There are two treatments for panic attacks – medication and psychological therapies. Some people advocate the former while others support the former; some insist on a combination of the two. It all gets a bit confusing so how do you know which treatment course to follow?

First of all, there is no single approach that suits everybody when it comes to panic attacks and anxiety disorders. A cornerstone of effective therapy is that it is individually tailored to the person after a detailed study of the symptoms and when they occur. This should apply regardless of which panic attack treatment you choose to follow – and, in the end, it is your choice and you have to feel comfortable with it.

One of the most effective psychological approaches is that of cognitive behavioral therapy or CBT. Studies have shown CBT to be more successful in the long run than medication. To be more specific, more people who were treated with CBT remained panic free six months after treatment stopped than those who were on medication. A further study showed that while medication may be effective in treating the symptoms of panic attacks, the benefits stopped when the medication stopped. That is, people had to keep taking the drugs which then lead to unpleasant side effects.

CBT therapy requires work and commitment by the therapist and, more importantly, by the person seeking treatment. It’s not as easy as taking drugs a few times a day and the effects are not seen so quickly, but if you compare a drug free life free of panic attacks to taking medication for the rest of your life, then the advantages are obvious.

The focus of CBT is getting you to solve the problem yourself so you feel in control of your life again. This is very important as one of the biggest fears of those suffering from panic attacks is that they have lost control over themselves, often to the extent that they feel they are losing their minds. The ‘cognitive’ part of the therapy means changing the way you think through a very gradual desensitization process.

For example, let’s say your first attack occurred in a crowded room, at a party perhaps. Because the feelings were so intense and you were so frightened, you never want to experience it again. So, you go out of your way to avoid that situation – you make up excuses so as not to face a reoccurence. But this means that you are sitting at home by yourself when everyone else is at the party having fun. Not an ideal situation.

So, desensitization means taking very small steps firstly to get you used to the idea of going to a party (cognition) and then getting you there (behavior). Your first step might be getting dressed as if you are going. That’s it. Just dealing with the feeling that you are going is enough for one day. This may go on for several days until you feel comfortable with the thought that you are going to a party. When you are ready, you take the next step which may be getting dressed and then opening the front door as if you are on your way out. That’s it for the second step. When you’re ready, the third step is getting dressed, opening the front door and closing it. And so on.

While you are going through these steps at your own pace, you are also taught how to deal with the conflicting feelings you have. Controlling your breathing is instrumental here. Rapid breathing is often the catalyst for the other symptoms you experience during a panic attack so if you have techniques for keeping your breathing rate steady then this could be the difference between a slight twinge of anxiety and a full-blown attack.

Many therapists agree that 10-12 sessions are sufficient for most people to be able to manage their problem on their own. After the first five or six, improvement can be seen and the person begins to feel confident that they can regain control of their lives.A final step in the treatment process is to teach management techniques in case panic threatens to rear its ugly head in the future. Armed with this knowledge, it’s a very real possibility that panic attacks are a thing of the past.

About the Author

Emma Hudson is a panic attack expert. For more information on help for panic attacks, visit http://www.panicattackneedtoknow.com.

Best answer:

Answer by natasha
Hi there,

Gerald Corey (theory and paractice of Counseling and Psychotherapy eighth edition) page 303.

Hope this helps.

Know better? Leave your own answer in the comments!

Panic disorder is a condition in which the body and the mind seem to loose temporary control. Conditions such as a racing heart, palpitations, shortness of breath, chest pain, fast pulse rate, dizziness and sometimes feeling nausea’s are common symptoms. In order to learn how to control panic attacks it’s important to first know the symptoms that you experience. It is in this way you will be able to eventually understand the root cause of the panic attacks in the first place to overcome them entirely. Many people have started to use Cognitive Behavioral Therapies (CBT) to solve their panic and anxiety problems. So far, Cognitive Behavioral Therapy has been one of the most successful forms of treatment for people undergoing high anxiety or panic attack problems. CBT has proven to be one of the best approaches to take since it deals 100% with natural methods to curing panic attacks. By using simple understandings, a different perspective of the situation, and well grounded techniques to overcoming and learning how to control panic attacks, individuals are able to see results just days into therapy. Patients are helped by being walked through the recovery process and are shown through their thinking process what exactly is causing their problems. They are helped to understand how their thinking process is creating their panic attacks and vice versa. And by changing their state of mind patients can learn how to control panic attacks and prevent them from starting in the first place. CBT has two parts. Firstly identifying and changing the distorted thinking pattern of the patient which leads to the panic attack, and secondly desensitizing through the repeated exposure to the situation which is feared.With CBT you are shown how panic attacks are a product of your anxiety, fear and thinking. It is nothing but your bodily sensation of the anxiety. The cognitive approach is one such natural treatment to overcome panic attack which does not result in any side effects. You are shown how to control panic attacks by controlling your fear. And it is the very fear of having another panic attacks that causes us to have more in the future. For example if a patient has a strong phobia for traveling in an elevator then every time that patient has to get into the elevator, the fear slowly starts to take over and a panic attack may eventually erupt. By dwelling on that same fear, you set yourself up to continue to repeat that same fear every time you have to use the elevator. Greater emphasis is placed on the fear of the elevator that it completely overrides our rational state of mind and prevents our mind from remaining calm. The cognitive approach will teach you how to recognize and free yourself from your fear – whatever it may be. With traditional medication you may be able to temporary solve the problem, but after sometime it will eventually return. Comparing the traditional method to CBT, patients generally don’t relapse and retain what they learn through therapy so panic attacks are never a problem again. In my personal opinion, the Panic Away program, developed by Barry Joe McDonaugh, is the best form of Self-Help CBT that is currently available. This self-help program is 100% natural, doesn not require any medicines or doctors and is already responsible for successfully recoving over 40,000 patients worldwide. This has been the definite answer for thousands of people and it could be for you too. I’ve just been using it for a few weeks and am already starting to see great results so make sure to check out Panic Away right away.

