Table of Contents
Cover
Endorsements
Title page
Copyright page
Cognitive Behaviour Therapy: An Introduction
What is Cognitive Behaviour Therapy (CBT)?
Negative Emotions
How to Use This Book
General Change has five steps
Philosophical Change has five steps
CHAPTER 1 Anxiety and Concern
Common Anxiety Triggers
Am I Anxious or Concerned?
Chapter 1 – Anxiety – Takeaway Tips
CHAPTER 2 Depression and Sadness
Common Depression Triggers
Am I Depressed or Sad?
Chapter 2 – Depression – Takeaway Tips
CHAPTER 3 Anger and Annoyance
Common Anger Triggers
Am I Angry or Annoyed?
Chapter 3 – Anger – Takeaway Tips
CHAPTER 4 Guilt and Remorse
Common Guilt Triggers
Am I Feeling Guilt or Remorse?
Chapter 4 – Guilt – Takeaway Tips
CHAPTER 5 Hurt and Disappointment
Common Hurt Triggers
Am I Hurt or Disappointed?
Chapter 5 – Hurt – Takeaway Tips
CHAPTER 6 Jealousy and Concern for One’s Relationship
Common Jealousy Triggers
Am I Jealous or Concerned for my Relationship?
Chapter 6 – Jealousy – Takeaway Tips
CHAPTER 7 Shame and Regret
Common Shame and Embarrassment Triggers
Am I Feeling Shame/Embarrassment or Regret?
Chapter 7 – Shame – Takeaway Tips
CHAPTER 8 Envy and Healthy Envy
Common Triggers for Unhealthy Envy
Am I Healthily or Unhealthily Envious?
Chapter 8 – Envy – Takeaway Tips
Theoretical Perspectives on Cognitive Behaviour Therapy
Albert Ellis and Aaron Beck
Glossary of Terms
Useful Organisations
Acknowledgements
About the Authors
Avy Joseph
Maggie Chapman
Patrick Watkinson (illustrator)
‘Visual CBT – this is a book which explains in a very accessible way how we all disturb ourselves emotionally and what we need to do to change.
I recommend it strongly as a self-help book, and for CBT therapists who may use it as a tool to help their clients too’.
Dr David Baker PhD. MSc. BSc(Hons). DMS. PGClin Sup. C. Psychol., Clinical Director at Kent and Canterbury CBT Services, Chartered Psychologist, Consultant Psychotherapist, Chairman BABCP IPSIG, Chair AREBT
‘A refreshingly clear guide to understanding emotions. The illustrations make the explanations resonate as they bring humour and perspective to what is usually confusing.
The book enables readers not only to understand their thought processes and emotional responses, but also to work towards, and implement, desired changes. A great publication by two very eminent therapeutic professionals.’
Christa Mackinnon, Psychologist, Family Counsellor and Hypnotherapist, visiting fellow at the Peninsula Medical School, University of Exeter, Director of the Kamdaris Psychological Consultancy, Author of Shamanism and Spirituality in Therapeutic Practice
‘These days there are literally thousands of self-help books on the market. Some excellent but many are sadly lacking. Even the Royal College of Psychiatrists is endorsing a series of self-help books in the pursuit of promoting mental health for the nation.
In my practice I commonly “prescribe” a book, but am always looking for a good quality self-help book that maintains the fine balance between thoroughness and accessibility, avoiding boring over-technicality leading to inapplicability. This can be a daunting task due to limited choice.
It is particularly with this in mind that I’m excited with the release of Visual CBT. The illustrations and intuitive usage of GUI (Graphic User Interface)-type presentation style, makes complex cognitively behavioural strategies easily understandable and practical.
Joseph and Chapman, the authors, are two very experienced therapists with a deep understanding of how to “cut to the chase” in today’s high-pressured psychological environment. I can easily recommend this as an adjunct to actual therapy, or as an initial “stand-alone” approach for any person who is looking for the first time or who has had a previous bad experience with overly technical CBT books in the past.’
Dr Claude A. Botha, MBChB. MRCPsych., Clinical Research Fellow and Honorary Consultant Psychiatrist at the Wingate Institute of Neurogastroenterology, at the Blizard Institute Barts and the London School of Medicine and Dentistry, Queen Mary University of London
‘The general tendency is to think of CBT as a “talking therapy”. With this new book, Joseph and Chapman turn that on its head and use the power of imagery to instantly bring the links between thoughts, feelings, action tendencies and behaviours to life. The illustrations cleverly and succinctly capture the often subtle, but immensely critical, difference between unhelpful and adaptive responding.
With an emphasis on emotional responsibility woven throughout, the book adopts a refreshingly non-pathologising perspective to focus upon eight of the most commonly encountered unhealthy emotions.
The authors gently guide readers to develop an awareness of how CBT frameworks can help us to understand the connections that trigger and maintain problematic behaviours – and how we can use that same framework to learn new, and healthier ways of responding. Suggestions are provided to inspire and equip readers to apply this understanding and make positive changes that can improve psychological health. The pithy “takeaway tips” at the end of each chapter aid this process.
