Tag Archives: cognitive behavioural therapy

Group Therapy For Self-Esteem, Using CBT Methods

Group Therapy, is one of those things that tends to have a big fat stigma, slapped on top of it. You can almost picture the scene – a group of people all sat in awkwardly in a circle, looking a bit shifty and trying to avoid each other’s gaze. A ball is thrown around the circle, and if it lands on you, it’s your turn to talk. That’s right, you have to stand up, open your mouth and pour out your inner-most fears, in-front of a load of strangers, who you couldn’t give a crap about.

Last night I attended my first self-esteem focused, group therapy session. As usual, I was late, so all eyes were on me, as I sheepishly sat myself down. Yes, we did sit in a circle (much to my amusement), however that’s where the similarities between that and my imaginary scenario ended.

This particular group therapy, is about raising your self-esteem and confidence, via the use of Cognitive Behavioural Therapy methods, in a group setting. Now, I’ve been using some CBT methods over the last few months, so I was somewhat familiar with what we would be doing, but I never realised how much more of an impact it could have, when you do it as a group, as opposed to on your own.

It wasn’t nearly as scary as I thought it would be for one. Everyone there was in the same boat. They all have anxiety, self-esteem and issues with depression in one way or another. They’ve all been to that place called ‘rock bottom’ and don’t like what they see there and they all want to do something about it.

The two-hour session last night, was about introducing us to the way in which our thoughts, effect our feelings, which then effects our behaviour. For instance we were given the following scenario.

Scenario

Imagine that you are walking down the road and in the distance, you see a close friend walking towards you. The same friend then walks straight past you, without any kind of acknowledgement and on down the road. What is the first thing you would think?

What have I done wrong? – This is your thought.

Now, what does that one thought, make you feel?

Maybe you feel upset because you were ignored. Worried because you don’t know what you’ve done wrong. You might start to get anxious, have sweaty palms, hot flushes, be agitated, distracted. You may be frozen to the spot, not knowing what your next move should be.

These are all your body’s reactions to that one single thought. It’s startling how many emotions and feelings can come out of that thought.

Now, what do those feelings make you want to do?

You might forget about where you were going. Maybe that nice thing you were going to do for yourself, gets forgotten in the wave of feelings going on in your body. Perhaps, you might cry because you are confused and upset about why you were being ignored. You may go home, retreat into your comfort zone.

All of these things, triggered from one little thought. One small incident and your whole day is ruined.

 Group Therapy For Self Esteem, Using CBT MethodsMy rudimentary triangle of thoughts, feelings and behaviour. MS Paint is your friend.

Our group leader then approached it a different way. What if on seeing your friend walk past without saying anything to you, you stopped and thought differently about it. What if, instead of presuming you had done something wrong, you turned and shouted after your friend? Perhaps you could have told yourself, “Oh she mustn’t have had her glasses on, I’ll give her a call later.”, or even, “She must be having a bad day, I’ll ring her later, to see if she is OK. ” If you approached it that way, do you think you would have ended up with the mental and physical reactions that you had in the first scenario? No. You may have just been curious and concerned. Your day certainly wouldn’t have been ruined by it.

This in essence is what the CBT approach to self-esteem is all about. It’s about being curious and looking at why we think, feel and behave in the way that we do. It’s about being able to know when we’re feeling anxious, and to be able to sit with that anxiety, knowing it’s there, but also not letting it overcome you. It’s about accepting that we will never be the uber, amazing, confident, perfect person that we want to be – that’s unrealistic, but also understanding that we don’t want to be the creature with no sense of self-worth, or self-respect, who doesn’t take risks and always stays inside her comfort zone. It’s about working in the middle – in the grey area, one step at a time. Knowing our limitations, and then being curious enough to push them a bit. It’s about giving it a go because there is nothing to lose.

I got a lot out of that one session and I left it feeling empowered. Research has shown that the more a person puts in to these sessions, and CBT itself, then the better the results are. Doing it in a group setting helps, because we can encourage each other with the knowledge that we’re all trying to reach the same goal, even if it’s in a round about kind of way. So, for the next eleven weeks, I will be pushing myself and putting as much as I can in it. For me, the grey area is where I want to be.

