Introducing Cognitive Behavioural Therapy (Introducing...) (11 page)

She realizes that it might be helpful for her to develop other ways of dealing with stress that are better for her – she takes up yoga, finding that she really enjoys it. She talks to her husband about his role in helping her with stressful events at home. She also tackles her worries about the social side of smoking. She discusses how to spend time with her friends without joining them for a cigarette break. She also persuades one of her friends that it might be a good idea for both of them to give up together – she finds this really boosts her motivation.

Unless you really want to change you will not be able to. It’s worth putting in some work at this stage in order to make change possible.

Examine your thoughts about change

Throughout this book we emphasize the importance of thoughts and how they affect the way we feel and behave. Obviously habit change involves changing behaviours, and for this we suggest a number of behavioural techniques, many of which are not exclusive to CBT. However, often what trip people up when they are trying to change old habits or create new ones are the negative thoughts they have about change, or about their ability to change. Frequently they’re quite unaware of these thoughts. Spend some time thinking about what thoughts, beliefs or assumptions might be holding you back from making the habit change you want.

Case study – Devika

Devika wants to lose weight. She is several stone overweight and this is affecting her health and self-esteem. Her relationships suffer because she feels so bad about herself. She avoids both social contact, and intimacy with her partner. Her breathing is affected and she has developed diabetes. Most of the time she is very motivated to change. She makes a good start, eating more fruit and vegetables and going swimming twice a week. However, she still often finds herself eating junk food like crisps or chocolate bars when she is in a hurry or busy. She needs to change this habit to make more progress. Devika examines her thoughts about eating. She notices the following pattern:

Thought:
I’m hungry, I want crisps.

Triggers
…

Thought:
You shouldn’t do that. You are a pig. You are fat and disgusting and lazy.
She gets a picture in her head of her mother criticizing her
.

Triggers
…

Emotion:
guilt, sadness, shame.

Triggers
…

Behaviour:
dwelling on negative thoughts and memories of the past.

Triggers
…

Thought:
It’s not fair. I never get to have what I want. Everyone else can eat what they like. I never get what I want.
She pictures her mother scolding her for eating crisps
. I’ll show them – I’ll do it anyway.

Triggers
…

Emotion:
anger.

Triggers
…

Behaviour:
she eats the crisps.

Devika realizes this has become a vicious cycle of guilt, shame and anger which leads to her behaving in ways she doesn’t actually wish to, and which results in her feeling worse. Once she’s aware of this she’s able to break the cycle. She recognizes the self-critical thoughts that make her feel guilty and challenges them. Instead of responding to these negative automatic thoughts she reminds herself that actually she’s been working very hard at changing things, that her partner has always found her attractive, whatever her size and that she’s successful in many areas of her life. She gathers evidence for herself to bolster these more positive thoughts.

Devika finds that challenging these self-critical thoughts means that they no longer trigger ruminations about things from the past which make her both angry and more likely to eat the wrong things. It’s more helpful for her to be kind to herself and to focus her thoughts on the fact that she is now
choosing
to eat differently because
she
wishes to – not because others are bullying her into it. This means that she feels much more able to follow her diet and to avoid slipping into old patterns such as rebelling by eating crisps.

When we find it a struggle to do things that we know are right for us, it’s usually because there are patterns of thoughts, emotions and behaviours like these holding us back. Identifying them and then working on changing them can enable us to make the alterations we’d like.

We may also have negative automatic thoughts about our ability to change. Anna-Maria in our first case study had thoughts that it was too difficult to give up smoking and that she was too vulnerable to stress to be able to do it. These thoughts held her back. She found it very helpful to do some preliminary work on testing out these beliefs before embarking on trying to give up smoking. Once she began to be convinced she had other ways to handle stress, she was more able to put in the energy needed to break her habit. Using the thought challenging and behavioural experiment sections from
Chapter 4
and
Chapter 6
would be helpful here.

Thoughts are not facts: your assumptions about whether or not change is possible may be holding you back.

Step 2: know your enemy

Habits are automatic – that means we do them without thinking about them and are very often unaware of why we do them or what sets them off. Take biting your nails for example – many people do this when they are anxious or stressed, others do it when they are bored or distracted.

Understanding and monitoring your habit

In order to begin to change a habit, you need to identify the following:

• When do you do it?
  
• How often?
  
• What are the triggers?
  

Becoming more aware

‘Autopilot’ is a mental setting that is very useful at times. However, it becomes the enemy when you are trying to change a habit. We can learn to switch from ‘autopilot’ to ‘manual’ by teaching ourselves to become more aware of our habits. This takes time and practice.

Key tips
:

1. Remind yourself daily to look out for your habit.

2. Write a note to yourself and leave it somewhere you will see it regularly.

3. Ask people to remind you.

4. Note down anything else that helps increase your awareness.

Keep a habit diary

One helpful way of increasing your awareness is to
keep a diary of your habit
. Each day monitor when you indulge in your habit and what is happening at the time. Look out for the
urge
to indulge in the habit, as well as noting when you actually carry it out. Can you recognize any triggers for it – what were you doing, thinking or feeling at the time? All of this information will help you to build up a picture of how your habit happens and the times or situations that you need to be particularly wary of when planning your habit change. You can include anything in your diary that looks like it could be useful information. The important thing is to note down whenever you catch yourself indulging in your habit. It may take some practice and discipline since, as we know, some habits may happen without our awareness. See how often you can catch yourself ‘at it again!’

Self-monitoring of any kind quite often alters whatever we are trying to measure. For example, have you ever tried to keep a food diary or to write down everything you spend in a week? If so, you might have found that you change what you eat or spend because you become more aware of it just by keeping the diary. Bear this in mind when trying to understand more about when and how you indulge your habits.

Case study – Mario

Mario sucks his thumb. He has done this since he was a small child and has never given it up. It used to soothe him when he was a baby and he still finds it relaxing. Mario is now in his teens and this habit often embarrasses him when people notice it. Sucking has made the skin on his thumb go dry and wrinkled, and sometimes it’s quite painful. Mario worries that his hand looks ugly, and also that others will think he’s childish. He starts a habit diary where he records whenever he notices he’s sucking his thumb: