View Full Version : CBT as I see it.
I thought what I did was CBT but apparently not. It has all the elements but not in the same order. But it works so here is the order and why.
1 relaxation techniques:
Box breathing, Progressive muscle relaxing, Relaxing teas. (valium if you use it and SSRI's)
2 coping skills:
Distractions which includes stacking, (meditation etc if you use it) I now would add mindfulness here which I did without having a name for it.
3 core beliefs:
Here is where I deviate from other CBT. With relaxation and coping skills you can now look at why the attacks are happening. And since core beliefs control our every thought and action you need to know which are false and which are true and accept the true ones no matter how painful. You also need to know about memory, it's parts, and how it works.
4 changing thought patterns: this is cognitive restructuring. This is more than just changing negative to positive. It is changing attitude and outlook. It is changing how you see your triggers not changing the triggers themselves, they are not the problem. (but my triggers make me panic. False, how you see your triggers makes you panic. you can change that)
5 exposure: Here you are not using it as a cure. At this point you need to be panic free and you should be so why do exposure if you already are? Because you need to see if you can put all the above into practice subconsciously. You need to see if you have actually changed or if you are still just coping. Coping is not a cure. Change is. Change is an actual locking the negative out and if it has happened exposure will do nothing. The trigger will be a fact you can disregard as harmless. All along the way there will be setbacks and this is normal after all you are making some major changes to how you think.
Pros: you have the potential to never have another panic attack or if you do they will be mild and you will shut them down in seconds.
Cons: It takes time where exposure therapy is faster but not permanent.
In future I will refer to this as complete cognitive reconstruction (or recovery if you want) therapy. CCRT for short.
If you want life back as it was this can do it.
I really like what you say about changing how you see your triggers not changing the triggers themselves. Could you give me an example as that would be even more helpful?
Many thanks
Agnes
Wow this is complicates because there is so much you need to know before cognitive restructuring makes sense. Things like what is posted in "words". See it is more than just changing negative to positive because that can change back so fast. It is using positive repetitively till you build a priority pathway in your brain. The brain works on appropriate, it cares nothing if it is right or wrong, repeating positive makes them appropriate. If wrong is appropriate it will use it just as easy as right. It is about closing gates to unwanted thoughts and locking them so you won't open them again.
Changing thought patterns can be as simple as "want to" verses "have to". This is posted here as a cure for agoraphobia. (fear of not being in control, fear of fear) "want to" is positive. You can do any thing if you want to. Stop here and think about it how many times do you do things with ease because they are the things you like to do and want to do. Now take that same thing you like to do and put a condition on it. Say you "have to" do it at a certain time when you really would rather not. You can do it and probably will but not as easy as you would If you want to.
The mantra, "I'm doing this because I really want to, I don't have to, I want to." Add on, "I can do this because I want to" and you can go to the store. The mantra is part distraction as a coping skill but also cognitive because done ten times it starts to become appropriate in your memory and your hippocampus will use that thought to bypass The fear centre Amygdala and send the message directly to Hypothalamus with out instructions for the pituitary gland so no panic symptoms. The difference between this and exposure even though they look the same like have to and want to look the same is that exposure forces you to face your fear, cognitive restructuring takes away the fear so there is nothing to face. In a short time it becomes permanent and the trigger no longer gets the same reaction. It is still there but in a different way. A store just becomes a store, something you use because you want to now. Does this make sense. You did the same process to install panic now you will do it to remove it. The first time you use want to it may only partially work because the negative gate is still open. but if you think "that was better" that helps to instal it. Some people say it worked right away some it took a few tries and some are so negative in attitude it can't possibly work. "words" is seven pages expanding on this theme with input much appreciated from others.
Thank you so much, Davit. Your post makes so much sense to me and I can see exactly what you mean. I need to keep rereading it to ensure that I've grasped it fully and then begin to try to apply it. I'm just trying to work out which symptom, initially, to apply it to. I've become so anxious and sensitized over the past couple of months that it's quite hard to isolate one particular trigger with which to begin. I feel like a bundle of anxiety at present, with one symptom after another taking over. I'm not agoraphobic but, internally, I'm almost constantly fearful over so many things, usually health or death related and this leads to incredible panic. But you've given me something to work with.
