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How are Cognitive Behavioural Therapies used in the National Health Service?

28 Jan

Before we start discussing this topic, it will be helpful to have a definition of Cognitive Behavioural Therapies (CBT), as defined by the NHS.

CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. Talking and changing your behaviour can change how you think (cognitive) and what you do (behaviour). This can make you feel better about life.

CBT has been shown to be an effective way of treating a number of different health problems, such as depression, eating disorders, phobias, addictions, insomnia and anger management. In fact, the list seems endless!

CBT can also be effective for long term health problems such as irritable bowel syndrome (IBS) and arthritis. Although CBT cannot cure the physical symptoms of these health conditions, it can help people cope better with their symptoms.
So how is the NHS using CBT in its treatments?

Well, the answer is in lots of ways, and as the Government aims to make counselling and other types of talking therapies, including CBT, more easily available on the NHS, this use will increase over the next few years.

cbh conversation

Indeed, the NHS has an Improving Access to Psychological Therapies (IAPT) programme. IAPT aims to put thousands more trained therapists into GP surgeries. The scheme will provide easy access to talking treatments on the NHS to those who need it. Part of the programme includes a four year plan of action for Talking Therapies.

Overall, the number of sessions, a client will need depends on individual problems and objectives. Treatment usually lasts six weeks to six months.

At CCBT, we understand the importance of CBT for treating all sorts of conditions, and are pleased that the NHS is working to improve access to these therapies. If you are interested in training to become a CBT Therapist yourself, please visit our website.

Cognitive Behavioural Hypnotherapy and Addictions

23 May

Cognitive Behavioural Hypnotherapy (CBH) can be used for a wide range of everyday problems, ranging from anxiety to depression, self esteem issues and procrastination. It can even be used to help individuals deal with all sorts of addictions, including smoking, gambling and drinking.

Addiction

Controlling your mind will help beat addiction.

Using hypnotherapy to deal with addictions is quite common. In a recent article, Indian police hired a hypnotherapist to help many of their police officers from addictions to drinking alcohol and smoking.

Why do we become addicted?

There are many reasons why people become addicted to something, some of us have personalities that are naturally more open to becoming addicted than others. Remember that addiction doesn’t always manifest itself in the form of things we typically see as bad for us. There are many cases of people becoming addicted to keeping fit, or going to the gym for example. Some are addicted to TV or their XBOX’s, not the first things that pop to mind when we think or talk about addiction.

Typical reasons behind addiction though relate to a form of escapism from life, triggered by typical factors such as stress, anxiety or depression. In the case of the Indian Police, many of the officers struggling with addictions stated they felt their addiction was linked to stress, working long hours and depression.

Combating addiction

Addiction is a powerful thing, and so it takes some time to break the addiction ccycle. Often when we picture people dealing with addiction we think of circles of people talking through their problems, looking for support from others. Talking therapies are very powerful, especially when delivered in a structured format, such as Cognitive Behavioural Therapy (CBT) and with the added benefit of Hypnosis (Cognitive Behavioural Hypnotherapy – CBH).  Both CBT and CBH are about a change in thinking and a change in behaviour.

CBH provides individuals with the tools that will help them break their addictive cycles and maintain a healthy life style.   For any therapist / counsellor, CBH is a powerful addition to any talking therapy.  For therapists wishing to learn these skills, there are a number of courses available from the College of Cognitive Behavioural Hypnotherapy, ranging from a foundation course in counselling, hypnosis and rapport skills, to advanced diploma courses. For individuals wishing to learn some of the skills CBH teaches, there are a number of Master Classes also available, each one focused on a particular skill, such as treating addiction, panic disorder, self esteem problems and more.

When it comes to combating addiction, CBH can be a valuable tool to your toolkit.

Emotional responsibility and accountability

20 Mar

The headline in today’s Mirror was a quote from Dennis Waterman saying ‘I hit Rula … but clever women make men lash out’ and the inside story had another quote ‘It’s not hard for a woman to make a man hit …’

Denis Waterman with Rula Lenska (Picture from the Mirror Newspaper)

This erroneous belief is at the heart of emotional problems and behavioural problems and indeed at the heart of abusive relationships.  If it was true then the only solution to solving this issue for those men who believe “clever women MAKE men hit them” is for women to be less clever than them.

