What are you afraid of?

Most of us a little bit scared about one thing or another: scared of things that, for fairly rational reasons, we just don’t like, or would prefer to avoid. But, for some people, it’s something way more than being scared, it’s something beyond their control and it’s called a phobia.

A phobia is an anxiety disorder that’s commonly referred to as a persistent fear of an object or situation, one that the sufferer will either go to great lengths to avoid, or endure with marked distress. It’s a fear they recognise as irrational and one that is typically disproportionate to the danger actually posed by the thing itself.

The word comes from the Greek, Phóbos – meaning ‘fear’ or ‘morbid fear’ – and is itself a derivative of Phebomai – meaning ‘to flee’ or ‘withdraw’ – hence the running away from the thing that scares you.

In Greek mythology, Phobos was the god of fear and terror. It’s also the name of the largest of the two Mars moons.

In psychotherapy, there are three main types of phobia: social, specific and agoraphobia.

Social phobias are broken down into two types, generalised social phobia (or social anxiety) and specific social phobia (where the anxiety is triggered only in specific situations).

Specific phobias cover almost anything and everything else including fears of flying, animals, catching a specific illness, water, heights, clowns, buttons, injections, thunder, bridges and, even, work.

Each specific phobia has its own name. The fear of clowns, for instance, is called Coulrophobia (and no, it’s not just restricted to evil clowns, but covers the nice ones too) while the fear of work is known as Ergophobia.

There’s even a phobia that is culture specific, in that it’s almost exclusively experienced by Japanese people: Taijin Kyofusho, a fear of offending or harming other people.

Agoraphobia gets its only special category however, as it’s a much more complex affair (or multi-phobic, to be precise), and can include a generalised fear of leaving home or other safe places, coupled with a fear of having a panic attack, a fear of open spaces, of being socially embarrassed and more.

However, CBT is considered to be the gold standard treatment for anxiety disorders (including phobias) by the NHS.

Not only that, but lots of research highlights the efficacy of hypnotherapy in the treatment of the same.

Put the two together and not only are you are looking at a more effective treatment package, but also faster results too (studies have shown that the two therapies together can be more effective and more rapid than when either one is used alone).

CBT has a very definite viewpoint on emotional problems, including phobias, namely it’s not the thing that disturbs you, but what you tell yourself about the thing that provokes your disturbance.

Unhealthy beliefs about a situation or an object will lead to an unhealthy and phobic you, whilst a healthy set of beliefs (whilst not quite having you fearless in the face of your thing) will lead to what we call healthy concern – a much more manageable emotion in which you realise, whilst you may never be comfortable around it, you can most definitely handle the ‘thing.’  (You can learn about these different types of emotions and what provokes them from our previous blogs or you can also check Visual CBT on Amazon by Avy Joseph and Maggie Chapman.)

Hypnotherapy in the context of beliefs can help support the work that CBT is trying to do.

However, it can also be used to gradually desensitise you to various aspects of your phobia (for instance, someone with a wasp phobia might have a phobic reaction on seeing pictures of wasps or even the word itself) as you build up to confronting the main event.

It can also be used to change your self-belief, mood and get better (typically, phobia suffers can suffer from depression and self esteem problems as a consequence of the phobia).

By-the-by, whilst the Office of National Statistics claim that 1.9 per cent of the adult UK population are phobic at any one time, animal phobia is the number one phobia in women, followed by heights; whilst heights is the number one phobia for men, followed by animals.

Finally, there are four states that are incompatible with fear: hunger, thirst, relaxation (which is why hypnotherapy works so well) and sex.

So, if you’re hungry, thirsty, under hypnosis or just plain …erm … “excited”, your phobia is not going to get a look in.

I don’t know…

In this blog we will look at why it is difficult for some people to say ‘I don’t know?’
The answer is simple, anxiety. Our feelings and emotions like anxiety and depression are determined not by events but by the way we think about these events. An event can be about all sorts of things including imagining saying ‘I don’t know’ or actually saying ‘I don’t know’. The specific triggers can vary from person to person.

At the heart of anxiety is irrational or unhealthy thinking or beliefs about the threat or risk of saying ‘I don’t know’ (be it real or perceived) to ourselves or to our personal domain (the things and people that matter to us). Rational or healthy thinking about this risk leads to what we call healthy concern or nervousness, different to anxiety or to panic.

Anxiety about saying ‘I don’t know’ is commonly triggered by two things:

• A perfectionist internal demand to always know and viewing ‘not knowing’ as something catastrophic, unbearable or proof of worthlessness or of being a total failure. Not knowing is not just perceived as bad, it is perceived as ‘end of the world bad’.

