you no longer want

• If you hold certain beliefs to be true, your brain will actively filter for evidence to keep proving them

• Search out counter evidence


5. Act “as if”5. Act “as if”

• Take a new belief – experiment to see what happens if you really

hold this belief

• By acting as if you believe something new– you will experience new behaviours and new

thoughts about yourself – there will be new emotional and physical

consequences


6. Repeat and practice6. Repeat and practice

• Change comes through practice– Enables you to form new habits of thinking,

acting and feeling– Do things in a different way– Conduct new behaviours in a way that feels

both comfortable and familiar


7. Self monitor7. Self monitor

• Self monitoring is key stage of change– Observe the changes you are making to your

thoughts and feelings– Measure mood –mood diary– Measure old beliefs and new beliefs– Changing ABCs.


REMEMBERREMEMBER

• Negative thoughts produce negative emotions

• Positive thoughts produce positive emotions

• Neutral thoughts produce neutral emotions


WHAT RESULTS SHOULD I WHAT RESULTS SHOULD I EXPECT FROM CBTEXPECT FROM CBT

• Change re-educates your thinking patterns– to produce more positive thoughts– and fewer negative ones– A calm neutral thought is better than a

negative one


UNHELPFUL AND UNHELPFUL AND IRRATIONAL BELIEFSIRRATIONAL BELIEFS

• Approval is a necessity ie you need to be loved by other people for everything you do– Focus on self respect and being a living person,

rather than someone who has to be loved

• Some people are awful and do terrible wicked things– Separate behaviour from the person– More useful to think they are stupid, unhelpful and self

defeating rather than “bad”– look at as many perspectives as possible, – discuss and find ways to put right.


EXAMPLES OF UNHELPFUL EXAMPLES OF UNHELPFUL AND IRRATIONAL BELIEFSAND IRRATIONAL BELIEFS

• See next 11 examples and what to do


YOU ARE A SUFFERING YOU ARE A SUFFERING VICTIM OF EXTERNAL VICTIM OF EXTERNAL

EVENTSEVENTS• This belief is based on idea that misery if

forced on us by external cirmstances and events

• Ie we are not able to cause the circumstances in our lives

• A more useful and empowering belief is that unhappiness is caused by the meaning we give to circumstances and events


WHEN THINGS AREN’T HOW YOU WHEN THINGS AREN’T HOW YOU WANT THEM TO BE , THEY ARE BAD WANT THEM TO BE , THEY ARE BAD

AND IT IS HORRIBLEAND IT IS HORRIBLE• This belief has the idea of finality and

permanence within it. – Instead it is more useful to see that you are

experiencing bad conditions – that you can change by choosing to react to

them in a different way.


IF SOMETHING IS IF SOMETHING IS FRIGHTENING, YOU NEED TO FRIGHTENING, YOU NEED TO

OBSESS ABOUT ITOBSESS ABOUT IT• It is pointless to waste energy thinking

obsessively about potentially dangerous or fearful situations

• It is better to face them full on and come up with options for getting rid of the aspects that worry you

• If you find that is not possible, accept situation as it is


YOU NEED TO BE PERFECTYOU NEED TO BE PERFECT

• It is pointless striving to be totally successful, intelligent or any other quality –accept that you and every other person on earth is imperfect and fallible


YOU NEED TO HAVE YOU NEED TO HAVE CERTAINTYCERTAINTY

• The world is full of uncertainty and risk

• The idea that we have to control all risk and get rid of all uncertainty cannot create a happy outcome

• Accept probabilities, possibilities and chance


`̀

IT IS BEST TO TAKE THE EASY WAY OUTIT IS BEST TO TAKE THE EASY WAY OUT

• Instead of facing the difficulties of life, you may be tempted to avoid responsibility or facing the facts

• Usually though the easy way turns out to be the hard way

• Better to face facts head on


YOU ARE NOT STRONG YOU ARE NOT STRONG ENOUGH BY YOURSELFENOUGH BY YOURSELF

• Many people buy into the belief that they cant survive without someone or something else to depend on for strength.

• Acting independently may seem riskier at first but leads to greater payoffs in the long term.