Is it true that events or people make us do what we do?

Let’s think about what we do and assume that people make us behave as we do.

Example:  A clever woman argues better than a man = Man hits her

If it is true that a clever woman ‘makes’ a man hit her, then every clever woman would experience the same physically abusive behaviour.  It would mean that every man who has relationship with a clever woman would be unable to control himself and would be hitting the woman.

10 Clever women argue better than 10 men = 10 Men hit the 10 women

100 Clever women argue better than 100 men = 100 Men hit the 100 women

1000 Clever women argue better than 1000 men = 1000 Men hit the 1000 women

Does this make sense?

The problem is that people say ‘he made me do it’ or ‘she made me lose my temper’, ‘she made me hit her’.  It is as if they have absolutely no control over how they feel or how they behave.  If we do not have a part to play in how we feel and behave then we would be completely stuck, unable to move forward or do anything useful.  Is this what we see happen to everyone around us?

So who is responsible for your feelings, attitude and behaviour? 

The simple answer is ‘you are’.  You are responsible for your feelings and reactions and they are provoked by your thoughts; the attitudes you’ve formed; the habits and beliefs you no longer question.

This is the principle of Emotional Responsibility:  “You are largely responsible for the way you feel and act”.  Largely does not mean the other person sometimes causes your behaviour.  We just mean that there are some disorders like Manic Depression or Clinical Depression that are organic in nature; meaning it’s do with the person’s biology or genetic makeup.

The principle of emotional responsibility can be difficult for some people to accept, particularly if you are going through a difficult time or have experienced a personal tragedy.  It is natural to feel angry, sad, depressed or hurt in response to accidents, illness and other challenges in life.  It is also natural to experience negative emotions when you find someone challenging, but you can change your reaction.

Different people feel and experience contrasting emotions even when they experience the same challenge or difficulty. Therefore it is not the situation or another person that makes you feel or do.

This quote is conceptualised by one of the main schools of cognitive behaviour therapy called Rational Emotive Behaviour Therapy’s (REBT) ABC diagram of human disturbance.  It is not the event, but the belief or view you hold about the event, which is at the heart of emotional states and performance.  Emotions, thoughts, behaviours can be healthy and functional or dysfunctional. The event can be something that has happened in the past, something that is happening now or something that could happen in the future.  It can also be real, imaginary or internal or external.  Internal events can be thoughts, images, memories, physical sensations or even emotions.

ABC Event Belief Consequences

ABC - Event, Belie,f Consequences Diagram

ABC – Event, Belief, Consequences Diagram

Beliefs that are unhealthy have at their core explicit or implicit rigid, powerful demands and commands usually expressed  as MUSTs, SHOULDs, HAVE to’s, GOT to’s e.g. I absolutely must not be rejected.  Essentially, unhealthy demands are not based on what is possible in reality.  Therefore, certain unfavourable or undesirable possibilities are not accepted e.g. rejection.

These demands also have powerful derivatives such as “If I am rejected, which I MUST not,

a) It’s awful (i.e. 100% bad)

b) It’s unbearable (i.e. can’t survive, cope or be happy at all)

c) It proves I am a worthless person.

So REBT is about:

  1. Helping      a client understand their emotions, behaviour and goals,
  2. Identify      their unhealthy or unhelpful beliefs that are sabotaging their happiness      and goals,
  3. Challenge      them and replace them with their healthier version in order to become      undisturbed and eventually happy.

So as far as the ‘Clever women make men hit them’, it is simply untrue and does not make any sense.  The B is missing in the ABC.  The A is Clever Woman, the C is Man hitting her but the B is the Man’s unhealthy belief about the clever woman which then leads him to lash out.  His belief is his responsibility and his alone.