Whether bought as a self-help book, read as part of a training course, or used by a therapist with their clients, Visual CBT makes a unique and valuable contribution to how we all strive to “make sense of emotions” and improve psychological well-being.’
Dr Jody Warner-Rogers, Consultant Clinical Psychologist, Head of Psychology Services at Guy’s and St Thomas’s NHS Foundation Trust
‘This concise book is a fun and informative guide, providing a practical overview for those already working in psychological services. It clearly spells out all fundamentals and is a much-needed, accessible handbook for all medical practitioners and physical therapists alike, supporting their patients with psycho-social issues they are presented with in clinical practice on a daily basis.’
Christien Bird MSc., Chartered Physiotherapist and Practice Owner of White Hart Multi-disciplinary Clinic
Cover design: Mackerel Ltd
This edition first published 2013
© 2013 Avy Joseph and Maggie Chapman
Registered office
Capstone Publishing Ltd. (A Wiley Company), John Wiley and Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, United Kingdom
For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com.
The right of the authors to be identified as the authors of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Wiley publishes in a variety of print and electronic formats and by print-on-demand. Some material included with standard print versions of this book may not be included in e-books or in print-on-demand. If this book refers to media such as a CD or DVD that is not included in the version you purchased, you may download this material at http://booksupport.wiley.com. For more information about Wiley products, visit www.wiley.com.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book and on its cover are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher and the book are not associated with any product or vendor mentioned in this book. None of the companies referenced within the book have endorsed the book.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.
Library of Congress Cataloging-in-Publication Data is available
A catalogue record for this book is available from the British Library.
ISBN 978-0-857-08354-8 (pbk) ISBN 978-0-857-08352-4 (ebk)
ISBN 978-0-857-08353-1 (ebk) ISBN 978-0-857-08351-7 (ebk)
Cognitive Behaviour Therapy: An Introduction
Why This Book? What Will You Get From It?
We train adults in a variety of cognitive and behavioural therapies. This includes one day workshops as well as longer term courses. We also run a private clinic working with adults on many issues including anxiety disorders, depression, relationship problems, trauma, psychosomatic issues such as irritable bowel syndrome and blushing to name but a few. Both our students and our clients learn how to understand and develop awareness of the different types of emotions we experience and how to change them in a constructive manner in order to make progress and to move on.
Understanding the different types of emotions we may feel, and knowing what is at the heart of these emotions, can be tricky at times, especially when we experience many at the same time.
This book is designed to help you make sense of your emotions using Cognitive Behaviour Therapy (CBT) displayed in a visual way. We believe that using illustrations to demonstrate how we think, what we tend to do, and do when we experience different emotions can be helpful to anyone who wants to use CBT in their life.
The aim of the book is to use visual techniques to help you understand:
- The different types of emotions we experience such as depression, sadness, anxiety, concern, anger, annoyance, guilt, remorse, hurt, disappointment, embarrassment/shame, regret, jealousy, concern for one’s relationship, unhealthy envy and healthy envy.
- How to differentiate between what’s an unhealthy and what’s a healthy negative emotion or feeling.
- How to find out what is at the heart of these feelings and emotions.
- How to change and move on in a constructive way.
Before we get started there is something you need to know.
Emotional Responsibility – You are largely responsible for how you feel and act.
At the heart of almost all emotional and behavioural change is Emotional Responsibility. Your feelings and reactions are greatly influenced by the attitudes and beliefs that you currently hold as true. Some of those beliefs you hold, but no longer question, may be untrue and unhelpful to you.
Being ‘largely’ responsible does not mean that another person, situation or event sometimes causes your behaviour. What this means is that there are some disorders like Bipolar Depression that are organic in nature; meaning that it’s to do with the person’s biology or genetic makeup. To change how we feel, understanding Emotional Responsibility is very important.
The principle of Emotional Responsibility can be difficult to accept, particularly if you are going through a difficult time or have experienced a personal tragedy. It is natural to feel angry, sad, depressed or hurt in response to people, accidents, illness and other challenges in life. Notice that people feel and experience contrasting emotions when they experience the same problem. Therefore it is not the event or another person that ‘makes’ you feel what you feel.
If it was true that events caused emotional responses or feelings, then everyone experiencing the same event would experience the same feeling BUT they don’t. At the heart of your emotional experience are your beliefs.
How you think about something or someone is generally down to you. The consequential feelings and behaviours are also generally down to you. Uncomfortable, but generally true, nevertheless.
What is Cognitive Behaviour Therapy (CBT)?
The two pioneers of CBT, Albert Ellis and Aaron Beck, shared the view that most emotional problems arise from faulty thinking and that the remedy is found in corrective actions. Both approaches concentrate on present problems and present thinking, in contrast to the earlier forms of psychotherapy.
Both recommended the inclusion of behavioural exercises.
It’s worth knowing a little more about the two main schools of Cognitive and Behavioural Therapies – you may decide that one works for you better than the other. Both have evidence-based theories and both have a structured framework and process of therapy. We have included a section explaining the Ellis and Beck models at the end of this book.
