Cognitive Behavioural Therapy (CBT)

What is CBT?
It is a way of talking about:
How you think about yourself, the world and other people
How what you do affects your thoughts and feelings.
CBT can help you to change how you think ("Cognitive") and what you do ("Behaviour)". These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the "here and now" problems and difficulties. Instead of focussing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
When does CBT help?
CBT has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue.
How does it work?
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:
A Situation - a problem, event or difficult situation
From this can follow:
Thoughts
Emotions
Physical feelings
Actions
Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it. There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them.

For example:
Situation:
You've had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you.

Unhelpful
Helpful
Thoughts:
He/she ignored me - they don't like me
He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?

Emotional:Feelings
Low, sad and rejected
Concerned for the other person
Physical:
Stomach cramps, low energy, feel sick
None - feel comfortable

Action:
Go home and avoid them
Get in touch to make sure they're OK

The same situation has led to two very different results, depending on how you thought about the situation. How you think has affected how you felt and what you did. In the example in the left hand column, you've jumped to a conclusion without very much evidence for it - and this matters, because it's led to:
a number of uncomfortable feelings
an unhelpful behaviour.
If you go home feeling depressed, you'll probably brood on what has happened and feel worse. If you get in touch with the other person, there's a good chance you'll feel better about yourself. If you don't, you won't have the chance to correct any misunderstandings about what they think of you - and you will probably feel worse. This is a simplified way of looking at what happens. The whole sequence, and parts of it, can also feedback like this:

This "vicious circle" can make you feel worse. It can even create new situations that make you feel worse. You can start to believe quite unrealistic (and unpleasant) things about yourself. This happens because, when we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.
CBT can help you to break this vicious circle of altered thinking, feelings and behaviour. When you see the parts of the sequence clearly, you can change them - and so change the way you feel. CBT aims to get you to a point where you can "do it yourself", and work out your own ways of tackling these problems.
"Five areas" assessmentThis is another way of connecting all the 5 areas mentioned above. It builds in our relationships with other people and helps us to see how these can make us feel better or worse. Other issues such as debt, job and housing difficulties are also important. If you improve one area, you are likely to improve other parts of your life as well. "5 areas" diagram.
What does CBT involve?
The sessionsCBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme. In England and Wales two computer-based programmes have been approved for use by the NHS. Fear Fighter is for people with phobias or panic attacks, Beating the Blues is for people with mild to moderate depression.
If you have individual therapy:
You will usually meet with a therapist for between 5 and 20, weekly, or fortnightly, sessions. Each session will last between 30 and 60 minutes.
In the first 2-4 sessions, the therapist will check that you can use this sort of treatment and you will check that you feel comfortable with it.
The therapist will also ask you questions about your past life and background. Although CBT concentrates on the here and now, at times you may need to talk about the past to understand how it is affecting you now.
You decide what you want to deal with in the short, medium and long term.
You and the therapist will usually start by agreeing on what to discuss that day.

The work
With the therapist, you break each problem down into its separate parts, as in the example above. To help this process, your therapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out:- if they are unrealistic or unhelpful- how they affect each other, and you.
The therapist will then help you to work out how to change unhelpful thoughts and behaviours
It's easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend "homework" - you practise these changes in your everyday life. Depending on the situation, you might start to:
Question a self-critical or upsetting thought and replace it with more helpful (and more realistic) one that you have developed in CBT .
Recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
At each meeting you discuss how you've got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don't seem to be helping.
They will not ask you to do things you don't want to do - you decide the pace of the treatment and what you will and won't try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished. This makes it less likely that your symptoms or problems will return.

How effective is CBT?
It is one of the most effective treatments for conditions where anxiety or depression is the main problem
It is the most effective psychological treatment for moderate and severe depression
It is as effective as antidepressants for many types of depression

What other treatments are there and how do they compare?
CBT is used in many conditions, so it isn't possible to list them all in this leaflet. We will look at alternatives to the most common problems - anxiety and depression.
CBT isn't for everyone and another type of talking treatment may work better for you.
CBT is as effective as antidepressants for many forms of depression. It may be slightly more effective than antidepressants in treating anxiety.
For severe depression, CBT should be used with antidepressant medication. When you are very low you may find it hard to change the way you think until antidepressants have started to make you feel better.
Tranquillisers should not be used as a long term treatment for anxiety. CBT is a better option.
Problems with CBT
CBT is not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for you.
If you are feeling low, it can be difficult to concentrate and get motivated.
To overcome anxiety, you need to confront it. This may lead you to feel more anxious for a short time.
A good therapist will pace your sessions. You decide what you do together, so you stay in control.