I'm just thinking, this approach is almost a form of acceptance, isn't it? Say, for example, I tell myself that I want to feel one of my particular triggers, that it's my choice and I restructure my thought process about it so that it doesn't start off the anxiety spiral, or secondary fear, is it acceptance or am I misinterpreting what you're saying? I know that I want to absorb what you wrote in your post, so I may well be jumping the gun a little in saying that.
You have accepted there is a problem already. You know you have anxiety but you don't know why. So you have three questions, where did it come from. Core beliefs. Why. and thirdly is it true.
If you fix one trigger the rest will fall like dominoes because your mind will choose positive over negative in all cases as appropriate. just as it is choosing negatives now that are causing anxiety.
So pick one trigger and what circumstances cause the symptoms. Where does it come from, and why these symptoms. Both are from memory as core beliefs. Remember the trigger only opens memory, it is harmless otherwise. Terry has information on core beliefs posted.
Now the question "is it true" is important because it might well be and you don't want to accept it.
This is a good thread Dave. This can help everyone, as well as the 'Words' and 'Core Beliefs' threads.
I have trouble with the acceptance of the things that are true.
Did you notice the ratings. Someone likes them.
Yes I hope it helps people. Too many young people on pills.
MyNameIsTerry
08-05-15, 05:38
Did you notice the ratings. Someone likes them.
I've rated them all. Hardly anyone seems to rate threads on this forum so it will help them to stand out.
Things are done is isolation on this forum so they disappear quickly and I think people need to be more involved in discussing how to recover as its mostly about individual situations where things are going wrong which means the advice also quickly disappears.
MyNameIsTerry
20-05-15, 06:09
Davit,
Is this one similiar to your panic triangle?
http://upload.wikimedia.org/wikipedia/en/1/1c/Depicting_basic_tenets_of_CBT.jpg
No There are quite a few of these, some have more corners. The anxiety triangle has three corners too but that is all it has in common.
Lets see if I can paste it.
Excellent post.
How do you rate it
It's at the top of the thread to the right hand side there's an option to Rate
MyNameIsTerry
23-05-15, 08:19
When you add a post there are also a few extra boxes underneath in the Go Advanced post option and one of them allows you to rate a thread.
---------- Post added at 08:19 ---------- Previous post was at 08:11 ----------
Lets see if I can paste it.
Thanks, I couldn't make it out when you posted it before as it was a bit small so it became too blurred when magnified.
I haven't seen this one before. The CBT one seems to be very common across the internet and it doesn't seem to vary much and never includes the memory aspect. Is this something we should be getting handed out in our CBT?
This brings me onto another criticism I have of IAPT. Where are the handouts? When I had Guided Self Help, I was given several booklets & exercise sheets at the assessment to get me started and then she sent a couple more in the post later. I can't recall having any in CBT. It would have been very useful to see the things I often post from the psychology tools website.
Another criticism I have is that in the NICE Stepped Care Model it shows CCBT for Level 2. Level 2 covers Guided Self Help. CBT therapy is Level 3. So, why aren't our GP's telling us we can use them? Would I be right in guessing they track the GP's reference number so it is chargeable hence we are losing out due to bean counting?
NHS Choices also advises the use of the Book Prescription Scheme. Its a very small list and includes some CBT books. It also includes Claire Weekes which I don't think is very appropriate thesedays given the NHS is supposed to be advocating evidence-based therapies! Why are GP's not issueg these prescriptions? I had one off my Guided Self Help lady for an OCD book. My GP could have got me started months before!
:mad:
ive been reading this post with interest and would like to ask a question about core beliefs as I don't really know what that really means sorry if i seem a bit dumb, but ever since i started suffering with anxiety 9yrs ago i believed that the feelings and symtoms of anxiety can harm me. even tho i know deep down it cant harm me and tell myself all the time that its ok its only anxiety it cant harm me and im ok, but that belief it can harm me is still there. so is that a core belief as im not sure that is why im keeping the anxiety going.
MyNameIsTerry
23-05-15, 11:44
Hi Tricia,
I think Davit will be able to explain this better as he understand them far more than I do.
