Trichotillomania

Personally, I had never heard about this disorder until I came across a Mental Health YouTuber called Beckie0. She documented the challenges she faced after being diagnosed with Trichotillomania and took a picture of herself for everyday for over 6 years (if my memory is right) she even dedicated a YouTube channel to her and this condition called TrichJournal…which I advise anyone who wants to know more about it in a personal sense to have a look at.

What is Trichotillomania? 

Trichotillomania is a condition whereby the individual feels compelled to pull out their hair (this is not limited to pulling but tearing etc). The hair is not limited to their hair on their head but; eyebrows, eyelashes, facial hair, body hair or pubic hair.

This disorder is described by the NHS as an impulse-control disorder, where the individual is physically unable to control or stop them from pulling their hair. The person will feel an intense urge to pull their hair and will not feel relief until they have carried out this behaviour.

As with any mental health condition, Trichotillomania is paired more than likely with negative feelings such as; guilt, depression and anxiety. The person may feel ashamed and embarrassed about their condition and therefore may try to deny or conceal their ‘illness’.

Diagnostic Criteria

A. Recurrent pulling out of one’s hair, resulting in hair loss.

B. Repeated attempts to decrease or stop hair pulling.

C. The hair pulling causes clinically significant distress or impairment to important areas of functioning; social, occupational etc.

D. The hair pulling or hair loss is not attritutable to any other medical condition e.g. dermatological condition.

E. The hair pulling is not better explained as symptoms of another mental disorder e.g. improve perceived defect or flaw in appearance in body dysmorphic disorder.

Diagnostic Features

The essential feature to this condition is the recurrent pulling out of one’s own hair (Criterion A). Hair pulling can occur from any region of the body in which hair grows; the most common sites according to the DSM are; the scalp, eyebrows and eyelids whilst less common sites
are facial and pubic regions. These sites may also vary over time and severity of condition. Hair pulling episodes may occur briefly; scattered throughout the day or during less frequent but more sustained periods that can continue for hours. As such the person may endure hair pulling for months or years. Criterion A requires the hair pulling to result to loss of hair, the individuals with this disorder may pull hair in a vastly distributed pattern therefore hair loss may not be clearly visible. Alternatively the individual may attempt to conceal or camouflage hair loss.

Criterion B acknowledges that individuals with this disorder may make repeated attempts to decrease or stop hair pulling.

Whilst, Criterion C indicates that hair pulling will cause clinically significant distress or impairment in social, occupational and other areas of functioning.

The term distress includes negative affects that may be experienced by a person with this particular condition; feeling a loss of control, embarrassment and shame.

Significant impairment may occur in several areas of functioning and the individual may take part in avoidance behaviours.

Associated Features Supporting Diagnosis

Hair pulling may be accompanied by a range of behaviours or rituals related to or involving hair. A individual may therefore search for a particular kind of hair to pull e.g. pulling hair with a specific texture or colour; they may try to pull out hair in a specific way e.g. the root comes out intact; or may visually examine, tactile or orally manipulate their hair after it’s been pulled e.g. rolling the hair between their fingers, pulling the hair between the teeth, biting the hair or swallowing the hair.

Hair pulling may also be preceded or accompanied by various emotional states; it may be triggered by anxiety or boredom, may be preceded by and increasing sense of tension or may lead to gratification, pleasure or sense of relief. The hair pulling may also involve varying degrees of conscious awareness, some individuals may display more focussed attention to pulling hair whilst for others it may be considered more automatic behaviour (without awareness).

Patterns of hair loss are highly variable; areas of completed alopecia, thinned hair density are common.

Hair pulling according to the DSM-5 does not usually occur in the presence of other people other than family members. However, individuals may have urges to pull hair and therefore may find opportunities to do some surreptitiously. Some individuals may also use replacement and may pull hair from other sources; pets, dolls and other fibrous materials.

The majority of people with Trichotillomania may also have one or more other body-focused repetitive behaviours including; skin picking, nail biting and lip chewing.

Prevalence, Development and Course

The condition is found predominantly in females. It usually develops at an early age from adolescence to early twenties and often can stay with the sufferer throughout their life until they get treatment. Trichotillomania may be present in infants, but the peak age of onset is 9 to 13.

The lifetime prevalence of this disorder is 0.6% of the population (in 2009) leading to 370,752 people possibly affected. However, as with many mental health disorder under-reporting is extremely likely to to the negative emotions associated with the condition.

Causes of Trichotillomania

It’s not known what causes Trichotillomania, but there are several theories. The NHS suggests that this condition may be a type of addiction; the more you pull, the more likely you want to continue the behaviour. It may also be a reflection of other mental health problems; anxiety, depression or stress. In some cases its suggested that this condition may also be a form of self-harm where the person deliberately pulls the hair to seek temporary relief from emotional distress.

Evidence also suggests that the condition can have a genetic link as with OCD.

