dealing with emotional problems using rational-emotive cognitive behaviour therapy: a practitioner's...

Dealing with Emotional Problems Using Rational-Emotive Cognitive Behaviour TherapyAlso available, Dealing with Emotional Problems Using Rational-Emotive Cognitive Behaviour Therapy: A Client's Guide.
In this practical companion to the Client's Guide, Windy Dryden draws on rational- emotive cognitive behaviour therapy (RECBT) ± a form of CBT that focuses on challenging and changing the irrational beliefs that largely determine emotional and behavioural issues ± to encourage people to deal with their emotional problems.
This Practitioner's Guide includes all of the information presented in the Client's Guide with the addition of helpful hints and tips for the therapist, making it straightforward to use in the consulting room with no need for further references.
Dealing with Emotional Problems using Rational- Emotive Cognitive Behaviour Therapy: A Practi- tioner's Guide will allow the therapist to work through and help the client learn to deal with their problems from an RECBT perspective, covering:
anxiety depression guilt shame hurt unhealthy anger unhealthy jealousy unhealthy envy.
This practical workbook presents each emotion in a similar way, allowing the reader to compare and contrast common and distinctive features of each problem. It will be essential reading for any professional using RECBT with their client.
Windy Dryden is Professor of Psychothera- peutic Studies at Goldsmiths, University of London.
Dealing with
WINDY DRYDEN
First published 2012 by Routledge 27 Church Road, Hove, East Sussex BN3 2FA
Simultaneously published in the USA and Canada by Routledge 711 Third Avenue, New York NY 10017
Routledge is an imprint of the Taylor & Francis Group, an Informa business
Ø 2012 Windy Dryden
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identi®cation and explanation without intent to infringe.
British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data Dryden, Windy.
Dealing with emotional problems using rational-emotive cognitive- behaviour therapy : a practitioner's guide / Windy Dryden.
p. ; cm. Includes bibliographical references and index. ISBN 978-0-415-67764-6 (pbk.) 1. Rational emotive behavior therapy. 2. Cognitive therapy. I. Title. [DNLM: 1. Cognitive Therapy. 2. Emotions. 3. Psychotherapy,
Rational-Emotive. WM 425.5.C6] RC489.R3D78632 2012 616.89©1425±dc23
2011013056
ISBN: 978-0-415-67764-6 (pbk) ISBN: 978-0-203-15763-3 (ebk)
Typeset in Stone Serif by Gar®eld Morgan, Swansea, West Glamorgan Paperback cover design by Andrew Ward Printed by TJ International Ltd, Padstow, Cornwall
Contents
2 Dealing with anxiety 22
3 Dealing with depression 56
4 Dealing with guilt 87
5 Dealing with shame 117
6 Dealing with hurt 148
7 Dealing with unhealthy anger 176
8 Dealing with unhealthy jealousy 207
9 Dealing with unhealthy envy 237
References 267
Preface
I have written this book as a practitioner's companion to Dealing with Emotional Problems with RECBT: A Client's Guide. In that book, I deal with the eight emotional problems that clients routinely seek help for and show them how they can deal with them.
There are three ways I could have written this Practitioner's Guide. First, I could have written totally separate Client and Practitioner Guides. In taking this approach I would have to make frequent page references to the Client's Guide in the Practitioner's Guide. This means that you would have to have both guides open when working with a client and go backwards and forwards from book to book. While there would be little repetition within each book, you would waste much valuable therapy time consulting both texts at the same time.
The second approach I could have taken is to write totally separate Client and Practitioner Guides but to include them in one volume. Again in taking this approach I would have to make frequent page references to the Client's Guide in the Practitioner's Guide. This means that you would have to go backwards and forwards from guide to guide within a single volume. While again there would be little repetition within each part of the book, you would again waste much valuable therapy time moving from one part to another.
The third approach I could have taken and which, in fact, I decided to take involves having a separate Client's Guide and reproducing this guide in the Practitioner's Guide. In taking this tack, I present the material so that you have access to it when and where you need it. You do not, therefore, have to go from book to book or from one part of a single book to the other part. While this necessitates repetition of salient material, I believe that this is a price worth paying to facilitate use by practitioners.
In the present book, then, I reproduce the Client's Guide and at salient points, I discuss issues that may come up in therapy when you use the Client's Guide with your clients and show how best you can address these issues. The material that I have written for practitioners in this book is in a different typeface to the Client's Guide so you can easily ®nd it.
In the Client's Guide (which is reproduced in this book), I begin with outlining the foundations of emotional problems from an RECBT
perspective. I then devote one chapter to each of the eight emotional problems and use a similar structure in each chapter. I start by helping clients to understand the emotional problem in question, discuss what they disturb themselves about when they experience the emotion, and outline what largely determines the emotion and how they tend to act and think when they experience it. I show clients how to deal with the emotional problem in question. I help them to identify the themes in the emotion, detail their behaviour and thinking when they experience it before encouraging them to set appropriate emotional, behavioural and thinking goals. Then, I help them to identify, challenge and change the rigid and extreme beliefs that account for their emotional problems and to develop the ¯exible and non-extreme beliefs that will enable them to achieve their goals. Next, I show clients what they need to do to strengthen their conviction in their rational beliefs so that they become less prone to the emotional problem. I then deal with a number of additional issues relevant to the emotional problem in question before ®nally outlining a number of world views that underpin each emotional problem and its healthy alternative.
The common chapter structure that I employ in Chapters 2±9 of the Client's Guide is to ensure that all relevant issues are discussed for each emotional problem. It is unlikely that clients will be prone to all eight emotional problems, but they may be prone to two or three. The view of emotional problems that I am taking in this book states that while there are common features among the eight emotions, there are also features that are distinctive to each emotion. This is re¯ected in Chapters 2±9 of the Client's Guide and they will need to bear this point in mind when they read these chapters or a selection of them.
The same is the case in this Practitioner's Guide. There are common and distinctive features that are relevant when helping clients deal with the eight emotional problems. To help you use this Practitioner's Guide, I produce common features in each of the eight chapters and the distinctive features where relevant. I have decided to organise this book in this way to help you get the most out of the relevant chapter when working with a client's chosen emotional problem. While this means that certain issues are repeated throughout the book, as I mentioned above, it also means that the relevant material is there when and where you need to consult it.
Windy Dryden London and Eastbourne
viiPreface
Emotional problems: foundations and healthy alternatives
In this book, I am going to discuss some common emotional problems and show you how to deal with them. The book is structured as a workbook so that you can implement the skills that I teach you in a step-by-step manner.
It is worthwhile stressing to your clients that the order of these steps is indicative and not set in stone. Over time and with increased experience, different clients will use the steps in different orders.
In this opening chapter, I am going to cover some important material that I regard as foundations to your understanding of the eight emotional problems that I discuss in this book and their healthy alternatives.
WHAT ARE THE EIGHT EMOTIONAL PROBLEMS?
I have been practising in the ®eld of counselling and psychotherapy since 1975 and have worked in a variety of different settings. In that time, I have seen many people suffering from one or more of the eight emotional problems that I cover in this book. They are:
anxiety
depression
guilt
shame
hurt
unhealthy anger
unhealthy jealousy
unhealthy envy.
You will note that I have put the adjective ùnhealthy' in front of anger, jealousy and envy. I have done this to distinguish the unhealthy version of
1
the emotion with its healthy version. I will discuss healthy alternatives to the eight emotional problems in the next section.
Unfortunately, we don't have agreed language for emotional problems. It is better to use the terms with which your clients resonate than to impose on them terms such as those above that are used in the RECBT literature. When you have agreed a term for an emotional problem with a client, make a clear note of it in the client's ®le.
HEALTHY ALTERNATIVES TO THE EIGHT EMOTIONAL PROBLEMS
Adversity is unfortunately a fact of life.1 None of us can say that we have lived a life untouched by adversity. An adversity is a negative event. So when you are looking for a healthy alternative to an emotional problem in the face of adversity, it is not realistic for you to select an emotion that is positive or neutral.
Problems with positive emotions as healthy alternatives to the emotional problems
If you want to feel a positive emotion about an adversity, you will have to convince yourself that it is good that the adversity happened. Now, I concede that adversities do have some positive features, but they are largely negative in nature. As such, the only way you are going to convince yourself that it is a good thing that an adversity happened is to lie to yourself and to believe your lie. As you can see, this is unlikely to work in the longer term and is, thus, not a good strategy.
Problems with neutral emotions as healthy alternatives to the emotional problems
It is also not realistic to have a neutral feeling about an adversity. If you want such a neutral response, you will have to convince yourself that it
1 Throughout this book, I will refer to events where you don't get what you want, or get what you don't want, as àdversities'.
2 Dealing with emotional problems: a practitioner's guide
does not matter to you that the adversity happened. However, that won't work since it does matter to you that the adversity happened. Quite properly, you would have preferred that the adversity did not happen. So again the only way you are going to convince yourself that it doesn't matter to you that the adversity happened is to lie to yourself and to ®nd your lie convincing. This, again, is unlikely to work in the longer term and is, thus, not a good strategy.
Problems with living in an emotional vacuum as a healthy alternative to the emotional problems
If a positive or neutral emotional response to an adversity is ruled out as a healthy alternative to an emotional problem, what is left? You could say that when an adversity happens, you don't want to feel the emotional problem that you felt.
Harry regularly experiences anxiety about going to see his tutor because he thinks she is going to criticise his work. When asked what he wanted to feel instead, Harry replied: Ì don't want to be anxious about the possibility of my tutor criticising my work'.
The problem with this approach is that we don't tend to live in an emotional vacuum when an adversity has happened or we think that it is likely to happen. Thus, it matters to Harry that his tutor does not criticise him. We experience emotions in areas of life that matter to us. Since it matters to Harry that his tutor does not criticise him, he is going to experience an emotion about this prospect. Don't forget that we are looking for a healthy alternative to the emotional problem of anxiety in Harry's case, and to all eight emotional problems in general.
Problems with reducing the intensity of emotional problems as healthy alternatives to these emotional problems
People often say when they are asked to nominate a healthy alternative to an emotional problem that they want to feel a less intense version of the emotional problem. Applying this to our example, when asked what he wants to feel instead of anxiety about seeing his tutor, Harry says that he wants to feel less anxious. Now the problem with having a less intense version of an
3Emotional problems
emotional problem as a healthy alternative for that emotion is that it is still unhealthy, albeit less intense. If something is unhealthy, it would make sense to want to have a less intense version of it only if this is the only alternative available. Fortunately, it isn't!
Healthy negative emotions as healthy alternatives to the emotional problems
Healthy alternatives to emotional problems are known as `healthy negative emotions'. This term is used for two good reasons. First, such emotions have a negative tone and this is their realistic aspect. Remember we are talking about emotions in the context of life's adversities. It is realistic to feel a negative emotion about a negative event. Second, such emotions are healthy in that they are associated with a different set of behaviours and ways of thinking than are emotional problems. I discuss this in greater detail later in this chapter. For now, here is the list of healthy negative emotions:2
concern (rather than anxiety)
sadness (rather than depression)
remorse (rather than guilt)
disappointment (rather than shame)
sorrow (rather than hurt)
healthy anger (rather than unhealthy anger)
healthy jealousy (rather than unhealthy jealousy)
healthy envy (rather than unhealthy envy).
As with emotional problems (or unhealthy negative emotions) we do not have agreed terms for healthy negative emotions and once again, therefore, it is better to use the terms with which your clients resonate than to impose on them terms such as those above that are used in the RECBT literature. When you have agreed a term for a healthy negative emotion with a client, make a clear note of it in the client's ®le. As we will see, this healthy negative
2 We do not have agreed terms for healthy negative emotions. Thus, it is important that you use the terms that are meaningful to you if they are different from the terms in this list.
emotion will be your client's emotional goal in response to the adversity that he or she is facing.
The idea that the only truly constructive emotional alternative to an emotional problem about an adversity is a healthy negative emotion will, in all probability, be a new and revolutionary idea for your client and one that will require quite a bit of digesting before your client accepts it. It is useful to suggest to those clients who are grappling with this idea that, as a homework assignment, they spend some time thinking about all the possible alternatives to their emotional problem and that they write down the advantages and disadvantages of each alternative as they see them. You can then review these with your client in an open and frank manner. Do not hesitate to correct any misconceptions that your client may demonstrate in the course of this review, but do so in an accepting and respectful manner. If you cannot think of any rebuttals to clients' misconceptions on this issue, discuss this matter with your RECBT supervisor.
RATIONAL-EMOTIVE COGNITIVE BEHAVIOUR THERAPY
This book is based on rational-emotive cognitive behaviour therapy. You may have heard of cognitive behaviour therapy (CBT) and it being described as a therapeutic approach. However, in my view, CBT is not a therapeutic approach, but a therapeutic tradition in which there are a number of distinctive approaches, of which rational emotive behaviour therapy (known as REBT) is one. REBT was founded in 1955 by Dr Albert Ellis (1913±2007). The term rational-emotive cognitive behaviour therapy (RECBT) ± which I will use in this book to remind you of the book's legacy ± shows that RECBT is placed within the CBT tradition and that its distinctive features are rooted in REBT.
Some clients may ask you about the differences between REBT and CBT since the term REBT is more prevalent on the internet and in the professional and self-help literature than is the term RECBT. They may well have heard of the term CBT, but not REBT or RECBT. One way of dealing with this question is to build on what appears above, but to say something about the distinctiveness of RECBT. Thus, you might say something like:
5Emotional problems
Well, RECBT is a speci®c approach within the general tradition known as CBT, so it is dif®cult to compare a speci®c approach within this tradition with the tradition itself. However, while most CBT approaches would agree with Epictetus, the Greek Stoic philosopher, who was reported to say `People are disturbed not by things, but by their views of things', RECBT holds that `People are disturbed not by things. Rather they disturb themselves by the rigid and extreme beliefs that they hold about things.' Thus, in RECBT we place particular emphasis on helping you to identify these beliefs and to change them to their more constructive ¯exible and non-extreme belief equivalents.
This emphasis on rigid and extreme beliefs is explored further in the Client's Guide, as you will presently see. Should a client want to go further with this comparison, you might suggest that they consult Dryden (2009a), which is a volume in the `CBT: Distinctive Features' series that details the distinctive features of REBT ± and to compare this with one of the other CBT approaches in the series, such as Beck's Cognitive Therapy (Wills 2009).
The eight emotional problems are underpinned by irrational beliefs
RECBT theory argues that each of the eight emotional problems stems from two irrational beliefs: a rigid belief and three extreme beliefs that are derived from the rigid belief. Thus, an irrational belief is characterised by being rigid or being extreme. It has three other characteristics:
it is false
it is illogical
it has largely unconstructive consequences (e.g. in the face of an adversity it leads to an emotional problem).
Let me consider rigid and extreme beliefs separately.
Rigid beliefs
Perhaps the most basic characteristic of human beings is that we have desires. We want certain things to happen and other things not to happen, but when we turn these desires into rigidities when we don't get what we want, or get what we don't want, then we experience one or more of the
emotional problems described in this book. Here are a few examples of rigid beliefs:
I must do well on the forthcoming test.
You must respect my boundaries.
The world must not give me too much hassle.
As these examples show you can hold rigid beliefs about yourself, others and life conditions.
Later on in the Client's Guide, I discuss ¯exible beliefs where the client's desires are kept ¯exible and not transformed into rigid beliefs. It may therefore be helpful to stress that rigid beliefs also tend to be based on desires as well. You can do this by reformu- lating the above examples, thus:
I would like to do well on the forthcoming test and therefore I must do so.
I want you to respect my boundaries and therefore you have to do so.
I would prefer it if the world did not give me too much hassle and therefore it must not do so.
The point to emphasise here is that a rigid belief is based on a desire and an ànd therefore' statement in which clients transform their desire into a rigidity.
Three extreme beliefs
According to RECBT theory, rigid beliefs are paramount in explaining the existence of the emotional problems and three extreme beliefs tend to be derived from these rigid beliefs. These are
awfulising beliefs
depreciation beliefs.
