Anorexia is a troublesome disorder characterized by an obsession with weight and food. With a target group consisting primarily of adolescent girls (80-90%), the anorexic will crave food, but will refuse to eat or retain it because of an overwhelming fear of weight gain. The individual may stop eating almost entirely, and will deny that her behavior is abnormal and that health is deteriorating. Typically, the anorexic will say that “she feels fat,” even when she is obviously underweight.
The behavior of the anorexic may be characterized by a pattern of social withdrawal, rigorous exercise, and ritualistic eating habits. The emotional profile of the anorexic is marked by a pattern of depression, fear of obesity, and loss of self-confidence. Physical symptoms include a loss of menstruation and a weight loss of up to 20-25% of body mass. According to diagnostic criteria, a female patient is clinically suffering from anorexia nervosa when body weight has fallen to 15% below normal and she has not menstruated for at least three months. The same body weight criteria apply to male patients.
Anorexic teenagers are generally unwilling to receive treatment, resisting any attempts at counseling. Those who reluctantly seek treatment begin the process from an adversarial perspective. Developing a collaborative relationship with an anorexic patient is no easy task. It is critical that the therapist develop a warm, friendly, honest and accepting relationship with the anorexic. The quality of the therapeutic relationship will be a factor in determining the individual’s willingness to deal with the terrifying aspects of eating and weight gain.
The relationship provides a means for examining cognitive distortions and maladaptive underlying assumptions that the anorexic applies to her internal world. It is critical that the counselor accepts the individual’s beliefs about body perception as genuine for her. Any attempt to refute, challenge, or devalue the person for holding erroneous assumptions about weight and body misperception is counterproductive. Anorexic teens are used to hearing from significant others that their beliefs are illogical and irrational.
It is the goal of the therapist to enter into a mutual fact-finding process with the anorexic client. By accepting the patient’s belief system as genuine for her, it is possible to introduce doubt about the anorexic’s basic cognitive assumptions. The individual may be encouraged to reexamine core assumptions about the value of thinness. Several lines of inquiry might be, “Is it practical for you to embrace this idea?” or “How does losing weight fit in with other values that you cherish?” Emphasizing that treatment will follow an experimental model is an important notion. The therapist’s approach with the anorexic might be, “Let’s try this out and see what happens.”
Therapy with the anorexic involves challenging faulty thinking and beliefs. For example, if the patient expresses apprehension around the issue of losing competence if she gains weights, the therapist can help her develop a working definition of competency that will establish a concept of whether or not it is influenced by weight changes. Such questions such as, “Would you appreciate your friend more if she weighed less than you?” may help cut into the double standard established by the anorexic patient.
Questioning the anorexic about what would happen if their worst expectations came to pass may minimize the imagined effects of the event. The person who demands “thinness” is obviously anxious when she considers herself “fat.” The counselor may inquire, “What’s the most horrible thing that could happen if you were to gain weight?”
Cognitive distortions are numerous in the anorexic and must be gently challenged. Distortions such as dichotomous thinking, (“If I gain weight, I’ll be considered obese.”), overgeneralizations, (“I will never get any better and my eating will never improve.”), magnification, (“Gaining any weight will be more than I can take!”) must be directly, but gently confronted in counseling. The anorexic is encouraged to design experiments to test the validity of specific irrational thoughts. For example, the anorexic individual may be encouraged to interview her friends for preferences in physical appearance, checking out how often people select a friend based exclusively on the merit of weight.
Body-size misperception is a significant feature of the anorexic disorder. The individual may be asked to reinterpret what she sees. Such counter-arguments may involve the use of reattribution techniques such as, “When I try to estimate my own dimensions, I am like a color-blind individual attempting to create my own wardrobe. I will rely on other’s objectivity to assess my actual body size.”
With the anorexic, maintaining a multidimensional approach to treatment is necessary, focusing on information processing, cognitions, and other strategies such as:
Dealing with family issues. Some therapist’s believe that the anorexic disorder actually acts as a stabilizing force for the family.
Dealing with personal goals and ambitions of the anorexic.
Focusing on issues of control, perfectionism, assertiveness and autonomy.
Dealing with social adjustment issues.
Assisting with problem-solving and coping skills.
Dealing with the anorexic patient is demanding and requires flexibility and creativity as necessary ingredients if the therapeutic process is to be successful. Many anorexic clients struggle with their body misperception issues throughout their life and may need to revisit the counseling process during times of high stress.
James P. Krehbiel, Ed.S., LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, personal growth book, Stepping Out of the Bubble is available at www.booklocker.com. He can be reached at www.krehbielcounseling.com.
Thursday, October 25, 2007
Wednesday, October 10, 2007
THE EMERGING POPULARITY OF COGNITIVE-BEHAVIORAL THERAPY
Cognitive-behavioral therapy is currently receiving a significant degree of attention as the treatment of choice for individuals needing assistance with a variety of psychological disorders. It is a structured, pragmatic approach to dealing with problems and is appealing to those seeking therapeutic treatment. People in need of counseling are seeking out clinicians who have specialized training in CBT. Understanding the reason for this current trend in popularity of cognitive-behavioral therapy can be found in the unique characteristics which are pivotal to this modality of treatment. There is a simplicity and yet effectiveness in the model which characterizes the concepts of CBT.