But it could be a core belief or it could be what is known as an "attached core" which simply means it is attached to the real core belief and is fueled by it.
If you think of a flower, think of the attached core as being one of the petals and the true core belief would be the centre. So, you can have several attached.
Davit says that in order to eliminate these, the core belief must be addressed and the attached cores will fall away with it. This makes sense because in ERP they also say the same, the therapist needs to search for the true problem and address that, with an exposure hierarchy not what the client is telling them is the issue.
So, if you think about how you are afraid of the symptoms (which is true of many of us, me included) it could be the core, or it could be an attached core and the core could be something like fearing losing control. Then you may get another attached core (petal) forming such as being afraid of being sick in public or fainting or something like that. Does that make sense?
Hopefully Davit agrees.
Until he comes back on later, have you read the Core Beliefs thread on this board? A couple of us have attached some links to the CCI website that has various workbooks that explain all this and how to change/modify them. They are worth a read.
Sunflower2
23-05-15, 11:50
Terry, I did get a LOT of handouts with my cbt, and I had homework to do every week. For a while I had about 4/5 different things I was having to do in one week. I've posted this before, but this is where my psychologist got her resources from and I continue to use them.
http://www.getselfhelp.co.uk/gallery.htm
Do you think a reason why cbt doesn't go far enough is because the anxiety itself makes you doubt that you can feel better by thinking differently? I know when I am absolutely full of panic, my thoughts towards cbt are quite negative and I tend to think it's useless. Then I fill in a thought challenging sheet and am surprised at how different I feel.
Terry
The triangle up till now has only been available to therapists, which is where I got it from. There should be two more things added to it. Between the first and second corner should be a survival check, where Hippocampus decides if the thought should go to Amygdala before memory and between the second and third core beliefs because they can stop you from making the change you need. I would and probably will redraw it with these added, but if it gets too complicated it won't be understandable.
There are more emotion triangles and circles because it has always been thought emotions cause anxiety rather than modify it.
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tricia
Core beliefs do a number of things and most of these things we don't even know we are doing. Like how and why we structure our day and our life overall. You build them starting around nine days after birth. And you will use what you build for the rest of your life. The first ones you build can be damaging because you have nothing in memory to compare what you are seeing to. These you build off other people you trust. So if at an early age you build a core that says you are something you are not you will believe it and use it even though it is not true. The mind works with appropriates, it doesn't care if they are right or wrong. It can't tell anyway since it can only work with what it has. But even if you know you have some negative core beliefs and you know what they are and you try to change them they are often only the petals on the flower. Often there is a core saying they should be believed. So they come back. They need to be followed to the root and that one changed and all those related to it change with it. And they don't come back. Not all core beliefs are negative you have some controlling routine and some controlling what makes you happy. Core beliefs are just things you believe except some beliefs, like the sky is blue don't influence. Where as a core belief that you can not eat bananas would. Or step on cracks, or that you are going to get Cancer. If they are not definite then they are negative and you want the belief that caused them in the first place.
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Kimberly
It is natural to believe it is something else's fault rather than us. This is a core we pick up from others at a young age and one we add falsely because at an early age we can't distinguish between venting and fact. A lot of cores are built this way. So if some one says "this is stupid it never works" to everything then you start to think this is how things are. But here it is venting not fact, but treated like fact. The damage is in that most cores are subconscious and do their influencing there. So instead of asking yourself why it isn't working you blame it. Filling out your thought challenge sheet corrects that but not the core because the core has a root and that root is believing the person that gave you that core in the first place. That is the one you need to challenge.
So with core beliefs having this much influence how can any CBT program get anywhere without dealing with them.
MyNameIsTerry
24-05-15, 08:04
Terry, I did get a LOT of handouts with my cbt, and I had homework to do every week. For a while I had about 4/5 different things I was having to do in one week. I've posted this before, but this is where my psychologist got her resources from and I continue to use them.
http://www.getselfhelp.co.uk/gallery.htm
Do you think a reason why cbt doesn't go far enough is because the anxiety itself makes you doubt that you can feel better by thinking differently? I know when I am absolutely full of panic, my thoughts towards cbt are quite negative and I tend to think it's useless. Then I fill in a thought challenging sheet and am surprised at how different I feel.