Please let me know your thoughts on this, as I’m always interested in hearing other people’s experiences, whether you’ve done group therapy or not. Just pop a comment below, or if you’d rather email me, then you can find my email address on my about page.

Cognitive Behavioural Therapy – Part 2: Thought Diary

If you’ve been following me for a little while, you’ll remember I opted to receive Cognitive Behavioural Therapy (CBT) as a way of trying to combat my Social Anxiety. Today was my second appointment and it’s left me feeling pretty perplexed about the whole thing. Before I start, as a reminder, I’m practising a guided self-help form of CBT. What this means is that my therapist will show me the tools I need to use, in order for me to go off and start to fix myself bit-by-bit. This is not full on, one-on-one therapist lead CBT. Does that make sense? I hope so.

Anyway, after shooing away the usual doubts of “Is this really worth it? Should I really go? Maybe I’ll just cancel and deal with this on my own”, I jumped in the taxi and got myself off to the doctors. I use a taxi otherwise I’d get halfway there, think twice about it, turn around and leg it back home.

So two things shook my resolve before we even started. The first was that no-one told her I was there, which resulted in me waiting, anxiously, for a further half an hour and secondly on entering the room, she announced that she didn’t have a lot of time. Great! I overcame several of my own mind-games in an attempt to get me there and found out instead of the usual 45 minutes I would have got, this time was cut down to about 10 minutes. I get that she was probably enormously busy, but it was irritating and only deepened my sense of “Why am I doing this?”.

The session itself was confusing. I have a table on a piece of paper with 4 headings. In heading one, I need to write down  a situation so for example “The Beef wanted me to go out for a walk”. In heading 2 I then have to identify a feeling that occurred as a result of the situation and then rate it between 0-100%, let’s say “I felt flustered, anxious and apprehensive – 95%“.In heading 3 I  add the thought that I get, when thinking of the situation and feeling and rate how much I believe it, like, “If I go out walking, I will get hot and sweaty and think that people looking at me, will think that I look fat, horrible and ugly – 100%.

 Cognitive Behavioural Therapy   Part 2: Thought Diary

Bare with me dear reader, it gets a bit more complicated from now on.

Now on a separate sheet of paper, I have a table with the headings “My thought” (call it heading 4) and “My % belief” (heading 5). Under “My thought”, I would write “When I go out walking, people will think negative things and laugh at me”. Under “My % Belief”, I would write “100%”, because right now, that’s how much I believe that thought. Now under these statements, in the first column is the heading “Evidence for” and in the second column, “Evidence against”. In the “Evidence for” heading, I need to write down the evidence I have for why I think that “When I go out walking, people will think negative things and laugh at me”. My evidence for this would be, “Last week I went to the shop and got dirty looks from a group of teenagers”, or “On my way to the doctors, the taxi driver didn’t say a word to me” and you carry on listing the evidence for. (In any normal situation this wouldn’t be a concern to anyone, just a bit awkward. With the way I think, it MUST be something wrong me ME that causes this.) You now move on to Evidence against. What have you done recently that would go against that thought you had? Something like, “I walked to the mail box and got a lovely smile from an elderly gentleman”, or “I took my toddler to the supermarket, and was told how well-behaved he was”. These are examples of where what I thought would happen, didn’t happen.

 Cognitive Behavioural Therapy   Part 2: Thought Diary

Phew we’re getting there.

Right.  We’ve done 1 – Situation, 2 – Feeling %, 3 – Thought % on the first sheet. On the other sheet we did 4 – Thought  and 5 – My Belief % and the subsequent for and against instances. We now go back to the first sheet for 6 – Revised Thought and how much I believe in it %.

What a Revised thought is (as it was explained to me), is a thought that I can come up with, that’s a bit more positive than my original one, and one that I can believe. So in my case, instead of “When I go out, people will think negative things, and laugh at me”, I will change it to “When I go out, people might notice me, but won’t think much about me”, then I rate it by how much I can believe it, lets say 45%. I could probably come up with a better thought to go on, but hopefully you get the idea. I create a new thought that I can believe in enough, to put into practice.

Then comes the last heading 7 – Feeling, how bad was it? %. I write down how I feel before I go and test my new thought. So I might put something similar to heading 2′s ‘feeling’, purely because this is my first time trying this method. The idea however is that the more I test out my “new thought” (heading 6), the more I will believe it, which will change how I feel about it and hopefully change my thinking enough that when I go in to the same  (1) situation, over time I will no longer (2)feel or (3)think as I used to.