About the Author

To get more information on how to control panic attacks, and Jeremy’s recommended CBT program ‘Panic Away’, you can visit Jeremys recommended website panicandanxietycenter.com where you will find plenty of information and some highly recommended self help guides to help you overcome your panic and anxiety.

Peter Andre visits a therapist to talk about his long term Anxiety & Panic Attacks. Footage taken from 2007.
Video Rating: 5 / 5

Clinical psychologists are providing important expertise to many sufferers of psychological problems. Increasing number of people are suffering from different kinds of psychological diseases due to increasing pressures of work, life, relationships, competition and more. When the problem is at initial stages, it can be sorted out by the help of family and friends. However, when it becomes serious, it cannot be solved by the simple measures. It requires the skill and expertise of trained and professional clinical psychologist. Any kind of major psychological illness can be treated with different clinical treatments such as cognitive behavioral therapy, family counseling and more. About 1/4th world population needs professional help to deal with feelings and situations that seem beyond their control. Clinical psychologists can treat people with variety of problems including marital and family problems, anxiety, loneliness, illness and injury, psychological aspects of medical illness, addiction, behavioral problems, sexual issues, disturbance in eating and sleeping, children?s educational problems, difficulties at work, caring for the elderly and more. These professionals can also assist during natural disasters, crisis and terrorism. Whatever be your problem, you can approach a licensed clinical Psychologist. You can work with your psychologist to solve your problem in a confidential and supportive atmosphere. Some people might deny the importance of a professional for solving the psychological problems. However, you can see that they are very important for our society that is reeling under the high pressures. These are highly trained professionals who solve a problem by evaluating, classifying and treating the emotional and behavioral problems. You can judge their expertise by the fact that they undergo 7 years of education and training after completing their undergraduate degree. How can a clinical psychologist help patients?To help the patients, clinical psychologists have initial consultations with them to understand their problems. They talk about the history of the problem, classify and analyze it to find the right solution. They put the patients on suitable treatment with right therapy such as cognitive behavioral therapy and family counseling. Some psychologists may prescribe a series of tests to provide the right aid. A psychologist may prescribe you psychotherapy, which helps you learn more effective way to deal with problems. The psychologist may recommend family therapy or may also tell you to become part of a therapy group. H may also use specialized techniques such as behavioral modifications, bio feedback and stress management training. In some cases, he may also recommend visiting a medical physician for medical evaluation.The duration and course of treatment differs for different patients. Some people may gain from short term of therapy. To receive the prescribe therapy; patients need to go to the doctor once or twice a week. The treatment may be provided through outpatient care or inpatient care, depending upon the case. There are good websites such as therapytribe.com which provide great information about the psychological diseases, their treatment and can connect you to various therapists, clinical psychologists and other professionals.

About the Author

Ryan FitzGerald is the Co-Founder of WebTribes Inc. WebTribes is a network of online community websites designed to bring people with similar life issues together from around the world that are in need of support. The support communities are for people affected by Depression, Addiction, OCD and HIV/Aids. Browse Therapy Tribe to Find Therapist, Find Marriage Counselor; find Grief Counselor, Depression Therapy.

People who suffer with migraines know that it is a hassle and a struggle that can interfere with a lot of the aspects of your daily life. However you choose to address it, it can seem like you are not getting enough relief from your migraines. When you are looking for migraine headache treatment, some times reaching for the closest Advil will not help your case. That is why there are better and different ways to help heal and address your migraines. One way is to use cognitive behavioral therapy for migraines, it is a great way to be sure that you are able to cure your migraines. This kind of therapy works with people who have migraines to help them identify when they are going to get a migraine. This kind of therapy helps you intercede and stop the migraine from happening, and there are steps you can take with your doctor to accomplish this feat.

The first thing you need to do is address your doctor about migraine headache treatment, and discuss cognitive behavioral therapy for your migraines. You work to identify the cause or the problem behavior that is causing your migraines and the struggle, and you can do so by keeping a journal of when you have your migraines, and the activities that prelude them. Establish a goal that you have in a mind, and it is one way to be sure you are working towards getting rid of your migraines for good, and then try to re-think your behaviors and your patterns. Establish a new way to work around certain things that trigger a migraine, so you can get over them.

Recovering and learning to live with migraines is easy, and using this kind of therapy you can learn when to recognize an oncoming migraine and how to stop it. Use the tools you are given by your doctor to change the behaviors that trigger migraines, and work step by step to accomplish a common goal. Whether that goal is less migraines, or stopping your migraines all together. It’s possible, and you can do it, so make the step today.

