The documents linked from
the bottom of each page are intended to be an integral part of this course, and
should not be omitted - the worksheet documents are included in the downloadable
Steps linked above.
In Step 1, we looked at
vicious cycles and learned how thoughts, feelings and behaviours are linked and
each one affects the others.
If we use the depression example from that page, we see that on waking in the
morning, 'Dave' had thoughts that included "There's no point", and "I'll only
mess up again". If we think those thoughts and believe them, there is every
chance that we are going to feel depressed. If we think those thoughts and feel
depressed, then it's likely that we would be sorely tempted to pull the covers
over our head and stay in bed.
How does doing that affect the way Dave feels and thinks? Hmm. Staying in bed
might mean that his thoughts get carried away and he continues to think that
way, making him feel even worse, and even more likely to stay in bed. A vicious
cycle.
Vicious Cycle of Depression VIDEO
DEPRESSION
Depression can happen to anyone - and does happen to one in four of us over our
lifetimes. Different factors that make it more likely to happen, include
biological make-up, upbringing, or reaction to life events. What keeps it going
though, is how we deal with those things. The way we think and what we do
affects the way we feel.
Depression is often
accompanied by other feelings such as guilt, shame, anger and anxiety.
Thoughts
People who are depressed tend to think very negatively about themselves, the
future and the world around them. It can be like seeing life through "gloomy
specs".
Everything is hopeless - nothing can change
I'm useless, worthless
It's all my fault
The world is a terrible place - everything goes wrong
We can dwell on these thoughts repeatedly, mulling over things, asking ourselves
why, thinking regretful things about the past, what we should or shouldn't have
done.
Physical Sensations
Tiredness, fatigue, lethargy
Difficulty concentrating or remembering
Sleep changes (sleep more or less)
Eating changes (eat more or less)
Lose interest in hobbies, activities, sex
Behaviours
Because of the tiredness, difficulty sleeping and eating, and negative style of
thinking, we tend to do less and less. We stop doing the things we used to do
and enjoy. It could get so bad that we can't even go to work, or do things at
home. We want to stay in bed, or stay at home doing very little. We might
isolate ourselves from friends and family.
ANXIETY
Anxiety is the body's way of responding to being in danger. Adrenaline is rushed
into our bloodstream to enable us to run away or fight. This happens whether the
danger is real, or whether we believe the danger is there when actually there is
none. It is the body's alarm and survival mechanism. Primitive man wouldn't have
survived for long without this life-saving response. It works so well, that it
often kicks in when it's not needed - when the danger is in our heads rather
than in reality. We think we're in danger, so that's enough to trigger the
system to go, go, go! People who get anxious tend to get into scanning mode -
where they're constantly on the lookout for danger, hyper-alert to any of the
signals, and make it more likely that the alarm system will be activated.
Thoughts
I'm in danger right now
The worst possible scenario is going to happen
I won't be able to cope with it
Physical Sensations -
The Adrenaline
Response
When there is real, or we believe there is a real, threat or danger, our bodies'
automatic survival mechanism kicks in very quickly. This helps energise us to
fight or run away ('fight or flight response'). We will notice lots of physical
sensations, which might include:
Heart racing - This
helps to take the blood to where it is most needed - his legs so that he can
run faster (flight); his arms so that he can hit out (FIGHT); his lungs to
increase his stamina. At the same time blood is taken from the places it is
not needed for example fingers, toes and skin. These changes cause tingling
coldness and numbness.
Breathing gets faster -
This helps the bloodstream to carry oxygen to the arms, legs and lungs. This
will give him more power. The side effects may include chest pain,
breathlessness and a choking feeling. As there is a slight drop in the blood
and oxygen being sent to the brain he may feel dizzy or light headed, he may
experience blurred vision.
Muscles tense and
prepare - The large skeletal muscles tense and create power, this may cause
pain, aching and shaking.
Sweating - Sweating
helps to cool the muscles and the body. It helps to stop them from
overheating. Sweating can also make us more slippery to our enemies!
Pupils dilate - This
lets more light into his eyes so his overall vision improves. Side effects may
include sensitivity to light or spots before his eyes.
Digestive system slows
down - These are not important while in danger and so are slowed down then the
saved energy goes to where it is most needed. Side effects may include nausea,
butterflies and a dry mouth.
More alert - He will be
concentrating on looking for danger, much less able to concentrate on anything
else. He will be waiting for something to happen. This is the basis of the way
we worry.
