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CBT and Guide to Brief CBT Self-help

CBT

Cognitive Behavioral Therapy (CBT) refers to widely recognized, effective psychological treatments for treating many psychological disorders and, more specifically, is very effective for anxiety disorder treatment. Firmly based on scientific evidence, CBT focuses on the ways that a person’s thoughts, emotions, and behaviors are connected and affect one another. The CBT therapist and the client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself. The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.

(Adapted, by permission, from the Association of Behavioral and Cognitive Therapy website, 2017.)

 

Our thoughts influence our feelings and actions.

 

Brief CBT Self-Help Protocol for Anxiety

You might wish to try out CBT as self-help if you don’t feel able or ready yet to engage in therapy but are determined to do what you can to overcome disturbing anxiety and worry.  CBT is most effective and precise when executed through dialogue with a skilled therapist with expertise in CBT, but people often find they can benefit from self-help cognitive therapy and behavioral interventions (like focus on the breath) implemented as self-help. If you would like a taste of CBT perhaps you’d like to begin here.

For more information on CBT, or to make an appointment, call David Mellinger, MSW at 818-716-1695.

Brief CBT Self-help for Anxiety, Panic, & Over-worry

This brief self-help protocol is designed to help you reduce disturbing anxiety enough to feel free from its grip. Try to follow this protocol faithfully.

You’ll learn select procedures of decentering, cognitive reappraisal, and overcoming sticky thinking.  Decentering is a mindfulness- and acceptance-based CBT technique for enabling a person to “step outside of his or her anxious thoughts and feelings enough to see them as just coming and going, rather than getting carried away by them.”  (Goleman & Davidson, 2017, pp. 196-197).

Anxiety is both driven by disturbing, irrational thoughts and perpetuated by getting you caught up in these thoughts and anxious feelings.  Cognitive reappraisal techniques will help you notice, identify, and remedy errors in your thinking that contribute to your anxiety – like over-generalization (e.g., “I almost had heat stroke once, so I’m too afraid to go out whenever it’s very hot.”) and catastrophic thinking (e.g., “I keep getting headaches lately. What if I have brain cancer?”). The brief acceptance- and mindfulness-based CBT procedures will help untangle you from the sticky thinking and feelings that keep you caught up in a state of anxiety.

What Can Improve?  By following the protocol – acknowledging when you’ve become anxious and pressing the pause button on your upwardly spiraling anxiety – you may discover that nothing really bad is about to happen and expand your awareness of what’s actually going on. Brief, mindful breathing will help you settle your state of mind and abide in the here and now [Mellinger (2017), FTAW Anxiety Workshop].  Clearing the tangle of your anxiety-laden thoughts by taking these steps is like disconnecting the main power from an old house with seriously short-circuited wiring:  It opens a window of opportunity to rethink scary thoughts more clearly and less fearfully.  Then you can cope well enough and decide what’s best to do next. Here’s how you do it:

The Protocol

> Acknowledge when you’re anxious, worried, or panicky.

> Check your anxiety in the here and now.

> Press the Pause Button.

> Engage in brief, mindful breathing.

> Remedy distinct thinking errors.

> Practice Resilience.

 

1. Acknowledge

First, acknowledge that you’re feeling worried or anxious. “Acknowledging” means “letting yourself know,” and knowledge is a powerful antidote to fear.

Whenever you’re feeling any form of disturbing anxiety – worry, self-blame, fear of an anxiety attack, a disheartening thought or feeling – simply acknowledge it with a quiet “mental” voice and label it with a simple label, such as “worrying myself sick”, “panic”, ‘’what-if’ thinking“, “dwelling”, or “beating myself up.”

 
2. Check your anxiety.
Now ask yourself whether there’s really anything to be afraid of right now. Answer either “yes” or “no”.If there seems to be no reason to fear, perhaps what you’ve already accomplished is good enough.If you find you’re still anxious or afraid, then move on to the next step. Try not to get caught up. No need to overthink it.
 