 

Treatment

Treatments advised by OCD-UK and evidence based reports link highly to CBT and medication treatment. However, a technique utilised by many cognitive-behavioural therapists is Habit Reversal Training (HRT). This technique was developed in the 1970’s by psychologists Nathan Azrin and Gregory Nunn for treating nervous habits which are done automatically, such as pulling, tics, stammering and skin-picking.

HRT is based on the principle that hair pulling is a conditioned response to specific situations and events, and that the individual with Trichotillomania is unaware of these triggers. Therapy often focuses initially on developing Habit Awareness through the use of journals; why, when and where they pull. HRT challenges the problems of sufferers as a two-fold. Firstly, the individual with Trichotillomania learns how to become more consciously aware of situations and events that trigger hair-pulling episodes. Secondly, the individual learns to utilise alternative behaviours in response to these situations and events. The therapist will encourage individuals suffering from this condition to develop and awareness of the times of day, emotional states and other factors which have lead to hair pulling.

Exposure Therapy has also been utilised in the treatment of Trichotillomania.

Conclusion

Well that’s my best effort at explaining from the DSM what Trichotillomania is, as I have never suffered from this condition I cannot begin to imagine to explain how it makes an individual feel. However, through research and watching Beckie0 on YouTube I have come to understand the condition and the affect it can have on a person. Treatment is available to evaluate thought patterns, behaviours and the urge to pull. Accepting that you are experiencing this condition and reaching out for help is the first step to a journey of learning and potentially changing behaviours.

Further Information;

NHS; http://www.nhs.uk/conditions/trichotillomania/Pages/introduction.aspx

OCD UK; http://www.ocduk.org/trichotillomania

Hoarding Disorder

This disorder as with many mental health conditions has been within the public eye through the use of television programmes based on Hoarding such as; Obsessive Compulsive Hoarder, The Hoarder Next Door and Britain’s Biggest Hoarders. These are often presented as extreme cases whereby other services have had to become involved to help the person discard personal possessions.

So, what is Hoarding? 

Hoarding disorder is characterised by persistent difficulty discarding or parting with possessions, regardless of their value as a result of a strong perceived need to save the items and the distress associated
with parting from them. This disorder however differs from ‘normal collecting’ as, the symptoms of this disorder result in the accumulation of a large number of possessions that take over, clutter active living areas to the extent that their intended use is substantially compromised. This disorder consists of excessive collecting, buying or stealing items that are not actually recquired for which there is no available space and stored in a chaotic manner.

Diagnostic Criteria

A. Persistent difficulty discarding or parting with possessions, regardless of their actual value.

B. This difficult is due to the perceived need to save the items and to distress associated with discarding them.

C. This difficulty discarding possessions results in the accumulation of possessions that congest and clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of third parties e.g. family members, authorities or cleaners.

D. The hoarding causes clinically significant distress or impairment in social, occupational,or other important areas of functioning (including maintaining a safe environment for self and others).

E. The hoarding is not attributable to another medical condition (e.g., brain injury, cerebrovascular disease, Prader-Willi syndrome).

F. The hoarding is not better explained by the symptoms of another mental disorder (e.g.,obsessions in obsessive-compulsive disorder, decreased energy in major depressive disorder, delusions in schizophrenia or another psychotic disorder, cognitive deficits in
major neurocognitive disorder, restricted interests in autism spectrum disorder).

Specifiers

With excessive acquisition; to put it bluntly this specifier is linked  with the nature of acquisition’…e.g. the extreme severity of the situation- are they buying these possessions? Sought out for free or stolen?

According to the DSM-5, approx.  80-90% of individuals display excessive acquisition. The most frequent form of acquisition is excessive buying, followed by acquisition of free items e.g. leaflets. Stealing is less common. Some people deny excessive acquisition when first assessed, yet it may appear later in their course of treatment. Individuals typically experience distress if they are unable or prevented from acquiring items.

With good or fair insight; the person recognises that their beliefs are problematic.

With poor insight; the person recognises that their beliefs and behaviours are not problematic despite evidence on the contrary.

With absent insight/ delusional beliefs; The person is utterly convinced that their beliefs and behaviours are not problematic despite contrary evidence.

Diagnostic  Criteria

The essential feature of hoarding is the persistent difficulties discarding parting with possessions, regardless of actual value (Criterion A).

The term persistent indicates a long-standing difficulty rather than more transient life circumstances that may lead to excessive clutter e.g. inheriting a property.

The difficulty in discarding possessions refers to any form of discarding e.g. throwing away, selling, giving away or recycling. The main reasons for these issues are due to the perception that the possessions can be utilised, may have aesthetic value or sentimental attachment. Some individuals feel responsible for the fate of their possessions and often go to great lengths to avoid waste. Fear of losing important information is also common. Commonly saved items are; newspapers, magazines, old clothing, bags, books, mail and paperwork but virtually any item can be saved or hoarded. It must also be noted that hoarded items do not have to have little value but can also be more valuable and these items can be seemingly mixed with the clutter and chaotic hoarded possessions.