Preferred Sources…

3 Aug

This is just a quick post to get you involved with our latest poll. Please take a few moments and select the answers that relate to you (you can select as many as you like). In addition, please comment and let us know any other sources you may use…

Looking forward to the results…

Cognitive Behavioural Therapy

25 Jul

Our last blog post explained the benefits of Cognitive Behavioural therapy as opposed to just Hypnotherapy.  In this blog post, we would now like to explain a little more about the different types of cognitive behavioural therapy. 

Cognitive Behavioural Therapy (CBT) is a talking therapy. The basis of CBT is that what people think can affect how they feel and how they behave.  Within this broad definition is a number of cognitive behavioural psychotherapies such as Behaviour Therapy (BT), Cognitive Therapy (CT), Rational Emotive Behaviour Therapy (REBT), Mindfulness Based Cognitive Therapy (MBCT),  Acceptance and Commitment Therapy (ACT) to name but a few.

 The two pioneers of CBT, Albert Ellis and Aaron Beck, shared the view that most disturbances arise from faulty thinking and that the remedy is to be found in corrective actions.  Both concentrate on present problems and present thinking in contrast to the earlier forms of psychotherapy.  Also, both recommended the inclusion of behavioural exercises.  Because of the inclusion of behavioural exercises, Cognitive Therapy (CT) is now known as Cognitive Behavioural Therapy (CBT).

This blog will briefly explain the two main schools of Cognitive and Behavioural Therapies.   Both have a scientific theory that can and has been tested, as well as a structured framework and process of therapy.   

Rational Emotive Behaviour Therapy (REBT)

REBT was founded in 1955 by Albert Ellis and has the longest history of any of the cognitive behaviour therapies listed above.   The often quoted phrase of Epictetus (Stoic Philosopher) “People are disturbed not by things but by their view of things” is at the heart of REBT. 

This quote is conceptualised by REBT’s ABC diagram of human disturbance.  It is not the event, but the belief or view you hold about the event, which is at the heart of emotional states and performance.  Emotions, thoughts, behaviours can be healthy and functional or dysfunctional. The event can be something that has happened in the past, something that is happening now or something that could happen in the future.  It can also be real, imaginary or internal or external.  Internal events can be thoughts, images, memories, physical sensations or even emotions.  For example, people can become depressed about their feelings of anxiety.  So anxiety in this example would be the A in the ABC diagram below and Depression would be the C in the ABC.

CBT, Event, Belief, Consequences Diagram

CBT, Event, Belief, Consequences Diagram

 

 

 Beliefs that are unhealthy have at their core explicit or implicit rigid, powerful demands and commands usually expressed  as MUSTs, SHOULDs, HAVE to’s, GOT to’s e.g. I absolutely must not be rejected.  Essentially, unhealthy demands are not based on what is possible in reality.  Therefore, certain unfavourable or undesirable possibilities are not accepted e.g. rejection.

 These demands also have powerful derivatives such as “If I am rejected, which I MUST not,

a) It’s awful (i.e. 100% bad)

b) It’s unbearable (i.e. can’t survive, cope or be happy at all)

c) It proves I am a worthless person.

So REBT is about:

  1. Helping a client understand their emotions, behaviour and goals,
  2. Identify their unhealthy or unhelpful beliefs that are sabotaging their happiness and goals,
  3. Challenge them and replace them with their healthier version in order to become undisturbed and eventually happy. 

REBT essentially helps clients develop resiliency and self acceptance by enabling them to face their worst case scenarios and their ‘what ifs’ rather than ignore them.  This can lead to a powerful philosophical shift which enables clients to focus on their desires, wants and wishes without becoming disturbed or stuck about the ‘what if’.  Clients then view setbacks and failures as purely temporary as opposed to life or soul destroying, while remaining motivated and focused on their desires and goals. 

 

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy is based on Aaron T Beck’s theory that our emotions and behaviour are influenced by the way we think and by how make sense of the world.  Our interpretations and assumptions developed from personal experience often conflict with external reality.   Beck encouraged his patients to focus their attention on their ‘automatic thoughts’.  This led him to reformulate concepts of depression, anxiety, phobias, and obsessive compulsive neuroses in terms of ‘thinking errors’.