These two great thinkers have made an enormous contribution to the understanding and application of psychological health. We tend to prefer Ellis’s model most of the time because of its philosophical basis. We find that it resonates both with our students and with our clients easily. This book is mainly influenced by Ellis’s model but uses some aspects of Beck’s model.
‘People are disturbed not by things but by their view of things’
This often quoted phrase of Epictetus (Stoic philosopher) is at the heart of the Ellis model. The intent behind Ellis’s work and his theory was to:
- Help people clarify their emotions, behaviour and goals.
- Identify the unhealthy beliefs that are at the heart of their emotional problems and that sabotage their goals.
- Dispute them and replace them with their healthier version in order to get better through consistent and constructive action.
- Finally, to generalise the change to other areas of life.
Epictetus’s quote can be conceptualised by the ABC diagram which follows.
It is not the event, but the belief or view you hold about the event, which is at the heart of emotional states. Emotions, thoughts and behaviours can be healthy and functional, or unhealthy and dysfunctional. The event can be something that has happened in the past, something that is happening now or something that could happen in the future. It can also be real, imaginary, internal or external. Internal events can be thoughts, images, memories, physical sensations or emotions.
A is the event, B is the unhealthy or healthy belief you hold about A and C are the consequential responses which can be:
- Cognitive (thoughts and assumptions)
- Action tendencies (what you feel like doing)
- Behaviours (what you do)
- Emotions (anxiety, concern, depression etc.)
- Physical symptoms (blushing, heart racing etc.)
CBT is problem focused and practical – its aim is to help you get better in the long term, which is done through changing your unhealthy beliefs to their healthy counterparts. The process of change requires repetition, consistency and vigour in the application of the healthy beliefs. This means you will think and act in accordance with your healthy beliefs even though it will feel uncomfortable at first. It is completely natural as emotional change takes time and comes last after the change in thinking and behaviour. Understanding does not create emotional change. If you were to read a book on how to drive a car, understanding that does not transform you into a competent driver instantly. You would have to apply what you understand, i.e. getting into the car, accepting it will feel uncomfortable and challenging at first and mistakes can be made but by being determined and persistent you will begin to feel comfortable.
Unhealthy Beliefs
Beliefs that are unhealthy have, at their core, explicit or implicit, rigid, powerful demands, usually expressed as MUSTs, SHOULDs, HAVE TOs, GOT TOs, e.g. I absolutely must not be rejected. Unhealthy demands are not based on reality.
Rigid demands have three powerful unhealthy derivative beliefs:
1. Awfulising – an unrealistic assessment of badness where negative events are viewed or defined as ‘end of the world bad’ or 100% or more bad.
Example: ‘It would be awful if I’m rejected’, ‘It would be the end of the world if I am rejected and therefore I must not be rejected.’
2. Low Frustration Tolerance (LFT) – the perceived inability to tolerate frustration or difficulty even though we do tolerate it. We do not spontaneously combust and die in the face of frustration and difficulty.
Example: ‘Rejection is unbearable’, ‘I can’t stand it’, ‘It’s intolerable, therefore I must not be rejected.’
3. Total Damning of Self or Other – rating the self, another or the world in a totally negative way, based on a condition.
Example: ‘Rejection proves I’m a failure or worthless or unlovable as a person, therefore I must not be rejected.’
These beliefs are unhealthy because they generate emotional disturbance or unhealthy negative emotions like anxiety and depression. They are unrealistic, do not make sense and are unhelpful to you. They sabotage the achievement of your goals.
The Three Major MUSTs
Albert Ellis identified the unhealthy beliefs at the heart of most emotional problems. These can be placed under three major headings. Each of these core beliefs is based on rigid demands. They are as follows:
1. I must do well, greatly, perfectly, outstandingly and must win the approval of others or else it’s awful, I can’t stand it and I’m no good and I’ll never do anything well. This can lead to many different types of unhealthy negative emotions like anxiety, depression, jealousy, hurt, unhealthy envy, guilt, shame and embarrassment and anger with the self.
2. Other people must do the right thing or be a certain way or treat me well or kindly and considerately and put me in the centre of their attention or else it’s horrible, unbearable and proves they are bad and no good. This may lead to a variety of unhealthy negative emotions like anger, rage and jealousy, anxiety, depression and hurt.
3. Life must be easy, without discomfort or inconvenience or any hassle or else it’s horrible, unbearable, that damned world doesn’t give me everything with ease and without effort. This could lead to a number of unhealthy negative emotions like anxiety, anger and depression and a plethora of behavioural problems like avoidance, procrastination, addiction, giving up on goals to name but a few.
Think of the above three core beliefs as the roots of three different trees. Each tree will then have branches and many leaves on each branch. These branches and leaves represent the many different and specific examples of the core theme. You will find, like many people, that you may have specific issues stemming from all three core beliefs.
Healthy Beliefs
Beliefs that are healthy have, at their core, preferences, usually expressed as wants and desires. They are realistic, make sense and are helpful to you in the pursuit of your goals. Preference beliefs accept the reality of what has happened, what is happening and what could happen, whether we like it or not.
Preference beliefs are expressed by:
a. stating the desire
b. negation of the rigid demand.