People with hoarding disorder purposefully save possessions and experience distress when facing the prospect of discarding them (Criterion B). This criteria emphasises that saving these possessions are intentional, which discriminated hoarding disorder from other forms of mental illness that are characterised by the passive accumulation of items or the absence of distress with the items are removed.

Individuals accumulate large numbers of items that fill up and clutter active living areas to the extent that their intended use is no longer possible (Criterion C). For example, the person may not be able to prepare food in their kitchen or are forced to sleep on their sofa. If the space can be used, it is only with great difficulty.

Clutter  is defined as a large group of usually unrelated or marginally related objects piled together in a disorganised fashion in spaces designed for other purposes e.g. tabletops, floors, hallway.

Criterion C emphasises the ‘active living areas’ of the hom
e, rather than more peripheral areas such as; garages, attics or basements, that are usually cluttered in homes where people do not suffer from Hoarding disorder. However, people with hoarding disorder often have possessions that spill beyond the active living areas and occupy and impair the use of living spaces and other spaces such as; vehicles, yards, gardens and storage spaces. In some cases however, living areas may be uncluttered due to the intervention of third parties such as family members this may then force the person to undertake renting storage units or using other spaces to hold their possessions.

Hoarding disorder is distinctively different from normal collecting behaviour as collecting is usually systematic and organised. The actual amount of possessions may be similar however the storage of these possessions is obviously different as normative collecting does not produce the clutter, distress or impairment of typical hoarding disorder.

Criterion D outlines that symptoms must cause clinically significant distress or impairment in normal functioning. In some cases where a person has poor insight the person may not report distress and the impairment may be only apparent to people around them. However, any attempts to discard or clear the possessions by other parties results in high levels of stress.

Prevalence, Development and Course of Hoarding Disorder

Figures from Help for Hoarders UK suggest that approximately 2-5% of the UK population, potentially over 1.2 million people suffer from Hoarding disorder where clinical, psychological help may be required.

According to the DSM-5 Hoarding Disorder affects both males and females however, epidemiological studies suggest that there is a significantly greater prevalence in males compared to clinical samples which predominantly feature females.

Hoarding symptoms appear to begin early in life and spans well into late stages of life. These symptoms are reported to emerge around ages 11-15 years old, they start to interfere with daily functioning in the mid 20’s and cause clinically significant impairment by the mid-30’s. Once symptoms are presented of Hoarding the course of hoarding is often chronic as these symptoms tend to increasingly become more severe throughout their life span.

Risk and Prognostic Factors

Tempremental; Indecisiveness according to the DSM is a prominent featutre of an individual with hoarding. As they are unable to come to a clear decision about whether a possession may be required in the future and therefore keep it to be on the safe side.

Environmental; Individuals with hoarding disorder often retrospectively report stressful and traumatic life events preceding to the onset of the disorder or the traumatic event may exacerbate the development of the disorder.

Genetic and Physiological; Hoarding disorder is believed to be familial with about 50% of people who hoard report having a relative whom also hoards. Twin studies suggest that 50% of variability in hoarding behaviour is due to genetic factors.

Interaction; The DSM states that their is evidence to suggest a genetic link to hoarding disorder. However, this may also be due to the person’s environment; sharing environments with a person who hoards may impart beliefs and understanding within their own children’s mind which may increase the likelihood of them picking up on hoarding behaviours and developing the disorder themselves.

GENETICS + ENVIRONMENT = POTENTIAL DISORDER

Treatment

The NHS website outlines the treatment for individuals suffering from Hoarding Disorder. These treatments include; CBT, SSRI medication treatment. I would also suggest Exposure therapy may also be helpful for the person to gain insight and gradually understand that these possessions do not necessarily need to be kept and understand their own thought patterns behind the behaviour.

Conclusion

Hoarding although chronic in course and can affect a persons life increasingly treatments have been seen to be effective in retraining a persons thought patterns and behaviours to acknowledge that the do not need to keep hold of possessions that are not required. These treatments may help the person to gain insight into their illness and try to understand why they hold beliefs about discarding possessions. Successful support and assistance however is the most important step. Treating someone with CBT away from the hoarding environment may prove to be ineffective, truthfully individuals need to be treated at home where their disorder stems from and disrupts to truly make a difference.

Personally, I am quite a sentimental person so I do have memory boxes on my bookshelf and a jar full of corks from special events which I am going to reuse and make into some art…you may see it eventually. I wouldn’t say I’m a hoarder in the slightest but I do attach sentimental values to items I suppose if I was a good at writing journals or scrapbooks then the memory boxes may be different but lets face it this blog I suppose could be considered hoarding of information and memories lets just remember the look back over 2015 posts. As with any mental condition it comes down to the person’s ability I believe to cope effectively if their disorder is clinically distressing and impedes on their life then clearly some intervention is required but I wouldn’t say that keeping hold of things which are sentimentally significant is a bad thing because well I do it. So please don’t think that I think keeping things that are sentimentally valuable or collecting things that you may feel is valuable or necessary is a bad thing, it is just when these need to keep and not discard anything impinges on your life that these beliefs and behaviours need to be addressed.