I did homework but it was either to document things like my rituals or create hierarchies for exposure or Behaviour Activation. Thats pretty much all we seemed to be doing outside of session.
I tend to use this one that I found http://psychology.tools/download-therapy-worksheets.html which also has some condition specific links towrds the bottom and these have much more in such as workbooks,vids, etc as well as the specific tools from the worksheets list.
I think severity does play a big part and this must be why NICE have a combined drug & talking therapy section which is normally applied after talking therapy alone fails. I was just too anxious to fully engage with it and I really struggling with change so it was veyr hard to do tasks, especially with my issues over strict daily routine which were fighting it all the way.
Hippocampus does the check and Amygdala and Hypothalamus are the choices, With it being either straight to Hypothalamus and it's part in memory or to Amygdala and Amygdala gives hypothalamus instruction based on Amygdala's memory which is separate from other memory. Hypothalamus then uses it's memory of past reactions to make a decision so the function of the triangle is the same just one way it is preloaded negative because that is all Amygdala can do.
My therapist is in a small group who believe in a different CBT, maybe the triangle isn't accepted by conventional CBT. It may be on the internet, just buried under so much more common stuff. Without a sponsor paying the bill it would not have priority. Unless wickipedia picks it up it would stay buried.
The emotions triangles would share space with the second corner of the thought triangle because they influence thought. In fact there could be quite a large amount of stuff hung off the triangle if we added everything that had influence. Negative or positive influence.It could get very complicated and therefore for most people just confusing.
Simply as it is it shows where to change thought and why.
---------- Post added at 09:41 ---------- Previous post was at 09:37 ----------
If hippocampus decides there is danger and sends the message to Amygdala you would get the spikes which would make things worse. Of course this is fine if there is actual danger, and not just perceived danger from a core belief hippocampus is using as a guideline for its actions.
MyNameIsTerry
25-05-15, 06:59
Terry, I did get a LOT of handouts with my cbt, and I had homework to do every week. For a while I had about 4/5 different things I was having to do in one week. I've posted this before, but this is where my psychologist got her resources from and I continue to use them.
http://www.getselfhelp.co.uk/gallery.htm
Isn't is bizarre how they don't have NHS branded ones? There is a NHS Scotland Moodjuice one for Panic & Agoraphobia that I've used on here fair bit as it has some useful explanations and tools in, I'll post it on here so Davit can have a look. I haven't checked on Moodjuice on NHS Choices to see if there are others though, never thought of it to be honest!
Here it is:
http://www.moodjuice.scot.nhs.uk/Anxiety.asp
Its not a bad guide. If you follow it this way it does deal with exposure but under avoidance instead of ERP specifically. The relaxation comes mid way by the looks of it which doesn't make much sense after all the Thought Records have already been used.
MyNameIsTerry
08-06-15, 07:40
Bump
MyNameIsTerry
23-06-15, 04:39
Bump
I bumped these so some one in pm who wants to read them can find them easier in the panic forum, not for my ego if anyone should think that. Not everyone can surf this site with ease.
lindy lou 2
04-07-15, 18:58
I have to keep reading this & absorbing it. I think I am getting on the right path, I wanted to go to the shop today, & I manged it fairly easily. Will keep reading & absorbing
Thanks.
MyNameIsTerry
02-08-15, 08:54
Nic has updated the links for CBT4PANIC so I thought it worth a look to see how they do their CBT.
I was really pleased with what I saw. It makes a point of stating that they don't simply try to expose people to situations in order to overcome them as they recognise they do that everyday and it doesn't work. They mention use of Behavioural Experiments which can be a little bit of an expose but they are controlled in a way that you are asked to question and detail your thoughts/feelings about the experiment. Whilst they don't always get you better, they do open your eyes and can help you to see that your beliefs are skewed.
So, from the short info provided, CBT4PANIC does in fact follow the common CBT protocol which is very big on Cognitive Restructuring (stage 2 of CBT, I recall) just as Davit has been saying throughout.
Nic has stated that NMP are believers in this programme because it is true to CBT.
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