About the Author

Jack Morrison has been helping people to deal with migraines.

He also manages a site for torchiere floor lamp deals at http://torchierefloorlamp.net

A sense of lowered self-esteem affects many people in our society. One school of psychology that has been found to help people with this problem is cognitive behavioral therapy (CBT). CBT is a form of therapy which focuses on and has the goal of helping people overcome emotional problems.

What characterizes CBT as a therapeutic approach? “Cognitive” applies to our mental processes such as memory, perception, and motivation. Behavior of course refers to our actions and conduct. Therapy has been described as a thorough and systematic way of approaching a life problem, usually in the area of emotions.One main strength of CBT is that it is based upon scientific studies. Not only have scientists been able to test and develop practical approaches to life problems, patients in this form of therapy frequently develop a somewhat scientific attitude toward themselves. As scientists will test a theory, individuals may test a perception or memory of a person or event in their life. They may ask, “is this reality or am I distorting my memories or perceptions”?

In CBT, the answer to this question is of great importance. If someone experiences negative emotions toward another, frequently that person is taught to ask themselves “what evidence do I have that this other person is trying to make me angry”? And further, “is it possible that I might be reading into the situation and attributing thoughts and motives to others when in fact these beliefs may more reflect my own concerns”?

CBT also recognizes a certain philosophical approach to life. CPT addresses beliefs that people hold about themselves and others. An important part of this therapy is to examine the reality of these beliefs. CBT is directed toward helping people be flexible and self-helping rather then self-defeating. This form of therapy also ultimately involves behavior. The theoretical underpinning is that thinking leads to feelings which then lead to behavior. If someone’s thought patterns can be changed, it follows then that their feelings and behavior can be changed also. The goal of the therapy is to bring about changes in thought patterns in such a way that feelings become more positive, and behavior becomes beneficial toward oneself rather than harmful as when negative feelings are acted upon.

CBT emphasizes a focused approach. A person utilizing CBT therapy is encouraged to move from self-defeating emotional and behavioral problems toward the direction of setting goals involving more satisfying feelings and behavior. Thus CBT is a systematic, problem-solving approach to the emotional problems that accompany life for all of us.

Many people believe that they feel a certain way, for example, angry, because of something that someone else has done to them. After some exploration they can see that they have attributed meaning to what the other person has done, and they have allowed themselves to become angry in reaction to the other person. They could have also chosen some other way to react. An alternative reaction may be healthier and involve thinking that produces feelings and behavior that are much more satisfying than prior self-defeating behaviors.

In fact, self-defeating behavior has frequently been the basis for the initiation of CBT. CBT has been shown to produce quite good results with removing self-defeating behaviors and is therefore undergoing increasing acceptance in the psychological community.

About the Author

Alan Wortman has been writing articles for 4 years. See his new website at http://www.flowersforspecialoccasions.com where you will see the best choice of flowers for each occasion.

When a person out of the blue feels a combination of symptoms leading to making him or her worried it can be defined as a panic attack. These panic attacks take place often with no visible causes. Researchers found that genetics, alcohol, serious illnesses, medications and drug withdrawal can cause these panic attacks.It happens frequently that people are unaware that they are having a panic attack.A panic attack can be short as 10 seconds to as long as 20 minutes. Treatments are widely available to aid people deal with the symptoms or the illness itself. There are two foremost methods that doctors take are: one, by cognitive behavioral therapy; and two, by taking medications.

Many disorders and also anxiety disorders are cured with cognitive behavioral therapy (CBT). It is regarded as the first line of therapy for a panic attack and the alternative for sufferers not reacting to medications. A therapist uses CBT to step by step expose his patient the grounds or cause of his anxiety. This is due to the assumption that fear of something is conditioned in a sufferer’s mind. Phobias are reinforced, when a patient constantly avoids the subject of his panic.As a result, it is crucial that a patient learn not to be afraid of the stimulus.In this method, the objective is tofind outhow one’s thinking process assesses and deals with the thoughts that causefear or fright. Subsequent to receiving information regarding the problem and how the treatment will be administered, the symptoms one would feel will be recreated in a controlled environment.This will be repeated up to five times a day for at least one minute.It can take weeks before a person is not troubled any longer by a sudden onset of symptoms.

Patients that followed cognitive behavioral therapy found positive long terms effects. Relative improvements can be seen after six to eight weeks with some sufferers.When people stop their medications, CBT can put a stop to relapses.A study about benzodiazepine withdrawal demonstrated that patients who underwent cognitive behavioral therapy had a higher success rate when put side by side to those people who did not. When the two methods are combined, it typically produces a more favorable outcome than when a person decides to use only one. Panic attacks are a severe disorder; therefore it is best to seek advice from one or two doctors before making use of any kind of therapy. The good news is that panic attacks can be effectively treated. The treatments are not as fearsome as a panic attack.A panic attack sufferer will be capable to cope with his attacks with correct supervision from the physician.