YOU ARE A VICTIM OF THE YOU ARE A VICTIM OF THE PASTPAST

• If something has affected you in the past, you do not have to be its permanent victim

• Instead look upon the past as a source of learning and resource


HAPPINESS SHOULD JUST HAPPINESS SHOULD JUST HAPPENHAPPEN

• The idea that anything happens without effort is again a disempowering victim belief.

• Focus instead on what you feel happiest doing and do more of it.


MORE RATIONAL BELIEFSMORE RATIONAL BELIEFS

• SEE NEXT 11 EXAMPLES


You can change your feelings You can change your feelings and it is useful to do soand it is useful to do so

• Unwanted feelings do not have to be permanent

• It is positive to feel and to be able to express your feelings

• It is not useful to be a slave to them


Your past does not control your Your past does not control your futurefuture

• You can learn from the past and use it as a positive resource for your future

• Just because you have had a particular problem in the past does not mean it has to be a part of your future

• Your past and your future are different

• Your future emotions will only be determined by your new thought patterns


Every person’s experiences are Every person’s experiences are unique. unique.

• Everyone has their own life and own view of life, based on their own experiences, thoughts, beliefs and values

• Forget about comparisons-focus on challenging your thought patterns and find a way to create new feelings for yourself.


To create change, willpower is not as To create change, willpower is not as useful as changing the meaning you useful as changing the meaning you

give to eventsgive to events• Thinking and emotional patterns are

unconscious habits

• CBT CAN HELP


You are an OK person as you You are an OK person as you are, right now.are, right now.

• We are not taught at school how to address thinking habits in a rational manner

• You are fine as you are, and now you have the opportunity to learn a useful new skill


YOU CAN’T PLEASE YOU CAN’T PLEASE EVERYONE ALL OF THE TIMEEVERYONE ALL OF THE TIME• You can never be certain that anybody will

love, like or approve of you

• By trying to make them like you , you undermine your identity

• Find out your own interests

• Cultivate happiness and happy friendships


ITS NOT WHAT HAPPENS TO ITS NOT WHAT HAPPENS TO YOU THAT IS IMPORTANT BUT YOU THAT IS IMPORTANT BUT

HOW YOU REACT TO ITHOW YOU REACT TO IT• Things you don’t like will continue to happen to

you• You cant make life perfect or have everything

your own way• What you can do is change the way in which the

events you experience affect you• It is not the events themselves but your thoughts

about them that are influencing you.


FACING PROBLEMS IS MORE FACING PROBLEMS IS MORE USEFUL THAN AVOIDING USEFUL THAN AVOIDING

THEMTHEM• Avoidance doesn’t create long term or

permanent change

• It may provide a short term solution or seemingly easy way out, but it just postpones the issue

• Facing problems will enhance your confidence, give you new skills and lead to long term change.


..YOU ARE RESPONSIBLE FOR YOUR OWN HAPPINESS

YOU HAVE ALL THE RESOURCES INSIDE YOURSELF TO CREATE IT

•Other people can’t make you happy or unhappy-take responsibility for the life you create.

•You don’t need to be dependent on anyone else to fulfil your life or create positive feelings.

•Your thoughts and beliefs can do this for you. If you don’t yet know how to create these changes, you can learn.


OTHER PEOPLE HAVE ALL THE OTHER PEOPLE HAVE ALL THE RESOURCES THEY NEED RESOURCES THEY NEED

• It is nice to help people and be empathetic

• Not useful – to rescue them – encourage dependency on you for solution

• Each of us is responsible for – own reactions to problems – finding our own solutions


YOU ARE FALLIBLEYOU ARE FALLIBLE

• Being imperfect is good enough– Give up looking for perfect solution– There may never be one– There may be several useful and workable options– Find out what happens when you just do “what if”– Perfectionism will bring you anxiety and sense of

failure– Being experimental brings lessons to learn from and

positive new thoughts and emotions


SETTING GOALSSETTING GOALS

• A goal is an end result you want to achieve and can work towards

• It’s important to have well thought out goals, because if not, you might find you no longer want them when you finally achieve them.