While the classic RECBT position is that rigid beliefs are primary, and awfulising beliefs, discomfort intolerance beliefs and depreciation beliefs are secondary beliefs derived from these primary rigid beliefs, it is best not to make this a stumbling block if your clients do not accept it. As long as they work to change both their
7Emotional problems
rigid belief and the one extreme belief that best accounts for their disturbance, then the question of what is primary and what is secondary can be put aside.
Awfulising beliefs
An awfulising belief stems from the rigid belief that things must not be as bad as they are. An awfulising belief is extreme in the sense that you believe at the time one or more of the following:
Nothing could be worse.
The event in question is worse than 100 per cent bad.
No good could possibly come from this bad event.
The above arguments are generic ones and you need to adapt them to your clients' speci®c beliefs. While it may be good if your clients accept all these arguments, this is not necessary. What is important is that your clients ®nd the arguments that they can accept persuasive. Bear this point in mind when you engage your clients in questioning their beliefs later.
In the following examples of awfulising beliefs, the rigid beliefs are listed in parentheses:
(I must do well on the forthcoming test) . . . and it would be awful if I don't.
(You must respect my boundaries) . . . and it's the end of the world when you don't.
(The world must not give me too much hassle) . . . and it's terrible when it does.
Please bear in mind that in RECBT we do not regard words such as àwful' or `terrible' as inherently extreme and therefore bound up with client disturbance. Thus, when people say Ìt's awful that it's raining outside', they are probably not disturbing themselves about the weather. It is only when these words are clearly extreme that they are examples of awfulising beliefs and when the person is in an emotionally disturbed frame of mind. Words have to be considered along with the meaning and context in which they are used. Explain this point to clients who may be confused about this issue.
Discomfort intolerance beliefs
A discomfort intolerance belief stems from a rigid belief that things must not be as frustrating or uncomfortable as they are. A discomfort intolerance belief is extreme in the sense that you believe at the time one or more of the following:
I will die or disintegrate if the frustration or discomfort continues to exist.
I will lose the capacity to experience happiness if the frustration or discomfort continues to exist.
In the following examples of discomfort intolerance beliefs, the rigid beliefs are listed in parentheses:
(I must do well on the forthcoming test) . . . and I could not bear it if I don't.
(You must respect my boundaries) . . . and it's intolerable if you don't.
(The world must not give me too much hassle) . . . and I can't stand it if it does.
Again, terms like Ì can't bear it' and Ìt's intolerable' may not re¯ect the presence of extreme, irrational beliefs. Bear in mind that there is a difference between words and their meaning and the context in which they are used. When someone says Ìt's intolerable that there are no taxis when it is raining' and is angry, but not unhealthily so, then the term Ìt's intolerable' is probably not an example of an irrational belief. However, the same words in this example can point to the existence of an extreme irrational belief if a person is furious and in danger of in¯icting damage on taxi drivers when he encounters one when unhealthily angry. If your clients appear to confuse language and meaning here, you can use such arguments to help dispel their confusion.
Depreciation beliefs
A depreciation belief stems from the rigid belief that you, others or things must be as you want them to be and is extreme in the sense that you believe at the time one or more of the following:
A person (self or other) can legitimately be given a single global rating that de®nes their essence and the worth of a person is dependent upon conditions that change (e.g. my worth goes up when I do well and goes down when I don't do well).
9Emotional problems
The world can legitimately be given a single rating that de®nes its essential nature and that the value of the world varies according to what happens within it (e.g. the value of the world goes up when something fair occurs and goes down when something unfair happens).
A person can be rated on the basis of one of his or her aspects and the world can be rated on the basis of one of its aspects.
In the following examples of depreciation beliefs, the rigid beliefs are listed in parentheses:
(I must do well on the forthcoming test) . . . and I am a failure if I don't.
(You must respect my boundaries) . . . and you are bad if you don't.
(The world must not give me too much hassle) . . . and if it does, the world is a rotten place.
Once again bear in mind the difference between words and their meanings and the contexts in which they are used. When some people say Ì'm bad', they are not necessarily depreciating themselves, as in Mae West's famous quote: `When I'm good, I'm very good. When I'm bad, I'm better'. However, if a person is consumed with guilt and says Ì'm bad', he probably is depreciating himself.
The healthy alternatives to the eight emotional problems are underpinned by rational beliefs
RECBT theory argues that each of the eight healthy alternatives to the emotional problems stems from two rational beliefs: a ¯exible belief and three non-extreme beliefs that are derived from the ¯exible belief. Thus, a rational belief is characterised by being ¯exible or being non-extreme. It has three other characteristics:
it is true
it is logical
it has largely constructive consequences (e.g. in the face of an adversity it leads to a healthy negative emotion).
Let me consider ¯exible and non-extreme beliefs separately.
Flexible beliefs
As I pointed out earlier in this chapter, it is a basic characteristic of human beings that we have desires. We want certain things to happen and other things not to happen. When we keep these desires ¯exible and when we don't get what we want, or get what we don't want, we experience one or more of the healthy negative emotions outlined earlier. Here are a few examples of ¯exible beliefs:
I would like to do well on the forthcoming test, but I don't have to do so.
I want you to respect my boundaries, but unfortunately you don't have to do so.
I would prefer it if the world did not give me too much hassle, but the world does not have to be the way I want it to be.
As these examples show, you can hold ¯exible beliefs about yourself, others and life conditions. You will note from these examples that ¯exible beliefs have two components:
an àsserted preference' component (e.g. Ì would like to do well on the forthcoming test . . .')
a `negated rigid' component (e.g. `. . . but I don't have to do so').
It is important that you encourage your clients to use both parts of a ¯exible belief until they truly grasp that they don't have to have their desires met. When they fully understand this, then when they say Ì want to be loved', for example, you will both know that this means Ì want to be loved, but I don't have to be loved'. Until that point, encourage your clients to use the full version of their ¯exible belief, with both components (i.e. the àsserted preference' component and the `negated rigid' component) stated.
Three non-extreme beliefs
According to RECBT theory, ¯exible beliefs are paramount in explaining the existence of healthy negative emotions and three non-extreme beliefs tend to be derived from these ¯exible beliefs. These are
non-awfulising beliefs
acceptance beliefs.
11Emotional problems
Non-awfulising beliefs
A non-awfulising belief stems from the ¯exible belief that you would like things not to be as bad as they are, but that doesn't mean that they must not be as bad. This belief is non-extreme in the sense that you believe at the time one or more of the following:
Things could always be worse.
The event in question is less than 100 per cent bad.
Good could come from this bad event.
In the following examples of non-awfulising beliefs, the ¯exible beliefs are listed in parentheses:
(I would like to do well on the forthcoming test, but I don't have to do so) . . . and if I don't do well, it would be bad, but not awful.
(I want you to respect my boundaries, but unfortunately you don't have to do so) . . . It's disadvantageous to me if you don't, but not the end of the world.
(I would prefer it if the world did not give me too much hassle, but the world does not have to be the way I want it to be) . . . It's bad when it's not, but not terrible.
You will note from these examples that non-awfulising beliefs have two components:
an àsserted badness' component (e.g. Ìf I don't do well on the forthcoming test, it would be bad . . .')
a `negated awfulising' component (e.g . . . `but it wouldn't be awful').
Ensure that your clients use both components of a non-awfulising belief until you are both sure that by saying Ìt's bad that x happened', they truly believe that it is also not terrible that x happened. Then, your clients can use the asserted badness component on its own to indicate a non-awfulising belief.
Discomfort tolerance beliefs
A discomfort tolerance belief stems from the ¯exible belief that it is undesirable when things are as frustrating or uncomfortable as they are, but unfortunately things don't have to be different. A discomfort tolerance
belief is non-extreme in the sense that you believe at the time one or more of the following:
I will struggle if the frustration or discomfort continues to exist, but I will neither die nor disintegrate.
I will not lose the capacity to experience happiness if the frustration or discomfort continues to exist, although this capacity will be temporarily diminished.
The frustration or discomfort is worth tolerating.
In the following examples of discomfort tolerance beliefs, the ¯exible beliefs are listed in parentheses:
(I would like to do well on the forthcoming test, but I don't have to do so) . . . It will be a struggle for me if I don't do well, but I could bear it and it would be worth bearing.
