CBT therapy for health anxiety

Obsessed with your health? Convinced you are ill, despite getting a clean bill of health? If you’ve arrived here, then it’s likely you (or perhaps someone you know) have health anxiety and you’re interested in finding out more about how CBT therapy and counselling can help health anxiety. I work as a CBT therapist in Bath and help clients to overcome their health anxiety using cognitive behavioural therapy. In this introduction, I hope to give you an understanding of what health anxiety is, some of the ways it is maintained and how we can begin to overcome the problem of health anxiety.

What is health anxiety?

Health anxiety is a preoccupation with becoming ill with a serious illness, or of succumbing to a serious illness, despite medical advice that this is not an issue. Many people worry from time to time about their health, but health anxiety is when this worry becomes persistent, taking up a lot of time and leading to restricted lifestyle choices. Someone with health anxiety might imagine they are ill, or overestimate the likelihood that they will become ill, even in the face of a doctor’s evidence to the contrary.

How does CBT help health anxiety?

Cognitive behavioural therapy is rooted in the theory that our thoughts, feelings, actions and physical symptoms (bodily sensations) are all connected. We assess the problem of your health anxiety by building up a detailed picture of it. Each person with health anxiety is unique, so the first requirement in therapy is to take a detailed look at your worries about your health, how you are thinking and what you are doing about these thoughts. Once a thorough assessment has been made, then with your therapist you can begin to deconstruct the problem…

Health anxiety worries

In health anxiety you might become preoccupied with having a serious illness or getting one. Typically, people tend to focus on serious and catastrophic health events, such as having a stroke, a heart attack or chronic, long term illness with uncertain outcomes, such as multiple sclerosis, or cancer, among others. Often what can happen is when one condition is ruled out, physical sensations can convince you that there is still something wrong. You may become an internet expert in digging out rarer conditions which appear to match the symptoms you are experiencing. It’s not uncommon for people with health anxiety to self-diagnose conditions their GP has rarely encountered in their practice.

The first step in health anxiety is to consider the possibility that you have a problem of worry about health rather than this being a real health problem. This is a huge first step and involves taking a leap of faith, possibly with the help of your therapist. Once this is acknowledged then we can begin to test out the theory that it is your problem of worry rather than an actual illness which is the target of therapy!

‘Real’ symptoms

The belief that you have an illness can be complicated by the existence of compelling and very ‘real’ symptoms. In the past, people with health anxiety were labelled rather dismissively as ‘hypochondriacs’ and told that their problem was all in the mind. The truth is that sensations and symptoms in the body are real and do exist, it’s just that the symptoms (sometimes coming from the anxiety itself) are being misinterpreted in a catastrophic way. If you experience health anxiety you may jump to fast conclusions about bodily sensations. In fact, it’s highly likely you are acutely tuned in to your body and how it feels on a day-to-day basis.

When we experience anxiety, we might attribute our bodily symptoms to serious illness: a tension headache might mean a brain tumour or an imminent stroke; a racing heart may be seen as the onset of a heart attack; tingling sensations may be interpreted as a sign of MS or other neurological disorder. Anxiety itself contributes many physical sensations which are in reality harmless, but which can become a focus of attention. When we focus on the symptoms, they take up more of our attention and a vicious cycle of health anxiety can begin.

Beliefs in health anxiety

Health anxiety is often driven by a need to be sure that you don’t have a particular illness. This need for certainty can compel you to find a certainty that is forever out of reach. It leads to a preoccupation with trying to prove with absolute certainty that you don’t have anything wrong with you.

You may also have beliefs about your worry which motivate you to keep worrying. For example, you may believe that if you don’t worry enough and keep your focus on your health, then you might miss something, and that if you did then you’d sorely regret it. Perhaps you believe it would be irresponsible not to worry, or that worry prepares you for a worst case scenario.

In CBT we really think about our thinking. Your therapist will help you to challenge some of these ways of thinking and to come up with more helpful and balanced thoughts which can help to soothe your anxious mind.

Why do you have health anxiety?

Often clients ask, ‘why do I have health anxiety?’ For this, there’s not a single answer. It can be helpful to explore what has happened to you or around you in your life to understand why you may be predisposed towards anxiety around illness. Factors which come up often are: sudden deaths in the family or among close friends, difficult illnesses in the family when you were growing up, perhaps you’ve had a serious illness in the past yourself, or have experienced a missed diagnosis in the past (either yourself, or others), for example. Often becoming a parent can trigger health anxiety as it becomes especially important to you to stay well and be around for your children. Knowing that we have understandable reasons why we may have a tendency to overestimate the likelihood of illness and perceive this as an ongoing present threat can help to unravel some of the automatic assumptions you might have when you experience a worrying symptom.

Coping in health anxiety

When you are experiencing health anxiety, you likely have developed ways of dealing with this with what therapists call ‘safety seeking behaviours’. Of course, we all strive for peace of mind and contentment, and when you’re anxious about health then you will have come up with ways which help you to feel better (some will be helpful, others not!). In health anxiety, there are some typical ways in which you might try to cope.

A common ‘coping’ method is to consult Dr Google. Dr Google holds a wealth of information for those seeking out symptoms online. The internet certainly has a lot to answer for when it comes to health anxiety. It offers unfiltered, general information and tends to lead to increased doubt and uncertainty, as well as more questions and lines of enquiry to pursue. In case you haven’t realised it yet, the internet is an ‘all you can eat buffet’ as far as health anxiety is concerned.

You might also frequently check out a particular part of your body which is giving you concern by closely monitoring it. If you have health anxiety, do you measure your own blood pressure or heart rate to reassure yourself you are okay? Do you poke and prod at particular areas to check for changes or pain?

Other ways in which you might try to help yourself include frequent visits to the doctor to seek out medical opinions, requesting further tests and visiting different doctors for second opinions. Other ways you might try to cope might be by trying to push aside the thoughts, trying to think positively, or avoiding activities which could, in your mind, put you at risk of something bad happening. You may also avoid talking about illness as if just talking about the illness increases the likelihood of this being true. And lastly, though not exhaustively, you may even avoid TV programmes or newspaper articles where you might come across reference to illness.

What is important to understand in all of the above, is to question how helpful these actions are for you in the short term and in the long term. Do they perhaps have some unintended consequences?

How does CBT help?

Cognitive behavioural therapy counselling for health anxiety helps to break and reverse the cycle which keeps it going. This means addressing thoughts and beliefs about our health. It also means reducing unhelpful coping behaviours which tend to keep our focus on the anxiety. An anxious focus on health unfortunately keeps you on high alert for sensations in the body and at the same time making you more likely to experience sensations which can then be attributed to something other than the anxiety which caused them.

In CBT therapy you learn to face the anxiety and work towards feeling a healthy level of concern for your wellbeing. It’s completely natural to feel concerned about your health, as this will motivate you to look after yourself but without the downsides of pre-occupation and missing out on life because of anxious worry. As an experienced therapist specialising in CBT, I have a wealth of ways to share with you to help you learn to tolerate your uncertainty as you learn to manage your anxiety. We use cognitive methods to soothe your anxious mind, and mindfulness based approaches to increase your resilience and learn to retrain your attention, as you begin to reduce activity which keeps you locked in the grip of health anxiety. It’s hard work, but it’s worth it, so you can get back to the life you value!

Ali Binns is a CBT therapist in Bath offering counselling for health anxiety and other anxiety problems. If you’ve a problem with worry, stress or anxiety, please get in touch if you’d like support in overcoming your difficulties.

CBT for insomnia - solve your sleep problems in a safe and natural way

Have your nights become a nuisance - tossing and turning with a good night’s sleep seemingly out of reach? Perhaps it might be a relief to learn that help is at hand; cognitive behavioural therapy can offer a safe, side-effect free alternative to medication to help you recapture your natural sleeping patterns.