3. Pause

Next, press the “mental pause button”:

Pause whatever anxiety-driven story or imagining has been going through your mind and, for a few moments, suspend your catastrophic thinking or chaotic, panicky thoughts.  A useful visual aid is to look at two fingers that you hold up vertically, parallel to each other – replicating the “Pause Button” symbol in your electronic devices.

     This “therapeutic pause” enables you to put on hold the momentum of pressurized anxiety. Stop in your tracks, briefly explore your feelings, and allow the higher-functioning, executive portions of your brain to re-engage in making better sense of things.

 

4. Engage in Brief, Mindful Breathing

After pausing, as above, and intentionally interrupting the nonstop flow of your thoughts and behaviors, “stop for a few seconds, take three conscious breaths, and move on. . . [Perhaps say “in” to yourself in a quiet mental voice when you breathe in and “out” to yourself when you breathe out.]. Pause and allow this interlude to be a gap in whatever you’re doing.  Don’t make it into a project.” [adapted from Pema Chödrön (2009), Taking the Leap.]

The purpose of this brief practice is to create a momentary contrast between being completely self-absorbed and being awake and present.  Practice as often as possible, preferably numerous times a day.

 
mindful breathingPhoto credits: “Beach at Night with Moon and Stars” – Ko Li Pe, Thailand. Photo by Piith Hant, 16 April 2013
Brief, mindful breathing is the informal practice of concentration on the breath (COYB), a traditional practice often known as samatha (from the Sanskrit).  Formal practice of COYB is a cognitive and behavioral strategy for enhancing our capacity for helpful action to work with disturbing feelings.  It trains us to bring our attention to the here and now, steadies our minds, and enhances our awareness when entering or exiting emotionally charged situations.  I encourage you to consider formally practicing COYB, because it’s likely to enhance the effectiveness of your brief cognitive-behavioral therapy as self-help. Click here to learn the formal practice of Concentration on Your Breath.

 

5. Remedy Your Thinking Errors

Don’t believe everything you think:

Thoughts are not facts.

Below are four of the most frequent thinking errors that arise automatically during acute anxiety, panic, and disturbing worry, each with perspectives and remedies for modifying them and relieving your anxiety.  Why not study these errors and – as soon as you recognize they’re occurring – try out the remedies? You may find you have the power and skill to choose sensible thoughts over irrational, negative thoughts and gain the upper hand over anxiety.

 

Common Thinking Errors and Their Remedies

  1. Dwelling on false solutions to important problems “If I were better looking, I’d attract someone, and I wouldn’t be alone.” The more we dwell, the more real a notion seems, regardless of whether it’s rational. In this example, the reality of the matter is far more bittersweet and nuanced: Neither beauty, handsomeness, nor cosmetic surgery can curtail aloneness.
  2. All or Nothing Thinking – “It’s all my fault” is a classic all-or-nothing statement that illustrates looking at things in absolute, black-and-white categories. Your performance was totally good or totally bad; if you are not perfect, then you are a failure. This thinking error does not recognize shades of gray, only black or white.  We always, or at least very often, share only a portion of both the blame and the credit with others. 

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Formal Practice of COYB

The Formal Practice of Breathing Meditation: 

Concentration on Your Breath

Brief, mindful breathing is the informal practice of Concentration on the Breath (COYB). You can learn concentration on the breath most effectively by practicing formally, as well.  Follow the directions below, and try to practice at least daily.

COYB lies at the very heart of mindfulness meditation, a traditional practice whose purpose is to become mentally clear and capable of coping in healthy and effective ways.  Formal practice of COYB is cognitive and behavioral strategy which enhances our capacity for helpful action to work with disturbing feelings. It trains us to bring our attention to the here and now, steadies our minds, and enhances our awareness when entering or exiting emotionally charged situations.

From David I. Mellinger & Steven Jay Lynn (2015). Anxiety Smarts: Cutting Edge Strategies for Overcoming Anxiety and Worry. Unpublished Manuscript.
 

