Cognitive Behavioural Therapy For Dummies. Rob Willson

Giving unpleasant thoughts and images time to subside

      

Practising mindfulness

      Traditionally, CBT has tended to concentrate many of its techniques on helping people change the content of their thinking – from a negative to a more realistic thought, for example. However, modern CBT has begun to tackle another area of human psychology – how we focus our attention.

      This chapter does not discuss what you think but does discuss how you manage your thoughts and attention. We introduce task concentration training and mindfulness, two techniques for managing problematic thoughts and exerting some power over your attention. This chapter has two main messages:

       For the most part, your random thoughts, no matter how distressing and negative, are not the real problem. Rather, the importance or meaning you attach to those thoughts is what causes you the problem. If you view the notion ‘I’m a hopeless case’ as a thought rather than a fact, you can greatly lessen its impact. Similarly, if you experience an unsavoury intrusive thought (like people with OCD often have), you can see it as a normal human phenomenon and not fall into the trap of taking it seriously.

       When you have an emotional problem, your mind tends to attach unhelpful meanings to aspects of yourself, the world around you and other people. You can also tend to overfocus on particular aspects of these unhelpful meanings. Fortunately, you can develop the ability to steer your attention towards, and away from, any features of your experience you choose, which can help improve your mood and reduce anxiety.

Training in Task Concentration

      Becoming adept at redirecting your attention away from yourself (this includes your bodily sensations, thoughts and mental images), in certain situations, is the essence of task concentration. Rather than thinking about yourself, you focus your attention towards your external environment and what you’re doing.

      

Task concentration involves paying less attention to what’s going on inside of you and more attention to what’s happening outside of you. You focus less on how well you are doing – for example, when giving a speech – and more on what you are doing. The task gets the bulk of your attention.

      Task concentration can be particularly useful in situations that trigger anxiety in you. Task concentration can help you to counterbalance your tendency to focus on threats and on yourself when you feel anxious.

      As you begin to practise task concentration, break down the process into two rehearsal arenas – just as when learning to drive you begin on quiet roads and eventually advance on to busier roads.

      The two rehearsal arenas are as follows:

       Non-threatening situations: Here, you typically experience little or no anxiety. For example, if you have social phobia, you may feel a little anxious walking through a park, travelling on a very quiet train or socialising with family members and close friends.

       More challenging situations: Here, you may experience moderate to severe anxiety. More challenging situations may include shopping in a busy grocery store, travelling on a train during rush hour or attending a party with many guests whom you may not know.

Typically, you gradually progress from non-threatening situations to more challenging situations as you practise and develop greater skill.

      

After you’ve practised redirecting your attention in situations you regard as relatively non-threatening, you can move on to using the techniques in increasingly challenging situations.

      Choosing to concentrate

      The point of task-concentration exercises is not to lessen your overall concentration but to concentrate harder on different aspects of the external environment. Some tasks require you to focus your attention on certain behaviours – such as listening to what another person is saying during a conversation or attempting to balance a tray of drinks as you walk through a crowded room.

      In other situations, you may feel anxious but not have a specific task to attend to. In such a situation (for example, while sitting in a crowded waiting room), you can still focus externally. You can direct your attention to your surroundings, noticing other people, the features of the room, sounds and smells.

      

With practice, you can be both task- and environment-focused rather than self-focused, even in situations that you regard as highly threatening.

      The following exercises aim to increase your understanding of how paying attention to sensations and images limits your ability to process information around you. The exercises will also help you realise that you can attend to external task-related behaviours. In other words, you can master choosing what you pay attention to in situations when your anxiety is triggered.

      

Intentionally directing your attention away from yourself does not mean trying to avoid noticing your sensations or suppressing your thoughts. Sometimes, people try to use thought suppression as a means of alleviating uncomfortable sensations and anxiety. However, suppression usually works only briefly, if at all. External focus is really about controlling your focus of attention even whilst feeling uncomfortable.

      Concentration exercise: Listening

      For this exercise, sit back-to-back with someone else, perhaps a friend or your therapist. Ask the person to tell you a story for about two minutes. Concentrate on the story. Then, summarise the story: note how much of your attention you direct towards the task of listening to the other person, towards yourself and towards your environment – try using percentages to do this. Your partner can give you feedback on your summary to give you some idea how you did.

Now do the exercise again, but this time round sit face-to-face with the storyteller and make eye contact. Ask the person to tell you a story, but on this occasion consciously distract yourself by focusing on your thoughts and sensations, and then redirect your attention towards the storyteller. Summarise the story, and note (using percentages again) how you divide your attention between yourself, listening to the other person and your environment.

      Repeat the storytelling activities, sitting back-to-back and then face-to-face, several times until you become readily able to redirect your attention to the task of listening after deliberate distraction through self-focusing. Doing so helps you to develop your ability to control where you focus your attention. Use a new story each time so that you don’t end up just memorizing the details!

      Concentration exercise: Speaking

      Follow the same steps for this speaking exercise as you do for the listening exercise, as we describe in the preceding section. Starting with your back to the back of the other person, tell a two-minute story, focusing your attention on making your story clear to the listener.

      Next, position yourself face-to-face with the listener, making eye contact. Deliberately distract yourself from the task of storytelling by focusing on your feelings, sensations and thoughts. Then, refocus your attention towards what you’re saying and towards the listener, being aware of her reactions and whether she understands you.

      Again, using percentages, monitor how you divide your attention among yourself, the task and your environment.

      Concentration exercise: Graded practice

      For this exercise, prepare two lists of situations. For your first list, write