• Most powerful when – defined as specifically as possible– You are really clear why you want them


PRINCIPLES FOR SETTING PRINCIPLES FOR SETTING GOALSGOALS

• Decide – What you want to get rid of– What you want more of in your life– Don’t censor list at this stage


SMART GOALSSMART GOALS

• Specific

• Measureable

• Attainable/achievable

• Check your goals

• Realistic

• Timed


SPECIFIC SPECIFIC

• Be clear and detailed about

what you want (feeling or behaviour)

where

with whom


MEASUREABLEMEASUREABLE

• Clear goal posts

• How will you know you are maing progress

• How often will you check

• How will you know when you have reached your goal

• What is it going to look like, sound like, feel like


ATTAINABLE ATTAINABLE

• Well formed goals are attainable by you

• They depend on you taking steps, not other people

• Stretching but no so huge you feel it is impossible


CHECK YOUR GOALSCHECK YOUR GOALS

• Are they self initiated and self maintained

• Are they for you and achievable by you

• Do you want your goal enough to achieve it

• If not, what would need to change for you to have that amount of commitment


REALISTICREALISTIC

• What is the gap between where you are now and your goal

• Make realistic assessment of what it will take to get there

• What resources do you already have to help reach goal-internal skills or help from others

• Solve resource gap..eg get more skills


TIMEDTIMED

• Best goals have a time frame..by not having one, are setting yourself up for failure

• Allows you to mark goal posts, maintain motivation and measure progress

• Can tweak goals if necessary to maintain progress


CLARITY OF GOALS CLARITY OF GOALS

• Unclear goal– I want to lose weight

• Clear goal– I want to lose 3kg in weight by Christmas and

will weigh 55kg.


`HELPFUL TIPS FOR GOALS`HELPFUL TIPS FOR GOALS

• Brain storm wants and don’t wants

• Change your don’t wants into goals

• Write down what you rally want

• Set both short and long term goals

• Set your goals in context

• Ask yourself how important it is to have these goals


HELPFUL TIPS FR GOALSHELPFUL TIPS FR GOALS

• What are the costs and consequences of your goals

• What resources do you have and need to achieve your goals

• Measure and reward your goals


CHANGING THOUGHTS AND CHANGING THOUGHTS AND FEELINGSFEELINGS

• ABC WORKSHEETS– Activating event you experienced about which

you had a negative feeling– Irrational belief or irrational evaluation you

had about this activating event– Consequences –emotional and behavioural –

of your irrational belief


Example of ABC worksheetExample of ABC worksheet

• A. my boyfriend didn’t return my calls for a week• B. he doesn’t love me • Thinking errors:

– I am not loveable,– I don’t believe that men are faithful, – I am always destined to be alone in life, – I have bad relationships,– I believe there is something wrong with me, – maybe I am a bad person

• C. anxious , depressed, worried


OBSERVE AND CAPTURE OBSERVE AND CAPTURE YOUR THOUGHTSYOUR THOUGHTS

Pay attention to your feelings

When you observe a negative change in emotion, observe the thoughts and write them down

Think about them later and analyse


WHAT BELIEFS DO THESE WHAT BELIEFS DO THESE THOUGHTS IMPLYTHOUGHTS IMPLY

• In relation to the trigger event, what do you believe about– Yourself– Other people– World at large


CHECK THE CONTEXT OF CHECK THE CONTEXT OF YOUR CURENT BELIEFSYOUR CURENT BELIEFS

• What is true – in one context may not be true in another– At one time may not be true at a later date– Do a camera check to identify faulty thinking.


CHANGING THOUGHTS AND CHANGING THOUGHTS AND

FEELINGSFEELINGS

A. Activating event

B. Irrational belief

C. Emotional and behavioural consequences

D. Disputing or questioning your irrational belief

E. Effective new thinking or answer

F. New feelings or actions that resulted from disputing your irrational belief.


Helpful approachesHelpful approaches

• Increase emotional vocabulary-reduces tendency to overgeneralise

• Rate strength of old and new beliefs

• Keep mood diary


Mood diaryMood diary

Week 1 Week 2 Week 3

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY


SOME REASONS WHY PEOPLE SOME REASONS WHY PEOPLE ARE AFRAID OF CHANGEARE AFRAID OF CHANGE

• Secondary gain eg loss of attention

• Shame and punishment-I don’t deserve to change

• Unrealistic expectations of change

• Not recognising success

• Pessimism-things might get worse, not better


OVERCOMING RESISTANCE OVERCOMING RESISTANCE TO CHANGETO CHANGE

• Do a cost benefit analysis of not changing for – you – family– friends – World– Immediately– Medium term– Long term