How long will the treatment last?
A course may be from 6 weeks to 6 months. It will depend on the type of problem and how it is working for you. The availability of CBT varies between different areas and there may be a waiting list for treatment.
What if the symptoms come back?
There is always a risk that the anxiety or depression will return. If they do, your CBT skills should make it easier for you to control them. So, it is important to keep practising your CBT skills, even after you are feeling better. There is some research that suggests CBT may be better than antidepressants at preventing depression coming back. If necessary, you can have a "refresher" course.

So what impact would CBT have on my life?
Depression and anxiety are unpleasant. They can seriously affect your ability to work and enjoy life. CBT can help you to control the symptoms. It is unlikely to have a negative effect on your life, apart from the time you need to give up to do it.

How can I get CBT?
Speak to your GP. They may refer you to someone trained in CBT - for example, a psychologist, nurse, social worker or psychiatrist.
The British Association for Behavioural and Cognitive Psychotherapies keeps a register of accredited therapists.
You can try 'self-help' - using a book, internet programme or computerised CBT. This is more likely to work if you also receive support from a professional.

What will happen if I don't have CBT?
You could discuss alternatives with your doctor. You could also:
Read more about the treatment and its alternatives.
If you want to "try before you buy", get hold of a self-help book or CD-Rom and see if it makes sense to you.
Wait to see if you get better anyway - you can always ask for CBT later if you change your mind.

CHANGE VIEW: 10 key facts about CBT
Change: your thoughts and actions
Homework: practice makes perfect
Action: don't just talk, do!
Need: pinpoint the problem
Goals: move towards them
Evidence: shows CBT can work
View: events from another angle
I can do it: self-help approach
Experience: test out your beliefs
Write it down: to remember progress


-Psy.Visesh,
Treasurer, APCPA,
94401 35779

An Early Psychologist: The Buddha

Buddhist Psychology is based on the example and teachings of the man who came to be called "The Buddha." In many ways the teachings of the Buddha, known as "the dharma," sound more like psychology than what most of us think of as religion. Who was he; what was his story?
Born more than 2500 years ago, the Buddha was born a prince in a small kingdom in northern India. The king, following tradition, asked a soothsayer to offer predictions about his son's future. He was told that his son would grow up to be either a great spiritual teacher or a great monarch. The king, like many powerful men, wanted his son to follow him in the family business. To that end, the king made sure that his son, who was known then as "Siddhartha," didn't hear about spiritual things. Instead, he made sure that the young prince was surrounded by every possible luxury and pleasure. There were musicians and dancing girls, rich fabrics and clothing, delicious foods and fine wines. He lived within the walls of the palace compound and was indulged in all of his desires-as long as they didn't have anything to do with spirituality. Even more, he was protected from seeing anything unpleasant.
Once, when the king had a festival to oversee, he took his son along. The boy was left sitting under a tree while the king attended to his royal duties. Tradition has it that Siddhartha sat under a rose apple tree and had an experience of being simply present and awake. He glimpsed the nature of reality-what we have called "brilliant sanity" in an earlier blog entry. In that moment he was clear, open, and filled with compassion for all beings. And then, the moment passed and was forgotten-as such moments often are for all of us.
As young Siddhartha grew to become a man, he became curious about what lay beyond the palace walls. He convinced his chariot driver to take him on a tour outside the walls. That trip changed his life. There are many versions of that chariot ride, but they all agree that the prince saw things he had never seen before, living as he had in a protected, royal environment. He saw an old man-wrinkled and stooped over. Imagine if you had never seen an old person. How strange he would look! The prince asked his driver, "What is wrong with that man?"
"He is old. If we live long enough, all of us will grow old and look like that."
Next he someone who was sick. Perhaps he saw a woman who was young though barely able to walk, who was gaunt and feeble, whose skin was covered with sores. "What is wrong with her?" he may have asked.
"She is ill. We all become ill."
Then, they saw a dead body by the side of the road. "What is wrong with that person?"
"Ah, this person has died. We all die."
I imagine how shocking these experiences must have been for the prince whose protected life had shielded him from old age, sickness, and death. The next person who caught the prince's attention was a wandering religious mendicant: a spiritual seeker. Such people were common in India at that time. This monk seemed radiant, joyful and calm. The prince had never seen anything like it before.
When I think of that spiritual seeker, I think of great spiritual teachers I have had the good fortune to meet in my life: people like the Dalai Lama and other Tibetan masters. Perhaps you have met such people in your own life: people who seem to exude a quality of peacefulness and wakefulness. Such people may seem "more real" than others, yet they are still very much human beings, not gods.
The prince asked about this man, too. "He is a spiritual seeker," came the answer.
Upon his return to the palace, Siddartha had much to think about. His eyes had been opened to the reality of pain and suffering. He had also seen the spiritual seeker and had glimpsed another way of being. How he had been living his life up to that point now seemed hollow and without meaning, and he couldn't imagine simply returning to it. What was he to do?
Next time, we will continue the story of how Siddhartha left the palace and eventually became the master teacher known to this day as "The Buddha," the "Awakened One."
-Psy.Visesh,
Treasurer, APCPA,
94401 35779

