Cognitive Behavioural Therapy For Dummies. Rob Willson

gather evidence for whether theory A or B best explains the phenomenon of your boss failing to be cheerful towards you in the mornings.

      

A theory is just an idea or assumption that you hold, which, to your mind, explains why something happens – a seriously technical word for a simple concept.

      Often, developing one additional theory to compete with your original theory is enough. However, you can develop more alternative theories if you think they may help you get to the bottom of what you’re experiencing. Taking the previous example, you may have a third theory, such as ‘My boss is cheerful only with employees that he knows very well’, or even a fourth theory, such as ‘My boss is cheerful only with employees of the same rank or above him’.

      Developing competing theories can be particularly helpful in the following situations:

       Dealing with predictions that may be months or years away from being proven: If you fear you’ll go to hell for having an intrusive thought about causing harm to someone, then this outcome is likely to be sometime away. Similarly, if you have illness anxiety and spend hours each day preoccupied with the idea that physical sensations in your body may be signs that you’ll become ill and die, you’re unlikely to know straightaway whether this will actually happen. With these kinds of catastrophic thought, you need to design experiments to help you gather evidence that supports the theory that you have a worry or anxiety problem, rather than a damnation ticket or a terminal illness.

       Dealing with beliefs that are impossible to prove or disprove conclusively: Perhaps you’re anxious about others having negative opinions of you. You cannot know for sure what other people think, but even if someone tells you that your fears are unfounded, you can never know with absolute certainty what he’s thinking. Similarly, if you have jealous thoughts that your partner desires someone else, but he reassures you otherwise, you may remain uncertain of his true feelings.

      For both of these situations, you can employ the theory A or theory B strategy:

       Design an experiment to gather evidence to support the idea that your jealous feelings are based on your jealous thoughts (theory B), rather than on reality (theory A).

       Similarly, devise an experiment to test out whether your original theory A, that ‘People don’t like me’, or alternative theory B, that ‘I often think that people don’t like me because I’m so worried about others’ opinions of me that I end up seeing a lot of their behaviour as signs of dislike’, best explains your experiences in social situations.

Here is an example of how Alex used the competing theories approach to get a better understanding of his physical sensations. Originally, Alex assumed his theory that uncomfortable bodily sensations signalled the onset of a heart attack was correct. By testing this in practice, Alex was able to consider that an alternative theory – uncomfortable bodily sensations are a by-product of anxiety – may be more accurate.

       Describe the problem. Alex suffers from panic attacks. He feels hot and his heart races, sometimes out of the blue. When he feels these sensations, he fears he’s having a heart attack. Alex sits down to try to reduce the strain on his heart (an example of a safety behaviour). He goes out of his way to avoid situations in which he has experienced these symptoms.

       Develop competing theories. Alex devises two theories about his raised heart rate:Theory A: ‘My heart beating quickly means I’m vulnerable to having a heart attack’.Theory B: ‘My heart beating quickly is a consequence of anxiety’.

       Execute an experiment. Alex decides to deliberately confront situations that tend to trigger his raised heart rate and to stay in them, without sitting down, until his anxiety reduces. He predicts that if theory B is correct, then his heart rate will reduce after his anxiety subsides and he can leave the situation without having come to any harm.

       Examine the results. Alex finds that his heart rate does indeed reduce when he stays with his anxiety. He’s struck by what a difference this knowledge makes to his confidence and the realisation that he’s not going to come to any harm from his raised heart rate when he resists the urge to sit down. He concludes that he can reasonably have about 70 per cent confidence in his new theory that his raised heart rate is a benign consequence of anxiety.

      

You can’t always prove conclusively that something isn’t so. However, you can experiment to see whether certain emotional states, and mental or behavioural activities, have a beneficial or detrimental effect on the kinds of thoughts that play on your mind.

Conducting Surveys

      You can use the clipboard and pen of the survey-taker in your endeavours to tackle your problems by designing and conducting your own survey. Surveys can be especially helpful in terms of getting more information about what the average person thinks, feels or does.

We suggest you have more than one type of behavioural experiment in your repertoire. Surveys are very useful if you believe that your thoughts, physical sensations or behaviours are out of the ordinary. If you have upsetting, intrusive thoughts and images or experience urges to say socially unacceptable things (symptoms typical of obsessive-compulsive disorder, OCD), feel pulled to the edge of high places (as in vertigo) or get a sense of impending doom when you’re not in a familiar place (symptoms associated with agoraphobia), you may think that you’re the only person who ever feels this way. Use surveys to see whether other people have the same thoughts and urges. You’ll probably discover that other people experience the same things as you do. You may also discover that the symptoms you experience are actually less of a problem than the way you currently deal with them.

      Henry suffers from OCD. His particular obsessional problem is related to frequent intrusive images of harm coming to his family. Henry’s convinced that he’s the only person in the world who gets such unpleasant and unwanted images entering his mind. Henry concludes that there’s something very different and wrong about him because he has such images. He tests his theory about his abnormality by conducting the following survey:

       Describe the problem. Henry’s convinced that his intrusive thoughts about his family being hurt in a car accident are unusual and mean that he has to protect his family by changing the image in his mind to them being happy at a party.

       Formulate a prediction. Henry comes up with the prediction ‘No one will admit to having the kind of thoughts I have’. He rates his strength of belief as 70 per cent.

       Execute an experiment. Henry tests his perception that his images are abnormal by devising a checklist of intrusive thoughts and asking his friends and family members to tick any that they experience.

       Examine the results. Henry’s surprised at the variety of thoughts that people report entering their minds. Henry concludes that perhaps his images aren’t so abnormal after all. He re-rates his conviction in his original prediction as 15 per cent. Henry also learns that other people simply discount their unpleasant images and don’t worry that they mean anything sinister.

      Charlotte worries a lot about her health and the possibility of developing a life-threatening illness. Sometimes, Charlotte notices funny sensations in her body and instantly interprets them as signs of an undiagnosed disease. Charlotte assumes that no one else gets unusual bodily sensations from time to time.

       Describe the problem. Charlotte worries that the bodily sensations she experiences are a sign of disease. She’s unsatisfied by frequent reassurance from her family doctor and husband. Charlotte’s problems are based partly on two ideas:Physical sensations must have a clear medical explanation.Any sensible person would seek an immediate explanation for the physical sensations she’s currently experiencing.

       Formulate a prediction. Charlotte makes the following prediction: ‘Most people