Behaviours
Avoiding people or
places
Not going out
Going to certain places
at certain times, e.g. shopping at smaller shops, at less busy times
Only going with someone
else
Escape, leave early
Go to the feared
situation, but use coping behaviours to get you through: examples include:
self talk, holding a drink, smoking more, fiddling with clothes or handbag,
avoiding eye contact with others, having an escape plan, medication. These are
called 'safety behaviours'.
Safety behaviours can
also help to keep your anxiety going. Whilst you depend on them to help you
cope, you don't get to find out that without them, the anxiety would reduce
and go away on it's own.
Whilst avoiding people
or situations might help you feel better at that time, it doesn't make your
anxiety any better over a longer period. If you're frightened that your
anxiety will make you pass out or vomit in the supermarket aisle, you won't
find out that won't actually happen, because you don't go. So the belief that
it will happen remains, along with the anxiety.
Vicious Cycle of
Anxiety
Vicious Cycle of Anxiety VIDEO
We all feel anxious some times. A certain amount of anxiety helps us to be more
alert and focused. For example just prior to an exam, a few exam nerves have a
positive effect - motivating us, helping us focus our thoughts on the job in
hand, making us more alert. Too much anxiety, or constantly being anxious, is
unhealthy and detrimental to our lives and relationships.
ANGER
Anger is a result of
thinking that we have been unfairly treated or disrespected, or that others have
broken or fallen short of our rules, standards or expectations, and we won't
stand for it.
Thinking this way leads us to feel angry, which stimulates the body's adrenaline
response which is our body's way of helping us to cope with either fighting, or
running away ('fight or flight' response). We respond to those thoughts and
feelings, by acting, or feeling an urge to act, in threatening or aggressive
ways.
Thoughts
I'm being treated unfairly
I'm being disrespected
They're breaking a rule or standard
I won't stand for it
When there is real, or we believe there is a real, threat or danger, our bodies'
automatic survival mechanism kicks in very quickly. This helps energise us to
fight or run away ('fight or flight response'). We will notice lots of physical
sensations, which might include:
heart racing or pounding - enabling good blood supply around our bodies
breathing quickly - allowing more oxygen around the body
tense muscles - a state of readiness to fight or flee
shaking
hot, sweating
light-headed
stomach churning or butterflies
fist or teeth clenching
Behaviours
staring & facial expression
aggressive body posture
attack
hit out (or urge to hit out)
argue
shout
run or storm away
don't talk
sulk
The Angry Cycle
Vicious Cycle of Anger VIDEO
We all feel angry some times. Some people tend to become angry easily (a "short
fuse"), and some have problems controlling their anger. Anger has consequences,
and they often involve hurting other people - more usually their feelings, but
sometimes physically. Anger can cause problems in our personal lives, and affect
work and study. After an angry outburst, we can think very critically of
ourselves and our actions, leading us to feel guilty, ashamed and lower our
mood, which might result in our withdrawing from others, not wanting to do
anything (see depression cycle).
Summary
In CBT, we aim to break those cycles by changing something - what we think or
what we do. We might start by looking at what might be easiest to change.
Perhaps in this case, it might be easiest to change what we do.
How would Dave, in the first example above, have felt if he had got up anyway,
in spite of how he was feeling. Maybe ate some breakfast, had a shower, got
dressed, then perhaps went out for a walk. How would that affect his depression?
What would that do to the way he was thinking?
It's very likely that his
mood would have improved, and that he would have started to think a little more
realistically. He might have even enjoyed his day, or got a sense of achievement
from having done something.
Emotions: A summary of particular emotions and their associated thoughts, body
reactions and behaviours
If you have a problem other than depression, anxiety or anger, then you can read
the information given in these information sheets, and then continue the course:
Have a look at what you've written down on your vicious cycle worksheets of
examples of distressing situations (Step 1 practice). What links can you see
between what you think and what you do, and how they affect the way you feel?
In order
to make effective positive change, it is essential to look at the factors
which help to keep the problem going. Once we've identified those
factors, we can then target each factor and start to make positive changes.
Using the example of a simple
clockwork mechanism, we can see how the smaller cogs keep the large central
cog turning. If there's a problem with any of the cogs, then the whole
mechanism will grind to a halt.
We can therefore use this
process to help us deal with our mental health problem. If our main
problem is "anxiety", then we can write "anxiety" inside the large central
cog. Then we can identify each factor than helps keep the anxiety
going.
In order to reduce and deal with the anxiety, we
need to target and make positive helpful changes in each of those smaller
cogs.