Since, on average, we spend a third of our lives asleep, disrupted sleep can feel very troubling indeed. Insomnia affects an estimated 30-50% of people at some point in their lives, and 10% experience chronic insomnia (technically, sleep disturbance which lasts for longer than three weeks). In short, insomnia is a common problem - you are definitely not alone.

In this post, I’m going to take a look at how we approach insomnia in therapy using a CBT approach. Obviously this is only a snapshot of how we can use techniques from mindfulness, Acceptance and Commitment Therapy (ACT) as well as classic CBT methods to get back to bedtime bliss.

Typically, a series of sessions of CBT for insomnia will cover a range of approaches to help you achieve a realistic sleep goal. To start, you’d be building up an accurate picture of your sleep problem with your therapist. In CBT we look at four distinct areas - thoughts, emotions, behaviours and symptoms. We will be focusing on how all of these areas can be contributing to a difficulty in falling asleep or getting back to sleep when wakened.

How much sleep do you need?

Experts agree that on average an adult requires between 7 and 9 hours of sleep per night. Sleep needs do change during the course of our lives, babies and toddlers sleep far more, for example. If you have a very physical job, you exercise a lot, or perhaps you have recently been poorly, then your needs may change. There’s no gold standard set amount, but the guideline of 7-9 hours holds true for most.

Insomnia is associated with an increased tendency to feel anxious or experience other mood difficulties. Here it can get a little chicken and egg, as sleep disruption can also be part of depression and anxiety, but whichever came first, we know that if we improve the quality of our sleep then we can see all-round benefits.

Benefits of a good night’s sleep

• Improves mood

• Helps with immune system function

• Regulates hormones - including keeping a healthy weight

• Helps with focus and productivity

• Improved energy

• Helps with rational thinking

• Increases our ability to deal with whatever life throws at us

• And last but not least: it’s actually quite nice, to be able to snuggle down at the end of a long day, and appreciate the cosy, safeness of your own comfortable bed

Tracking your sleep

The first steps in therapy for insomnia involve tracking your sleep - the number of hours, what you were doing before bedtime, any remedies you may have used, caffeine or alcohol consumption and so on. There are plenty of apps on the market for this, but we don’t have to get too snazzy… pen and paper will do and probably more easily shared with your therapist. This sleep diary from The Sleep Foundation is comprehensive and will help to establish your current pattern and is a way for you to monitor your progress if you choose to.

What’s sleep hygiene?

Of course, sometimes sleeplessness can be down to modifiable factors, which can be easily remedied, so the next steps in insomnia treatment would be to take a look at your ‘sleep hygiene’. Contrary to how it sounds, this doesn’t mean keeping your sheets clean - although downy duvets and laundry-fresh sheets might assist! Sleep hygiene means taking a look at your bedtime routine, sleeping arrangements and bedroom environment. You can then take practically address areas which are in your control.

When we talk about sleep hygiene, we are ensuring we have some healthy habits in place. eg.

• Reducing alcohol at bedtime (can lead to night wakening)

• Reducing caffeine consumption

• Ensuring your room is a comfortable for sleep: temperature, light levels, comfort, noise

• Reducing over-stimulating activity at bedtime: playing video games, using phone in bed, reading news, going on social media etc

• Eating too late in the evening

• Introducing an effortless healthy wind-down routine

By setting up sleep-welcoming habits, we begin to set the body up for relaxation and sleep. If these simple strategies are still not bringing the progress you would like, then it’s time to move on to look at how your thinking and the very quest itself to get a good night’s sleep can make it increasingly out of reach.

Your sleep beliefs

While a period of interrupted sleep (due to a specific trigger, perhaps illness, a difficult period at work, a loss, relationship problems, having a new baby) might trigger an episode of sleepless nights, when this persists, it can be because our own thoughts about our lack of sleep can keep us locked into sleepless nights of tossing and turning. Paradoxically, the harder we try to get to sleep and the more we might be telling ourselves that we HAVE TO get to sleep, the more we might be getting ourselves stirred up, so preventing sleep from happening when we want it to.

The truth is, sleep will happen whatever we do or don’t do, but in insomnia it ends up happening at the wrong time, perhaps in short snatched bursts. We might find ourselves catching up one night after a sleepless night, or in naps, or at weekends. Just as we can’t force ourselves to stay awake, we can’t truly prevent sleep. Our body has inbuilt sleep regulation - if we’re in a sleep deficit, then we will fall asleep, even if that is during the day when we need to be awake. This isn’t ideal, as not only could it be outright dangerous if we are driving or operating machinery, but it may not suit you to be dozing off at random moments!

Don’t try too hard

Once we find ourselves in a cycle of overnight sleeplessness, we can get into a cycle of behaviours and thought patterns which become fixated on the idea of getting a good night’s sleep. In the case of sleep, there’s a paradox here. The more we try to get to sleep, the more this escapes us. This is called the Law of Reversed Effort. Have you ever tried to stop yourself from laughing where silence was required? Remember when you learnt to swim, how hard you tried and how now, well, really it’s effortless… There are many activities where trying harder does not work, and so it is with sleep. Because sleep comes naturally, we don’t need to be taught how or to strive to do so, it’s more about letting go of everything. It’s all the things we do in our minds and the physical actions we might carry out which keep our body alert, and in a state which isn’t conducive to sleep.

Sleep beliefs

Working out your beliefs about your sleep and challenging these during your waking hours can be helpful and supportive. As can educating yourself about sleep itself. The more you understand about sleep is that you’ll see that it is a natural process, which in reality needs no effort. It is often our thinking about the lack of sleep which keeps insomnia going. Common beliefs might be:

I won’t be able to cope or function without sleep

I have to fall asleep now, I can’t stand not being able to sleep (while watching the clock)

I can’t bear it when I haven’t had a good night’s sleep

I have to ensure my mind is empty before I go to bed, or I won’t fall asleep

I have to have silence to sleep, I can’t bear not having silence

I must have a perfect night’s sleep

If you’re an insomniac, do any of these resonate with you? There are others, but those are some of the typical themes I come across among my clients. These beliefs about your sleep can be addressed and helpful beliefs can be developed which are more conducive to helping your body to wind down for the evening.

A modern CBT approach for insomnia is Acceptance and Commitment Therapy (ACT) which takes a mindful approach towards the thoughts, rather than getting into a bedtime battle. Acceptance and Commitment Therapy is a third wave CBT approach which uses, among other things, mindful awareness to accept thoughts rather than try to wrestle and wrangle with them at the very time we could be drifting off to dreamland. ACT techniques are particularly helpful at bedtime when we don’t want to be getting into increasing mind activity by trying to rationalise thoughts away. Being able to disengage with worry thoughts and let them go, while focusing on the present moment can help. Mindfulness training to accept and allow thoughts, feelings, external distractions to come and go can be of benefit. Imagine your thoughts as clouds in the sky which drift in and out, or as leaves on a stream which bob off into the distance. There’s no need to get into the river with the thoughts, you can learn to allow them to float away without attending to them.

Sleep behaviours to tackle

Aside from the basics of sleep hygiene, unhelpful habitual sleep patterns can be addressed.

There are two tried and tested methods of breaking the sleep pattern called Stimulus Control Therapy and Sleep Restriction Therapy which may be of help. Stimulus Control is for those who may have conditioned themselves to associate their bedtime as something negative. Sleep restriction Therapy aims to improve the ratio of sleep to time spent in bed (sleep efficiency), by restricting your sleep to begin with. It’s not quite as brutal as it sounds, and can get you quickly back on track if you are feeling highly motivated.

