Introducing Cognitive Behavioural Therapy (Introducing...) (8 page)

•
Hands
– clench first, then relax.

•
Arms
– bend your elbows and tense your arms. Feel the tension especially in your upper arms. Remember, do this for a few seconds then relax.

•
Neck
– press your head back and roll it from side to side slowly. Feel how the tension moves. Then bring your head forward into a comfortable position.

•
Face
– there are several muscles here, but just concentrate on your forehead and jaw. First lower your eyebrows into a frown. Relax your forehead. You can also raise your eyebrows, and then relax. Now clench your jaw, then relax – notice the difference.

•
Chest
– take a deep breath, hold it for a few seconds, notice the tension, then relax. Let your breathing return to normal.

•
Stomach
– tense your stomach muscles as tight as you can … and relax.

•
Buttocks
– squeeze your buttocks together, then relax.

•
Legs
– straighten your legs and bend your feet towards your face. Relax. Finish by wiggling your toes.

You may find it helpful to get a friend to read the instructions to you. As you go through the exercise, don’t try too hard – just let it happen.

Exercise 2: a new take on ‘bibliotherapy’

• This is not reading a book – it’s using one! You’ll need just 15 minutes, though if you want to do it for longer, enjoy!

• Find a reasonably large book, take it to a quiet place and then set an alarm for 15 minutes, so you needn’t worry about the time.

• Lie down, open the book and put it face down on your tummy.

• Concentrate on breathing in slowly through your nose for a count of 4 seconds, hold your breath for 2 slow seconds, then exhale slowly through your mouth for 4 more seconds. Keep repeating this step.

• Focus your attention on the book. Watch it rise and fall. Study it as closely as you can.

• Your busy mind is bound to try to intrude with lots of distracting thoughts. Don’t follow through with them, but rather tell yourself you’ll deal with them later, as you are currently doing your bibliotherapy. Then back you go to concentrating on counting, breathing, and watching the book slowly rise and fall, rise and fall … is that the alarm already?

Exercise 3: a safe place

This is a visualization exercise which can take some practice to get the hang of. It’s also called
self-hypnosis
. People often think they are not good at visualization, but with practice and patience most of us can actually conjure up pictures in our minds. What’s great news is that research shows you don’t need vivid pictures for this to work – faint, fuzzy ones are equally good.

• Find a quiet space and sit or lie comfortably. Again, it might help to set an alarm for 15 minutes so you aren’t worrying about the time.

• Relax and concentrate on your breathing. Breathe in and out slowly and deeply from your stomach. Aim to slow your breathing down to 10–12 breaths per minute, but then forget about it. Just breathe naturally.

• Close your eyes and start to imagine yourself in a place that’s safe and warm and peaceful. This could be anywhere – a tropical beach, a park in summer, your bed or the moon. It can be real or imaginary.

• Focus on your senses. What can you see, hear, smell, taste and touch in this safe place? How do you feel while you are in this place? What’s around you?

• Spend a few minutes exploring your safe place. Relax your muscles and let all the tension disappear while you are in your safe place.

•Again, your busy mind may try to distract you with other thoughts, worries or images. Just gently let them go. Remind yourself that right now you are in your safe place – the other thoughts can be dealt with later. Practice
turning down your thoughts
– just like you turn down the volume on a radio.

With practice, you’ll find that you can very usefully call up your safe place whenever you are stressed or anxious. Going to this place briefly in your mind can help you refocus, calm down and then be able to move forward in a less stressed state of mind.

Physical relaxation does not come naturally to many of us – it is a useful skill to be learnt and developed. Practice makes perfect!

Break the panic cycle

Earlier we looked at how thoughts and physical sensations interact to create a panic attack. The first step in dealing with panic attacks is to educate yourself about what causes them. Panic feels incredibly awful – terrifying. It’s very hard to believe that something catastrophic isn’t happening to you. However, we know that panic is a self-limiting system. It cannot harm you. There is no evidence that anyone has ever died from having a panic attack without having an underlying health condition. Neither is there evidence that anyone has ever ‘gone insane’ from having a panic attack. Just because you are feeling very strong physical sensations does not mean that the catastrophe you believe will happen is inevitable. The chances are it won’t happen at all.

For example, many people feel that when they have a panic attack they’ll pass out. But guess what needs to happen to your blood pressure for you to pass out? It needs to drop suddenly. What do you think generally happens to your blood pressure in a panic attack? It increases (though generally not dangerously). The only exception to this is if you have a phobia of blood or injury, in which case seeing these things could make your blood pressure fall. So, it’s virtually impossible for most people to pass out during a panic attack.

Consider what your fears are when you panic:

• What is the worst thing that could happen?
  
• How likely is it that this will actually happen (rather than how much it feels like it will)?
  
• How likely would someone else consider it to be?
  
• If the worst did happen, how likely is it that you would not be able to cope with it (no matter how awful it was)?
  

Thinking in this way can be very helpful when trying to break a panic cycle. However, ultimately the only way you will
prove
to yourself that all this is true is by facing your fears and testing out this new way of looking at things. The sections below on
graded exposure
and
behavioural experiments
will help you do this.

Graded exposure

Exposure therapy is the way that CBT helps people to face up to and overcome their fears. It is used in various ways in treating all the anxiety disorders. Here we describe the fundamental principles that apply to them all.

1. Develop a graded hierarchy.
   Write the numbers 1 to 10 along the side of a piece of paper. 1 represents activities that aren’t particularly scary – those you would be a little anxious about but could do by pushing yourself. 10 represents activities that hold the most fear for you – the ones that make you say ‘No way! I could never do that!’ Start by writing something down for the top and bottom of this scale. Then think of what might go in the middle – what activity would rate about a 5? Continue until you’ve got 10 activities, and have filled out the scale. Getting help from someone who knows you well can be invaluable.
   
2. Start working through your hierarchy from the bottom up.
   You may ask someone close to you to accompany you if that helps to get you started, but then it is very important that you continue to practice on your own. Keep repeating each item until you begin to feel confident about it, and until you find that the scary outcome you feared, whatever it might be (spiders crawling all over you, bats getting tangled in your hair, falling from a height or even drowning), doesn’t happen. At each stage make a note of what you learned and use that to help you progress to the next step on the hierarchy. Do remember to congratulate yourself each step of the way, rather than saying ‘it’s easy for others so my achievements are no big deal’. These are big achievements
   for you
   .
   
3. Stay in the situation until your anxiety falls.
   At the beginning of each exposure task, rate your anxiety out of 10. It is likely to be very high at first. It is very important that you stay in the situation until your anxiety falls to at least half of what it was originally. This can be tough. However, if you ‘escape’ too early you won’t learn how you
   can
   cope with your fear. Stay put – your anxiety will fall and you will learn what you need to in order to progress to the next step.
   

As one person put it:

When I turned to face my fears, I found that the ferocious lion was really only a pussycat!

A word about safety behaviours

Think about the following story:

A man was sitting outside, rhythmically clapping his hands. A boy approached him and asked ‘Why are you clapping like that?’ The man replied, ‘It keeps the tigers away’. The boy smirked and looked around, ‘But there aren’t any tigers!’ And the man replied, ‘See? It works!
’