The cause of the disturbance in Beck’s CBT is attributed to the following:

 1)      Schema.  This is similar to Ellis’ belief system in the ABC model.  Schema refers to ‘belief system’ or ‘network of beliefs’.  That system or network is made up of a host of beliefs about people, events, situations etc.  These schematic beliefs are maintained in a conditional form e.g. if I don’t win, I am a failure. 

2)      Law of Rules.  Our reactions to many situations are consistent, guided by a ‘set of rules’ which help us make sense out of the world. 

3)      Cognitive Errors.  Thinking errors or faulty thinking which are common to many psychiatric disorders.  All patients show distortion to reality to varying degrees.  For example, seeing things only in black and white or focusing on a specific detail whilst ignoring everything else and drawing conclusions from that.

Clients are helped test their assumptions and views of the world in order to check if they fit with reality.  When clients learn that their perceptions and interpretations are distorted or unhelpful they then work at correcting them. 

Difference

Both schools are open to influence from each other and in practice ideas from both can be utilised, as appropriate, to achieve successful outcomes for clients.  However REBT and CBT remain distinct.

 Testing Assumptions

 In REBT the client’s assumptions are assumed to be true and are not immediately put to a reality test.  In Beck’s CBT, the client’s assumptions are tested for validity first.  The reason for this is that REBT theory states that a client’s assumptions are a consequence of holding an unhealthy beliefs, so these assumptions are assumed to be true in order to ‘cut to the chase’ and identify the unhealthy beliefs.  It deals with the questions of ‘what if’ at the outset.

 

Treating symptoms or generalised philosophy?

CBT is based on the treatment of the symptom.  Whilst REBT also treats the symptom, in REBT, the aim is to effect ‘profound philosophic change and a radically new outlook on life’ (Albert Ellis) by transforming deeply held core beliefs about the self, others and the world.   

 However, a drawback to REBT may be that some clients may not like the model or its application.  CBT is more cautious and aims for some kind of improvement and return to normal functioning, symptom relief or symptom management but offers a variety of problem-solving techniques.  On the negative side, this approach misses the chance to offer a client a simple philosophy and the tools to become their own therapists when faced with different problems in the future. 

REBT or CBT, that is the question…

So, when it comes to REBT or CBT there is always a question for therapists. Should they use REBT, CBT or a combination of both?  At CCBH, we prefer REBT to CBT but not always, it will depend on the particular situation.

We know this has been a longer blog post, but hopefully it has been useful to you! Do ask any questions about REBT or CBT below…

A Potent Combination – Cognitive Behavioural Therapy and Hypnosis

11 Apr

The combination of Cognitive Behavioural Therapy and Hypnosis is a potent one. Combining these two approaches appears to turbo charge the benefits of both approaches, in what is called Cognitive Behavioural Hypnotherapy. Like many other winning combinations it appears that either approach used alone is reasonably effective for many people, but when used in conjunction by properly trained therapists the effect is dynamic. So, as someone who has been practicing this approach with my clients for over 5 years, as well as lecturing it at the College of Cognitive Behavioural Hypnotherapy (CCBH), I thought I would attempt to explain why this should be the case…

Our minds are wonderful, creative, aspects of ourselves. When we are struggling to deal with difficult issues such as depression and anxiety, crippling panic or low self esteem,  it is the way in which we think about the events, or ourselves, which is the biggest culprit in maintaining the problem. The cognitive approach helps you to take on the role of a Detective and examine the beliefs and thoughts, which you are holding on to so tightly that your behaviours, thoughts and feelings are becoming problematic for you. When this is combined with the relaxation of hypnosis, the new way of thinking is integrated at a deeper, unconscious level which, for most people enables the changes to take place more quickly.

Our unconscious or subconscious minds are where all our habitual thoughts and responses are held. When we relax with hypnosis there is a direct route to our subconscious, bypassing the more critical conscious mind. Hypnosis alone is very effective in helping people to ‘feel’ better, but unless the faulty thinking is changed, it is likely that when faced with the same or similar situation, the unwanted response will remain and re-emerge over time.  Cognitive Behavioural Hypnotherapy is designed to help a person get better.