(I want you to respect my boundaries, but unfortunately you don't have to do so) . . . It's hard for me to bear it if you don't respect my boundaries, but I can tolerate it and it is in my interests to do so.
(I would prefer it if the world did not give me too much hassle, but the world does not have to be the way I want it to be) . . . When the world is not the way I want, it is dif®cult me to tolerate it, but I can stand it and it's worthwhile for me to do so.
You will note from these examples that discomfort tolerance beliefs have three components:
an asserted struggle component (e.g. Ìt will be a struggle for me if I don't do well on the forthcoming test . . .')
a negated unbearability component (e.g. `. . . but I could bear it . . .')
a worth it component (e.g. `. . . and it would be worth bearing').
Ensure that your clients use the ®rst two components of a discomfort tolerance belief until you are both sure that by using the ®rst component (i.e. the struggle component) they understand that it indicates a discomfort tolerance belief. The third component of this non-extreme, rational belief stresses its pragmatic value and as such it is a good idea to encourage your clients to use it since it provides a reason to tolerate discomfort.
Unconditional acceptance beliefs
An unconditional acceptance belief stems from a ¯exible belief that it is preferable, but not necessary, that you, others or things are the way you
want them to be and is non-extreme in the sense that you believe at the time one or more of the following:
A person cannot legitimately be given a single global rating that de®nes their essence, and their worth, as far as they have it, is not dependent upon conditions that change (e.g. my worth stays the same whether or not I do well).
The world cannot legitimately be given a single rating that de®nes its essential nature and that the value of the world does not vary according to what happens within it (e.g. the value of the world stays the same whether fairness exists at any given time or not).
It makes sense to rate discrete aspects of a person and of the world, but it does not make sense to rate a person or the world on the basis of these discrete aspects.
In the following examples of unconditional acceptance beliefs, the ¯exible beliefs are listed in parentheses:
(I would like to do well on the forthcoming test, but I don't have to do so) . . . If I don't do well, it's bad, but I am not a failure. I am an unrateable, fallible human being capable of doing well and doing poorly on tests.
(I want you to respect my boundaries, but unfortunately you don't have to do so) . . . If you don't, you are not a bad person; rather you are an ordinary human being capable of doing good, bad and neutral things.
(I would prefer it if the world did not give me too much hassle, but the world does not have to be the way I want it to be) . . . When the world does give me more hassle than I want, it is not a rotten place; rather it is a complex mixture of good, bad and neutral aspects.
You will note from these examples that unconditional acceptance beliefs have three components:
an aspect evaluation component (e.g. Ìf I don't do well, it's bad . . .')
a negated depreciation component (e.g. `. . . but I am not a failure')
an asserted acceptance component (e.g. `. . . I am an unrateable, fallible human being capable of doing well and doing poorly on tests').
It is useful to encourage your clients to understand that the ®rst two components (the aspect evaluation component and the negated depreciation component) are insuf®cient for an unconditional acceptance belief to be held, since clients can hold the ®rst two components (e.g. Ìf I don't do well, it's bad, but I am not a failure'), and still depreciate themselves (e.g. `. . . but I would be worthier if I succeed than if I fail'). Thus, the really important
ingredient of an unconditional acceptance belief is the asserted acceptance component and the unconditionality of this component (e.g. Ì am an unrateable, fallible human being capable of doing well and doing poorly on tests and this is the case whether I succeed or fail'). Help your clients grasp this point and they will understand the core of unconditional acceptance beliefs.
INFERENCE THEMES IN RELATION TO YOUR PERSONAL DOMAIN
While emotional problems and healthy negative emotions can be differ- entiated in general by the beliefs that underpin them (irrational in the ®rst case, rational in the second), in order to distinguish between particular emotional problems and their speci®c healthy alternatives, we need to understand a concept known as inference themes, because these relate to an individual's personal domain. Let me discuss the concept of `personal domain' ®rst.
Personal domain
The concept known as the `personal domain' ®rst appeared in the psycho- logical literature in 1976 in an excellent book entitled Cognitive Therapy and the Emotional Disorders by Dr Aaron T. Beck, one of the grandfathers of cognitive behaviour therapy. Your personal domain has three features:
Your personal domain contains people, objects and ideas in which you have an involvement.
Your personal domain is like an onion in that these people, objects and ideas can occupy a central, intermediate and peripheral place within it.
There are two basic areas within your personal domain ± an ego area and a comfort area. As you will see, six of the eight emotional problems that I discuss in this book can be related to one or both areas, while two of them (i.e. shame and guilt) appear to be related only to the ego area.
Inference
An inference is an interpretation that you make about a situation that goes beyond the data at hand and one that has personal meaning to you. An
inference may be accurate or inaccurate and needs to tested against the available evidence. Often you do not know for certain if an inference that you have made is accurate or inaccurate and therefore the best you can do is to make the `best bet' given the data at hand. The accuracy of an inference often becomes clear after you have made it. This is particularly the case when you make an inference about a future event. Let me illustrate these points.
You will recall that Harry, to whom I referred earlier in this chapter, was anxious about going to see his tutor. If someone asked him what he was anxious about, he would reply Ì am anxious about being criticised by my tutor'. The statement `being criticised by my tutor' is an inference in that (a) it goes beyond the data at hand; (b) it has personal meaning for Harry; (c) it may be accurate or inaccurate. Whether it is the `best bet' in the circumstances depends on how critical Harry's tutor is in general.
Inference theme
When Harry made his inference about his tutor's criticism, we know that he felt anxious. When people feel anxious they tend to do so because they infer some kind of threat to their personal domain. Therefore, we can assume that Harry's inference about his tutor's criticism was threat based. However, we also know that when people feel concerned (which is the healthy alternative to anxiety), they also tend to do so because they infer some kind of threat to their personal domain. We can conclude from this that when you make an inference with a threat theme, you will feel either anxious or concerned, but without knowing anything more, the inference on its own will not help you know whether your emotion is anxiety or concern.
As you will see in the following chapters, when you experience one of the following pairs of emotions, each emotion pairing is related to a speci®c theme or themes concerned with your personal domain: anxiety vs. concern; depression vs. sadness; guilt vs. remorse; shame vs. disappointment; hurt vs. sorrow; unhealthy anger vs. healthy anger; unhealthy jealousy vs. healthy jealousy, and unhealthy envy vs. healthy envy. I will discuss and illustrate these themes in the relevant chapters.
It is useful to remind your clients at this point that an inference does not create feelings. Rather, your clients have an emotion (either an unhealthy negative emotion or a healthy negative emotion) about this inference (in this case an adversity) and the healthiness of the negative emotion is not determined by the
adversity. The adversity is the same whether the client's negative emotion is healthy or unhealthy. What differentiates between unhealthy negative emotions (UNEs) and healthy negative emotions (HNEs) are the beliefs that your clients hold about the inferences (i.e. adversities) that they make ± rigid and extreme (i.e. irrational) when they are disturbed (i.e. they have UNEs) and ¯exible and non-extreme when they experience HNEs.
DISTINGUISHING EMOTIONAL PROBLEMS FROM THEIR HEALTHY ALTERNATIVES
In this section, I discuss in general how you can reliably distinguish emotional problems from their healthy alternatives. In the chapters that follow I discuss in detail how to distinguish the emotional problem in question with its speci®c healthy alternative.
Inference themes and beliefs
We know from the above that inference themes show you which of the eight emotional pairings you are experiencing (e.g. when your inference theme is threat, you experience either anxiety or concern), but on their own they do not help you to distinguish which emotion you are experiencing within the pairing (i.e. you cannot tell by the inference theme of threat alone whether your emotion is anxiety or concern).
We also know that when you hold an irrational belief about an adversity (but we do not know the inference theme of that adversity), your emotion will be unhealthy, but we don't know which of the eight emotional problems you experience. Conversely, we know that when you hold a rational belief about an adversity (again we do not know the inference theme of that adversity), your emotion will be a healthy negative one, but again we don't know which of the eight healthy negative emotions you experience.
However, when we combine these two bits of information, we are in a better position to distinguish speci®c emotional problems from their healthy alternatives. For example, if we know that the theme of your adversity is threat and you hold an irrational belief about that threat, we are well placed to conclude that you are experiencing anxiety. Similarly, if we know that the theme of your adversity is threat and you hold a rational belief about that threat, we are well placed to conclude that you are experiencing concern. Putting this more succinctly:
Threat Irrational Anxiety
Threat Rational Concern
If your clients already know something about RE(C)BT and are wondering how this ®ts with the ÀBC' model, help them to see that inferences (and inference themes) occur at À' in the model, beliefs at `B' and emotions at `C'.
Associated behaviour
So far, I have mentioned one way of distinguishing between an emotional problem and its healthy negative emotion alternative is to take the theme of what the person has feelings about with respect to the adversity that they are facing and the belief that the person holds that accounts for the emotion. You have learned the following:
Adversity inference theme + irrational belief = emotional problem Adversity inference theme + rational belief = unhealthy negative emotion
Now when you hold a belief about an adversity, you don't just experience an emotion, you also experience a tendency to act in a certain way (known as an action tendency) which you may or may not convert into overt behaviour.
Thus, another way to tell if what you feel in a speci®c situation is an emotional problem or a healthy negative emotion is to examine how you acted or, if you did not take action, to examine your action tendency. Let me illustrate this when a person is trying to ®gure out whether the anger that they felt was negative and unhealthy, or negative but healthy.
Geraldine was angry with her boss when he did not recommend her for promotion, an advancement which she considered that she thoroughly deserved. Geraldine considered that her boss had acted in a very unfair manner towards her. Geraldine was unsure whether her anger was negative and unhealthy, or negative but healthy, so she considered how she acted in the situation. This did not help her because she did not take any action when she discovered the news, nor subsequently. Finally, she considered what she felt like doing, but did not do. Geraldine's action tendency was to scream abuse at her boss and to get revenge against him by getting him into trouble with his own boss. Such action tendencies were clearly hostile in nature and showed Geraldine that her anger was an emotional problem.
When you hold an irrational belief about an adversity, your behaviour (or action tendencies) will tend to be dysfunctional and will prevent you from dealing with the adversity in a constructive manner. Whereas, when you hold a rational belief about an adversity, your behaviour (or action tendencies) will tend to be functional and will help you to deal with the adversity in a constructive manner.
In the ÀBC' model of RECBT, behaviours occur at `C' and are known as behavioural consequences of beliefs. Dysfunctional behaviours are consequences of irrational beliefs and functional behaviours are consequences of rational beliefs.
Associated thinking
The ®nal way of determining whether you are experiencing an emotional problem or a healthy negative emotion about an adversity is to inspect the thinking that is associated with the emotion. This is different from the inference that you made about the situation that constituted your adversity. Such thinking has not yet been processed by your beliefs. The thinking that I am referring to here is the thinking that is associated with your emotion. This is the thinking that has been produced when your adversity has been processed by your beliefs. When your adversity has been processed by irrational beliefs, the thinking that results is very likely to be highly distorted and skewed to the negative in content and ruminative in nature. However, when this adversity has been processed by rational beliefs, the thinking that results is very likely to be realistic and balanced in content and non- ruminative in nature. David Burns, a leading cognitive therapist, ®rst outlined in his book Feeling Good: The New Mood Therapy (Burns 1980) a list of thinking errors ± which are by nature highly distorted and skewed to the negative ± that people make when they have processed adversities with irrational beliefs. I outline and illustrate some of these thinking errors and their realistic and balanced alternatives in Appendix 1. You should consult this list if you are unsure whether the thinking you engage in when you are experiencing an emotion is realistic and balanced or highly distorted and skewed to the negative.
Let me illustrate all this with reference to another person who is trying to ®gure out whether the anger that she felt was negative and unhealthy or negative, but healthy.
Francine (a co-worker of Geraldine) was also angry with her boss when he did not recommend her for promotion, an advancement which she considered that she thoroughly deserved. Francine considered that her boss had acted in a very unfair manner towards her. Francine was unsure whether her anger was negative and unhealthy, or negative but healthy, so she considered how she thought in the situation. She thought about asserting herself with her boss after planning what to say. After she had done this she made an appointment to see her boss and in the days that followed until the meeting, she thought about the issue in passing, but did not ruminate on the issue. Given that Francine's thinking that went along with her anger was realistic and balanced and non-ruminative in nature, she considered that her anger was a healthy negative emotion and not an emotional problem.
In the ÀBC' model of RECBT, thinking can occur:
At À' where it occurs as inferences that your client focuses on. These may be accurate or distorted. If the latter, they are less distorted than the thinking that occurs at `C', when it stems from irrational beliefs.
At `B' where your client processes these inferences with either irrational (i.e. rigid and extreme) beliefs or rational (i.e. ¯exible and non-extreme) beliefs.
At `C' where it is considered as thinking consequences of irrational beliefs and is also inferential in nature. Skewed and highly distorted ruminative thoughts are the thinking consequences of irrational beliefs, whereas realistic and balanced non-ruminative thoughts are the thinking consequences of rational beliefs.
This shows that thinking occurs throughout the ÀBC' model. If your clients are confused about the ubiquitous nature of thinking, you can use the above information with an appropriate example to clarify it for them.
Let me summarise the points that I have made in this section and the previous one on behaviour and add it to the material that I presented on p. 15
Adversity inference theme + irrational belief = emotional problem
Unconstructive behaviour and action tendencies
Highly distorted thinking that is skewed to the negative and ruminative in nature
Adversity inference theme + rational belief = healthy negative emotion
Constructive behaviour and action tendencies
Realistic and balanced thinking that is non-ruminative in nature
In the chapters that follow, I employ a similar structure. First, I outline the major factors that need to be considered when understanding the emotional problem under focus. Second, I show you what steps you need to take in order to change each emotional problem to an appropriate healthy negative emotion. Finally, I discuss what you need to do make yourself less prone to whatever emotional problems you are particularly susceptible to. Throughout each chapter, I illustrate the major points whenever relevant.
Dealing with anxiety
In this chapter, I begin by presenting RECBT's way of understanding anxiety and then address how to deal with this very common emotional problem.
UNDERSTANDING ANXIETY
In understanding anxiety, we need to know what we tend to make ourselves anxious about (i.e. its major inference theme), what beliefs we hold, how we act or tend to act, and how we think when we are anxious.
A major point for practitioners who use this guide with clients to consider concerns language and I return to this theme a number of times in this Practitioner's Guide. Basically, it is my contention that the working alliance between clients and RECBT therapists is strengthened when they both use language that is most meaningful to clients rather than language that is typically used to describe concepts in RECBT theory and practice (Dryden 2009a). If you are a novice RECBT therapist, you are especially prone to use `RECBT' language rather than language with which the client resonates (see Dryden 2009b) and you should pay particular atten- tion to this issue when you work with your clients who are using the Client's Guide. In addition, discuss this issue when listening to digital voice recordings of your therapy sessions with your supervisor.
With respect to the term ànxiety', you need to be aware that not all clients with an ànxiety' problem resonate with the term ànxiety'. They may identify more closely with synonyms such as `fear', `being scared', `feeling insecure' or `feeling threatened'. If so, your task is to satisfy yourself and your client that these terms represent the unhealthy negative emotion known in RECBT as anxiety. Once you have done so, use the client's language and write this down in your client's notes.
2
Major inference themes in anxiety
When you are anxious, you are facing or think you are facing a threat to some aspect of your personal domain (see p. 15). There are different forms of anxiety which I list in Table 1 together with the typical threats that feature in them.
Some clients may not resonate with the term `threat' concerning the theme about which they are anxious. If this is the case, you may suggest `danger' or `risk' as possible synonyms. The important thing here, as mentioned above, is that you and your clients use the term that makes most sense to them and not the term that is used most often in the `RECBT' literature.
Irrational beliefs
As I explained in Chapter 1, according to RECBT, an inference of threat that you make does not account for your emotional problem of anxiety. It is possible for you to make the same inference and be healthily concerned, but
Table 1 Different types of anxiety and their major inference themes
Type of anxiety Typical threats
Social anxiety Acting poorly in a social setting (e.g. revealing that you are anxious; saying something stupid; not knowing what to say)
Being judged negatively by people
Health anxiety Being uncertain that a symptom that you have is not malignant
Generalised anxiety A general sense that you do not know that you are safe
A general sense that something may happen which will result in you losing self-control in some way
Thinking that you become anxious
Public speaking anxiety
Performing poorly while the focus of the audience is on you (e.g. going blank; revealing that you are anxious)
Being judged negatively by people
Test anxiety Doing poorly on the test
Going blank
Panic Not knowing that you will regain self-control immediately in a situation where you have begun to lose it
23Dealing with anxiety
not anxious. In order for you to feel anxious when you infer the presence of threat to your personal domain, you have to hold an irrational belief. When you think irrationally you hold a rigid belief and one or more extreme beliefs. While the rigid belief is at the core of anxiety, the extreme beliefs that are derived from the rigid belief often distinguish between whether you are experiencing ego anxiety (where you depreciate yourself ) and non-ego anxiety (where you àwfulise' or ®nd the adversity intolerable). You may, of course, experience both ego anxiety and non-ego anxiety in a given situation.
If your clients are unsure about the mediating role that irrational beliefs play in their anxiety, ask them how they would feel if they really believed the rational alternatives to what RECBT holds are their anxiety creating irrational beliefs. In using this strategy, it is important that you formulate the rational beliefs for your clients who cannot be expected to do this for themselves at this stage. When you do this, ensure that you match your clients' rigid belief with a ¯exible alternative and their main extreme belief with a non-extreme alternative, and then ask them how they would feel if they had strong conviction in this rational belief.
For example: Ìf you really believed that you wanted to pass the test, but did not have to do so and that if you failed it, that would be bad, but it would prove that you were fallible and not a failure, how would you feel about the prospect of failing the test?'
Once your clients can see that they would feel differently, go back and help them relate their irrational beliefs to anxiety and their rational beliefs to concern.
This is quite an elegant strategy since it accomplishes a number of things at once:
1. It addresses your clients' doubts about the mediating role of irrational beliefs in anxiety if they have such concern.
2. It introduces rational beliefs as a meaningful alternative to these irrational beliefs.
3. It helps your clients to see that holding rational beliefs can have bene®cial effects.
Behaviour associated with anxiety
When you hold an irrational belief about a threat to your personal domain, you feel anxious and you will act or tend to act in a number of ways, the most common of which are as follows:
You avoid the threat.
You withdraw physically from the threat.
You ward off the threat (e.g. by rituals or superstitious behaviour).
You try to neutralise the threat (e.g. by being nice to people of whom you are afraid).
You distract yourself from the threat by engaging in other activity.
You keep checking on the current status of the threat hoping to ®nd that it has disappeared or become benign.
You seek reassurance from others that the threat is benign.
You seek support from others so that if the threat happens they will handle it or be there to rescue you.
You overprepare in order to minimise the threat happening or so that you are prepared to meet it (NB it is the overpreparation that is the problem here).
You tranquillise your feelings so that you don't think about the threat.
You overcompensate for feeling vulnerable by seeking out an even greater threat to prove to yourself that you can cope.
You will see from the above list that the main purpose of most of these behaviours (and action tendencies) is to keep you safe from the threat. However, such safety-seeking behaviour is largely responsible for the maintenance of anxiety since it prevents you either from facing up to the situation in which you think that the threat exists and dealing with the threat if it does exist, or from seeing that your inference of threat is inaccurate.
Overcompensation is particularly worthy of comment. Some people are intolerant of the feeling of vulnerability or non-coping that they experience when they are anxious. They seek safety from the threat of non-coping by proving to themselves in actuality that they can cope with a greater threat. This is like a competition high jumper electing to jump a much greater height than the one at which she has twice failed. This is still a safety- seeking measure because the person seeks safety from the smaller threat by proving to herself that she can cope with the bigger threat.
Encouraging your clients to surrender their safety-seeking behaviour is a very important part of helping them to deal with their anxiety effectively. Consequently, you need to enquire speci®cally if they have any doubts, reservations or objections to doing so. When they express such doubts, it is important that you strive to understand their sources and deal with them effectively. If you fail to do this, their continued use of these safety-seeking measures will
undermine the development and maintenance of their healthy rational beliefs about threat.
You will ®nd that most clients' doubts about surrendering the use of safety-seeking behaviours centre on their need to feel immediately safe from threat. When some clients understand this dynamic, they see what they need to do and this understanding is suf®cient for them to commit themselves to the idea of tolerating the discomfort of feeling anxious while they learn to deal with the threat without using safety-seeking behaviours. Other clients are much more reluctant to surrender the use of safety-seeking behaviours, and with these clients you will need to target for change the irrational belief that underpins their reluctance (e.g. Ì must feel safe at all times and I can't bear it when I don't'). Once these clients have begun to develop and strengthen the rational alternative to this irrational belief, they begin to become more open to facing threat without using safety-seeking behaviour.
Thinking associated with anxiety
When you hold an irrational belief about a threat to your personal domain, you will feel anxious and think in a number of ways. Remember what I said in Chapter 1: the thinking that accompanies your anxiety is the result of your threat being processed by your irrational belief and therefore it is likely to contain a number of thinking errors that I present in Appendix 1. There are two types of post-irrational belief thinking which are important for you to understand:
threat-exaggerating thinking
safety-seeking thinking.
It is important to note that in both types of post-irrational belief thinking, such thinking may be in words or in mental images.
Threat-exaggerating thinking
In the ®rst type of post-irrational belief thinking that is associated with anxiety ± which I have called threat-exaggerating thinking ± you elaborate and magnify the threat and its consequences in your mind as shown below:
You overestimate the probability of the threat occurring.
You underestimate your ability to cope with the threat.
You ruminate about the threat.
You create an even more negative threat in your mind.
You magnify the negative consequences of the threat and minimise its positive consequences.
You have more task-irrelevant thoughts than in concern.
Safety-seeking thinking
The second type of post-irrational belief thinking that is associated with anxiety is the thinking version of behaviour that is designed to keep you safe in the moment. I call this form of thinking safety-seeking thinking. Here are some common examples:
You withdraw mentally from the threat.
You try to persuade yourself that the threat is not imminent and that you are ìmagining' it.
You think in ways designed to reassure yourself that the threat is benign, or if not, that its consequences will be insigni®cant.
You distract yourself from the threat, e.g. by focusing on mental scenes of safety and well-being.
You overprepare mentally in order to minimise the threat happening or so that you are prepared to meet it (NB once again it is the overpreparation that is the problem here).
You picture yourself dealing with the threat in a masterful way.
You overcompensate for your feeling of vulnerability by picturing yourself dealing effectively with an even bigger threat.
In the ®nal two forms of thinking, the person is seeking safety from the threat of non-coping by mentally creating images of masterful coping.
One important point to note about these two forms of post-irrational thinking is that they are quite different: in one you elaborate and magnify the threat and in the other you are thinking of ways to protect yourself against the threat. You can, and people often do, switch rapidly between these different forms of thinking. The more your safety-seeking thinking fails, the more you will mentally elaborate and magnify the threat, and the more you do the latter, the more you will try to search mentally for safety.
The following points are relevant to safety-seeking thinking. I will consider threat-exaggerating thinking directly after. The points that I made about safety-seeking behaviour are also relevant to safety-seeking thinking. It is important for clients to understand that such thinking is designed to keep them safe in the immediate situation, but in doing so they do not get the experience that they need of facing and dealing with their threat while holding rational beliefs. However, while they can readily understand the concept of not acting in ways that are designed to seek immediate safety from threat, they are usually more confused concerning what to do with safety-seeking thinking when such thoughts come into their mind. I recommend using the following strategy:
Encourage your clients to acknowledge the existence of the thought without trying to suppress it or to distract themselves from it. Explain that if they try to suppress the thought, they may unwittingly make it more likely to come into their mind and if they distract themselves from it, they are not dealing with it.
Encourage your clients not to engage with the thought. For example, if your clients are anxious about other people doing better on an exam than them, they may try to neutralise this by thinking: Ì'm sure I will do as well as most of the others'. If they engage with this thought, they will feel reassured. If they do not engage with the thought, they won't feel reassured, but will have the oppor- tunity of either rehearsing their rational belief about the threat brie¯y or getting on with whatever they would be doing if they did not have the thought (e.g. revising for the exam) even though they feel anxious or uncomfortable in the moment.