Broken Symmetry: Nobel physicist explains why you miss old places, friends

The bittersweet sad intense pain of missing a place, a person, a crew, a time. What's with that? How does that happen? Here's a take on it you probably haven't heard before. I'll start way back with the big bang. If everything was all concentrated and homogeneous at the origin, how did our universe ever get so lumpy, with separate things like stars and planets, you and me? The 2008 Nobel Prize in physics was awarded to scientists who identified the source as broken symmetry. A first pass explanation of their idea is simple. You know how you can easily balance a broomstick on the palm of your hand? If it's centered, symmetrically upright, it tends to stay there. But if it tips asymmetrically toward one direction, then it becomes increasingly difficult to balance. The symmetry was broken. The tipped get tippier. The butterfly effect is the most familiar version of this. Remember it? Conceivably a butterfly's wings flapping could lead to major shifts in weather patterns. People latched onto that idea as evidence of uncertainty and the potential for miracles. We like ideas that suggest that life has shoots-and-ladder-like qualities, so it's not just stepwise plodding. It gives us hope of rag-to-riches leverage but also allows that if we don't end up fulfilling our ambitions we have an explanation that makes it not our fault: "I tried, but life has surprising shoots and I fell down one." Shoots and ladders aside, the butterfly effect is really about broken symmetry, how a little thing can start a big thing. How just as a slight tip can cause the broomstick to fall or how a shout can cause an avalanche. Think of it also as the way a meteorite passing the earth could fall under our gravitational influence, being taken off course. The closer it gets to the earth, the stronger the earth's gravitational pull. That's broken symmetry too.With the big bang everything flew apart. It would have flown apart evenly but the tiniest little micro-variation got things tipping. Not falling over as like the broomstick but comparable. The universe got lumpy by the same basic process that made our moon. The moon formed when a meteor hit the earth kicking up an enormous dust cloud. Imagine that the dust started out almost evenly distributed, but little variations caused the gravitational pull in some regions to be greater than in others. The dense grew denser. And now most of that dust is concentrated in that great lump of green cheese. A little difference in distribution causes a big difference in concentrations. Broken symmetry explains seperateness and difference.There's broken symmetry in thought and culture too. You meet someone, fall under their gravitational influence, start hanging out, fall further. For good or ill--it could be the love of your life or a heroin dealer. Either way a little tipping becomes a lot. And these days we're rarely tipped in just one direction. In ancient tribal days, you could be born into a tribe that tipped you strongly into its ways there, in the tribe you would stay for all your days. Now, we're under diverse influences. You move a thousand miles to be with your new partner, but miss your old town and people. You design your whole life around a job you love and then they lay you off and you have to find a new place to orbit. Broken symmetry implies something really fundamental about the universe but also about your life. If the universe is lumpy, then this notion that we are all one and that everything is connected needs to be refined. We are all one but some of us are more one than others of us. Everything is connected but not equally. There are plenty of people who have negligible influence on you. They are off in their own lumpy region under their own influences. They're not part of your tribe and therefore are different from you. But then you happen to meet. You've been on independent pages a long time so you start out on different pages. But vive la difference, you like each other. Being with each other you start to influence each other. But lumpy life that it is, you're not just under their influence. You've got other influences operating on you from before and they still tug. So you miss what you had even while your drawn into what you're having. We are all planets under changing influences falling in with some and tearing away from others. Something like that. There's more to this story of course. In particular I'll want to say more about influence. How does influence happen? For that we get into another one of these new scientific concepts: Constraint propagation.

-Psy.Visesh,
Treasurer, APCPA,
94401 35779