• An internal demand to always be thought of in a positive way by others and viewing negative judgement as catastrophic, unbearable or proof of worthlessness or of being a total failure.

Examples:
Irrational or unhealthy belief at the heart of ‘anxiety’ and avoidance:

I absolutely must know, if not it would be awful, catastrophic, I couldn’t bear it or tolerate it, it would prove I’m a total failure.

The above does not accept the possibility of not knowing, even though in reality the person may not know.

People must not judge me negatively, because it would be awful, I couldn’t bear it, it would prove I’m a failure.

The above does not accept the possibility of negative judgement, even though it exists for everyone. The worth is linked to other people’s opinions.

Rational or healthy belief at the heart of healthy ‘concern’ and non avoidance:

I would really like to know but I accept the possibility that I may not or don’t know. If I don’t know it would be bad but not the end of my world, I would find it difficult but I will tolerate and bear it, it would not mean I’m worthless. I accept myself as a fallible human being like everyone else.

The above attitude allows for the possibility of not knowing to exist without linking one’s worth to it.

I would prefer it if people always thought positively of me but I accept that some might not (when I say I don’t know). It would be bad but not the end of the world, I would find it difficult but I can stand it, it would not mean I’m worthless. I accept myself as fallible. My worth does not depend on whether people like me or not.

The above belief accepts that negative judgement exists without linking one’s worth to it.

So how do you free yourself from the paralysis of anxiety about saying I don’t know?

1) Change your beliefs about not knowing. Accept that you are human and therefore fallible. None of us know all the time.

2) Keep the badness of not knowing in proportion. Of course not knowing something may be bad in some situations and may have negative consequences but nevertheless the world does not come to an end. So keep it bad but not the end of the world bad.

3) Develop resiliency to not knowing. Accept you will find it frustrating, difficult, uncomfortable, but the truth of the matter is that you do survive it. Telling yourself you can’t tolerate nor stand not knowing is simply not true but it does impact greatly on your feelings of anxiety. So tell the truth ‘it’s hard but bearable’.

4) Accept yourself as fallible. No one is perfect so not knowing something at times is human. Believing that you’re a total failure or a worthless person because of it is unhelpful and is at the heart of your anxiety.

5) Accept uncertainty. Accept that at times you are unsure.

6) Put it into practice and say ‘I don’t know’, ‘I’m not sure at the moment’, ‘Let me think about it and I’ll come back to you’, ‘I don’t know but I will find out’. Then in your head repeat ‘I accept myself as fallible. My worth does not depend on whether I know or not or on whether people judge me or not.’

Accepting ourselves as worthwhile but fallible human beings frees us from the anxiety of saying ‘I don’t know’. As a consequence, we then can be free to find out and learn and improve and it also connects us to people as we come across as confident and happy in our own skin.

You may be interested in learning more about self acceptance and ego disturbance in our new Master Class Treating Ego Disturbance on 1st June 2013.

CBT and long-term health conditions

Although Cognitive Behavioural Therapy (CBT) has been shown to be an effective way of treating a number of different mental health conditions, another important way CBT can be used is to treat people with long-term health conditions, such as arthritis and irritable bowel syndrome (IBS).

Although these are physical complaints and CBT cannot cure them, it can be very successful with helping people cope with their symptoms. As CBT is a practical therapy, it can focus on particular specific problems. These strategies can then be used for a lifetime. CBT can also be used alongside medication if the condition is severe. If used with hypnosis i.e. Cognitive Behavioural Hypnotherapy (CBH), for some people, the combination can also be extremely effective.

It is well established that hypnosis, for IBS, is an effective treatment.

Any harmful, unhelpful thoughts which may trigger health problems, or make them worse are identified. The aim is then to change the ways of thinking to avoid these ideas. A certain amount of dedication and persistence by the individual is required to achieve optimum results.

In the case of IBS, CBT and CBH usually involve teaching the individual specific strategies for calming the body and reducing their anxiety. They learn to cope with the unpleasant symptoms of IBS and to be able to face the difficult situations in life that can cause stress and trigger an attack of IBS. This can involve people monitoring which foods impacts negatively on their condition. They would note how they felt while eating, anxious, happy, relaxed, stressed etc to see if they can see a pattern emerging.

CBT combined with medical treatment has been shown to be more effective than medical treatment alone in reducing IBS symptoms.

CBT has also been shown to significantly improve sleep and reduce pain in arthritis sufferers.

People learn how to control their pain. This can be through diverting their attention and practicing relaxation techniques. The reduction in pain enables them to enjoy a more active lifestyle and this improvement in their quality of life can be maintained. They also find after their course of CBT they are less depressed and have more energy.