Further Information;

NHS;http://www.nhs.uk/conditions/hoarding/Pages/Introduction.aspx 

OCD UK; http://www.ocduk.org/hoarding

Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a preoccupation with one or more ‘perceived defects or flaws’ in a persons’ physical appearance that are usually not obvious or appear slightly to others. It is also characterised by repetitive behaviours such as; mirror checking, excessive grooming, skin picking or seeking reassurance from others or mental acts such as; comparing oneself to others. These preoccupations are not better explained by other concerns; body fat, weight or eating disorder.

It is estimated that up to one in 100 people in the UK may currently have BDD. As with any statistic this may be considered an underestimate due to people concealing their illness. The condition can affect all age groups but onset tends to occur during adolescence or young adulthood; when people are generally most sensitive about their appearance.

Statistics also suggest that is more common for people whom have a history of depression or social phobia. It often occurs alongside OCD, generalised anxiety disorder and eating disorders such as; anorexia or bulimia.

[Information taken from NHS website]

Diagnostic Criteria

The Diagnostic Criteria according to the DSM-5;

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing their appearance with that of others) in response to the appearance concerns.

C. The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

The DSM also specifies if;

• With Muscle Dysmorphia; The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
• Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., ‘I look ugly’ or ‘I look deformed’).
  • With good or fair insight; The individual recognises that the BDD beliefs are definitley or probably not true or that they may or may not be true.
  • With poor insight; The individual thinks that the BDD beliefs are probably true.
  • With absent insight/ delusional beliefs; The individual is completley convinced that the BDD beliefs are true.

Diagnostic Features

A person whom is suffering from BDD are preoccupied with one or more percieved defects or flaws in appearance which they believe they look; ugly, abnormal, unattractive or deformed (Criterion A). The perceived flaws are not observable or may appear slight to other people. Concerns may range from; ‘unattractive’ or ‘not right’ to looking ‘hideous’ or ‘like a monster’. Preoccupations can focus on one or more body areas most commonly the skin (e.g. acne, scars, lines, wrinkles, paleness), hair (e.g. thinning, excessive body or facial hair) or nose (e.g. size or shape). However, any area can be the focus of conern. Some individuals are concerned about perceived symmetry of body areas. These preoccupations are intrusive, unwanted, time-consuming (occuring on average 3-8 hours per day) and usually difficult to resist or control.

Excessive repetitive behaviours or mental acts are performed in response to the preoccupations (Criterion B). The individual may feel driven to perform these behaviours which are not pleasurable and may increase anxiety and dysphoria. They are typically time-consuming and difficult to resist or control. Common behaviours are; comparing ones appearance to that of others, repeatedly checking defects in mirrors or examining them directly, excessively grooming (e.g. combing, styling, shaving, plucking or pulling hair); camouflaging (e.g. applying make up, or covering disliked areas with other objects e.g. hats, clothing); seeking reassurance about how the perceived flaws look, touching disliked areas to check them, excessively exercising or weight lifting and seeking cosmetic procedures.  Some individuals may excessively tan (to darken pale skin or diminish acne), repeatedly change their clothes (camouflage perceived defects) or compulsively shop (for beauty products). Compulsive skin picking intended to improve perceived skin defects is common and can cause skin damage, infections or ruptured skin vessels.

The preoccupation must cause clinically significant distress or cause impairment in social occupational or other important areas of functioning (Criterion C).

Development and Course

According to the DSM the mean age of disorder onset is 16-17 years however, the most common age of onset is 12-13 years. Two thirds of individuals have disorder onset before the age of 18. BDD does occur in the elderly but little is known about the disorder in this age group. Individuals whom develop the disorder before the age of 18 are increasingly likely to attempt suicide.

Causes of BDD

According to Mind UK;

• Abuse or Bullying; if an individual experiences bullying or abuse a person may develop a negative self image which may lead to obsessions about their appearance. This is particularly true if this is endured during adolescence.
• Low self-esteem; if a person has low self-esteem they may become fixated upon aspects of appearance that they wanted to improve. This is more likely if a person attaches a lot of importance upon their appearance…if you think that your appearance is the most valuable thing about you.
• Fear of being alone or isolated; if you worry about fitting in to a group of friends or developing intimate relationships then a person may develop thought patterns that could lead to BDD.
• Perfectionism or Competing with others; if you try to appear physically perfect or regularly compare your appearance to others you may have a greater risk of BDD.
• Genetic; suggested by the NHS many mental disorders have a link to hereditary.
• Chemical Imbalances within the brain; due to successful treatment and alleviation of symptoms with the use of SSRIs; this suggests that a chemical imbalance can be present with people experiencing BDD.