 So, it is the combination of these two powerful approaches for change that is so effective for people dealing with emotional, behavioural and symptomatic problems.

 If you want to find out more about CBH, or are interested in becoming a CBH therapist, check out our website for CBH courses. At CCBH all the lecturers are practicing CBH therapists and are all MSc graduates from Goldsmiths College, University of London ensuring that the training students receive is of the highest standard.

 By Beverley Harper, Student Liaison and Lecturer at College of Cognitive Behavioural Hypnotherapy.

Feel Good Music

8 Apr

Fancy winning a one on one life coaching session, as well as a £50 Debenhams voucher? Then enter our “Feel Good Music” competition, and get thinking positively!

Cognitive Behavioural Therapy examines how unhealthy (negative) thoughts can affect our happiness and helps us change our attitude into healthy (positive) thoughts.  Unhealthy thoughts can be found everywhere, but a very common place for them is in song. So for our competition we want you to rewrite your favourite song, CBT style!

 How to enter the competition:

 First off, you need to “like” our Facebook page. www.facebook.com/ccbhlondon

Now this is the fun part, all you have to do is “re-write” one of your favourite songs that contains lots of negative thoughts. What you need to do is put a positive spin on it, CBT style…Then upload it to our Facebook page, either in the form of a status update, or if you are really confident, upload a recording of you singing your new version. Don’t worry, you don’t need to re-write the complete song, just one verse or chorus.

 You will need to include your name, the name of the song and the original artist.

 Before you get writing, we have compiled some helpful hints and tips and provided our own example songs, so read on for a little while longer.

 What are healthy lyrics?

  • Based on things that you want, while accepting that it is possible that sometimes we don’t always get what we want. 
  • Accept that bad things happen without catastrosphising the badness e.g. it’s really bad that I didn’t get what I want but the world has not ended. 
  • Acknowledge that we experience difficulty and frustration whilst remaining resilient e.g. it’s very tough but I am still alive and breathing.
  • Separate the worth of the individual from that person’s desire.  e.g. if a relationship breaks down, I believe that I am worthwhile person with or without that partner.

 Spotting some unhealthy lyrics which you want to avoid / change (hint there):

  • Based on ‘MUST’, ‘HAVE TO’, ‘GOT TO’, and ‘NEED TO’.
  • Inconsistent with reality and don’t accept other alternatives
  • Catastrophise the bad situation and underestimate the person’s ability to cope with the hardship.
  • Links the person’s worth to the condition the person is insisting on e.g. I must have love, and if not I am nothing.

 One last pointer. It’s all about ME, the song needs to accept that we are largely responsible for all our own emotions. It is not someone else who or the situation that causes them.  E.g. if you break up with someone, believe that it’s bad to be without love, but you remain worthwhile in spite of it.

 Here’s two we did earlier:

 1. Mariah Carey, I cant live (if living is without you)

 Unhealthy original:

I can’t live
If living is without you
I can’t live
I can’t give anymore
Can’t live
If living is without you

can’t give,
I can’t give anymore

CBT style healthy version:

 I can live
If living is without you
I can live
I can give, I can give some more … even if now it feels like I can’t

I can live
If living is without you

I can give,
I can give somemore

 Toni Braxton: Unbreak My Heart

 Unhealthy original:

 Don’t leave me in all this pain
Don’t leave me out in the rain
Come back and bring back my smile
Come and take these tears away
I need your arms to hold me now
The night are so unkind
Bring back those nights when I held you beside me

 CBT style healthy version – not a number 1 we agree but you get the idea

 I’d like you not to leave me in this pain

I’d like you not to leave me out in the rain … but you did

I’d love it if you came back as I would smile again

Please come back, I would stop crying

I really want your arms around me to hold me now but I don’t need them

I feel so bad at night at the moment but I know it won’t feel like this for ever

I wish for those nights when I held you beside me but you buggered off

  OK, we will never make it in the music industry, but you might…Let’s see how you do, good luck…

You can find the T and Cs here