A big responsibility is for the client to carry out the work required themself. Literature such as our book ‘Visual CBT’, written by the founders of the College, can be very helpful, as it has been designed to help anybody apply Cognitive Behaviour Therapy to change their life, in a very visual way, using imagery and illustrations. This visual approach makes the CBT very clear and easy to follow.

Oh dear! I just can’t decide!

How many times have we all been faced with decisions that we find very difficult to make!

This blog is going to delve a little in to the mind processes that help or hinder us in decision making.

In order to make decisions we have to weigh up the costs and benefits of making a decision and then take action in accordance with our decision. This is much harder than it sounds to achieve!

Decision making is a cognitive (mental) process. This process can be conscious or sub-unconscious (below our conscious awareness).

So what stops us from making decisions about certain things in our life?

The simple answer is us.

Here are some possible reasons as to why we may not make certain decisions or why we may find it hard to make a decision.

1) We require more information to help tip the balance ‘for’ or ‘against’ whatever we are mulling over. You have asked 3 suppliers to provide you with an estimate about something. You will then wait to receive all three quotes before choosing which to go for.

2) Because it doesn’t matter to us or we don’t care about it or we think it has no impact on us or on what we think is important and finally we think that nothing would change anyway.

3) Anxiety. This is really at the heart of whether we have problems with making decisions. So the question is why do we feel anxious?

Our feelings and emotions are provoked not by events but by the way we think about these events. At the heart of anxiety is irrational or unhealthy thinking or beliefs about risk (be it real or perceived) to ourselves or to our personal domain (the things and people that matter to us). Rational or healthy thinking about risk lead to what we call healthy concern or nervousness, different to anxiety or panic.

Obviously decision making is part and parcel of everyday life and we need to be able to do it!
So how do we free ourselves from the paralysis of anxiety about making decisions?

1) Change your beliefs about mistakes and about getting things wrong. Accept that you are human and therefore fallible. The possibility of making a mistake exists for all of us.

2) Keep the badness of getting something wrong in proportion. Of course making the wrong decision can be bad and may have negative consequences but nevertheless the world does not come to an end. So keep it bad but not the end of the world bad.

3) Develop resiliency to getting things wrong. Accept you will find it frustrating, difficult, uncomfortable, but the truth of the matter is that you do survive it. Telling yourself you can’t tolerate nor stand making the wrong decision is simply not true but it does impact greatly on your feelings of anxiety. So tell the truth ‘it’s hard but bearable’.

4) Accept yourself as fallible. No one is perfect so getting things wrong is human. Believing that you’re a total failure or a worthless person because of mistakes or wrong decisions in unhelpful and is at the heart of your anxiety.

5) Accept uncertainty. Accept that at times you are unsure.

6) Construct a cost and benefit analysis of the options. The costs and benefits of making a decision in short and long term and the costs and benefits of not making a decision in the short and long term. This may help you see that avoiding making a decision about something you deem important does not have any long term benefits for you.

7) Gather relevant information before making an important decision but be realistic about it. Allow for the fact that you may never have all the information. You are more likely to realise this if you accept risk and uncertainty.

So, could you become a Cognitive Behavioural Therapist?

Well here at the College we train people from all sorts of backgrounds. These have included marketing executives, medical practitioners, nurses, PR consultants, hypnotherapists, psychotherapists, IT managers as well as housewives. Quite a list!

They all have one thing in common though, a desire to make a difference.

However, as in all walks of life, different careers suit different people, so let’s do some investigation!

The first point to note is, to begin the training, you do not have to be an academic! There are no specific requirements for the Foundation course, such as a degree, as we believe that your experiences in life and other skills are just as valid.

Of course, initially you will not know what to expect and whether it would be a good step for you, so we invite you to an interview in an informal setting.
This interview is nothing to worry about as it is designed to give all concerned the opportunity to assess each other’s suitability. After all, there would be nothing to gain, if at a later date you found you had made the wrong decision and it was not for you!

So, sounds interesting and worth pursuing so far? Well, let’s move on to some practicalities to consider.

Although our courses are very flexible and held at the weekends, so you can fit them in around your present employment; it has to be said embarking on any change of career is a big step and can impact on those around you.
For example, they will miss your presence for several weekends and the training will require your dedication and full attention.
However, when family members see how you are progressing, no doubt you will have their full support.

There are also financial considerations as well. We aim to make these as helpful as possible and it is a good idea to discuss them at the initial interview. Our fees can be paid in installments or, if you are able to, if you pay in full you will receive a discount.

So could you become a Cognitive Behavioural Therapist? We think you could and would welcome the opportunity to welcome you to our College to begin your training.