Functional Consequences of BDD

Nearly all individuals with BDD experience impaired psychosocial functioning because of appearance concerns. Impairment can range from moderate (avoidance) to extreme and incapacitating (inability to leave the home). On average psychosocial functioning and quality of life are markedly poor for people with BDD. Most individuals will experience impairment in their job, academic or role functioning (parent) which is often severe (performing poorly, missing school or work or lack of attendance). Impairment in social functioning including avoidance is common.

Treatment

The NICE guidelines for treating BDD recommend;

• CBT
• Medication; usually perscribed are SSRIs to improve serotonin levels within the brain.
• Specialist support

Conclusion

Despite the affect that BDD can have on a person, there are treatment techniques which can help a person understand their dysfunctional thoughts and alleviate repetitive behaviours. Treatments such as; CBT and Medications can help a person understand and potentially reduce their feelings of inadequacy and gain insight into their appearance. BDD I imagine can be extremely frustrating and soul destroying but with the right, effective help treatment can help to reduce symptoms and readjust dysfunctional thought patterns.

Further Information; 

MIND; http://www.mind.org.uk/information-support/types-of-mental-health-problems/body-dysmorphic-disorder-bdd/about-body-dysmorphic-disorder-bdd/#.VpP6zvmLRaQ

NHS; http://www.nhs.uk/conditions/body-dysmorphia/Pages/Introduction.aspx

Body Dysmorphic Foundation; http://bddfoundation.org/ 

Exposure Therapy

Exposure Therapy is a technique used in behavioural therapy to treat anxiety disorders such as Phobias and Post-traumatic stress disorder (PTSD). To put it bluntly it means exposing an individual to an object or scenario; the source of their anxiety or fear. Evidence suggests that is one of the most successful way in treating phobias and alleviating the anxiety and fear caused in PTSD.

This form of therapy or therapeutic technique helps to retrain a persons thought patterns and specifically focuses on the avoidance behaviours that people tend to undertake in reducing the phobic stimulus or triggers of PTSD. It also allows a person to gain a some form of ‘control’ over their fear. In short, Exposure therapy helps to break the pattern of fear and avoidance that commonly exists in people suffering from a phobia or post traumatic stress disorder. In this form of therapy the clinician helps to provide a safe environment to expose the person to the main source of their phobia or  triggering situation and help coach them through exposure.

Purpose 

The fundamental purpose of E.T. is to decrease a person’s anxiety and fearful reactions to certain stimuli, through repeated exposure of anxiety-provoking material. The reduction of anxiety is known as habituation and the elimination of the anxious response is known as extinction.

Description of Exposure Therapy

This therapy begins with making a list or hierarchy of situations which make the person anxious or fearful; if it’s a specific phobia it would be situations related to the specific phobia e.g. looking at pictures of a snake, being in the same room as a snake and holding a snake if they have a specific fear of snakes. These situations are rated on a scale from 0 (least anxious) to 10 (most anxious). The individual are asked to rate their anxiety levels during each scenario from 0-100. This scale is referred to as the subjective units of distress scale.  Patients are asked to rate their level of anxiety using this scale at regular intervals of exposure therapy.

Variations of Exposure Therapy

There are several different variations of ‘exposure therapy’;

In vivo exposure
This form of exposure involves directly facing a feared object or scenario in real life. For example, a person whom has a specific phobia of snakes may be instructed or have a final goal of handling a snake throughout a gradual exposure plan.

Imaginal exposure

This exposure involves the person imaging the feared object or situation. For example, a person experiencing post-traumatic stress disorder may be asked to imagine or recall the traumatic experience in the hope of reducing feelings of fear and alleviate their anxiety.

Virtual Reality exposure 

In some cases virtual reality equipment can be used if vivo exposure is not available. For example, a person who fears flying may be asked to use virtual reality equipment and take a ‘flight’ in their therapists office.

Interoceptive exposure

This involves deliberately bring physical sensations that are harmless which may be feared. For example, someone with panic disorder may be instructed to run to increase their heart rate to retrain their thoughts ensuring that these symptoms are not harmless where they previously may have thought they were.

Methods of delivering exposure treatment

Patient Directed Exposure; This form of exposure requires the individual to work through their hierarchy at their own rate. The patient usually starts at the lowest level of anxiety provoking stimuli and keeps diaries to of their experiences. This form of exposure is usually done on a daily basis until the patients fears and anxiety has decreased. After they are able to perform the task on their hierarchy without feeling anxious or a low level of anxiety they would move on to the next level in the hierarchy. Treatment would proceed until they had achieved all levels on their hierarchy. During therapeutic sessions the clinician would review the individuals diaries, gives the individual positive feedback on the progress they’d made and discuss any obstacles the individual faced during the exposure.