About the Author

You can get more information how to treat a panic disorder attack at http://www.antianxietyconsumerreport.com

Best answer:

Answer by Aunty
Your problem sounds like the very thing CBT would be good for. But I went for depression and didn’t find it helpful. I was given forms to fill out throughout the day, how I felt, what I was thinking etc, every hour. It’s about catching yourself out, recognizing symptoms and halting their progression, basically.
I reckon you would find it good…was just being honest about my experience :) Good luck.

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There are many approaches in therapy that are available for anyone who wants this service. Cognitive Behaviour Therapy (CBT)is the most well known, because it is the most researched form of therapy. CBT is the product of the West, where people are encouraged to think and discouraged to feel emotions. CBT is based on the premise that our thinking can change our feelings.

This is not always true. When people undergo abuse or torture, no amount of thinking is going to sort out the feeling of rage that underlies such experiences. The rage that one feels about such experiences overwhelms the thinking ability of an individual and the person still ends up acting out the emotion. In all such cases CBT fails to get any results. Yet because it has been written about widely, mental health practitioners erroneously believe that it is the only suitable form of therapy in almost all forms of psychological conditions.

A middle aged man, enraged by an ex-employee’s deception wanted to harm the ex-employee physically. Overwhelmed by anger, he felt that the only way the person would realize how they felt was by conferring physical pain. No amount of reason or logic was useful. According to him, ‘action had to be taken’. The best solution in this case was to reduce the anger by releasing it. When it was done in a few minutes, he thanked me for helping him out of the situation. The perception had changed. The thoughts were non-aggressive. Needless to say, he did not act out the rage.

When our inner drives are strong, they overwhelm our thinking. At such times reason or logic is governed by the drives. Anger is one such emotion. When it takes the form of rage, the person may lash out physically. The solution does not lie in reasoning with the person, but to help the person reduce the drive. In other situations when the anger is in the form of annoyance, reason can still be used to ‘distract’ the person away from the issue. But the feeling stays. To distinguish between times when behaviour can be changed by thinking and when it cannot be changed by thinking requires wisdom.

Is there a way to completely remove the urge to talk to women, so I no longer have to get so nervous around them anymore? I’m a 22 year old male.

Thanks!

OCD is characterised by obsessions and compulsions. An obsession is a persistent thought, image or urge that comes into your mind and sets off feelings of anxiety and distress. These obsessions occur frequently, are intrusive and not easy to get rid of. For example, common obsessions in OCD include, thoughts or images of violence, blasphemous thoughts, fear of contamination, sexual thoughts or images and excessive concern with health. In OCD a compulsion is an act or ritual that is repeated and repeated in reaction to an obsessive thought. A compulsion may be an behavioural act such as repeatedly checking the door is locked or a mental act such as saying something or picturing something to make the distressing feeling, associated with the obsessive thought feel better.

Usually when I treat people for OCD at my CBT therapy practice in Edinburgh, I find that the method that the person with OCD uses to cope with or solve their OCD, is the very factor keeping their OCD going. This is because people with OCD commonly give a special meaning or powerfulness to their obsessive thoughts, usually that having the thought will lead to something bad happening to themselves or others. As a consequence, the person will usually mistakenly believe that the way to solve the obsessive thought is to try to block it or carry out a compulsion to “undo” the thought. What we know is that our brains work in such a way that trying to block a thought will only make it more frequent and whilst carrying out a compulsion will make the person feel better initially, it will actually feed the OCD so that the problem keeps going.

This can be likened to having “just one puff” to get rid of a craving for nicotine when trying to give up smoking. Whilst for a short period the craving is dealt with (distressing feeling in OCD), it actually leads to stronger and increased cravings.

When working with clients at my CBT therapy practice, Edinburgh who have OCD a lot of time is spent identifying the persons OCD maintaining factors. Typical factors that keep OCD going include: giving thoughts more meaning then they deserve, misunderstanding about why you have the particular obsessions you have, avoidance and safety seeking behaviour (avoiding anxiety triggered by the thought by blocking or undoing the thought with a compulsion, avoiding situations that you associate with the obsessive thought, asking others for reassurance), giving too much time and attention to your obsessions, trying to control your thoughts and thinking biases.

CBT therapy, Edinburgh, works by helping the person unravel the factors that maintain their OCD in order to build a different solution to overcome it. Treatment will then involve exposure and without responding, with the support of your therapist. This basically involves accepting your obsessive thoughts in such a way that you learn to tolerate the anxiety which accompanies them without carrying out any compulsions. Eventually the anxiety naturally fades so that you will be able to experience the thought without finding it distressing. This is called habituation.

Cognitive Behavioural Therapy, also known as CBT, is a psychotherapeutic approach that primarily aims to influence dysfunctional thought processes. It is one of the treatment procedures that helps the patient to become aware of thought distortions which cause both psychological and physical distress.

CBT makes use of use psychological approaches that are based on scientific, clinically proven research. It has emerged as one of the best treatment options in recent times and proved to be effective for problems associated with various eating disorders. This therapy starts with an assessment procedure using diagnostic tests, and a semi-structured interview. In the treatment phase the client has an individualized program specifically drawn up for them.

For any individual who is suffering from Bulimia, understanding the relationships between thoughts, emotions and actions is extremely important. This is because, once these relationships are understood, the patient can recognize and appropriately react to the negative thoughts and feelings that have previously resulted to abnormal eating behaviours with more positive thoughts that lead towards a healthy lifestyle.

The first and the key part of this treatment targets symptomatic relief for specific by using a series of Behavioural techniques. The second part of the treatment actually educates clients about the relationship between thoughts, feelings and behaviours. This is very important and plays a vital role in treating Bulimia. As clients learn to recognize and categorize negative thoughts, he or she can challenge those thoughts and replace them with more balanced alternatives. For an individual, it is important to have some type of relaxation or “de-stress” strategy and with CBT it is accessible. Cognitive Behavioural Therapy has been clinically proven as an effective treatment for Bulimia Nervosa.

1. Cognitive Therapy – At NLP and CBT Edinburgh, people are supported to identify and challenge information processing errors that maintain anxiety. Panic attacks and anxiety are initiated by unhelpful thinking. Thoughts alone do not cause anxiety, but believing negative thoughts does lead to anxiety. During CBT and NLP sessions, clients are supported to question the evidence for and against their interpretations.

2. Behavioural Therapy – This is the doing part of cognitive behaviour therapy and in the case of agoraphobia, the therapist will support you in identifying a hierarchy of goals related to going out. The therapist will be aiming for you to become desensitized to going out activities that you currently fear. The therapist accompanies you into the community where appropriate.

3. Learning cognitive strategies to master panic – clients that come for NLP and CBT Edinburgh are taught techniques to practice during homework tasks. You are supported in becoming effective at using these techniques when you are feeling panicky.

4. Practising – You will get out of therapy what you put in and mastering your panic will involve you carrying out practice in between sessions. Typical practice assignments include keeping a ‘Beating Panic’ Journal’, carrying out practice related to your ‘going out and about’ goal and creating a routine that involves empowering ‘calm’ activities. You will also be required to practice any coping techniques taught to you by the therapist, such as using your anchors (see below).

5. NLP Communication Model – Clients are taught NLP clean language techniques. This means learning to think and communicate with your self in a way that supports being safe, confident, and relaxed.

6. NLP Change Techniques – NLP, which is an understanding of how we code experience in our brain, has a range of techniques, which can be used to reduce or eradicate the intensity of remembered experiences. Its possible to take an unpleasant memory, examine how it is coded and then make changes so that it is no longer unpleasant and the emotion can just drain away. If you suffer from unpleasant memories or fears, an NLP therapist can help you deal with this, via submodality work. These treatments are available from my therapy practice, where I use NLP Edinburgh. You can also learn to be aware of the impact of how you code experience yourself.

7. Anchoring For Emotional Balance – Anchors are naturally occurring associations between an external stimulus and a behavioural or emotional response. They occur because the human mind constantly seeks to make sense of the environment by looking for patterns and associations between things. People learn to make negative associations between things. In the case of agoraphobia this may be associating going for a walk to the corner shop with fear and panic. NLP deliberately makes use of anchors in order to empower people to have control over their emotional states. There are specific NLP techniques in which a stimulus is used to trigger and link an emotional state. The stimulus is usually external and may be a sound or touch. Through these techniques it is possible to for an individual to build up a resource of positive emotional states, which they can access in any situation in which they need them. It is also possible to completely collapse negative anchors so that external stimuli that cause you negative emotional states will no longer be a problem.

These are just some of the ways that NLP and CBT Edinburgh can be effective at empowering people to overcome agoraphobia and other panic disorders.

CBT views emotional problems as the result of unhealthy and irrational thinking. It employs terms such as Negative Automatic Thoughts and Thinking Errors to describe the different ways in which unhealthy thinking can cause emotional problems. Having identified these unhealthy thinking habits, CBT also provides us with the tools to develop alternative, healthier ways of thinking about ourselves and the world around us. By thinking in a more balanced way we will feel better emotionally. Please see my articles on Negative Automatic Thoughts and Thinking Errors for a more detailed explanation of the above methods.

However, Negative Automatic Thoughts and Thinking Errors are not the whole picture. Many people will wonder why they have such ways of thinking when other people don’t. CBT uses the term Negative Core Belief to describe the fundamental root cause or causes of a person’s emotional difficulties.

A Negative Core Belief (or NCB) is a strongly held, intrinsic belief that a person holds about either themselves, others, or the world in general. Frequently people will have NCBs about all 3 categories. NCBs are usually an integral part of a person’s personality – so much so that they’re often blissfully unaware that they even have such a thing. One of my other articles on NCBs outlines ways that people can identify their NCBs – this article will focus on their causes.

Negative Core Beliefs arise most commonly during childhood and adolescence. This period would seem critical in the development of a person’s personality – it is the time when they first form opinions about themselves, others and the world around them. In lay terms, we are “impressionable” in our younger years.

If our experiences during these years are generally positive and empowering, then we are likely to develop healthy Core Beliefs. If we have loving parents, a pleasant and supportive schooling experience, and are lucky enough to have good friends when we are growing up etc, then we are very likely to see ourselves, others, and the world in general in a positive light. We may end up with Core Beliefs such as “I’m a generally nice person” or “People are usually OK”.

