How CBT Can Change How You Think, Act and Feel.

Using CBT to Think, Act and Feel Differently.

Cognitive Behavioural Therapies are the most researched of all the talking therapies. The term has come to encompass various approaches which work primarily with thoughts (cognitions), behaviours or both. These approaches have a good evidence base to support their use in the treatment of anxiety and depression and are approved by NICE. (The National Institute for Clinical Evidence)
This sort of approach has a number of advantages. Firstly it tends to be bring about change quickly thus courses of treatment tend to be shorter than is the case with many other approaches. Secondly, because this sort of approach is very structured, the techniques are capable of being standardised. This is helpful in a service where care is provided by a number of different providers. Another advantage is that you the client can learn to utilise the techniques on your own. This means that once you address one problem using these techniques it is likely that you will be able to go on to use the same approach in addressing other issues. In other words it teaches you how to be more psychologically resilient, to be, if you like your own therapist.
The cognitive element of CBT is about looking at thought processes and identifying and challenging thought patterns which are illogical, irrational or unhelpful. Once these have been identified and challenged they are replaced with with versions which are perhaps more balanced, true and most importantly helpful to you. Recognising this faulty thinking is called cognitive insight but it is only the beginning of change. The real challenge is to start to feel differently. This is sometimes described as knowing with our heart rather than our head. The behavioural part of CBT is about this shift. It is often only as we start to behave inline with our healthier thoughts and beliefs that we start to feel differently.
CBT is not a panacea though and it has also been criticised. A client has recently told me that CBT to her seemed only to be about changing behaviour and not emotion. Certainly there is a emphasis in this approach to looking at behaviour and thoughts. This can leave some clients feeling that this approach allows them little opportunity to explore their emotions.
Whilst changes in emotional state often follow from changes in behaviour and thinking sometimes clients find that ‘acting differently’ doesn’t translate into ‘feeling differently’. It is as if a part of them isn’t fooled and hasn’t changed. Though we might know in our head what would we should think or do our emotion be it anxiety, panic or depression is just too overwhelming for us to think or act differently. This is when other approaches such as hypnosis can be very helpful when used with CBT and I will explore this in future blog.

The Road to Hell is Paved with Good Intentions – Positive Intentions Behind Negative Behaviours

When working with unhelpful or unwanted behaviours it can be helpful to consider the original purpose or intention that the behaviour evolved to serve. One of the presuppositions of neuro linguistic programming (NLP) is that every behaviour has some positive intention behind it, or in other words it has at least at sometime served a positive purpose. NLP is of course a theory and this is a supposition not a proven fact. It does seem sensible, however, to assume that as human beings we seek to behave in ways that meet our needs, that is we do not deliberately self sabotage ourselves.

Accepting that we originally derived our behaviour in order to meet a need does not mean that we have to like or accept the behaviour. Indeed it may now be unhelpful or destructive to ourselves or others. Nevertheless, if we can identify and accept the positive intention that was behind it, this can help us to find more compassionate approach to change and one that results in changes that are more likely to be maintainable.

For example a person may overeat in order to meet the need for self-soothing, the need to ally boredom, or the need to be distracted from difficult thoughts or feelings. Recognising these needs allows us to consider whether they are any longer being served by the behaviour. It is much more likely that change can be sustained if alternative ways of meeting these needs can be found. When a behaviour, though unhelpful is continuing to meet a need this is also termed a ‘secondary gain’. For example secondary gains from anger might be feeling energised, feeling in control, or being able to maintain an emotional distance from others.

Secondary gains are often about getting more of something (e.g. power or attention) or about avoiding something we don’t like facing (e.g. difficult emotions, doing something that we are not confident about.)

Whilst we can sometimes recognise the positive intention of our behaviour at other times we may not be consciously aware of this. This is often the case when behaviours began in childhood. Children generally have less choice than adults when it comes to making meaning of their experience and meeting their emotional needs. For example the child who growing up in an unpredictable environment might meet their need to feel safe by striving to always behave perfectly or avoiding attention. This may result in the persistence of unwanted perfectionist or avoidant behaviour in later life.

As we grow our awareness of the world develops allowing for new meanings and choices to be made. Sometimes a part of us get stuck unable to move on this way. The therapeutic space is one in which we can start to recognise this and create for ourselves new meanings choices and behaviour.

Banking Our Good Times

As many of us return to work or studies after the Summer break, I have noticed that enquiries as to how friends and colleagues enjoyed their holidays have often been met with the reply ‘it was great but it feels like ages ago’. How is it then that pleasant memories, emotions and experiences can seem to fade from our memory so quickly once we find ourselves again consumed by our everyday pressures and worries?

We know that memory is highly complex. As neuroscience advances we are starting to become aware of the different areas of the brain involved in laying down, storing and retrieving memories. Whilst there is still much to learn, one thing that seems to have an important influence on our ability to remember situations and events, is the degree of emotion that we experienced at the time. Thus moments of intense joy are often easy to recall, as are those of intense embarrassment or repulsion. However recalling those of contentment or simple pleasure might prove to be more challenging.When we experience emotion our body responds to sensory stimuli in the environment with physical and chemical changes. When we re-create experiences through imagination or memory  these changes occur in response to not to outside stimuli but to those generated internally. Thus re might imagine or recall sounds, sights, textures, sensations or conversations.  As individuals we may find that we are better able to recreate some types of stimuli than others. You can try this out for yourself by trying to close your eyes and imagine these scenarios :

  • jumping from a metre high wall onto shingle
  • looking at of your front door
  • hearing the theme tune of a favourite programme
  • smelling your favourite perfume
  • the taste of your favourite food.