If a client is unclear about what non-engagement with a thought involves, you may need to use an analogy such as the one below, which I present as if I am talking directly to a client.
How not to engage with a thought: an analogy
You may well ®nd it dif®cult to grasp the idea of having a thought without engaging with it, so here is an analogy that you may ®nd helpful. Imagine that you are walking down a high street and a charity worker approaches you and tries to engage you in a con- versation about a local charity. You know that the charity worker wants you to sign a direct debit form whereby you pay a regular sum every month to the charity. Now, let's suppose that you neither want to give to the charity nor want to talk to the person. What is the best way of stopping the person from talking to you without
being overtly rude to him? My view is that the best way to do this is not to respond to the person. As you continue down the road, the charity worker walks beside you and you are aware of what he is saying but you say nothing in return. You give the person no eye contact nor show him any recognition that he is there. If you take this tack, after a short while the person will stop pursuing you. This is the approach you need to take with your safety-seeking thoughts. Acknowledge that they are present, continue with what you are doing while not engaging with the thoughts and without trying to get rid of them.
The following points are relevant to helping your clients deal with threat-exaggerating thinking if they raise questions about how to deal with this form of cognitive consequences of irrational beliefs:
Encourage your clients to recognise the existence of such thoughts and dis- courage them from trying to suppress them or to distract themselves from them.
Help them to understand that these thoughts are the products of still active irrational beliefs and are not plausible predictions about what is about to happen, no matter what feelings accompany such thoughts.
Encourage them either to brie¯y rehearse their rational beliefs about the threat and/or get on with whatever they would be doing if they did not have the thought.
HOW TO DEAL WITH ANXIETY
If you are prone to anxiety, you tend to experience this emotional problem in a variety of different settings and in response to a variety of threats. Here is how to deal with anxiety so that you become less prone to it.
Step 1: Identify reasons why anxiety is a problem for you and why you want to change
While anxiety is generally regarded as an emotional problem, it is useful for you to spell out reasons why anxiety is a problem for you and why you want to change. I suggest that you keep a written list of these reasons and refer to it as needed as a reminder of why you are engaged in a self-help programme. I discuss the healthy alternative to anxiety in Step 4.
If your clients are still undecided whether or not anxiety is a problem for them and/or whether or not they want to change, you will need to carry out a more thorough assessment of the possible factors involved. This is known as a cost-bene®t analysis where you encourage your clients to detail the perceived short-term and longer-term advantages and disadvantages of their anxiety and of their concern (the healthy alternative to anxiety). Respond to any perceived advantages of anxiety and perceived disadvantages of concern, correcting any misconceptions that your clients reveal on these issues.
Let me start with the issue of a client who is unsure if anxiety is a problem for her. It is useful to start by asking her to spell out ways in which anxiety is a problem for her and ways in which anxiety is not a problem for her. In the latter case, you may well discover that your client thinks that anxiety can be helpful to her in certain ways (e.g. that it motivates her or that it helps her to spot the presence of certain threats). If so, the client understands that concern (to which the client will be introduced presently as the healthy emotional alternative to anxiety) will do the job that the client thinks anxiety does for her but without the detrimental `side-effects' of anxiety. For example, I often say to clients that anxiety is motivating in the same way that a headless chicken is motivated to ®nd its head (i.e. with frenzied activity, but without focus). Concern, on the other hand, motivates a client, but in a focused manner and without the frenzy. In addition, you can help your client to consider what for her are the positives and negatives of concern. For example, some people say that concern is too weak to be a plausible alternative to anxiety. In which case you need to show the person that concern can vary in intensity and if she is very anxious, she can be very concerned, but unanxious.
Now, what if your client acknowledges that anxiety is a problem, but is ambivalent about targeting it for change? The main strategy is to understand her ambivalence. It may be that she does not see a clear alternative to anxiety, in which case you need to teach her what RECBT has to say about concern as a healthy alternative to anxiety. It also may be that anxiety has positive features for the client, at least from her frame of reference. In which case, you can respond as suggested above.
Time spent on helping your clients to be clear and unambivalent about anxiety being a problem for them so that they can fully commit themselves to the process of RECBT is time well spent.
Step 2: Take responsibility for your anxiety
In RECBT, we argue that people or things do not make you anxious; rather you create these feelings by the rigid and extreme beliefs that you hold about such people and things. You may object that this involves you blaming yourself for creating your anxious feelings, but this objection is based on a misconception. It assumes that taking responsibility for creating your anxiety is synonymous with self-blame. In truth, responsibility means that you take ownership for the irrational beliefs that underpin your anxiety while accepting yourself for doing so. Blame, on the other hand, means that you regard yourself as worthless for creating your anxiety.
The idea that emotional problems (including anxiety) are based largely on the way that a person thinks about what happens to them may be a familiar one in the professional ®eld of counselling and psychotherapy, but it is still an eye-opener to many clients. Thus, your clients may hold that the reason they are anxious, for example, is that the person they are anxious about is truly scary or that driving tests or going to the dentist are inherently frightening. This type of thinking is known in RECBT circles as À-C' thinking (where events are deemed to cause feelings). By contrast, the RECBT model stresses the ÀBC' model, where the impact of events on a person is mediated by the beliefs that they hold about these events. The ÀBC' model holds that the person needs to take responsibility for creating their feelings of anxiety by holding a set of irrational beliefs.
If your clients have dif®culty accepting responsibility for their anxious feelings, it is important for you to identify and deal with the source of this dif®culty. In the Client's Guide, I mention one common obstacle that stops clients from accepting such responsibility (i.e. the self-blame that clients engage in if they accept responsibility for making themselves anxious). However, there are other obstacles to accepting responsibility, such as the following:
Hopelessness about self-help (e.g. Ì can't do anything to help myself?).
Self-pity (e.g. Ìt's not me that makes me anxious, it's the lousy situation that I am in and that I don't deserve to be in').
Loss of bene®ts (e.g. Ìf I accept that I make myself anxious then I will lose out on the bene®ts that blaming my environment gives me ± such as being spared from doing dif®cult or potentially threatening tasks to do at work').
It is important to help your clients to understand the impact of these obstacles on their emotional problems. Then, help them to develop alternatives to these obstacles and review the impact of these alternatives on their emotional problem-solving. This often helps clients to deal effectively with these obstacles. If not, you may need to do a more detailed assessment of the obstacle, which is outside the brief of this book.
Step 3: Identify the threats you tend to be anxious about
The best way of identifying which threats you are particularly vulnerable to is to ask yourself whether or not such threats are to your self-esteem.
Major threats to self-esteem
The prospect of failure
Major threats that do not involve your self-esteem
The prospect of losing self-control
Uncertainty that one is not safe from threat
The prospect of experiencing discomfort
The prospect of loss of order
The prospect of experiencing certain internal processes (e.g. unwanted thoughts, feelings, images and urges).
Use the above list to identify the themes which you ®nd threatening.
If your clients ®nd it dif®cult to ®nd their threat related theme, you can help them by assessing a few speci®c examples of their anxiety. Have them focus on a speci®c situation in which they were anxious and ask them what they were most anxious about or found most threatening in the situation. If they still ®nd it dif®cult to identify
the threat in this or other speci®c situations, use the `magic question' technique. This involves you doing the following:
Have your clients focus on the situation in which they were anxious.
Ask them to nominate one ingredient that would eliminate or signi®cantly reduce their anxiety without changing the situation.
The opposite of this nominated ingredient is what they are most anxious about.
Hilda was struggling to identify the speci®c threat in her dental anxiety. I helped Hilda to use the `magic question' technique as follows:
I asked Hilda to focus on the situation in which she was anxious: Ì am waiting to be called into the dentist's surgery.'
I asked Hilda to nominate one ingredient that would eliminate or signi®- cantly reduce her anxiety without changing the situation: Ì would not have thoughts about the drill cutting my tongue.'
The opposite of this nominated ingredient was what she is most anxious about: `Having thoughts about the drill cutting my tongue.'
If you assess a number of speci®c examples of your clients' anxiety in this way, the threat related theme should be apparent. In Hilda's case, it was having thoughts about external dangers happening to her when she was in a vulnerable position.