Cognitive-behavioral therapy facilitates a collaborative relationship between the patient and therapist. Together, patient and counselor develop a trusting relationship and mutually discuss the presenting problems to be prioritized and explored in therapy. In CBT, the most pressing issue troubling the patient typically becomes the initial focus of treatment. As a result, the patient tends to feel relieved and encouraged that the primary problem that brought him to therapy is immediately being acknowledged and addressed.
Problems are tackled head-on in a very practical manner. The patient is coached on the ABC’s of cognitive-behavioral therapy. The therapist explains the connection between thoughts and beliefs and their impact on behavior. How the patient thinks about problems determines the way in which the individual responds to various issues. It’s the manner of thinking about life’s issues that steers the patient’s way of behaving.
Let’s assume that you work in an office and for an entire week a co-worker has walked past you without acknowledging your presence. Each day you go back to your cubicle and wonder why this colleague is treating you so unjustly. You build up thoughts about her being condescending and snobbish and begin questioning what you might be doing to annoy her. Anger begins to emerge and your start thinking, “How dare she treat me this way!” Eventually, you settle down and start to rationally consider the problem. You think, “This is stupid, why don’t I go visit her at her office and see what’s going on in her life that might be affecting this situation. You enter her office and begin starting a conversation. In the midst of your discussion, she reveals that her son is suffering from depression and needs to see a counselor. Your colleague is disturbed about the situation and confides in you that she has been on edge with everyone at the office. She asks you if you know of a qualified therapist. You give her some ideas and before you leave, she gets up from her chair and gives you a firm hug. This incident demonstrates how our thinking can be faulty and can be based upon some erroneous assumptions.
CBT is effective because it teaches the patient to modify patterns of thinking which affect behavior. CBT is a straight-forward therapy which is designed to alert the patient to self-defeating ways of thinking. Locating distorted or maladaptive thinking is accomplished through an exploratory process which is dependent upon a solid patient/counselor therapeutic alliance.
Cognitive-behavioral therapy focuses on the patient’s negative self-talk, and offers practical suggestions on how to untwist one’s thinking to make it more adaptive. The CBT therapist assists the client in thinking more rationally by examining the individual’s spontaneous thoughts, observing ways in which they may distort reality, and ferreting out underlying assumptions or beliefs that affect ways of thinking and behaving.
Spontaneous thoughts are the nonsensical things that we tell ourselves when we are under stress – “I’ll never get a date, who would ever want me!” Cognitive distortions are the lenses out of which we perceive reality – “You always make me feel like a loser” (either or thinking). Underlying assumptions are the “hot buttons” which crystallize as a way of coping and getting our needs met during childhood – “I must avoid conflict at all costs; I hate disapproval and getting my feelings hurt.”
Cognitive-behavioral therapy seeks to refute the nonsensical things we tell ourselves and assists us in developing more rational ways of responding to our maladaptive thought processes. Since homework is an integral part of therapy, patients will be encouraged to complete exercises designed to change negative thinking. One concrete procedure helps the client to identify current troubling events, negative self-talk, and ways of rationally responding to situations sited. The individual logs difficult situations, identifies self-defeating thinking and refutes the negative thought processes with more rationally, adaptive way of responding to events. During each therapy session, the log sheet is reviewed for patient progress.
With CBT, clients are in control of their own progress. They are aware of the process that is necessary for change, and diligently work at modifying faulty thought patterns. Therapeutic progress is easily monitored through self-inventories and patient feedback. Time is always left at the end of sessions to review the benefits or pitfalls of the counseling sessions. Clients are asked to assess the effectiveness of their counselor’s treatment process.
Patients often ask, “How long will this counseling treatment take?” Although each case is unique, six to eight sessions are generally sufficient to teach clients strategies for reshaping their thinking. CBT is a time-limited, user-friendly, practical process for helping individuals to assess their negative thinking and making needed transformation in the way they respond to themselves and others. Individuals with anxiety, addictive patterns and depressive disorders are particularly well suited to benefiting from this from of treatment. The good news is that many behavioral health disorders can be treated successfully through cognitive-behavioral therapy. NACBT or The National Association of Cognitive-Behavioral Therapy is a good resource for locating counselors who are sufficiently trained, certified, and specialize in this treatment approach.
James P. Krehbiel, Ed.S, LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.amazon.com. James can be reached at www.krehbielcounseling.com.
Cognitive-behavioral therapy facilitates a collaborative relationship between the patient and therapist. Together, patient and counselor develop a trusting relationship and mutually discuss the presenting problems to be prioritized and explored in therapy. In CBT, the most pressing issue troubling the patient typically becomes the initial focus of treatment. As a result, the patient tends to feel relieved and encouraged that the primary problem that brought him to therapy is immediately being acknowledged and addressed.