Any activities you undertake with the sole purpose of getting to sleep may keep the focus too much on the lack of sleep and give you extra pressure. It’s as if sleep becomes some kind of performance for which you must be ready. Reducing the amount of props or aids to sleep may also take the pressure off.

Helpful behaviours at bedtime might include relaxation techniques, a mindful body scan or simple mindfulness of breath. The key to success here is not to carry them out with an explicit goal, but to practise just accepting and being curious about what you find and what happens, rather than having an expectation that these must work for you. These exercises can be helpful to switch off and to engage the parasympathetic nervous system (our relaxation response) but their effectiveness may be affected by worry about your lack of sleep and focusing on striving for sleep.

Managing general anxiety or stress

Often being able to explore your everyday stressors can go hand-in-hand with insomnia. If you’re at the end of your tether and stressed to the max at the end of the day, it’s no wonder that you’ll find it harder to drift off to sleep. As CBT is a therapy which helps you to help yourself, many of the approaches we use to manage your insomnia can be cross-pollinated into everyday life.

Sleeping beauty. Sounder sleep could be just a few steps away with CBT for insomnia.

As I hope you can see from this introduction to treating insomnia with CBT, we have lots of options to get you back to sounder, more refreshing sleep. If I can be of support, please reach out.

Ali Binns is a CBT therapist in Bath specialising in anxiety problems. Feel free to get in touch using the contact form on the main menu if you’d like support and help in working through your particular problems.

How to manage anxiety: The Worry Tree

When we’re anxious or stressed our mind has a tendency to focus on all the ‘what ifs’ and to steer towards the negative. It’s natural, it’s our friendly mind’s way of trying to seek out threats. Unfortunately the human mind is also very creative so it can take a difficult situation and catastrophise it into something far worse. Many of the worries we have are hypothetical, that’s to say, they are something that hasn’t happened yet, often unlikely to happen and merely stories our mind is feeding us with about future possibilities. If we can recognise our minds tendency to do this, we can learn to address it.

Certainly there will be times when worries are real and valid too, but it’s important to ask yourself whether worry is helping you. Is worrying really the same as problem solving? Is worry the same as taking action? If you can’t do anything about the situation at all and it’s an imagined problem, what are the consequences of continuing to worry about it?

Maybe worry was modeled to you in your family as a way to show you care and that you thought that if you didn’t worry, then maybe this would mean you didn’t care. As a fellow human being, I notice myself doing my fair share of worrying… I often worry about my teenage sons (let’s hope they don’t read this). I find myself worrying if they will get home safely. While my worrying shows that they are two of the people who matter most to me in life, the worrying doesn’t keep them safe and it only harms me. There are other ways to show I care, worry is not one of them! So knowing this, it makes it a little easier for me to begin to put my worries to one side and let them be.

It’s all too easy to get caught up in worry, and those who have anxiety will find themselves trapped in loops of worry. They’re so well practised at it, it’s automatic.

This post is to share with you a practical strategy you can use to begin to break this cycle. Of course this is only one tool but many people find it useful to pin down their worries.

The first step is to notice your worry. It might be pretty nebulous. It really helps to pin it down. Then follow the simple steps. Specify the worry. Is it a real worry or hypothetical - can you realistically do something about this? Then follow the steps in the diagram below.

You can download a full size Worry Tree pdf here. Print it out, hang it on your wall and give it a try, or share it with fellow worriers!

Ali Binns is a CBT counsellor in Bath specialising in anxiety disorders, including GAD, OCD, phobias. If you’re finding it difficult to cope with your worries, then don’t be afraid to seek the help of a professional. If you live in Bath, I offer private counselling sessions using cognitive behavioural therapy. Please don’t hesitate to get in touch if you would like my support.

What is OCD (obsessive compulsive disorder)?

Obsessive compulsive disorder (OCD) is a highly distressing anxiety condition experienced by approximately 1.2% of the UK population. All types of OCD include obsessions and compulsions. Obsessions can include intrusive and distressing thoughts, images and feelings (urges). Compulsions are the actions which are carried out in an attempt to ‘get rid’ of the intrusive thoughts, obsessions and feelings, which are highly distressing to the person with OCD. OCD can eat into a person’s time, taking them away from living the kind of life that they would value. In terms of treatment, CBT for OCD is your best option for managing the condition because it helps you to tackle the thoughts and the behaviours which keep the problem going. Cognitive Behavioural Therapy has been widely researched as the most effective method for overcoming OCD.

Why have I used a ladder to illustrate? This is to draw attention to the fact that as human beings we all have the propensity to think in superstitious ways. eg. Don’t walk under a ladder or you will have bad luck. Superstitious and magical thinking has at its heart a very similar theme to OCD, that of preventing harm and bad things from happening. Magical thinking can play a part in OCD when you may come to believe that by thinking certain things, and not carrying out certain rituals that harm can be caused or prevented.

While superstitious thoughts can be normalised as part of the human experience, OCD is an anxiety problem where you may become stuck in a loop of intrusive thoughts and actions while trying to reduce the potential distress caused by believing that you may be responsible for capable of causing harm to the self or others.

In this short introduction to OCD and CBT for OCD, I am aiming to give a broad overview of what OCD is and what you may expect from CBT for OCD, but there are limitations to such a short piece. Towards the end of the article I’ll recommend a couple of excellent books for you to turn to, should you want to know more.

What is obsessive compulsive disorder?

OCD begins with a trigger situation which is closely followed by an intrusive thought or obsession. To the sufferer this is not merely a passing obsession, but one which is highly distressing or anxiety-provoking. There are certain themes which these thoughts might fall under (contamination fears, obsessions related to perfectionism, religious obsessions, unwanted sexual thoughts, fear of causing harm, or fear of losing control to give a general overview). OCD is not limited to feeling anxious, the emotions experienced as part of the problem can be many: including anxiety, shame, guilt and depression.

OCD compulsions fall into two main camps - visible (overt) and invisible (covert). When most people out there think of OCD, they think of visible actions (such as hand-washing, checking candles are out or electrical plugs off, doors and windows being locked, seeking reassurance) but just as common are invisible compulsions which are carried out in the mind of the person who has OCD. Examples might include counting, memory hoarding, reviewing events to see whether or not something happened, self-reassurance, rationalising intrusive thoughts, neutralising words, or trying to prove the thoughts untrue beyond doubt.

Each person’s OCD takes on its own unique ‘flavour’, but whichever form you have, you can be assured that in all cases, the compulsions keep the OCD going. Yes, temporarily you may feel less emotional distress when you carry out a compulsion, but in the long term these are unhelpful actions. Over time these actions can increase your distress, as they keep you locked into a battle with the OCD, limit the activities you would otherwise choose, and negatively impact close relationships.

The problem with OCD compulsions

Compulsions are behaviours which give your brain the message that the intrusive thought (or urge) you have experienced has something of note to offer you. Responding to the intrusion or the obsession with an activity (covert or overt) gives your brain the message that the thought is important. Correspondingly, your brain, will offer more intrusive thoughts as long as you continue to respond with a compulsion. The brain is so generous like that! You can kindly thank your mind for this, it really does want the best for you, it’s just being an overhelpful friend.

Everyone’s OCD is unique to them so it’s important to be clear what you are doing which might keep the problem fired up. This will be useful material in the treatment of your OCD. Treatment of OCD involves a multi-pronged approach. Understanding what OCD is and how it is maintained, learning about the nature of thoughts, relating differently to the intrusive thoughts, and (most important) learning to tolerate the uncertainty and discomfort which comes when you begin to refrain from responding to your obsession through ERP (Exposure and response prevention) are some of the ways forward.

