Cognitive Therapy in London
Help with depression, stress, anxiety, worry, indecision and low self-esteem through CBT (cognitive behaviour therapy)
Need help? CBT from "Wise Therapy" author Tim LeBon is available for psychotherapy in Central London.
Cognitive Behavioural Therapy is particularly suited to help quickly if you are suffering from stress, depression, anxiety or low self-esteem. CBT can is an evidence-based approach that can also help with panic attacks, feeling worried, decision-paralysis and low self-confidence. If you have been diagnosed with OCD (obsessive compulsive disorder), social anxiety (or social phobia) or GAD (generalised anxiety disorder) then CBT is also the NICE recommended treatment.
Enquire about a consultation today.
I offer an affordable, timely service with the extra benefit of the possible Skype and e-mail sessions and a Central London location
(Fleet Street/Chancery Lane ).
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What is CBT (Cognitive
Behaviour Therapy)?
CBT
(Cognitive
Behavioural Therapy) is one of the most popular and
respected forms of therapy practised in the UK, probably because it is
evidence-based
and can produce results relatively quickly. The
central idea of CBT is that our emotions
are connected to
our thoughts. By becoming aware of your thoughts, and substituting
realistic
thoughts for unrealistic ones, you can overcome emotional difficulties
such as
depression, anxiety as well as low self-esteem and relationship issues.
Although
coming to prominence in the 1960s through
Albert Ellis’s REBT and in the 1970s through Aaron
Beck’s Cognitive model its
roots lie in the ancient philosophy of the Stoics.
Epictetus’s “ People are
disturbed not by things but by the views which they take of
them” is not so
very different from David Burns’s: “By learning to
change your thoughts, you
can change the way you feel”
If
you have any emotional difficulty, CBT provides
a structured approach to help. CBT is particularly suited to deal with
depression, anxiety, anger-management, low self-esteem, relationship
issues and
stress management. It
aims not only to
relieve symptoms, but also to help you acquire longer-term coping
strategies
and modify underlying beliefs and patterns of behaviour.
David
Burns, a leading cognitive therapist says
there are three steps to CBT:-
1)
Understanding
your moods: distorted thoughts
cause negative feelings
2)
Changing the
way that you feel: Spotting
distortions and answering back to them
3) Developing a Healthy Value System: digging deeper to rules for living and the bottom line
The
Cognitive theory of the
emotions – the ABC
model
The
cognitive
theory of the emotions posits that thoughts (including beliefs,
inferences and
evaluations) play a major part in determining our emotions and moods.
A
=Activating
Event
B
– Belief
- inferences Oliver
infers that Kate doesn’t like him
- evaluation Oliver
fancies Kate so thinks this is terrible
C
–
Consequences
- emotional
consequences Oliver
is upset for the rest of the day
- behavioural
consequences Oliver does not ask Kate out
as he planned to.
2) Changing the way that you feel: Spotting distortions and answering back to them
"Cognitive Distortions": The 10 Types of Twisted Thinking (adapted from David Burns,The Feeling Good Handbook)
Distortion |
Meaning |
Example |
1.
Jumping to
conclusions |
Drawing
a conclusion
in the absence of sufficient evidence |
Mind-reading
"He
thinks I'm stupid" Fortune-telling
"They
are going to turn me down" |
2.
Overgeneralisation |
Drawing
a general rule
or conclusion from isolated instances |
"No-one
appreciates
me” |
3.
Mental filter |
Not
noticing positive
things |
“Its
been a lousy day”
(when you had a very nice morning) |
4.
Discounting the
positive |
Noticing
positive
things but saying they are unimportant |
“You
are
just saying that to make me feel better” |
5.
All-or-nothing
thinking |
Placing
experiences in
one of two extreme opposite categories |
"I've
blown my diet
completely" |
6.
Magnification |
Catastrophising
about
bad things |
“It’s
a disaster” |
7.
Emotional Reasoning |
Assuming
that your
emotions are always a good guide |
“I
won’t go to the gym until I feel like it.” “I
feel like
I’ve no future, so there must be no future” |
8.
Shoulds and musts |
Unrealistic
personal rules |
“I
should feel OK all the time" “
People must always treat me with respect.” |
9.
Labelling |
Unfairly
using
pejorative and emotive and negative terms to describe oneself and others |
"I'm
a failure" “He’s
a plonker.” |
10.
a) Personalisation b) Blame |
Relating
external
events to oneself or others when there is no basis for this |
"It's
all my fault" "It's
all their fault" |
Ways
to Untwist thinking (adapted
from
Burns, The Feeling Good
Handbook)
Way
to untwist |
Notes |
1.
Identify the
Distortion |
Which
one of
distortions 1-10 applies? |
2.
Examine the evidence |
Look
at actual
evidence for and against belief |
3.
The Double-standard
method |
Talk
to yourself as
you would to a sympathetic friend |
4.
Experimental
Technique |
Experiment
to see if
belief is correct |
5.
Think in Shades of
Grey |
Rate
from 0-100; look
for learning points |
6.
The Survey Method |
Ask
friends if they
agree with your belief |
7.
Define Terms |
e.g.
Ask yourself what
a real "failure" is or even if anyone really is a complete "failure" |
8.
The Semantic Method |
Use
less emotionally
loaded language about yourself |
9.
Re-attribution |
Think
of many factors
that could have contributed to problem |
10.
Cost-benefit
analysis |
What
are the pros and
cons for having this feeling, belief or behaviour ? |
Automatic
thoughts can
be compared to the top of the
weeds spoiling our garden; rules for living and bottom line are the
roots.(these are sometimes called silent assumptions and core beliefs
respectively)
A) The Bottom Line (Core beliefs)
Your
own assessment of yourself, or the world, or other people (in general)
Examples:
“I am not good enough”, “The world is
dangerous”, “People are hostile”.