Problems are tackled head-on in a very practical manner. The patient is coached on the ABC’s of cognitive-behavioral therapy. The therapist explains the connection between thoughts and beliefs and their impact on behavior. How the patient thinks about problems determines the way in which the individual responds to various issues. It’s the manner of thinking about life’s issues that steers the patient’s way of behaving.
Let’s assume that you work in an office and for an entire week a co-worker has walked past you without acknowledging your presence. Each day you go back to your cubicle and wonder why this colleague is treating you so unjustly. You build up thoughts about her being condescending and snobbish and begin questioning what you might be doing to annoy her. Anger begins to emerge and your start thinking, “How dare she treat me this way!” Eventually, you settle down and start to rationally consider the problem. You think, “This is stupid, why don’t I go visit her at her office and see what’s going on in her life that might be affecting this situation. You enter her office and begin starting a conversation. In the midst of your discussion, she reveals that her son is suffering from depression and needs to see a counselor. Your colleague is disturbed about the situation and confides in you that she has been on edge with everyone at the office. She asks you if you know of a qualified therapist. You give her some ideas and before you leave, she gets up from her chair and gives you a firm hug. This incident demonstrates how our thinking can be faulty and can be based upon some erroneous assumptions.
CBT is effective because it teaches the patient to modify patterns of thinking which affect behavior. CBT is a straight-forward therapy which is designed to alert the patient to self-defeating ways of thinking. Locating distorted or maladaptive thinking is accomplished through an exploratory process which is dependent upon a solid patient/counselor therapeutic alliance.
Cognitive-behavioral therapy focuses on the patient’s negative self-talk, and offers practical suggestions on how to untwist one’s thinking to make it more adaptive. The CBT therapist assists the client in thinking more rationally by examining the individual’s spontaneous thoughts, observing ways in which they may distort reality, and ferreting out underlying assumptions or beliefs that affect ways of thinking and behaving.
Spontaneous thoughts are the nonsensical things that we tell ourselves when we are under stress – “I’ll never get a date, who would ever want me!” Cognitive distortions are the lenses out of which we perceive reality – “You always make me feel like a loser” (either or thinking). Underlying assumptions are the “hot buttons” which crystallize as a way of coping and getting our needs met during childhood – “I must avoid conflict at all costs; I hate disapproval and getting my feelings hurt.”
Cognitive-behavioral therapy seeks to refute the nonsensical things we tell ourselves and assists us in developing more rational ways of responding to our maladaptive thought processes. Since homework is an integral part of therapy, patients will be encouraged to complete exercises designed to change negative thinking. One concrete procedure helps the client to identify current troubling events, negative self-talk, and ways of rationally responding to situations sited. The individual logs difficult situations, identifies self-defeating thinking and refutes the negative thought processes with more rationally, adaptive way of responding to events. During each therapy session, the log sheet is reviewed for patient progress.
With CBT, clients are in control of their own progress. They are aware of the process that is necessary for change, and diligently work at modifying faulty thought patterns. Therapeutic progress is easily monitored through self-inventories and patient feedback. Time is always left at the end of sessions to review the benefits or pitfalls of the counseling sessions. Clients are asked to assess the effectiveness of their counselor’s treatment process.
Patients often ask, “How long will this counseling treatment take?” Although each case is unique, six to eight sessions are generally sufficient to teach clients strategies for reshaping their thinking. CBT is a time-limited, user-friendly, practical process for helping individuals to assess their negative thinking and making needed transformation in the way they respond to themselves and others. Individuals with anxiety, addictive patterns and depressive disorders are particularly well suited to benefiting from this from of treatment. The good news is that many behavioral health disorders can be treated successfully through cognitive-behavioral therapy. NACBT or The National Association of Cognitive-Behavioral Therapy is a good resource for locating counselors who are sufficiently trained, certified, and specialize in this treatment approach.
James P. Krehbiel, Ed.S, LPC is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.amazon.com. James can be reached at www.krehbielcounseling.com.
Tuesday, October 09, 2007
HOW TO MAKE PAIN LESS PAINFUL
Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.
In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health.
Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”
Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.”
Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain.
The following ideas are some guidelines for managing pain more effectively:
· Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?”
· Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish.
· Use various activities to refocus away from your pain. Dwelling on pain makes it more painful. Stretching, music, swimming, meditation, and other activities are important.
· Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management.
· Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments.
· Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.
James P. Krehbiel is an author, freelance writer, and nationally certified cognitive-behavioral therapist in private practice in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at http://www.booklocker.com/. He can be reached through his website at http://www.krehbielcounseling.com/.
In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health.
Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”
Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.”
Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain.
The following ideas are some guidelines for managing pain more effectively:
· Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?”
· Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish.
· Use various activities to refocus away from your pain. Dwelling on pain makes it more painful. Stretching, music, swimming, meditation, and other activities are important.
· Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management.
· Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments.
· Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.
James P. Krehbiel is an author, freelance writer, and nationally certified cognitive-behavioral therapist in private practice in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at http://www.booklocker.com/. He can be reached through his website at http://www.krehbielcounseling.com/.
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