ERP involves gradual exposure to your intrusive thoughts, so that you can begin to habituate to the discomfort you experience as you learn to refrain from the compulsions. This exposure will be through imaginary exposure and real life exposure; your plan for treatment will be quite specific to your own symptoms and behaviours. To overcome the obsessions you will need to repeatedly expose yourself to situations you fear by whilst not carrying out your compulsions. This is done in a gradual way at a pace you can handle! Over time and with repeated new actions, your obsessions and your fear should start to trouble you less.

Thoughts are just thoughts

Learning not to respond to your intrusive thoughts will be a valuable goal. In studies, we know that 90% of people have odd, strange, unwanted thoughts. (And who really knows for sure whether the remaining 10% had thoughts they didn’t want to admit.) Any thought is possible in any person, and for the most part, these intrusive thoughts don’t cause people problems, but if you have OCD and you have begun to attach layers of meaning to those thoughts, you’ll have begun to get hooked by them. What keeps you getting reeled in is acting to try to alleviate the anxiety, guilt or shame which might accompany those intrusive thoughts or urges.

Cognitive behavioural therapy means working on thoughts and behaviours. With OCD, this means that not only are we tackling the behaviours which maintain obsessive compulsive disorder, but we may also be looking at your beliefs about your thoughts and your feelings, your drive to obtain absolute certainty where you may experience a persistent sense of doubt, and a sense of overdeveloped responsibility for preventing harm. With consistent effort and practice, you can learn to manage OCD and break free of its vicious cycle. You can stop yourself getting reeled in, hook, line and sinker. You can stay on the shore and you don’t need to get into the swirling water with it.

You might also be interested in Courtroom Drama analogy for relating to your OCD in a different way.

As I finish this short intro to CBT for OCD, I’m aware this only scratches the surface of what it means to have obsessive compulsive disorder, but I hope it serves as a brief primer on what keeps this problem going and how you can begin to unravel the problem.

If you want to read more, I highly recommend the following:

Break Free From OCD by Fiona Challacombe, Victoria Bream Oldfield and Paul Salkovskis

Managing OCD with CBT (For Dummies series) by Katie d’Ath and Rob Willson

Overcoming Unwanted Intrusive Thoughts by Sally Winston and Martin Self

Ali Binns is a CBT therapist based in Bath. She helps clients to manage their anxiety and mood using evidence-based cognitive behavioural strategies. Please use the contact form if you would like to get in touch.

OCD: the Courtroom Drama analogy

If you have OCD, learning new ways of managing difficult thoughts, feelings and urges with CBT for OCD is the key to living the life you want rather than the one OCD convinces you to lead. One of the approaches we focus on in overcoming OCD with CBT is to learn to relate differently to your thinking. There are many helpful metaphors which might help you to relate differently to your thoughts, but I particularly like this one…

It might help you to imagine your OCD as something like a very experienced, driven, but flawed prosecutor in a court of law. Think back to watching American courtroom dramas at the movies or on Netflix and picture the most opportunistic prosecutor who will stop at nothing until he can prove you are guilty.

The OCD prosecutor believes you are guilty and responsible for causing harm until proven innocent. You’re in the dock and you’re on trial. You, as the defendant, naturally want to defend yourself and prove the prosecutor wrong beyond all reasonable doubt. However, whenever you do this, you are playing into the hands of the prosecutor. Your problem is that you are trying to obtain proof for something which hasn’t happened. This defence case is going to cost you, and big-time. Hours of worry, guilt, shame, wasted hours putting in the effort of trying to argue your side of the story, proving once and for all, beyond certainty that you weren’t, couldn’t be or are never capable of causing the harm or wreckless abandon you fear. The OCD prosecutor means to win, and will use every doubt-enhancing trick in the book to keep you defending. You might get temporary evidence, but very soon the OCD prosecution will come back for another round, with another witness or another event.

You may even plead the defence that “it’s not me, it’s my OCD”. Often this will create a temporary adjournment in proceedings (to continue the metaphor), but occasionally a particularly crafty prosecutor can even use this against you. “What if you don’t have OCD, and these thoughts are a sign that you are a terrible person?” Forewarned is forearmed, it is true, it’s not you, it is your OCD, but a hotshot lawyer will even try to get you to doubt the diagnosis.

Fortunately, if you watch US courtroom dramas, you’ll know there is a route out of this. You can plead the right to remain silent. By telling the prosecutor that you choose not to respond to their demands for proof that you could not or would not act in the way you fear, be what you fear, or be to blame for what you fear might happen, you give the prosecutor no more material to work with. Over time the case will fall apart. There is no evidence to be found, no certainty to be obtained. You can choose to walk away from the proceedings, knowing that you no longer have to play into the hands of the prosecution.

Of course, this isn’t as easy as it sounds, but the metaphor itself may help to remind you not to play into the hands of your OCD mind. Working alongside a CBT therapist you’ll learn strategies to take you through the changes how you relate to your thoughts and change your behaviours which will help you to manage your difficulties.

You can read a little more here: What is obsessive compulsive disorder?

Ali Binns is a CBT therapist based in Bath. She helps clients to manage their anxiety and mood using evidence-based cognitive behavioural strategies.

What is social anxiety?

Excuse the stupidly cute hamster, he was just to grab your attention… but the wide-eyed gaze, his still body and clasping hands reminded me of how humans look when they are feeling socially anxious. If you’ve arrived here, then this feature is to introduce you to social anxiety and how I approach this in CBT (cognitive behavioural therapy).

What is social anxiety?

Social anxiety is when you experience fear or anxiety in social situations. It can vary in intensity from mild distress to extreme phobia of social or public engagements where the sufferer has come to avoid and retreat from any social situations. It typically begins in the early teens. It seems to me important to make the distinction between shyness and social anxiety. Some people can be shy and yet quite able to engage in a wide variety of social situations. Likewise, if you just prefer small groups and quiet socialising, then this may be your preference and just the way you are. Social anxiety is when (whether you are outgoing or of a quieter disposition) your anxiety gets the better of you and you begin to avoid, and excessively worry before future engagements, and/or spend time after the event going over it in your mind. Social anxiety can affect you before, during and after social interactions. It affects your life, your relationships and how you feel about yourself.

The main characteristic of social anxiety is when you fear negative judgement from others, particularly in your social group (friendships, peers at work or at college/university, groups you attend). If you experience social anxiety, then you worry a lot about people thinking badly of you in some way and even that others may reject you as a consequence of this negative judgement.

While social anxiety sufferers’ worries and anxieties may vary slightly, if you have social anxiety then you will almost certainly be thinking that other people might think you are weird, uncool, stupid, rude, weak, or not good enough, for example.

Where does social anxiety affect people?

The situations which are triggers for social anxiety vary. Common places include meetings at work, social engagements, any situation where you might need to perform in front of others (giving a talk or presentation), parties, going to the pub or a restaurant, making phone calls or even going to the shops. You may experience in small groups or large, or even one to one. When you have social anxiety, other human beings pose a threat.

Why does social anxiety feel so bad?

From an evolutionary standpoint, if through our life experiences we have come to develop beliefs where we see others as threatening (anxiety is always about a perceived threat!), the idea that we may be rejected by others provokes a strong mind and body response. Our fight or flight response is activated and our body and mind go on high alert when it perceives a threat to our survival. Why does it do this when we’re not really at risk? The reason is that our brain reacts in a very primitive way even in today’s modern and relatively comfortable world. Even if our worst fears are true and someone does have a negative opinion of us, then our life is rarely at immediate risk because of this. But, in our evolutionary past, if we were rejected from our social group, our peers, or our tribe, then we probably were at real risk as we might lose our shelter, our food, our means of surviving as a group. Our ancient ancestors depended on living in tribes to survive - cast out of a group and we would risk starvation or predators. Unfortunately our brains respond as if we were still living in this way. That’s the tricky modern brain with its alarm on a highly sensitive setting.