Step 4: Identify the three components of your anxiety response and set goals with respect to each component
The next step is for you to list the three elements of your anxiety response in the face of each of the threats listed above.
Identify the three components of your anxiety response
I use the term ànxiety response' to describe the three main components that make up this response. The three components of your anxiety response are the emotional, behavioural and thinking components.
Behavioural component
The behavioural component concerns overt behaviour or action tendencies. These will be largely safety-seeking in nature. Consult the list that I provided to help you identify your behaviour associated with each theme when you are anxious (see p. 25).
Thinking component
The thinking component concerns theme-exaggerated thinking or safety- seeking thinking. These may be in words or in mental pictures. Consult the list that I provided to help you identify your thinking associated with each theme when you are anxious (see pp. 26±27).
Set goals with respect to each of the three components
You need to set goals so that you know what you are striving for when you deal effectively with anxiety. The three goals are emotional, behavioural and thinking goals.
Emotional goal
Your emotional goal is concern rather than anxiety (or whatever synonym you prefer to the term `concern'). Concern is a healthy negative emotion which is an appropriate response to threat, but one which helps you to process what has happened to you and move on with your life rather than get stuck or bogged down.
The concept that concern is the healthy alternative to anxiety in the face of threat is based on the following idea. Threat is negative and therefore it is realistic to have a negative emotion about it. The choice, therefore, is between an unhealthy negative emotion (anxiety) or a healthy negative emotion (concern). But what if your clients specify unrealistic goals? Here are a number of such goals and how to respond to clients who nominate them:
Ì don't want to feel anxious.' Show your clients that they have indicated what they do not want to feel in the face of threat, but not what they do want to feel. Help them to specify an emotion to aim for like concern!
Ì want to feel less anxious.' Show your clients that as anxiety is a disturbed emotion, wanting to feel less anxious is still to nominate a disturbed emotion, albeit of lesser intensity. Concern can be strong and healthy.
Ì want to be cool and calm.' Show your clients that if they are facing a threat (or think that they are), they need to be alert, aroused and geared up to deal with it. Being cool or calm may be attractive states for your clients, but show them that these states are not appropriate when they are facing threat. Show them that being concerned, but not anxious in the face of threat, will gear them up without overstimulating them (as would be the case if they were anxious).
Ì want to feel indifferent.' Being indifferent in the face of threat will also not help your clients to be appropriately geared up to deal with it. Help them to see this. Also show them that the only way that they could achieve a state of indifference about threat is to believe that it does not matter to them if the threat exists or not. In other words, show them that they would have to lie to themselves.
Ì want to be in control.' Anxiety is a state where you are not fully in control of yourself. As a result, it seems entirely acceptable for clients to nominate `being in control' as something to aim for when they are anxious. This seems entirely reasonable, but you need to be on your guard when your clients nominate such a goal. Dealing with anxiety is counterintuitive. Thus, achieving a sense of being in control in the face of threat involves your clients tolerating not being in self-control. Some clients hold irrational beliefs about self-control and if they bring such beliefs to the task of dealing with anxiety, it will lead them to be more anxious. If your clients do have such a rigid belief about self-control, you will need to target this belief for change. In doing so, you need to help them see the difference between self-control as a goal and self-control as a means to achieve this goal. Your clients need to learn that tolerance of not being in self-control is the best way of achieving self-control. Be aware though that this is likely to be an alien concept for them and one that will need a lot of discussion and debunking of misconceptions on your part. This is de®nitely an issue that you should (ideally) take to supervision.
Behavioural goal
Your behavioural goal should re¯ect actions that are based on concern about the threat rather than anxiety. The following are the most common behaviours associated with concern rather than anxiety. You may wish to
compare these behaviours with those associated with anxiety that I presented on p. 25.
You face up to the threat without using any safety-seeking measures.
You take constructive action to deal with the threat.
You seek support from others to help you face up to the threat and then take constructive action by yourself rather than rely on them to handle it for you so that they will handle it or to be there to rescue you.
You prepare to meet the threat but do not overprepare.
You will note that this list is much shorter than the list outlining the behaviours that are associated with anxiety. The reason is that when you seek safety from threat there are far more ways of doing so than when you face up to the threat.
It is important that your clients understand that as they strive to develop healthy behavioural responses to threat, they will still feel the urge to act in ways designed to help keep them safe from threat. Help them to understand the reason for this. Explain to them that as they question their beliefs and commit themselves to strengthening their conviction in their rational beliefs and to weakening their conviction in their irrational beliefs, their irrational beliefs will still be active and producing urges for them to act dysfunctionally. Encourage your clients to accept these urges, to recognise that they do not have to act on them and to use them as cues to act in functional ways.
Thinking goal
As well as setting behavioural goals related to the feeling of concern in the face of threat, it is important that you set thinking goals associated with this emotion. The following are the most common forms of thinking associated with concern rather than anxiety. Again you may wish to compare these forms of thinking with those associated with anxiety that I presented on pp. 26±27.
You are realistic about the probability of the threat occurring.
You view the threat realistically.
You realistically appraise your ability to cope with the threat.
You think about what to do concerning dealing with threat constructively rather than ruminate about the threat.
You have more task-relevant thoughts than in anxiety.
As the above list shows, the dominant feature of thinking associated with concern is that it is realistic and coping focused. Thus, when you are concerned, but not anxious, you do not elaborate or magnify the threat and nor do you mentally seek safety from it. Please remember that such thinking may be in words or in mental pictures.
The point I made above with respect to clients' behavioural goals is also relevant with respect to their thinking goals. Clients will still have some conviction in their irrational beliefs until they have full conviction in their rational beliefs. Given this, your clients' irrational beliefs will have some impact on their subsequent thinking as they strive to achieve their goals. Thus, highly distorted and/or safety-seeking thoughts will still come into your clients' minds. Help your clients to understand why this is the case. When you come to help them deal with these forms of post-irrational belief thinking, do one or more of the following as indicated. Discuss this issue with your RECBT supervisor, if necessary:
Encourage your clients to acknowledge the existence of such thoughts without trying to suppress them, distract themselves from them or engage with them.
If relevant, use the presence of this post-irrational belief thinking to help your clients to identify and deal with the irrational beliefs.
Question the empirical nature of these thinking `C's' once or twice and then return to the acceptance strategy detailed above.
Step 5: Identify your general irrational beliefs and alternative general rational beliefs
A general irrational belief is an irrational belief that you hold across situations de®ned by the theme that you ®nd threatening. It accounts for your anxiety response. Its rational alternative, which will also be general in nature, will account for your concern response.
I suggest that you identify both sets of beliefs at this point for a number of reasons (as follows). Doing so will help you to
see quickly what the alternatives to your irrational beliefs are
see that you can achieve your goals by acquiring and developing your rational beliefs
get the most out of questioning your beliefs later.
Identify your general irrational beliefs
When you identify a general irrational belief, you take a common theme (e.g. criticism or loss of self-control) and add to this a general rigid belief and the main extreme belief that is derived from the rigid belief. Note the following:
If you are particularly prone to self-esteem based anxiety, your main extreme belief will be a self-depreciation belief.
For anxiety that is non-self-esteem based, your main extreme belief will either be an awfulising belief or a discomfort intolerance belief, and less frequently it may be an other-depreciation belief or a life-depreciation belief.
For example:
Ì must not be criticised and if I am it would prove that I am worthless' (a general self- esteem based irrational belief ).
Ì must not lose self-control and it would be awful if I do' (a general non-self-esteem based irrational belief ).
Identify your alternative general rational beliefs
When you identify your alternative general rational belief, you take the same common theme (e.g. criticism or loss of self-control) and add to this a general ¯exible belief and the main non-extreme belief that is derived from the ¯exible belief. Note the following:
If your general extreme belief is self-depreciation (when you are particularly prone to self-esteem based anxiety), then your general non-extreme belief will be a self- acceptance belief.
If you are prone to non-self-esteem based anxiety, then your alternative general non- extreme beliefs will be a non-awfulising belief, a discomfort tolerance belief and less frequently an other-acceptance belief or a life-acceptance belief.
For example:
Ì would prefer not to be criticised, but I don't have to be immune from criticism. If I am criticised, it would be unpleasant, but it would not prove that I am worthless. I am t

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