Therapist Assisted Exposure; In this form of therapy the therapist attends the exposure sessions with the client. They provide on the spot coaching to help the individual maintain and manage their anxiety. The therapist may challenge the individual to challenge the maximum anxiety provoking scenario. In prolonged vivo exposure the patient and therapist will stay in the situation aslong as it takes for the anxiety to reduce. The therapist will also explore the client’s thoughts during exposure so any adverse thinking patterns can be challenged and readjusted.

Group Exposure; In group exposure self-exposure and practice are combined with group education and discussion of exposure. These session are normally quite lengthy; long enough for the individual to practice self-exposure and then discuss their feelings in a safe environment. These session may be schedule on a daily basis for 7-14 days.

The pace of therapy and therapy techniques?

Exposure therapy depending upon which type they choose to impose can be paced in a variety of ways; graded exposure, flooding, systematic desensitisation, prolonged exposure and exposure response prevention. In graded exposure therapy the clinician helps the client to construct a fear hierarchy in which feared objects or situations are ranked according to difficulty. They begin with mild to moderate fears to more difficult ones. Flooding uses the hierarchy yet focuses on the most difficult tasks first. Systematic desensitisation is a combination of exposure and relaxation techniques to make them more manageable and helps to associate the feared tasks with relaxation. Prolonged exposure is proven to be effective with trauma-related issues, this technique is similar to flooding but incorporates psychoeducation and cognitive processing. Finally exposure and response prevention is an effective technique in treating a person with OCD. ERP works to weaken the link between obsession and compulsion; the obsession is provoked and then the individual is asked not to engage in behavioural rituals or compulsions.

How can it help?

This form of therapy is thought to help in a number of ways; through habituation– overtime people find that their reactions to the feared object or situation decrease, extinction- the exposure can help weaken previously learned associations between feared objects, situations and “bad” outcomes, self-efficacy- exposure can help the individual is confronting their fears and manage their feelings of anxiety and finally through emotional processing- during exposure the individual can learn to attach new, realistic beliefs about their phobic stimulus and be “ok” and more comfortable with the experience of fear.

The History of Exposure Therapy

Exposure therapy originated from the works of well-known behavioural psychologists termed the ‘behaviourist’ such as; Ivan Pavlov and John Watson in the 1900’s. The principles of exposure therapy trace back to the priniciples set out by Pavlov in his classical conditioning experiment with dogs. In 1924 the behaviourist Mary Cover Jones shifted the field closer to that of exposure therapy. Her studies focused on counter-conditioning; the process of changing unwanted, learned responses to more desirable learned responses. She used comfort food and pleasurable experiences to gradually ‘erase a boy’s fears of rabbits’.

After a period of stagnation the behaviourist Joseph Wolpe developed ‘systematic desensitisation’ (1958) a technique combining relaxation and exposure. Later in the 1970’s Stanley Rachman developed exposure and response prevention whilst working with people experiencing obsessions and compulsions. The history behind the theories of Exposure Therapy are vast and suggestions from most areas suggest that it can be helpful in alleviating fears and anxieties.

Results

Progress of E.T. is usually slow to start with and setbacks are often expected. However, as the patient gains experience with various anxiety-provoking situations and the individuals rate may increase. While flooding can be successful and produce positive results more quickly than graded exposure it is rarely utilised due to the high level of anxiety and discomfort associated with this form of E.T.

A 2012 study published by, Rauch, Eftekhari and Ruzek in the Journal or Rehabilitation Research and Development cited that prolonged exposure therapy is the ‘gold standard treatment for post-traumatic stress’ in combat and military related trauma.

According to the OCD Foundation 2 out of 10 people with OCD issues experience a 60-80% decrease in symptoms when they start to participate in a combination of exposure response prevention and cognitive restructuring.

Finally, according to a 2011 article published in the Psychiatric Times by Kaplan and Tolin a meta analysis study of those whom participated in E.T. reported positive results at post-treatment follow up, approx. 4 years after recieving treatment. 90% of participants reported that their anxiety had reduced and 65% of participants we no longer experiencing their ‘specific phobia’.

Conclusion

Although this form of treatment in retrospect can seem harsh and extremly distressing, the success stories are vast. Many people report reductions in their anxiety/phobic scales. However, with all forms of treatment it is best advised that experienced PTSD, OCD or phobia clinicians would be best served employing exposure therapeutic techniques in safe and proven ways.

Further Information and Resources;

1. Kaplan, J. S., & Tolin, D. F. (2011, September 6). Exposure Therapy for Anxiety Disorders. In Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
2. Cognitive Behavior Therapy. (n.d.). In International OCD Foundation. Retrieved January 19, 2015, from http://iocdf.org/about-ocd/treatment/cbt
3. Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: a gold standard for PTSD treatment [Electronic version]. Journal of Rehabilitation Research and Development, 49(5), 679-688. doi:10.1682/JRRD.2011.08.0152
4. What is exposure therapy? http://psychcentral.com/lib/what-is-exposure-therapy/
5. Video; exposure therapy https://www.youtube.com/watch?v=_fskbOW40Zs
6. What is an exposure hierarchy?