Unfortunately, this is not the case for everyone. Children grow up in violent or abusive households, children are bullied at school, children are ostracised by their peers – all these experiences can have a detrimental effect on a person’s core beliefs. Even seemingly minor experiences – perhaps having “pushy” parents or over-critical teachers – can influence our views of the world. Negative Core Beliefs are the result of such an environment, examples of such beliefs being “I’m bad” or “People are aggressive”.

It can seem reasonable (even logical) that a child forms these beliefs. After all, they’re young and have limited alternative experiences to compare. If your father is aggressive, or your teacher critical, then it can easily seem like every adult is aggressive or critical. Also, these people are powerful figures in your early life – role models – and you are likely to believe what they say. A father saying “You’re bad” or a teacher calling you “Useless” is, as far as you can see, the truth. You begin to believe that these are undeniable facts about yourself, facts that obvious to everyone.

These beliefs are the conclusions that are formed in a child’s mind based on his or her limited experience. You only have your parents judge how all parents are, and you only meet a certain number of teachers and schoolmates in your formative years. As a child, your view of the entire world is based on these few contacts and experiences.

The Core Beliefs we form as a child and adolescent tend to persist throughout our adult lives. This is not a problem if they are healthy, but Negative Core Beliefs predispose the individual to emotional difficulties. If you go through life believing, deep down, that you’re a bad person or a failure, then you’re prone to seeing much of your adult experiences in these terms. If a loved one is upset then you feel guilty even if it wasn’t your fault, or the passing comment by a boss can seem like the end of the world. Negative Core Beliefs are the cause of Negative Automatic Thoughts and Thinking Errors – and these are the causes of emotional difficulties.

Finding the cause of a clients Negative Core Beliefs is an important step in the treatment of their emotional problems. Please see my other articles on the Identification and Treatment of Negative Core beliefs.

Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He makes extensive use of CBT techniques to treat common problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for further information about psychological problems and CBT.

The first step for the client is to start “recording their thoughts” when they feel  anxious – that is, writing down (in brief sentences) what’s going through their head. This may sound a little strange at first, but it really is an essential part of the CBT method. Ideally the client should stop and write down what they’re thinking at the moment they’re thinking it, but writing it down at the end of the day is also acceptable. They should write down everything they were thinking of – this will usually produce quite a list of thoughts and statements and beliefs. In addition, the client should note both how they felt (physically and emotionally) and the situation in which these feelings occurred.

In my example, the client would record that the situation was a social gathering of work colleagues after work. His heart was racing, he felt hot and sweaty, and he was a  little light-headed (physical feelings). He described his emotional feeling as “very anxious”. Afterwards, when back at home, he wrote down the following thoughts that  he remembered having at the time: “I don’t know anyone very well”, “I’ve got body odour”, “They’re all friends”, “This place is too busy”, “I hate these things”, “I want to go home”, “I’m going to faint and make a fool of myself”, “I’ve got to get out of here”

This list of thoughts that he has recorded is a list of what a CBT therapist would call “Negative Automatic Thoughts”. They’re “Negative” in that they tend to hinder the person’s motivation and ability to engage with activities, and contribute to emotional problems. They’re “Automatic” in that they seem to occur “just like that”, popping into the person’s head as if from nowhere. Indeed, unless the person specifically focuses his attention on what he’s thinking – as in the thought-recording exercise – they may pass unnoticed. All that the person would then be aware of is a sudden feeling of anxiety and a desire to leave the situation.

These Negative Automatic Thoughts (or NATs) cause emotional problems (in this case, social anxiety). Thinking in this way triggers the “Fight or Flight” response to perceived threat, leading to the physical symptoms of anxiety such as a racing heart and nausea. If the person didn’t have these NATs (i.e. he didn’t think thoughts such as “I’m going to faint”) then the “Fight or Flight” response would not kick-in. No physical symptoms of anxiety would result, and he would be free to enjoy the social do.

Having identified the client’s NATs, the next step is to find alternative, more helpful ways of thinking about the situation. This is best done by examining the NATs for their rationality or “truthfulness”. A CBT therapist (along with the client) does this by conducting a “trial” for a particular NAT. In this example I will take the NAT “I’m going to faint and make a fool of myself” – this NAT was described by the client as the most distressing thought (in CBT parlance, this would be called the “Hot Thought”).

In a trial, evidence is presented “for” and “against” the party concerned. It’s the same in a trial for Negative Automatic Thoughts. So what evidence is there that the statement “I’m going to faint and make a fool of myself” is true? Very little – the client felt physically unpleasant and was anxious. And the evidence that says the thought is false? Much greater – he didn’t actually faint, he’s never actually fainted in all the times when he’s felt anxious, and it’s a well known fear of people experiencing anxiety that they will faint. And besides, there seems little evidence to suggest that even if he did faint, his colleagues would be anything other than concerned about him.

The verdict? That his NAT “I’m going to faint and make a fool of myself” is irrational and false.

Next, it’s time to identify an alternative thought that does actually fit with the evidence. How about “My heart is racing and I feel uncomfortable because I’m anxious, but I won’t faint and my anxiety will pass with time”? This seems a more accurate statement of the situation, and is clearly less likely to exacerbate his anxiety symptoms. Thinking in this way will reduce his anxiety and enable him to stay out longer with his colleagues, which in turn will help to reduce his anxiety.