Teenagers can be moody…

Teenagers can be moody, difficult entities but it is hard to tell if that perceived state is the norm or due to depression
The influence of hormones and the natural process of growing in to an adult can cause a great deal of stress. Things such as not doing well at school, arguments with parents and romantic breakups, can lead to feelings of low self-worth and not being in control.

There may be a lot going on in the teenager’s life; there may be bullying at school or the of experience losing a parent to death or divorce.
The average teenager can normally tolerate and overcome these types of events with time and patience but for others they can contribute to a state of depression.

So, you may suspect a teenager is depressed but how to confirm your suspicions?
Depression can alter the way they act; they see everything in a negative way. Problems seem insurmountable. Try to be alert for changes in behaviour.

Some of the changes in behaviour may be very obvious such as:

• Appetite changes
• Difficulty concentrating and making decisions
• Starting to forget things
• Staying in bed and being very tired for no reason
• Becoming upset, restless, and irritable
• Loss of interest or pleasure in activities that were once fun
• Failing at school/college
• Talking about death/suicide

However, it is not always so easy to spot. There may be problems at home. Often the teenager may behave badly or out of character but not seem to be depressed. They may act irresponsibly or start shop lifting. They may want to be alone and not want to spend time with their family. All important signals to be aware of.
Although depression in teenagers can be difficult to diagnose, symptoms should not be ignored as suicide is a risk for all teenagers with depression.

Once the teenager has been diagnosed with depression, action should be taken swiftly before other complications manifest themselves, such as:

• Drug, alcohol, and tobacco abuse
• Effects on relationships with family and friends
• Other mental health problems, such as anxiety disorders
• Teenage suicide
• Violence and reckless behaviour

Almost all teenagers with depression benefit from some type of talking therapy. A talking therapy such as Cognitive Behavioural Therapy is a good place to talk about their feelings and concerns, and to learn ways to deal with them.
You may find our Master Class on Depression taking place in March 2013 of interest

Excess and Moderation

Are you interested in knowing why we find it difficult to be moderate?

When we eat, exercise, work, get praised, challenge ourselves, or do something that benefits someone else, we are achieving goals that trigger positive feelings. When we achieve what we want in life, we feel happy. Therefore a goal of creating balance in life needs to be something that we want to achieve in order for it to be happiness evoking.

Striving for your healthy desires, without needing them is key to achieving a balance.

We all like to be in state of comfort as opposed to discomfort. This can be tricky because achieving the goal of a balanced and healthy life requires you to do the work in the here and now in order to succeed later. Naturally, this means that working and putting in effort is essential. You may feel uncomfortable at first.

If you focus only on achieving future goals, constantly working and putting in lots of effort, you will not feel happy in the here and now. This usually triggers stress. A philosophy of balance is necessary so that you can experience happiness and enjoyment in the short term while you are working towards long term goals.

It is easy to understand why you want to be in state of comfort, enjoyment, happiness as opposed to discomfort. Comfort feels good. Excitement feels good. Alcohol, for most people feels good, food tastes good, exercise releases endorphins and that feels good and so on.
You grow up knowing that there are certain things you can do or have others do for you that provoke feelings of comfort and happiness. If as a child you feel uncomfortable or fearful, your parents will look after you or remove the object of fear. You grow up learning that if you avoid something that triggers you to feel fear, your feelings of fear will disappear quickly.

This can also be a source of problems for adults. Emotional maturity will not be accomplished if the adult continues to engage in the same strategies of either avoiding things that trigger feelings of discomfort or having a desire to indulge in excess because you need to continue feeling happiness, positivity, joy etc.

Two main reasons why people indulge in excess

1) A strong need for immediate gratification and hedonism e.g. need for enjoyment now, oblivion, joy, happiness, relaxation
2) Low frustration tolerance to discomfort e.g. boredom, effort, negative feelings

Some might see moderation as being middle aged and dull. This assumption is called ‘rationalisation’. This means the person is justifying the behaviour so they can continue it. The real reason is the need for immediate gratification and hedonism.

“The road of excess leads to the palace of wisdom” William Blake

Avoidance of discomfort is a major coping unhealthy strategy for many people. For example, someone may eat too much because it distracts them from a feeling of anxiety about being alone. Others may play on their Xbox or surf the net because to avoid the discomfort of filling an application form or organising bills.

Unhealthy beliefs stop you from moving forward and creating the balance in life you desire. They provoke feelings like anxiety, depression, guilt, hurt, rage, shame etc. They also provoke unhealthy behaviours like excess and difficulty in moderating gratification. They can also trigger unhealthy behaviours as a means of coping with other problems i.e. they trigger dysfunctional behaviours like excess as a way of avoiding emotions or focusing on problems.

Unhealthy beliefs are unrealistic, rigid or inflexible and sabotage goals.