ANGERANGER

• Bad for health-better not to have it in first place

• Faulty thinking behind anger– Thinking that the other person should obey our rigid rules– All or nothing thinking-assuming you are right and others wrong– Seeing only one perspective– believing world should be fair and just– Believing people should not disagree with you or disrespect you– Believing you should be perfect – Believing you should have what you want whenever you want.


EXAMPLES OF THINKING EXAMPLES OF THINKING THAT CAUSES ANGERTHAT CAUSES ANGER

• He should do what I tell him to• She should give me presents if she loves me• He should not be late• He should be more polite to me when he

serves me in the shop• She should apologise when she is wrong• She should not tell me what to do now I am

an adult


NEGATIVE EFFECTS OF NEGATIVE EFFECTS OF ANGERANGER

• Thoughts of revenge• Passive aggressive behaviour• Wanting to turn other people against the person you

think has hurt you• Stress and muscle tension• Fear of being attacked in future-constantly alert• Heart disease• Violence and abusive behaviour• Taking out anger on objects or animals• Alienating relationships through adversarial attitudes


DEFEATING ANGERDEFEATING ANGER

• Recognise that – it is your thinking that is making you angry,

not the event or the other person– Anger reduces effectiveness– If you stay calm, the other person is more

likely to change


ANGERANGER

A. Husband forgotten to phone

B. He doesn’t love me

C. I feel upset and we have row

D. Dispute the irrational belief

E. Effective new thinking-he is busy..I will let him know that if he doesn’t call, it affects how I feel

F. New feeling-irritated but not angry



• Prepare example of event that makes you angry

• Identify faulty belief, and feeling it causes

• Dispute irrational belief

• Effective new thinking


ASSERTIVENESSASSERTIVENESS

• Alternative to anger• Express what you want• Ask for it clearly• Not afraid of taking a risk• Express positive and negative feelings• Can refuse requests and invitations• Give and receive compliments• Calm• Receive and give feedback


Why be assertiveWhy be assertive

• Make it more likely others will listen to your point of view, so you are less likely to get angry

• Good for relationships-more win win• Enables you to handle different situations

which will feed self confidence and self regard

• Saves energy that can be used instead to get goals you want


Assertive communicationAssertive communication

• How I feel (emotion)

• About what (fact)

• Why I feel like that (need)

• Leave space so other person can hear what I am saying.

• I am very upset that you didn’t call me as I put aside time for the call as we agreed.


ASSERTIVE ASSERTIVE COMMUNICATIONCOMMUNICATION

• Use “I” language

• “You” language will be heard as criticism

• Distinguish opinion from fact


State disagreementState disagreement

• “ I see it differently in that…”

• Give a reason for disagreement

• State clearly what you disagree with and what you agree with

• Avoids sense that you are simply knocking down other person’s ideas

• Follow doubt with a suggestion


Demonstrate understandingDemonstrate understanding

• Listen and demonstrate you are listening by– I can see you feel A (emotion)– About B (fact)– When you want C (need)

• Put forward suggestions and ask for other views– How about we…, shall we…..?– What’s your opinion, what’s your view on..?

• Ask for more information

– Have I got this right, you want to..?