Cognitive Behavioural Therapy (CBT) says that “we feel the way we think”. An important first step in the recovery from emotional problems is to learn to identify and challenge our irrational thoughts (or “NATs”). As a Psychiatrist and therapist in Edinburgh I have found this to be an effective (and surprisingly quick) way of relieving some of the burden of difficulties such as depression and anxiety. But it is just a first step, and most clients will benefit from a more in-depth CBT approach that addresses not just their Negative Automatic Thoughts but also their Negative Core Beliefs. Please see my other articles on this subject.

Dr Steve Last is a Psychiatrist and therapist based in Edinburgh. He uses CBT techniques to treat common problems such as depression, anxiety, and OCD.  Please visit http://www.drstevelast.co.uk for further information about emotional problems and CBT.

What can be done about Negative Core Beliefs? There are several options open to a CBT Therapist, but in my experience as a Psychiatrist and Therapist in Edinburgh I find that the following method is particularly effective.

Firstly, the method is to challenge these Negative Core Beliefs, in much the same way that a CBT Therapist would challenge a person’s Negative Automatic Thoughts. The CBT Therapist and the client can look for evidence that the Negative Core Belief is true, and then look for evidence that it is false. The client is then in a position to make a reasoned judgement as to whether it is rational and healthy to continue holding their Negative Core Belief. If they don’t think it’s rational, then they can begin to look for alternative beliefs that better explain the evidence.

An example of this method might be challenging a client’s Negative Core Belief that “People are dangerous”. Evidence in favour of this belief might be that they had unpleasant and frightening experiences growing up – perhaps their father was abusive, or they were severely bullied at school. Experiences as an adult may also play a role – the overbearing boss at work, or the “friend” who turns out to be rather two-faced etc. Evidence against the belief that “People are Dangerous” could include the fact that their mother and grandparents were kind and loving, and that she had a few friends at school who were supportive. Perhaps most of her work colleagues now are nice and trustworthy, and the boss is renowned for being unpleasant and cantankerous to everyone.

With evidence of this sort compiled both “for” and “against” the belief, the client can weigh it up and make a judgment. In this particular case, the evidence may seem roughly evenly balanced both “for” and “against”. In which case the client may decide not to totally reject their original belief, but modify it somewhat. They may decide that the statement: “Some people are dangerous, but some aren’t” is a better description of the evidence. Learning to live with this new modified belief will almost certainly lead to the client having less emotional problems.

However, this is easier said than done. After all, your Negative Core Beliefs have been with you a long time – they can seem like an integral part of who you are, and as such, you can’t just “turn them off” like that. They’re well-trodden paths that can feel very comfortable and familiar, even if (in the long run) they cause you a lot of problems.

What a CBT Therapist may suggest is that rather than trying to actively eliminate your Negative Core Belief, it can be more productive to focus your attention on actively cultivating your new, alternative Core Belief. In my experience as a therapist in Edinburgh, one of the most powerful ways that a client can employ in order to start thinking in newer, healthier ways is to start behaving as if they already truly believed the new Core Belief. That is, to make a conscious decision to act in accordance with their new belief. In the example given, the client will act as if they already believed the new core belief “Some people are dangerous but some aren’t”. They will (quite consciously and deliberately) assume that people are not always dangerous and act in accordance with this (e.g. smile, be friendly, trusting etc), and make a conscious note of the results of such behaviour. Ordinarily the results will be pleasant, positive, and re-inforcing of the new belief. By repeating this behaviour day-in and day-out it will become second-nature, and the client will, deep down, really start to believe their new Core Belief. No longer will they see all other people as inevitably dangerous, and their instinctive initial responses to others will reveal a mature and trusting attitude.

This CBT technique of acting “As-If” is a very powerful way of inculcating real sustainable changes in your Core Beliefs. As a Therapist in Edinburgh I always encourage my clients to use this method in their day to day lives, in addition to keeping a close eye on any Negative Automatic Thoughts or Thinking Errors they may be having. Emotional problems tend to be very resilient to change, so you need to be on their case at all times to prevent relapse.

Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He uses CBT techniques to treat common problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for more information about psychological problems and CBT.

A CBT therapist aims to help people suffering from emotional problems by helping them to identify the ways in which their thinking may be causing their problem. A first step in CBT is therefore the identification of “Negative Automatic Thoughts” (or “NATs” for short) – these are the thoughts that accompany unpleasant or unhelpful emotions such as depression or anxiety.

A closely related aim of the CBT therapist is the identification of so-called “Thinking Errors”. These are habitual (and unhelpful) ways a person has of thinking about themselves, others, and the world around them. These thinking errors will often twist or distort experiences, acting to make the person seem a failure, others as hostile, and the world as dangerous or unpleasant.

The identification of NATs and related Thinking Errors is half the battle in CBT – once a person is aware of their unhelpful thoughts and mental habits they can then choose to think in more rational, healthy ways. A CBT therapist can guide them through this (fairly straightforward) process.