If you’re looking for a simple answer on why your brain might have a more sensitive setting than another’s, then there’s no single answer. Biological and social factors, your temperament, your family upbringing, being around critical people (parents, carers or teachers), as well as your individual experiences in life can all make you more or less vulnerable. A compassionate understanding of these influences can help, but real changes can be made when you are ready to confront and challenge your fears.

When the social anxiety alarm bell has been set off, this will affect how you feel, how you think and how you act.

Social anxiety - what does it feel like?

Social anxiety symptoms can affect any part of the body and all of these sensations are created by your fight or flight response. You may feel hot, experience a racing heart, feel like you want to run away, have sweaty palms, or a tight chest. You might find it hard to find your words.

Things can really up a notch if you are someone who blushes or shakes, because this can become an extra part of the problem, as you may think you will be judged for having anxiety when the signs could be noticed.

Rest assured while these symptoms are uncomfortable, they are actually your body doing its job, preparing itself for survival. It’s just that it’s being a little too helpful for our requirements when it gears up like this in social situations.

Social anxiety - what do you do?

When you’re feeling it, what do you notice you do? If you are in the thick of it, you may feel like running away, leaving places early, or avoiding the situation, or you may find yourself scanning for the nearest exit. You may avoid feared situations entirely or find yourself cancelling plans at the last minute with an excuse.

Your body posture may become ‘smaller’ as you attempt to hide, or perhaps you do hide in the corner or stick only with people you know. If you’re in public, you may often look down rather than make eye contact with others. Maybe you talk very quickly, or you speak very quietly, or perhaps you don’t say a word. You may find yourself overcompensating, trying too hard, or acting in a way that isn’t really you. Perhaps you have a crutch, such as alcohol to get you by.

Social anxiety - where’s your thinking?

You may find yourself analysing what to say, or focusing on how you are coming across. Your focus becomes very much on what others might be thinking of you, in terms of what you say, how you look or how you sound. You may worry before and during the event, and spend time after the event rating how badly it went… When you are worrying you may find yourself catastrophising, labelling yourself, comparing or jumping to conclusions about how others see you.

Wow - I’m even starting to feel quite anxious as I write this, and I’m imagining you might too, especially if you are familiar with any of these symptoms. So what can be done to manage social anxiety?

How does CBT help?

CBT looks at how your thoughts, emotions, behaviours and physical symptoms interact. As a CBT therapist in Bath, I work with my clients to explore how their anxiety is made more intense by their beliefs, thoughts and behaviours. By pulling all of this together, we can work on strategies to offer ways to break the cycle.

Often with social anxiety people can be experiencing a degree of shame and feeling unworthy or not good enough, so some of the therapy may be in learning to be compassionate to yourself in the face of difficulties. Often harsh self-criticism can keep social anxiety going and learning to support yourself in a nurturing way can be so important.

While working through understanding social anxiety, and learning supportive and calming techniques, we would begin to get you approaching situations which you may have previously avoided, and engaging socially while experimenting with new ways of behaving. Although at the start of therapy, this may seem daunting, many clients find this part of the therapy hopeful, even exciting (it’s true!) The aim is to begin to adapt and take on small social challenges as you work towards your chosen goal.

If you have social anxiety and would like support, you can find out more about me by exploring the site.

Ali Binns is a CBT therapist based in Bath. If you have social anxiety and would like support in overcoming this problem, you can find out more by exploring the site. Or feel free to get in touch by hitting the contact button.

Mindfulness: 5 ways to destress at Christmas

Christmas carries with it a lot of expectations. It's a time of year when the pressure to have the perfect holiday with family or friends can take its toll. Perhaps you are overloaded with tasks, or perhaps, for you, it's the opposite, you feel alone and as if everyone else is having the time of their lives. Wherever you are in the run-up to the big day, it's probably a good enough guess to say that it's not always the most relaxing time of year. Fortunately we can unwrap a few CBT and mindfulness cues to help us stay calm and prevent us from going off like a Christmas cracker!

Think of each of these are your very own mindfulness Christmas gifts to yourself and use them as reminders to tune in and watch your thoughts and how these relate to how you might be feeling over the Christmas period:

1. Christmas music

It's everywhere. Love it or loathe it, if you leave your home, you will hear it. You can use festive music as a reminder to check in with your thoughts, noticing what's going through your mind, noticing how you feel (your emotions and your body), before shifting your focus for a few minutes to focusing on your breathing, just noticing your breath going in and out. It's like a mini-timeout and can help to soothe stress, giving you a little space before choosing to move on to something new or continue what you are doing with fresh eyes.

2. Christmas wrapping

A necessary chore which can feel overwhelming when there's so much else to do, with a little mindful attention  wrapping gifts can become a way to bring you back to why you are wrapping these gifts, these tokens of love and appreciation for those people you truly value having in your life. You might even feel inspired to be more creative once you get focused in this way. To get mindful as you wrap up the presents, you can focus on the sounds of the paper as you unroll it, you can listen to the paper as you slice it with your scissors, feel the texture, notice the springiness of the ribbon as it curls, and notice the colours and shapes as you fold stick and pile the presents. If your mind wanders to other chores taking you away from your task, try to repeatedly bring your focus to the task at hand, tuning into what you can see, hear, feel and perhaps touch. No tasting though for now - the chocolates you bought were meant as a gift!

3. Mulled wine or mince pies

Food and drink are big features of the Christmas season, offering ample opportunities to be mindful. You can find out more on how to savour and notice the tastes, smells and sounds of Christmas food and drink here in this guided Christmas mindfulness exercise.

4. Christmas candle

Gifting yourself a Christmas candle can be a special way to mark the countdown to Christmas, filling your home with wonderful aromas. Lighting a candle can be symbolic of many things, celebration or a time for reflection, or even just a general sense of cosiness in your home. It also can mark the start or end of a mindfulness practice, when you might choose to set a small intention for yourself for your meditation or for the rest of your day. You can, if you choose not to close your eyes, use the candle as your mindfulness focus, and use it to gaze on the flickering flame, noticing the warmth coming from it, noticing the scent as it lingers in the air. Is there anything else that you notice?

5. Christmas compassion

Go easy on yourself and others. Maybe this is a difficult time of year for you - absent friends, stress, workloads. See if you can notice what it is like to experiment with being forgiving of yourself and others, or your own mistakes. Practise being aware of any tendency for too-high standards or expectations of a perfect day. Notice and be mindful of the times when you are demanding a lot of yourself and be flexible in your approach. Compassion could be the best Christmas gift you can offer yourself and others. If you find self compassion difficult, you can begin with a guided breathing exercise such as Soothing Rhythm breathing. Just a simple act of taking time to breathe can be the beginnings of self compassion.

I hope these five festive mindfulness reminders give you some inspiration to stay present over Christmas. As you practise being mindful, I'd like to encourage you to ask the following... What do you notice when you really pay attention? What do you miss when you don't?

Ali Binns is a CBT therapist in Bath. She supports clients with their emotional wellbeing, using a cognitive behavioural therapy approach combined with mindfulness techniques to support the process. 

Breathing exercise: Soothing rhythm breathing

Using our breath can be a helpful way of settling our mind and body when we are experiencing negative emotions such as anxiety, anger, depression or general stress. It can help to create a more secure and grounded feeling and reduce the impact of the body’s natural fight or flight reflex. By deliberately using our breath, we are helping our mind to receive the message that we are safe.

Soothing rhythm breathing is a breathing exercise designed to soothe body and mind. There are other breathing exercises where you can just allow the breath to be as it is, but this technique is about discovering a breathing rhythm that is supportive and calming for you. The counting element can help to focus your mind on your breath.