Acquaint yourself with your breath.  Find or create a place that’s relatively free from distraction to start your practice.  Seat yourself in a relaxed, upright position.  Notice your breathing and focus your attention steadily at the place in your body where your breath seems most vivid. Start getting to know your breath with its associated sensations – the movement of air through your airway, the sounds of breathing in and out, perhaps the coolness of the air going in, the warmth of exhaled air, or the motion of your nostrils, mouth, chest, diaphragm, and stomach.  Get acquainted with the ins and outs of your breathing and allow all else to glide into the background.

Our breath takes care of itself and of us.  Should you find yourself judging, simply remind yourself to return to observing or just following your breathing (“Where am I?  In…or out?”).  If you become panicky, remember that your breath takes care of itself and of you.  Our breath, controlled automatically and effortlessly by our cerebellums from deep within our brains, puffs wind into the sails of our vitality and sustains us.  So it’s simple: learn to find and follow the breath.  Allow your mind to chatter away in the background—and it will– while tuning back into your breath and keeping it center stage.

Crank Up Your Concentration.  Begin each practice by verbalizing your intention to focus on every breath and to notice whenever your mind wanders.  Spend a few moments putting everything else aside and then just think about the breathing. Breath in, breath out, counting each set until you count set #7, and then start back at 1, and continue like that.  Notice when you get distracted, disengage for a moment, and start again.  Recognizing distraction heightens your awareness of when you’re mindful of your breathing and when you aren’t.   Once you find you can sustain your concentration long enough to count 10 to 15 breaths, then try to maintain your concentration without the counting.  Just keep your body relaxed and balanced, work with your attention riveted to the present, to the extent possible, and see what you can accomplish.    

Try practicing for a total of about ten or fifteen minutes every day, and longer, if you can manage it.  Start each practice by verbalizing your intention to become more familiar with your breath and conclude by engaging in a little reflection.  Remember the idea of openness?  Allow yourself to be open to the totality of your experience—all of it:  Stick with it, and you’ll probably notice slow and steady improvement in your ability to concentrate.


Remedy Your Thinking Errors

Common Thinking Errors and Their Remedies


Remedy Your Thinking Errors
Don’t believe everything you think:

Below are four of the most frequent thinking errors that arise automatically during acute anxiety, panic, and disturbing worry, each with perspectives and remedies for modifying them and relieving your anxiety.  Why not study these errors and – as soon as you recognize they’re occurring – try out the remedies? You may find you have the power and skill to choose sensible thoughts over irrational, negative thoughts and gain the upper hand over anxiety.


Thoughts are not facts.

 

Common Thinking Errors and Their Remedies

 

  1. Dwelling on false solutions to important problems “If I were better looking, I’d attract someone, and I wouldn’t be alone.” The more we dwell, the more real a notion seems, regardless of whether it’s rational. In this example, the reality of the matter is far more bittersweet and nuanced: Neither beauty, handsomeness, nor cosmetic surgery can curtail aloneness.

  2. All or Nothing Thinking – “It’s all my fault” is a classic all-or-nothing statement that illustrates looking at things in absolute, black-and-white categories. Your performance was totally good or totally bad; if you are not perfect, then you are a failure. This thinking error does not recognize shades of gray, only black or white.  We always share only a portion of both the blame and the credit with others.

    Remedy this error by honestly evaluating the negativity of your actions on a range from 0 to 100; recalling any neutral and positive actions, and then correcting your perspective (from David D. Burns (1989), The Feeling Good Handbook. New York: Penguin, 1989.)

  3. Catastrophizing – Catastrophizing is the essence of disturbing anxiety – potent, irrational thinking that arises “automatically” when our vital concerns or values seem jeopardized. Catastrophic thinking can make us feel like major upheavals or personal disasters are in the works and activate our instinctive “fight, flight, or freeze” reaction – despite the absence of solid evidence that a catastrophe actually will  Ask yourself earnestly, “Where’s the evidence?”
  4. Wild Ride in the Time MachineMuch anxious disturbance involves irrational fear of future plans and events. When we travel through time in our thoughts, it’s very easy to have wrong emotional reactions when you aren’t in the Here and Now. Deliberately return yourself to the present. Breathe in, pay attention, breathe out, pay attention – gather yourself and experience this moment mindfully. For now, just acknowledge and accept what really is.  This isn’t a time to judge yourself.

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