Forgiveness-accept self and Forgiveness-accept self and othersothers

• Forgiving others and yourself allows you to move on from place of stuckness and negative self rating to flexibility in thinking

• Foregiveness=process of letting go and ceasing to feel anger, bitterness or resentment for perceived harm, mistakes or offences

• No longer wanting restitution from others


FORGIVENESSFORGIVENESS

• People who forgive are healthier and happier

• Holding on to non-forgiveness triggers– anger and stress, – cortisol – depression , memory loss, heart problems,

fatigue – and wear and tear on body


FORGIVENESS AND HEALTHFORGIVENESS AND HEALTH

• When you feel hurt, betrayed, humiliated etc– Blood flow to heart and skin restricted– Nutrients to cells reduced – Digestion affected– Muscles tighten and may cause pain in head,

back or neck– Immunity lowered– Breathing shallower and restricted


BELIEFS THAT STOP BELIEFS THAT STOP FORGIVENESS OF OTHERSFORGIVENESS OF OTHERS

• The world is fair and just

• Bad things should not happen to us

• We are morally superior to the person who has done something to us


BELIEFS THAT STOP BELIEFS THAT STOP FORGIVENESS OF OURSELVESFORGIVENESS OF OURSELVES

• I am bad and deserve punishment

• Bad things always happen to me


RATIONAL BELIEFS THAT ALLOW RATIONAL BELIEFS THAT ALLOW FORGIVENESS OF SELF AND FORGIVENESS OF SELF AND

OTHERSOTHERS• You live in the present, not the past

• All sorts of things happen to us– at the core of CBT thinking is –its not what happens to

us that is important, it is the meaning we give to events

• You have a choice about what you think, feel and do now


ABC OF FORGIVENESSABC OF FORGIVENESS

• A. my girlfriend cheated on me

• B. It was a terrible thing to do– She is a horrible nasty person– It wasn’t fair– My life is over

• C. I feel full of grief, depressed and anger, and I carry that anger into other relationships


ABC OF FORGIVENESSABC OF FORGIVENESS

• A. my girlfriend cheated on me

• B. life is sometimes unfair

• We are all fallible

• I can survive this

• I can choose to let go of the past and move on with my life

• I can learn lessons and communicate better with my new girlfriend


ANXIETYANXIETY

• Identify your automatic anxiety related thoughts

• Identify activating event

• Identify underlying belief

• Questione your irrational belief

• Effective new thinking or answer

• New feelings or actions that resulted from disputing your irrational belief.


Anxiety rating recordAnxiety rating record

• Before you enter a situation, write down your worst fears about what might happen

• Rate 0-10 how bad you think your anxiety will be • Go into situation and see how bad it actually is• Rate 0-10 and how long you managed to stay in

it• Usually can rate how bad the anxiety will be but

over-estimate the negative consequences


DEPRESSIONDEPRESSION

• Experience leads person to make assumptions which lead to automatic negative thoughts


Example of automatic negative Example of automatic negative thoughtthought

• Early experience sets up irrational assumptions – Eg parental loss leads to lack of love in home, leading to

assumption of I am worthless; people will reject me unless I do what they want

• Critical Incident– Eg major relationship breakdown

• Assumptions triggered• Negative automatic thoughts

– eg people always reject me

• Symptoms of depression– eg guilt shame, sadness, withdrawal from friends and family


Group exerciseGroup exercise

• Develop examples of automatic negative thoughts– Early event– Critical incident– Assumption– Negative automatic thoughts– symptoms


CBT strategies for combatting CBT strategies for combatting depressiondepression

• Distraction techniques• Scheduling activities• Monitoring activities• Identifying negative automatic thoughts• Challenging negative automatic thoughts• Identifying the beliefs and assumptions

underlying the thoughts• Challenging the beliefs and assumptions

underlying the thoughts


4 distraction techniques4 distraction techniques

• Sensory awareness– Focus on what is happening right now– What can you hear, see, taste, smell, feel

• Mental distraction– What shape is it– What colour is it– What is it made of– Any other details

• Counting sheep• Endorphin raising

– Think about something pleasurable eg holiday


ACTIVITY DIARYACTIVITY DIARY

MONDAY TUESDAY WEDNESDAY

THURSDAY

FRIDAY SATURDAY

SUNDAY

8am Describe activity and rate mood

10am

12am

2pm

4pm


Common thinking errors in Common thinking errors in depressiondepression

• Personalisation-my friend hasn’t rung me. It must be because I am negative

• Overgeneralisation-making one mistake and assuming it means everything will now fail

• Mental filtering-only noticing the negative in the situation

• Black and white, all or nothing thinking-I cant get everything right today so I may as well give up.

