Addictions.

Aaron Beck developed a model of understanding addictions. This can again be seen in a cyclical view and CBT can intervene at any stage by challenging behaviours and thoughts. This model can be used for alcohol addiction, drug misuse and even eating disordered behaviour:

Situation - Stress at work

Negative Thought about Situation-“I can’t cope”

Positive Thought about substance/habit-“If I drink I will feel better”

Craving-Memory of light headedness after drinking alcohol.

Urge-Desiring the drink, appetite, sensation.

Preparation-Getting to the liquor store

Action-Using the substance (drink) or habit. Gives short term relief.

Behaviours

Often challenging our thoughts is not enough. We have to change how you act and respond to situations as well. That is, people have to change the way they behave. There are ways to help to change behavior.

Sometimes it is difficult to be aware of what our behaviors are and how they change when our mood changes. This exercise helps people identify what they do when they feel positively (high) and negatively (low):

So far we have been looking at various tools to challenging negative thinking. However, people also act or respond negatively which are not helpful behaviors. CBT claims that even without challenging thoughts and just by challenging or changing how we behave can change our mood.

Low moods are often about being inactive. The goal of behaviour change in CBT is to activate people again so that they can find motivation and purpose. Positive activity is very important for mental health.

Positive Highs/ Negative Lows

Positive Highs/ Negative Lows. How to do it:

(See worksheet)

1. Moods

List two examples of when you last felt high and low.

2. Behaviours.

Describe how you react when you feel this way, how you respond and how you are.

3. Thoughts.

Write down what you were thinking at these times

4. Changing the behaviours

Once you have identified these areas, you become aware of what you are like or what you do when you are low and how different you are when you are happier. It’s a simple technique – make yourself do what you would do if you were happier even when you don’t feel like doing it. For example seeing your friend may be something you do when you feel happy. So, when you feel sad, make yourself go out and see that friend, even if you don’t feel like it. Changing your behaviour can change the way you feel and think.

Behavioural Experiments

Arguing against our negative thoughts is usually not enough by itself to convince us that they are incorrect. We will need to build up a body of experience which contradicts them. The best way to do this is to act on our rational beliefs, that is, our new realistic and more helpful beliefs, and discover whether they are true or not - whether we can believe in them or not. The best way to test out a new belief is by setting up an experiment. The following can help people to do that:

How to do it?

1. Write the thought you want to test in THOUGHT TO BE TESTED.

2. In the EXPERIMENT column, write down what you have planned to do.

3. In the PREDICTION column, write down how you think it will go, positively.

1. In the POSSIBLE PROBLEMS column, write down what you think might go wrong, or areas you think you might struggle with.

2. In the STRATEGIES TO OVERCOME THESE PROBLEMS, list positive coping strategies you could use to overcome these problems.

3. In the OUTCOME OF EXPERIMENT column, report how you think it went.

4. In the last column, rate how much the experiment supports the new thought, that is, rate how much the experiment proves to you that you can believe this new thought – percentage (0% - 100%).

5. There are more boxes for you to plan further experiments. It will take several experiments to convince you of thoughts and for you to overcome anxieties or discomfort about doing new things. Be patient.

Finally, write what you learned from these experiments

Activity Scheduling

The aim of Activity Scheduling:

When people feel low and depressed usually they slow down mentally and physically. People lose concentration and the desire to do anything that is pleasurable. Often a sure cure for depression (as well as medication and CBT) is to rediscover pleasure. This not only lifts moods, but will engage people in rediscovering a sense of self-worth, deserving and self-esteem.

Activity makes you feel better! Activity motivates you to do more!

Activity makes you feel less tired! Activity improves your ability to think!

Two methods:

The two methods of using Activity Schedules are:

1. To self-monitor i.e., people record what they have been doing and they record their moods.
2. To plan ahead i.e., they plan to do more of the things that give them pleasure and help them to become active again so that their moods will be lifted.

Using the Weekly Activity Schedule:

1. Write in each box the activity – what they were doing that hour.
2. Also write in each box a mood rating (0% - 100%)
1. They can rate any mood, e.g., depression, anxiety, anger, even loneliness.
2. They can rate any behaviour.

The aim is self- monitoring. People record what they were doing and how it made them feel. Boxes should look like this:

The numbers in the example are rating ‘stress’. At breakfast the stress was felt a little (low score). The stress was felt more at work (score goes up).

3. Thinking about patterns:

Once people have a Weekly Activity Schedule completed, they can use the “Working with Activity Schedule” sheet to identify which activities affected their mood for the better and for the worse and which they could plan to do more of next week. The aim is to build up pleasurable activities, not tiresome cores, or destructive behaviours.

Working with Activity Schedules

1. Intense Moods (describe the rate and range of rate, both positive and negative)

2. Activities affecting moods:

Write down the activities that made you feel better

(Describe any awareness and thoughts you had at those times)

Write down the activities that made you feel worse

(Describe any awareness and thoughts that you had at those times.)

3. Coping Activities

(Describe what you used to cope with when experiencing activities that made you feel worse – healthy and unhealthy coping strategies)

Other activities (that made you feel better)

4. Times – any noticeable pattern :

Best Times:

Worst Times:

5. Action Plan

When: Where: With Whom:

6. Key Thoughts to challenge:

Planning Ahead with Activity Schedules:

Once people have discovered a pattern of their moods and what activities affect them they can then plan ahead – that is , they can plan more pleasurable activities. They plan to do more of the things that lift their mood. These may literally be pleasurable activities, like self-care activities or spoiling yourself, or, they may be activities like doing a Flashcard Heading, where people choose to face their negative thoughts rather than avoid or try to ignore them.

Assumptions and Core Beliefs

Our negative thoughts come from far deeper and from earlier life experiences. CBT is about challenging our daily negative thoughts and mainly about our ‘here and now’. However, there are often deeper assumptions and core beliefs which underlie the surface every day negative thoughts.

There are several ways to identify underlying assumptions and Core beliefs.

1. There may be recurrent themes which emerge during treatment.

2. Global self-statements such as ‘stupid’ and/or ‘weak’ may reflect self-expressions .

3. Memories of childhood experiences may ‘match’ current beliefs.

4. The Dysfunctional Attitude Scale will high-light areas of vulnerability and give examples of specific attitudes.

5. The Downward Arrow Technique .

Assumptions and Core Beliefs.

Underlying Assumptions are the rules we hold, usually recognized if we use

‘I should’ statements, or

‘If’……. ‘Then’

Core Beliefs are the absolute statements we make about ourselves. These come from very deep down, from experiences in the past and from the negative (or positive ) messages we received from others.

E.g.,

‘I am a failure’

‘I am loved’

‘I am valued’

‘I am accepted’

Assumptions

The following questions can be used to challenge negative assumptions.

1. In what way is the attitude unreasonable?

How does it fit into the way the world works?
How does it reflect reality?

2. What is the effect of this attitude on my life?

Does it help or hinder my getting what I want from life?
What are the advantages or disadvantages of this attitude?

3. Where did the attitude come from?

How relevant is this attitude to the here and now?

4. What alternative attitudes are there?

Am I making extreme or unrealistic demands of myself/others/life?
How would someone else view this?

5. What action can I take?

What can I do to test out a new, better attitude?