The rate and rhythm of breath which you find soothing may vary from the count here, so please feel free to adjust your counting if need be. Your natural soothing rhythm may even vary from day to day, so initially it is worth taking a little time to find your rhythm before settling into a pattern which feels soothing and natural for you. There’s no rush to find the right pace; just keep your in and out breaths of equal length, with a brief pause between each.

You can experiment with the sequence below until you find the rate which feels most beneficial for you. There’s absolutely no pressure to do this right or get it right first time, just set aside a few minutes a day to practice and you will soon get the hang of it.

As with other mindfulness based practices, if you find your mind wandering off onto other concerns, that’s okay, just bring your attention back to your counting and your breath.

Instructions

• First sit in a way that you feel supported, yet alert, in an upright posture with feet flat on the floor, and head facing forward.
• To begin with, slowly take a steady and long in-breath for a count of four.
• Pause there for a moment…
• Then gradually release the breath for a count of four, keeping it steady, long and slow.
• Repeat this count for three minutes.

As with any breathing exercise, these are best practised in a quiet relatively calm environment to begin with, and as you become used to doing them, you will be able to use them while going about your day when you feel the need to give yourself some time to reset.

If you would like to try a different mindful breathing technique, you can go here to find a Beginners Mindfulness of Breath exercise.

Ali Binns is a CBT therapist in Bath. She regularly teaches clients to use these simple breathing techniques as part of their general care plans. These exercises help clients to work with their emotions in a more helpful way. 

Progressive muscle relaxation

Progressive muscle relaxation is a classic exercise which has stood the test of time and is helpful to reduce tension and relieve the symptoms of stress and anxiety. Often clients wonder why I’m teaching them another relaxation exercise, so I hope the following helps to explain the why as well as the how.

When we are under pressure and our fight or flight system is being regularly activated by threats in our environment, one of the physical symptoms we can experience is a build-up of muscle tension. This muscle tension arises because of the impact of adrenaline, the way we are holding our bodies, and the way we are breathing. The fight or flight reflex prepares our muscles to act in face of a perceived threat in our environment. The threat doesn’t have to be real, even an imagined threat will do!

Our threat system is rather like an overhelpful friend, at times, pointing out threats, much of the time are not an actual danger at all. Nevertheless, as humans we get to live with a brain which responds to everyday situations and threats in much the same was as it would to a sabre toothed tiger. Our mind is working hard to protect us, and while we’ll all have our unique combinations of triggers, when the adrenaline hits our bodies, we all react in the same biological way. Our heart rate rises and our muscles are being prepared to take action – to fight and defend ourself, or to run away and take cover.

The benefits of progressive muscle relaxation

Whether we react with fear or anger to threats, muscle tension can be a feature. Muscle tension is one of the physical symptoms which forms part of the unhelpful cycle when the fight or flight system is activated, so this progressive muscle relaxation is a way of breaking into that vicious circle, creating a helpful loop instead. Because muscle tension as a symptom is linked to our thoughts, feelings and actions, if we can actively reduce muscle tension, it can have a positive impact on stress as a whole. (This, fact fans, is one of the reasons why therapeutic massage can help to relieve the symptoms of stress.)

Take the time to practise regularly and PMR can help to release and reduce muscle tension. Persistence is key. It would not be enough to do progressive muscle relaxation just once, although, you may experience an immediate benefit. It is best if you can run through this at least once per day. Most people start to notice a difference after 2-3 weeks of practice.

In time, you might be able to run through this as a brief body scan to look for areas of muscle tension in your body and take action to relax those areas. The exercise will also give you the knowledge to notice when muscle tension may be building for you. This can serve as an early warning sign to you to take action to reduce stress levels and ensure you are looking after yourself with appropriate self care.

How to practise progressive muscle relaxation

Find a comfortable and quiet place to sit or lie down. If you can, try to ensure that you can get 15-20 minutes without interruptions. So phones off, door closed, and ask anyone you may share a house with to give you a little time alone.

Close your eyes and bring your attention to your breathing. Try as best you can to keep your breathing slow and even, lengthening on the out breath. Try saying the word ‘relax’ to yourself a few times as you breathe out to encourage this lengthening of the out breath.

You are going to work through your main muscle groups one at a time, starting with your right foot. Begin by tensing your right foot, squeezing your toes together and pointing them downwards. Focus on that tension. Slowly release that tension as you breathe out, saying the word ‘relax’ to yourself. Notice the different sensations as you hold the tension and release the tension. Notice what it is like as the muscles relax. How does it feel different?

Now do the same with your right calf muscle. Tense your right calf and hold this tension for a while. Slowly release the tension as you breathe out.

Move slowly through the parts of your body as follows, working through the muscles of your right leg, left leg, buttocks, back, abdomen, chest, shoulders, left arm, left hand and fingers, right arm, right hand and fingers, neck, jaw, lips, eyes, and forehead. With each group of muscles create tension followed by releasing and relaxing for each group of muscles.

Once you have worked your way through the different areas of your body, scan through your body and make a note to see what, if anything, feels different now. If some areas are still tense, spend extra time focusing on those muscles.

When you’re finished, you can open your eyes and see if you can take some of this feeling of relaxation into the rest of your day. If you have used this before bed, let yourself drift into a sleep naturally.

Ali Binns is an accredited CBT therapist in Bath. If you'd like to find out more about how she works, feel free to browse the site. Or if you would like to book an appointment or find out more about how CBT might help you, you can get in touch via info@alibinns.co.uk

Unhelpful thinking styles: filtering and emotional reasoning

Emotional reasoning (emotional filtering) is a common unhelpful thinking style. Each of us views the world, ourselves and other people in our own unique way. And, of course, this all depends on a complex set of life circumstances, upbringing, contemporary social and environmental influences, sex, religion, health, random events, genes, and more or less anything else a human can come into contact with. Despite each person's individuality, we do all have a lot in common. We're all subject to the human brain's tricky manoeuvres and resulting unhelpful thinking styles.

We all see the world through our own lens or filter, but when subject to stressors, our brain relies on experience to match up what it recognises with previous triggers which have been filed away in our memories as 'threatening' situations, people or places. Once our fight or flight system (our primitive survival mechanism) is activated, cortisol and adrenaline are released which produce primary emotions such as anxiety or anger.

The impact on the body can't be missed - racing heart, feeling sweaty, tingling sensations, light headedness, muscle tension, feeling ready to run or fight (plus a host of other intense physical symptoms). The resulting emotions feel so strong that they can compel us to act or behave in certain ways to avoid a feared situation, or to defend ourselves against a threat. 

Emotional filters

Our mind needs to filter our experiences and let through the right stuff. If our filter is flawed, then like a coffee machine that is playing up, we can end up with a poorer than necessary experience. If we use our emotions to filter or decide on our course of action, we can unwittingly work against our own best interests. Consider some of the following examples of emotional filtering:

• I feel guilty, therefore I must be bad.
• I feel afraid, the danger must be real.
• I feel so anxious... I'm pathetic.
• I'm very angry, they need to pay for what they did.
• I'm feeling very anxious, this must be a bad thing and I need to do something about it.

In CBT we learn that our emotions are a consequence of our thought patterns, and a response to the way we are thinking. Our thoughts can be automatic, like a reflex, and our beliefs can be out of date and no longer serving us. 

Our emotional responses may also be influenced by memories of past events or traumatic circumstances, tricking us into believing that a past threat is here and now. The memory may lead you to feel upset, but it is not happening now, so your current emotion would not be the wise way to determine your choices. Your emotions can lead you to confuse the past with the present.