In essence, instead of:

The Beef wants me to go out for a walk. I feel about %95 flustered, anxious and apprehensive, because when I go out, people will 100% think negative things and laugh at me for being hot and sweaty.

a change in the thought process, should help me get to:

The Beef wants me to go out for a walk, I feel a little flustered, anxious and apprehensive, HOWEVER, when I go out, people might notice me, but won’t think much about me and I believe this 100%.

I sincerely hope this has made sense to any of you who have had a go at following. I’ve been trying to understand it as I go along, because I didn’t have a clue what the woman was talking about at the time. Explaining it to you though, has helped to explain it to me. I’d also like to add that the examples of thoughts and feelings I’ve used, are indeed my own. This is how I think and behave, which is why getting to grips with this therapy is so important.

Have you gone through a similar experience? If so, please, comment and help me to make some sense of it all. All comments are welcome, even if it’s just to say how impossible it was to follow any of the above.

Well done!

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Cognitive Behavioural Therapy – Part 1: Assessment.

To Re-cap

Not too long ago, I admitted to myself that I needed help. I put into words, what I had been keeping to myself for a very long time and in doing so, cleared the cobwebs a little and put things into a bit of perspective. What came from it, was my resolution to visit the doctors and get it all out in the open – to ask for help and to try to make some kind of plan for the future of my mental state.

I made it to the doctor’s surgery and eventually succeeded in getting across what I wanted to say, (even if it was in a very round-a-bout way, akin to the ramblings of Boris Johnson). Thankfully instead of staring somewhat confused at me, she nodded sympathetically and gave me my options:

Antidepressants
Cognitive Behavioural Therapy

or a mixture of the two.

I decided on Cognitive Behavioural Therapy (CBT), because of the many good things I had heard about it, along with my dislike of anything drug-related.

 Cognitive Behavioural Therapy   Part 1: Assessment.Picture from: Get Self Help

The assessment.
Going to the appointment today, I didn’t really have any expectations, aside from the fact that hopefully, going down this route would lead to something positive at the end. I walked in with my questionnaire filled in, which asked me to rate various manifestations of depression and anxiety that I may or may not have been feeling over the past two months. I tried to answer the questions as honestly as I could, even if it meant confirming to myself that my problems were as real as they appeared to be.

After she introduced herself, the woman seeing me went through a series of questions, asking me specific things about my various problems – such as my daily struggle to get out of the house, that the anxiety of walking anywhere and the feeling of being looked at and judged was more intrusive than my actual destination. This then led on to how it affects my children, in that by not being able to leave the house without any difficulty, I am depriving my children from quality time with their mother and relying on others to give them that experience.

It’s hard having to say that out-loud, and I mentioned to her that this makes me feel like I’m failing as a mother, which in turn makes me feel useless and worthless and the whole cycle spirals downwards, until I’m incapable of doing some of the basic things like looking after myself.

After these admissions we looked at my options and she was very frank with me. Although I scored quite highly on the questionnaire – being in the high to severe ranges of anxiety and depression – the waiting list for the full on, one-to-one with a therapist kind of CBT was extremely long and I’d have quite a wait on my hands, therefore for now she would suggest a guided self-help form of CBT, in which I would be given the reading materials and short sessions with herself to guide me into making short goals and pushing myself, into making changes in the way I think and behave. What was also mentioned was that CBT is the most effective and has the most impact, when being used in conjunction with antidepressants.

To Conclude

I’m not entirely sure how I feel about this. I’ve been trying to push myself and self-help my way into a better way of thinking for a long time, and I’m not convinced that this will make much difference. I also don’t relish the idea of being on antidepressants. Perhaps it’s the bad press that they get or here-say but it’s not something I want to do if I can avoid it.

I have an open mind though and am willing to try anything, (with in reason of course) if it means that I can get my life back. So my next appointment is in two weeks time. I just need to encourage myself to keep going back!

Have you engaged in Cognitive Behavioural Therapy, either through a self-help programme or via one-to-one therapy? Perhaps you went down the group therapy route. Did you take antidepressants in conjunction with your therapy? I’d very much like to hear of your experiences regarding this, so please feel free to comment!