As a Psychiatrist and therapist working in Edinburgh I use CBT techniques extensively. Some of my clients are quite happy with the results they get from simply challenging their NATs and Thinking Errors – they feel much better and have no desire to delve further. However, the majority of clients are keen to “get to the bottom” of why they had their emotional problems in the first place. I tend to encourage this further work as it helps to reinforce the progress made to date and, in my opinion, helps to prevent the client from relapsing at some future date.

This further work involves a search for “Negative Core Beliefs” (or “NCBs”). These are the unhelpful beliefs that a person has had throughout their later childhood and adult life. They are core components of the person’s personality and they are the root cause of the person’s Thinking Errors and ultimately their NATs. If a CBT therapist can help a person to change their Negative Core Beliefs (or, more realistically, find more rational and healthier alternatives), then the person’s Thinking Errors and NATs will diminish, and their emotional problems will lessen (usually!).

A difficulty with NCBs is that a person is rarely aware of them. Even when someone is competent at identifying NATs and Thinking Errors, the cause of these problems may be hidden. But we can use NATs and Thinking Errors as clues.

In my experience as a Psychiatrist in Edinburgh I have found two techniques of most benefit in the search for the NCBs of my clients.

Firstly, there is the method of “Repeated Questioning”. I ask the client what a particular NAT he has identified means to him – he will give an answer, and I then ask him what that answer means to him. He will give a second answer, and I then ask him what that second answer means to him, and so on. Within a short space of time, the client ends up with a global statement that can’t be taken any further. This is a Negative Core Belief. It’s probably best demonstrated with an example:

Client:                                    “There’s loads of litter around Edinburgh” (He’s angry)

CBT Therapist:            “What does that mean?”

Client:                                    “That I’m the only one who cares about it”

CBT Therapist:            “What does it mean if you’re the only one who cares about it?”

Client:            “People don’t care about things that aren’t their personal property”

CBT Therapist:            “And what does it mean if people only care about their own stuff?”

Client:                                    “People are only out for themselves”

(“People are only out for themselves”. This is the client’s Negative Core Belief – a global statement that is uncompromising and will clearly influence the way he views and interacts with others in other areas of life, not simply littering!)

A second method of identifying Negative Core Beliefs is to look for the “themes” that run throughout a persons many NATs and Thinking Errors. Such themes may be “I’m a failure” or “There’s no point to life” (very common in depression), or perhaps “The world’s a dangerous place to live” (common in anxiety conditions).

Once a client’s Negative Core Beliefs have been identified, the CBT therapist will (along with the client) try and explore alternative and more rational ways of thinking about the self, others, and the world in general. This is where real, sustained recovery from emotional problems is made and I will discuss this in a follow-up article entitled “Cognitive Behavioural Therapy (CBT) and Negative Core Beliefs (NCBs) – Treatment”.

Dr Steve Last is a Psychiatrist and Therapist in Edinburgh. He makes extensive use of CBT techniques to treat problems such as depression, anxiety, and OCD. Please visit http://www.drstevelast.co.uk for further information about psychological problems and CBT.

A). During exposure therapy, you expose yourself to small doses of the feared event and increase the duration of exposure over time. If you are afraid of talking in groups, start by imagining yourself in front of groups, then speak in front of a couple of family members or close friends, then a couple of acquaintances and build up to a room full of strangers. 

You don´t need to pay someone to help you; you can work on this at home.

1. Start off imagining an event that causes severe anxiety, talking to your boss, asking a girl out, talking in front of your class, whatever it may be. Feel the anxiety, nervousness and agitation wash over you. After a minute or two, withdraw your mind from that situation. You have endured it and you are still here to tell about it. 

2. Increase your exposure time gradually and then work your way up to real life exposure to the situation.

B). Image desensitization is a great way and process to implement exposure therapy on your own or in a group setting. 

A great place to find support while you are working to desensitize yourself to the social phobia inducing situations is to work in a group with other sufferers. By rehearsing stressful situations within a group, not only do you know you are in a safe place where you will not be judged but you might learn from other sufferer´s coping strategies. 

The second part of the cognitive behavior approach involves retraining the thought process in your mind. For many anxiety sufferers, the immediate and instinctive thought reaction to stressful situations is negativity. Social phobic don´t see the glass as half full but rather half empty and dirty. 

It is important to substitute positive thoughts for the negative ones and not to overestimate the dangers, reactions and thoughts in any given social situation. You have a surprising ability to cope with what the world throws at you; you just need to uncover those resources. 

Cognitive restructuring is used to help social phobia sufferers uncover the thoughts that automatically flood their minds whenever they are in stressful situations. 
The thoughts flooding in the head probably involve fears of messing up a story, sounding stupid, having people think you are an idiot or maybe they´ll just turn their backs and walk away, completely uninterested in anything that comes out of your mouth. 

Are these fears realistic? You need to test these notions to see if they compare with what will happen in the real world. You have told funny stories before, so you can probably do it again. Even if the story is stupid or uninteresting, the listeners would surely never be so rude as to turn their backs and walk away and most if not all will at the very least pretend to be interested. 

However, you could also tell an interesting and engaging story that starts you down the road towards new friendships and better interaction with colleagues. If you constantly look at and examine your beliefs and rationalize them it can chip away at the long-held, negative beliefs that are holding you back. You can train your mind not to react negatively in every circumstance and certainly not to overestimate or over exaggerate the negative.