If we only use how we feel as our filter for living our lives, we can unwittingly make mistakes and hold ourselves back in life. The emotions we feel when we are experiencing stressful events are so compelling that we 'feel' we need to take evasive or defensive action. This does not always take us closer to where we want to be - it often takes us further away from our valued goals. 

Here's a rather everyday example which many people can relate to. Take a fictional character Procrastinating Peter... "I feel so stressed about all this work I have to do." His anxiety feels so uncomfortable, he unknowingly feels compelled to avoid this feeling of anxiety, by avoiding the work he needs to get done. Anything will do: making endless cups of coffee, going on social media, tidying his desk, taking a sickie so he can feel better.

All of these actions take away the anxiety for a while, but the work doesn't get done, because Peter has used his 'feelings' to guide his action. The key is to understanding what thoughts or beliefs are underlying Peter's stress. Peter's thoughts could be going along several directions - "I'm not going to do a good enough job", "I can't ask for help, I'll look stupid", "I will get the sack, if this isn't up to scratch."

As observers, we can easily see that if Peter keeps putting off his work because he feels anxious, he is leaving himself less and less time to do the work, and possibly increasing the likelihood of his work not making the mark. He could end up rushing, staying up late, making mistakes, or not giving himself time to carry out any revisions his boss might ask for. Additionally the more he acts on his anxiety, the more he increases his own stress, as, by avoiding the situation, he even gives his brain the message that this is a real danger.

How to handle emotional reasoning

So, what can we do? Emotional reasoning or emotional filtering requires awareness and a mindfulness of emotions. There are many things people find helpful, but if you can follow these simple steps you may find it easier to step back and observe what is happening...

1. When you are experiencing a strong emotional reaction, it's helpful to step back and acknowledge how you are feeling. Can you name your emotion? eg. I am feeling anxious / angry / fearful right now. Accept and be kind to yourself in that moment, and nod to the fact that you do have a Tricky Brain which is primed to experience these difficult emotions.

2. If you are feeling the full force of anxiety or anger, and feeling shaky or out of control, you can try some deep breathing to steady yourself. A good technique is Soothing Rhythm Breathing (blog post to follow). This can balance your emotional response and enable you to discover that you can cope.

3. As you begin to settle, you can choose to take a look at the facts here. What are your thoughts? What specifically is going through your mind? Are other unhelpful thinking styles (eg. black and white thinking or jumping to conclusions) taking hold and increasing the pressure? Write this down. When you get better at this, you can do it on the fly. Try reframing or balancing your thinking. Nobody claims this is easy, it takes practice and perseverance, but with practice old thinking patterns can be broken.

The main problem with emotional reasoning is that it can keep you stuck in an unhelpful autopilot state, where you continue to act on your emotional filter. The emotional filter's go-to actions include avoiding people or places, procrastinating, lashing out at others, all in an attempt to stay 'safe' or 'defend' yourself from harm. In situations where you really need protection, this is genuinely helpful, but realise that when you are being adversely affected by stress or are suffering from anxiety disorders or depression, for a lot of the time, your mind is like an overhelpful friend giving you advice you don't need.

If you'd like to find out more about other unhelpful thinking styles, take a look here:

Jumping to Conclusions 
Black and White Thinking 

Unhelpful thinking style: Labelling

Ali Binns is a CBT therapist in Bath, UK. She help her clients to identify and manage their unhelpful thinking patterns and underlying beliefs. If you're looking for therapy in Bath, please feel free to get in touch at info@alibinns.co.uk

Unhelpful thinking styles: Black and white thinking

The thoughts we have, the words we use to frame the world and how we describe ourselves and others can all impact on our mood. It might surprise you to know there are several unhelpful thinking styles which we can become prone to when we’re experiencing difficulties.  Over my next few blog posts, I’m going to introduce you to some of these classic negative thinking styles. When we think in these ways, we can start to get in our own way! Unhelpful thinking styles can impact on our emotions, our actions and even our physical symptoms.

One of the most prevalent of the unhelpful thinking styles is 'black and white thinking', sometimes known as 'all or nothing thinking'. Have you ever caught yourself thinking along these lines?

• I’m useless at running, so I’m not going to bother entering that race.
• I’m a rubbish cook, so I’m not inviting friends here for dinner.
• If I don’t get a good enough mark in my exam, I have failed.
• I'm too old to do that.
• I'm exhausted, I couldn't possibly.
• Feel free to come up with your own here...

You can probably see from these examples, that when you stand back and look at these words, they are extreme ways of thinking. They don’t allow for shades of grey, they don’t allow for the possibility of making mistakes, they don’t allow for human fallibility or the potential to learn new skills. In short, they are thoughts which keep us stuck at the wrong end of a whole spectrum of possible thoughts. They certainly don't help us to do the things we might want to do. Dichotomous thinking (to give it a fancy name) makes our difficulties worse.

We call black and white thinking an unhelpful thinking style because these types of thoughts tend not to be 100% true, they’re hard to back up, and they’re sweepingly general. Many of us fall prey to this from time to time, when we’re under pressure, so feel free to acknowledge that this is a fairly common human experience. You are not alone in this!

The automatic thoughts which come tumbling out when someone is experiencing anxiety, stress, depression, or other negative emotion do not help to soothe or alleviate the situation, they increase and sabotage any possibility of moving closer to your goals. In the above examples, these wishes might have been to get fit, improve cooking skills, get a better social life, or feel relaxed and pass a test. Looking at the examples of black and white thinking, how do you think these thoughts impact on the mood of each person?

The good news. This is where a little knowledge goes a long way. Becoming aware of your thinking styles is a good first step. Once you recognise your thinking styles, you are already ahead of the curve. Many clients find it helpful to capture the thoughts that go through their minds when they are experiencing a strong negative emotional reaction and note them down in a journal. You can then begin to notice patterns in your thinking, some of which crop up over and over. We can call these negative automatic thoughts. Negative automatic thoughts often conform to the different unhelpful thinking styles, so it can be good practice to identify and name the type of thought we are experiencing. 

When learning to deal with all or nothing or black and white thinking, you can begin by reflecting on your thoughts as soon as possible after the event and have a reality check. Is this thought 100% true? Am I exaggerating or overestimating the badness of this situation? Am I failing to see the real-life detail in the situation?

Keep an eye out for further posts on the different unhelpful thinking styles. I’ll be sharing some further tips to help you to discover alternative ways to develop healthier, more flexible thinking styles.

Unhelpful thinking styles: Jumping to conclusions

Unhelpful thinking styles: Emotional filters / emotional reasoning

Unhelpful thinking style: Labelling

As a CBT therapist in Bath, I help my clients to identify and manage their unhelpful thinking and underlying beliefs. If you're looking for therapy in Bath, please feel free to get in touch at info@alibinns.co.uk

Your tricky brain

One of the biggest hurdles of being human is how we handle our tricky brain. Whoever we are, we go through life’s experiences with a brain that leaves us vulnerable to difficult negative emotions, including anxiety, depression, anger and shame. One of the first steps to overcoming any emotional difficulty can be to learn to understand your mind and how it’s only trying to help. Let’s get real about the way our minds work, because the mind is a tricky beast. Left to its own devices, your human brain can get up to all sorts! It’s just the way human minds have evolved and that’s no fault of your own. Your mind means well, it just goes a little overboard at times, trying to keep you safe.

Evolution of the human brain

The human brain is a product of evolution. The brain is a marvelous thing – if you think of the positive potential and capabilities of human beings – over the centuries, societies have made advances in science, knowledge, art and technology in ways that are truly astonishing. While it’s open to debate that all of these advances are a good thing (that’s another story in itself), there’s no question that the human brain’s capacities to think, reason, plan, invent and create are immense.