You may well have discovered that you have a bias towards noticing and recalling either visual, auditory or kinaesthetic information.

The good news is that we can become better at storing and recalling positive experiences. With practise we can become better at noticing, remembering and recalling the sensory information associated with experiences we would like to remember and re-experience.  Thus when we look at a photograph we might be reminded not just of a beautiful scene, but also of the feel of the sun or wind on our face, the sound of the waves or the birds, the colours and textures of the sand and the sea. We might also start to notice our heightened stature when someone praises us, or how we register feelings of peace or contentment in our body. With practise we can start to recognise and re-create the thoughts, pictures in our mind or physical gestures that can help us to re-experince those feelings.  In short we can learn to savour our experiences more and to enjoy them again, keeping us going until the next holiday!



Working with Our Somatic Intelligence

Joe the horse (see previous blog) demonstrated his emotional intelligence by identifying and responding to tiny physiological changes in those around him. These changes occur largely unconsciously and are a result of our somatic intelligence responding to the world around in ways programmed by our previous experience and our beliefs.  Our somatic intelligence speaks a different language from our cognitive intelligence. It is one not of verbal language and socially constructed thinking but one of ‘felt sense’ or ‘embodied knowing.’ We acknowledge its presence when we refer to having experiences such as a ‘gut feeling’, a ‘weight lifted’ or a sense that something ‘sits right’. Because we have become less familiar with and ‘tuned into’ this type of intelligence, we are often deaf to its more subtle nudges, often only responding when flooded with unwanted psychosomatic symptoms.

Our emotions, thoughts and behaviours are intricately connected, and as we, as therapists, work with our clients to engender change in any one one of these so we might see their whole system begin to shift. Often it is a change in a way of thinking or behaving that is the catalyst for this type of change and this is the stuff of the behavioural and cognitive therapies. However, this kind of approach can have limitations if the cause of our distress is largely out of our conscious awareness.

Increasingly these approaches are acknowledging and integrating approaches from more ancient and traditional wisdoms. Mindfulness, meditation, hypnosis, and the use of metaphor, gesture and movement, allow us to tune in to the more subtle language of the somatic intelligence and to utilise it in ways that complement our cognitive intelligence. These approaches seem to allow us to widen our consciousness, giving us access to, and allowing us to adjust, learnings that he have hitherto been stored unconsciously. We begin a dialogue between the different parts of our intelligence and are able to make subtle adjustments to bring them into an alignment. Shifts and insights are made and healing allowed to occur. When we seem have sudden moments of insight, or creativity, when things suddenly seem to ‘come together’, a process of learning has been going on much of it consciously but often the crucial step unconsciously. In a similar way our journey of self-development or therapeutic change might be largely a cognitive, intellectual process, and yet it may be our unconscious mind or somatic intelligence that facilitates us in taking our most crucial steps.

Clever Joe and Emotional Intelligence

I was reminded recently of the story of Clever Joe. Clever Joe was a horse who became famous some hundred or so years ago, on account of his astounding intelligence (well, astounding that is for a horse!) His ability to follow simple instructions, such as ‘go to the lady in the hat’, and to apparently solve simple sums, stamping out the answer with his hoof, amazed people, all the more so because he was able to achieve these feats whether it was his owner or a stranger giving the instructions. However, when the person instructing him stood out of view behind a screen Clever Joe was no longer able to perform, and actually became rather agitated. His abilities, it seemed, were not due to his ability to understand human language or to do mathematics, but rather to his extraordinary talent for observing non-verbal cues from those around him. By observing the tiniest of signals, a twitch of the corner of the mouth, a flicker of tension in the shoulders, the horse could tell that this was the right person or number. Clever or not? Maybe not in the sense that it was first thought, but in another, Joe was more intelligent than most humans. He was, and many animals are, extremely emotionally intelligent.

Emotional intelligence is the ability to recognise and respond to emotion in ourselves and others. Since emotion is expressed physiologically, this means being aware of ourselves as physical beings, and of the subtle changes which happen, as the physical and chemical changes that constitute emotion occur in our bodies. Sometimes our emotional response to situations can seem to be at odds with our reasoning or thoughts about it, for example feelings of nervousness in a situation which we know rationally to be safe. In these situations emotional distress can occur because different parts of our intelligence seem to giving us different information. The famous psychiatrist Milton Erickson, regarded by many as the father of modern hypnosis, said that clients come into therapy when their conscious minds are in conflict with their unconscious minds. Uncomfortable emotions can often indicate to us that there is something we need to attend to or revise, perhaps a generalised rule, assumption, or response which was once helpful to us, but is now no longer so. The therapeutic space is one in which we can learn to recognise our emotions, and choose how we wish to respond to the feedback that they give. Thus we can start to utilise different parts of our intelligence in a complementary way, in moving towards our goals.