Crying

Crying can be a very cathartic experience for many people it allows people to release pent-up stress and emotion. Its a natural process by which a person inevitably feels better after the release of emotion. Whether it’s happy or sad emotion crying can cover a wide range of emotions. Some people can become teary-eyed over films, advertisings…well done to those advertising psychology experts somewhere. Then there’s others who cry when they are ecstatic, happy and enjoying joyous occasions and events. Finally, there’s the people out there whom are labelled as ‘criers’ the people whom cry at anything and everything, people whom where their heart on their sleeve and are proud to display such signs of emotion.

I sadly am by no means a ‘crier’, if you would have asked me a few years ago I probably would have said that I was, I could cry at anything- films, books, jokes, sadness. There was a period of time whilst at school that I would cry every morning…granted my Mum and Dad were going through a divorce but still I cried. I over the years have faced so much more than my parent’s divorcing yet now I am not a crier. I struggle to cry even when I feel a good cry would make me feel better…I carry on and find the will somehow not to cry. The last time I cried was probably when I was living at university so pre-June time when there hasn’t been the influence of alcohol anyway. Yet last week I found myself feeling so emotional and hett up that I felt as if I walked into work and my sassy Queen was in I probably would have started crying and I knew that I may have felt better for it. Embarrassed at first but better eventually, I just needed to release the stress that had become built up. But, in the end I didn’t cry. I held back my emotions and coped with all the stresses anyway.

If you ask me now am I an emotional person? I would say yes I can be an emotional person; I feel happiness, sadness, joy, empathy, worry but I am not openly emotional anymore. My friend once joked that instead of a heart I had a swinging brick…I have even said this myself. But, this does not mean that I don’t feel the emotions that others would cry at. I feel them, ever perhaps more so than others. When people cry they let the tension, stress, upset go when you don’t have that outlet and don’t have techniques in place you keep that with you, you carry all those feelings around. One of my best friends at university whom I have lived literally next door too for 3 years minus the Christmas and festive breaks I would say has only seen me cry a handful of times, especially where alcohol hasn’t been involved! Does it mean that I am not open with my emotion? No. I just display my emotions differently I have already touched on hiding behind a smile and using humour and that’s just what I do. I can talk about what some would view as traumatic events, stressful situations til the cows come home yet I would not cry I may get a ‘frog in my throat’ and choke up a little but I just don’t cry. Well not infront of ‘large’ audiences anyways!

I sometimes think that I have cried thousands of tears, tears that would last me a lifetime and that’s why I no longer cry. But Annabelle what is the point of this post? Well…I wanted to discuss this because I think people feel all sorts of negative emotions when associated with ‘crying’.

1. Crying is nothing to feel shameful or guilty about…most people cry.
2. It’s a healthy response to releasing emotions…
3. You are by no means ‘weak’ if you cry.

Stigma and prejudice I still think effect the males across the world about crying; like me some will be open to it more than others. Yet, the negative associations with crying is evermore present with the male species. These prejudices may make it difficult for men to experience emotion and healthily deal with those emotions. So men out there, it’s ok to cry!

Finally,  I want to say that if you have ever seen me cry (lucky you, because I am an ugly, crier) I must have felt extremely comfortable with you or really needed to cry. Now, I don’t cry at any trivial matters I can’t even remember the last time I cried at a film and its not that I don’t watch the tear-jerker chick flick types…I didn’t even cry at The Notebook! Basically, I am trying to say it takes a lot for me to cry…A LOT! Whether I think this is a good or bad thing is by the by (mostly don’t think it’s healthy though) I just have become accustomed to showing, alleviating my emotions in other ways and through all my theories and techniques I think I’ve found some that work…like this for instance. I still wear my heart on my sleeve (sadly, still a romantic at heart) yet it takes an awful lot for me to display my emotion in such physical ways, like crying. When I was grieving for my Gran I cried a lot…as would be expected perhaps. Thinking about her sometimes makes me cry but not always ‘sad’ tears but ‘happy’ tears too. So basically, I am not saying that I am a stony-faced all the time; but… I tend to only cry when I overwhelmed with emotion or overcome with joy or laughter…I am a comedienne after all.

Anyways, that’s all the musings for tonight folks. I hope your able to take healthy steps in releasing your emotion and you have found this useful. Remember those who love you for you will support you despite your ability to cry or not and remember crying can sometimes make you feel better in the long-run.

 

Phobias

What is a ‘phobia’?

A phobia is an overwhelming and debilitating fear of an object, place, situation, feeling or animal. Phobias are more pronounced than the usual fear. Phobias develop when a person has an exaggerated or unrealistic sense of danger about a situation or object. Anyone can be fearful of a situation or object for example, I don’t hold a fond affinity to masks and clowns now this is just a general dislike perhaps from all the horror films I have watched. Now if this was a ‘phobia’ I would do everything in my power to avoid masked people or clowns, and my reaction to seeing a person like this would be extremely distressing.