The problem with our tricky brain stems from the simple facts that our brain still retains many old brain functions from our evolutionary past – our ‘old’ mammal brains. Our brains are ruled by complex motivations for survival, food, reproduction, status and caring, all of which were essential for the survival of our species. There are also primary emotions of anger, anxiety, sadness and joy, all of which motivated us to take action, whether that was to fight, take flight, shut down, find food, compete for resources or find a partner, or engage in caring for young.

Bigger brain, bigger problems

Over thousands of years our brains evolved and, in simple terms, grew bigger. However, the trade-off that came alongside all the benefits of being a human were the disadvantages that can come of being able to think about your own experiences. We can monitor and judge ourselves, we can criticise, we can worry about and imagine what can go wrong, we can be frightened of our own feelings, we can feel inferior to others, we can ruminate about the past... Being able to comment on the content of our own minds can be sometimes be a design flaw in an otherwise amazing brain. The good news is that knowing that our own mind is a product of evolution we can begin to leave behind any ideas that we are to blame for any unhealthy negative feelings. Through no fault of your own, your brain will sometimes respond in a way that is out of proportion to a threat, because that’s the way our brains are made. Our modern brains have the unfortunate capacity to rev up and sustain any sense of threat for far longer than a mammal in the wild.

Fight or flight reactions

One way of thinking about this is to picture a zebra in the wild. The zebra is happily grazing with his pack, when along comes a lion. Lion gives chase and the zebra flees for survival. As luck would have it, on this occasion the zebra gets away. It then wanders back to the herd, and continues to graze. Its threat system served it well. The threat system kicked in, and the zebra’s body took over, ensuring its best chances of survival in a real life or death chase. Now, if that zebra had been gifted with a more human brain, he would still have that instinctive fight or flight reflex, but problems could begin after the event.

Rumination and worry

On returning to the herd, the zebra may begin to reflect as follows: “That was scary – I could have died. I can picture how awful that might be. What if next time I die? What if I had tripped and fallen, that could have been the end of me. How am I going to prevent that from happening again? Why did the lion pick me? Did I look weaker than the others? Hey, wait a minute, why didn’t anyone help me out there? They all just carried on grazing as if nothing happened. Maybe they don’t like me. What would have happened to my children?” Not only would the zebra be giving itself a wealth of new threats to dwell upon, but he’d be feeling worse for longer by ruminating about the past and worrying about the future.

This is what happens to humans. In face of a threat, real or imagined, we can bring the threat into our heads and keep it going in creative and unhelpful ways. As humans we can add to our original problems with shame and self criticism, unhelpful comparisons and negative judgments, all of which can sustain the feeling of threat and create a more persistent cycle of negative emotions.

The important thing to remember is that when this happens this is not your fault, it all comes down to your brain’s evolutionary design. The good news is we can take responsibility for our tricky brains and learn to manage it. Once we can see under the bonnet it becomes easier to understand and work with its foibles. There is a freedom and a power in knowing this.

Ali Binns is a CBT therapist in Bath. If you need further help and would like to talk things through with an accredited CBT therapist, please feel free to contact me  at info@alibinns.co.uk or via my Contact page.

Self acceptance: What’s not on the label

You know the deal. You’ve been promising yourself you’d never do that thing again, and there you go, you made that mistake again. Before you know it, you’re labelling yourself a failure, a loser, a hopeless case. At times in life, we can become prone to labelling ourselves in unhelpful ways. In the heat of the moment, these negative labels reappear momentarily, or, worse, stick around and become a habitual way of thinking.

How does it help us to label ourselves in a negative way? What benefit did you ever get from labelling yourself as a loser, a failure, unlovable or worse? Can you gently become aware of the labels you give yourself and consider for a moment that not only are these labels unfair and unhelpful, but they also don’t make sense.

Of course, on the face of it, you might buy into those labels if you’re feeling depressed, ashamed or anxious, but the truth is, as a human being it’s just not kind to label yourself in the same way you would a piece of luggage.

Let’s look at it another way... Think for example of a jar of jam. Any kind, your favourite perhaps? Think of the label on that jar. What does it say? Maybe Strawberry Jam, Raspberry Jam. What else is on the labels, maybe a short or long list of ingredients?

However detailed you make the list of ingredients on the label, the label will never come close to being the jam itself. The words can’t capture the essence of the jam, the taste, the look, the attributes. Think of yourself in that way, and see if you can give up the habit of labelling yourself.

If we return again to our jar of jam, you might also realise that each jar of jam is unique and each has its own merits. Some people prefer one jam, some like another – a jam can be different fruits, consistencies, home made, shop bought, organic, sugar free, runny or set. Regardless, this doesn't make one jam somehow intrinsically better or more universally valuable than another either. It takes all sorts to create a supermarket shelf of jams, just as it takes all kinds of people to make up a world of human beings. Accept your uniqueness, foibles and all, but above all see if you can peel off the label and see what’s underneath.

Ali Binns works as an accredited CBT therapist in Bath and sees self acceptance as a key to improved mental health. If I can help you, please feel free to get in touch via my Contact page or email info@alibinns.co.uk

A tale of self acceptance: The Two Waves

Ever summed yourself up as a failure, not good enough, worthless or other sweeping negative description? You’re not alone. This tendency to downgrade ourselves if things aren’t going the way we want in life is common place. Self esteem can come crashing down when we do this. In CBT, we call this a global negative evaluation of ourself, and it’s helpful if we can learn to notice when we are doing this and work towards an understanding of the self as far too complex to rate and sum ourselves up with unhelpful all-encompassing evaluations. All too commonly, people suffering from depression, anxiety or stress can sum themselves up as ‘a failure,’ ‘not good enough’, ‘useless’ and so on, when the truth is that none of these can be proved to be 100% true.

Ever noticed yourself doing this? Some of us label ourselves down when things have gone badly in a particular area of our life, but then proceed to sum our whole self up as a result of one mistake or failing. Each person on the planet has a unique and interesting combination of strengths, weaknesses, traits, roles, history, attributes, thoughts, beliefs, emotional responses, so when we explore a ‘global negative rating’, it’s just never true. Each person is so much more than the sum of their parts.

I recently heard this story of the two waves, which I think explains in a vivid way how we are much more than we imagine we are.

There are two waves racing towards the shore, one large and one small. The larger wave is frightened and he says to the little wave, “Oh no, this is it, it’s all over for us. I can see the shore and the cliffs and we are doomed.” The little wave looks back at him and says, “No, we’re fine. I can’t see what the problem is.” The big wave replies, “Look, I am bigger than you, I can see over the top of you and I can see the foam and the shore – I can see that our journey is over.” The little wave looks back and replies, and says, “The end? Not at all you’re not just a wave, you’re the ocean.” The big wave has given himself a self-limiting label, just as we often do, and that has increased his distress as he chases in to shore. Consider for a moment how you might limit your own progress with your own negative labels.

Perhaps you can work on this idea for yourself? Grab a pencil and note down everything you can think of that makes up you. For example, make a note of all your strengths, weaknesses, neutral points, roles in life, beliefs, ideas, attributes, thoughts, likes, dislikes, and feelings.  If it’s hard, you can ask a close friend or family member to get you started. When you’re done, take a look. Now does it make sense to ever sum yourself up in global terms? Can it also be true that you are so much more than any label you give yourself?

Can you begin to learn to accept yourself for who you are – this wonderful one-off and complex human being. There will never be another like you! Sure, you make mistakes, from which you are welcome to learn, or you have weaknesses you'd rather you didn't, but that’s where you’re not alone. Welcome to being human!

I work as an accredited CBT therapist in Bath (MNCS Accred, National Counselling Society) and see self acceptance as one of the keys to improved mental health. If I can help you, please feel free to get in touch via my Contact page or email info@alibinns.co.uk