• Irrational inference-drawing a conclusion based on one instance

• “must” thinking “ I must have a relationship. I don’t so I am a failure”

• Expectations of negative outcomes “I cant do it now, I haven’t been able to do it in the past. I wont be able to do it in the future.”

• Expectations of loss and sadness-I have lost everything in my life

• Feelings of being out of control-my memory is going. I cant focus n anything”



• List examples of common thinking errors


Challenge negative thought Challenge negative thought patternspatterns

• Identify the emotions you are having

• Identify the situation that started the thoughts

• Identify the automatic thoughts

• Dispute and challenge your automatic thoughts and assumptions


Challenging thoughts and Challenging thoughts and assumptionsassumptions

• What is the evidence for this• What thinking errors am I making• What are the advantages and disadvantages of this way

of thinking• In what way is the assumption I am making

unreasonable/irrational• In what way is the assumption I am making unhelpful.• Where does this assumption come from-eg parents

thinking• Is there an alternative way of thinking about this that

would give me the advantage


Example of depressed thought Example of depressed thought recordrecord

• I am feeling depressed and sad again about my relationship. It started when we went out for the evening and she paid attention to someone else

• Automatic thoughts-we are not going to survive as a couple because I am too negative

• Assumption-no one wants me. I am a failure and unloveable



• Give examples of depressed thought record


More effective thinking 1.More effective thinking 1.

• I cant change what has happened in the past• I am a human being and therefore fallible• I still have time to experiment with new ways of doing

things• People often fail and then succeed at something after

years of failing• There is no point constantly thinking about mistakes in

the past• Things can change in the future


More effective thinking 2More effective thinking 2

• There is no “must” as to how or when I have a relationship

• Maybe in the past I have not ended relationships I knew were wrong early enough because I wanted a relationship too much, and because I didn’t like conflict

• A good relationship doesn’t have to be perfect• If I go out to new places and meet different kinds

of people maybe I will have different types of relationship


Conducting new belief Conducting new belief experimentsexperiments

• Predict what you think will happen

• Look at evidence for existing predictions

• Experiment to test your predictions

• Learn from results

• Do another experiment


Stress and faulty thinking Stress and faulty thinking patternspatterns

• Perfectionism– you may feel you have failed when in fact you

have done 95%

• Personalisation– if you take responsibility for everything that

happens, you may be taking on stress unnecesarily . Who else is involved. What could other people do?


Stress and faulty thinking 2Stress and faulty thinking 2

• Pessimism– Pessimistic thinking triggers stress, ageing, low

immunity– Allow for fallibility– Reward yourself when you achieve 80%– Reward small successes

• Procrastination– Putting off action til tomorrow raises stress– Must, should and have to beliefs


Gratitude techniqueGratitude technique

• Each day just before bed, write down 3 things you are pleased and grateful for that day

• Then write down what you did to make those situations happen


Tricks to overcome stress linked Tricks to overcome stress linked to procrastinationto procrastination

• Challenge your inertia-set project/goal and spend at least 5 minutes a day on it

• Give yourself a routine-set specific time of day• Don’t allow yourself to do things you usually do

until you have done at least one thing you don’t usually do

• Learn new skills• Give yourself rewards• Give yourself penalties


Self esteemSelf esteem

• To have a good opinion of yourself

• Low self esteem has negative consequences, but so can too high self esteem

• Better not to rate/label yourself

• Rather to accept that you are a complex person


If you don’t accept yourselfIf you don’t accept yourself

• You look for others to make you complete• You hunt for love from others• You stop your own growth and learning through fear of what finding

out the truth about yourself might reveal• You don’t accept your past, present or future• You view parts of your life as wasted• You try to hide from yourself• You are sensitive to rejection• You beat yourself up at the first sign of underperformance• You compare yourself with others and try to beat them• You don’t live in the present• You try to win self esteem through achievements and material

possessions


How to learn self acceptance How to learn self acceptance and stop self labellingand stop self labelling

• Human beings are complex

• You are unique

• People are always changing and developing over time

• Human beings are fallible and imperfect

© WHO Collaborating Centre COGNITIVE BEHAVIOURAL THERAPY INTRODUCTION.

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