Having
negative bottom lines can have a major
negative effect on your life. It can lead to you having unhelpful rules
for living,
automatic
thoughts and
psychological problems.
Guidelines,
policies and strategies for getting by, given the truth of the bottom
line. Situational
(as opposed to the
bottom line which is global). Often
“if
… then .. statements
or “musts”.
Examples:
“Unless I do something perfectly, it will be
viewed as useless”.
“If I let
people
see the real me, they will reject me”
In
the short-run, rules
for living often
have a pay-off – e.g. avoiding discomfort, especially caused
by situations
where the bottom line is shown to be true. In the long-run though some
rules
for living can maintain harmful patterns of behaviour.
Sometimes
your
bottom lines and rules for living are obvious, sometimes they become
clearer in
therapy. One technique specifically designed to identify them is
Burns’s
‘Vertical Arrow Technique’ .
1) Instead of challenging
a negative thought,
buy into it
2) Write down the
thought, and underneath it a
vertical arrow.
3) Now ask ‘If
this is true, why does this
matter, what would it mean to me?’
4) Repeat steps 2 and 3
until you have got to
what you think are really basic, silent assumptions or ‘core
beliefs’ e.g.
(from Burns, p. 124)
a)
If I don’t study harder,
I may blow my
exam
â (why does this
matter?)
b)
If I blow my exam, I may fail the course
â (what would this mean
to me?)
c)
That would mean that I was a failure and people would think less of me?
â (why does this
matter>)
d)
Then I’d feel terrible, because I need people’s
approval to feel happy and to
be worthwhile
This
can be a much longer process than just dealing with automatic thoughts. There are two basic ideas
– one to challenge
the old rules/beliefs (as in challenging automatic thoughts)
– the other to
construct new, more helpful rules and beliefs.
To
construct a more realistic rule for living,
the following questions
(from
Fennell)
The
new bottom line may well be the opposite of the old bottom line, and may well be less
all-or-nothing than the
old one.
Behavioural
Experiments are a key way of breaking unhelpful rules for living.
Experiments
designed to gather evidence for and against either new or old
predictions,
thoughts , rules & bottom lines.
When designing experiments, you should write down
-
what you are testing
-
how much you believe it now
-
what you will do, where and when
-
what problems are likely and how to deal with them
After
the experiment
-
the outcome – what happened, what you
observed, what you have learnt
-
what next
Melanie
Fennell's Overcoming Low self-esteem is highly recommended on
experiments
CBT is a
collaborative process between therapist and patient that ultimately
teaches
patients how to identify and manage their negative thoughts.
A
session may typically begin with client and
therapist deciding on an agenda for today’s work. This is
important as it gives
you the chance to decide on what the session will cover, and to
prioritise
agenda items. The agenda will often start with a review of the week and
any ‘homework’
set from last week. The main part of the session may focus on a
particular
incident that occurred in the week, with a view to increasing your
awareness
and ways of dealing with such issues in future. For example, if are anxious about a job
interview, then the
therapy may look at the thoughts leading to your anxiety as well as how
these
relate to underlying beliefs about yourself and the world and more
– and less –
helpful behaviour patterns. The session will often end with a summary
and an
agreement on homework tasks for the next week.
CBT’s
collaborative and educational nature makes
Socratic Questioning (sometimes called Socratic Dialogue or Guided
Discovery) a
key technique. Socratic Questioning aims to use a process of careful
questioning in order for the client to reach their own conclusions. It is used:
(i)
clarify or define
problems;
(ii)
assist in the
identification of thoughts, pictorial images or assumptions;
(iii)
examine the
meanings of events for the client, and
(iv)
assess the
consequences of specific thoughts and behaviours.
Example of a depressed man staying in bed all day
Therapist
(Beck): What is the probability that you
will go back to bed when you leave the office?
Patient: About 100 per cent.
Therapist:
Why are you going back to bed?
Patient: Because I want to.
Therapist:
What is the reason you want to?
Patient: Because I’ll feel better.
Therapist:
For how long?
Patient: A few minutes.
Therapist:
And what will happen after that?
Patient: I suppose I’ll feel worse again.
Therapist:
How do you know?
Patient: Because this happens every time.
Therapist:
Are you sure of that?...Have there been
any times when lying in bed made you feel better for a period of time?
Patient: I don’t think so.
Therapist:
Have you found that not giving in to
the urge to return to bed has helped you at all?
Patient: I guess when I get active, I feel better.
Therapist:
Now to return to your wish to go to
bed. What are the reasons for going to bed?
Patient: So I’ll feel better.
Therapist:
What other reasons do you have for
going to bed?
Patient: Well, I know theoretically that I will feel worse later.
Therapist:
So, are there any reasons for not going
to bed and doing something constructive?
Patients: I know that when I get involved in things I feel better.
Therapist:
Why is that?
For the general
public and therapists
For
Therapists
Training
Institutes
What
else can I read on the web about CBT?
Here
is a selection of useful links on CBT.
I
offer private CBT which can help you if you are suffering from a number
of problems including stress, panic attacks, worry, depression,
self-esteem related problems and problems relating to indecision.
The therapy will normally be for up to 12 individual weekly sessions. The fee is £60-£80 (depending on what you can afford) per 50 minute session.
Enquire now to book your session or find out more details..
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Chancery Lane, counselling, therapy, depression, anxiety, stress, low self-esteem, CBT London Therapy, CBT London