A phobia is considered an anxiety disorder due to the reaction and symptoms that are prevalent. A person may not experience any symptoms until they come into contact with the source of their phobia. However, others may become anxious, distressed and panicky if they think about the source of their phobia this is known as anticipatory anxiety.

Phobias and the DSM;

Now the DSM-5 breaks phobias down into three individual disorders;

1. A ‘specific’ phobia; pretty self-explanatory but a specific phobia are phobias about a specific object, scenario etc. Phobic stimulus’ are categorised by;
   • Animal– spiders, insects, dogs…
   • Natural Environment– heights, storms, water…
   • Blood-injection-inquiry– needles, invasive medical procedures
     • Fear of blood
     • Fear of injections and transfusions
     • Fear of medical care
     • Fear of injury
   • Situational– aeroplanes, elevators, enclosed spaces
   • Other– situations that may lead to choking or vomiting: in children, loud sounds, costumed characters.
2. Social Anxiety Disorder (Social Phobia); a phobia where the person has marked anxiety or fear of one or more social situations e.g. social interactions; having a conversation, meeting new people, being observed; eating or drinking, performing in front of others; giving a speech or performance.
3. Agoraphobia; phobic stimulus where the person perceives the environment to be dangerous or unsafe.
   • Using public transport– cars, buses, trains…
   • Being in open places– car parks, markets, bridges…
   • Being in enclosed spaces– shops, theatres, cinemas…
   • Standing in line or being in a crowd…
   • Being outside of their home alone…

Symptoms

Symptoms may include;

• Unsteadiness, dizziness, lightheadedness
• Nausea
• Sweating
• Increased heart rate or palpitations
• Shortness of breath
• Trembling or Shaking
• An upset stomach

These are a very basic outlines that are common in all three disorders above. Diagnostic criteria is the changeable factors relating to phobias; I am going to post about them individually.

What causes phobias?

Phobias as with any mental illness that I have ever come across of heard of does not have one single cause but there are a number of associated factors that can be instrumental in developing a phobia.

A phobia may be associated with a articular incident or trauma.  Particularly in childhood, if for example a child is bitten by a dog then they may develop a specific phobia of dogs. If a person is suffering from ‘agoraphobia’ it may be related to a specific trauma such as; a car accident, or sexual attack these may cause a person to feel unsafe in open situations or when they aren’t at home.

Watson and Rayner (1920) Little Albert- Conditioned phobias within a infant*.

A phobia may be a learned response that a person develops early in life from a parent or sibling. Thanks to the behaviourists and there research a phobia can result

from learned responses in childhood, which continues into adulthood. An example of this may be a specific phobia of spiders a parent may be physically frightened of spiders and the child may learn that spiders are dangerous and something to be fearful of.

Genetics may also play a role in the development of a phobia; there is evidence to suggest that some people are born with vulnerabilities to have a tendency to be more anxious than others. This vulnerability may make it easier for phobias to develop.

Prevalence 

Phobias are the most common type of anxiety disorder, around 1.9% of British adults experience a phobia of some description and according to the data women are twice as likely to be affected by this disorder than men (Mental Health Foundation, Online). Agoraphobia affects between 1.5% and 3.5% of the general population; in less severe forms it 1 in eight people may experience this form of phobic disorder.

Phobias can affect anyone regardless of age, sex and social background. Some of the most common phobias however, are;

• Arachnophobia- the fear of spiders
• Claustrophobia- the fear of confined spaces
• Agoraphobia
• Social phobia.

Conclusion

There is literally a phobia for anything nowadays being fearful of certain situations or objects is very different than having a full-blown phobia. Treatments such as exposure therapy and talking therapy help a person understand their phobia and take steps to alleviate some of the symptoms and reduce the fear associated with the situation or object…look out for a more in-depth post about treatment in the future. But for now, this is the introduction into phobias.

Further Information;

NHS; http://www.nhs.uk/Conditions/Phobias/Pages/Introduction.aspx

Mental Health Foundation; http://www.mentalhealth.org.uk/help-information/mental-health-statistics/anxiety-statistics/

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:Author.

Watson and Rayner Explanation Video

Watson, J. B., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3(1), pp. 1–14.

 

 

Images; the presentation of Mental Health

Sadly, another ‘quick’ post tonight…I literally can’t wait to jump into bed. However, I am off work for a few days this week so look forward to a more in-depth post. But for tonight….

Anxiety

1. The irrational, constant, sometimes overwhelming worrying that can happen when a person is suffering from Anxiety…
2. The many guises and symptoms of anxiety…
3. Reliving events, almost always the negative of an event or scenario…
4. The representation of many an anxious person’s mind…
5. Not necessarily a quote about ‘anxiety’ yet when I was anxious I was always reliving things or worrying about things to come I forgot to live in the present…

 

Just a few images that I felt portrayed ‘anxiety’ in a particular way. If your struggling with anxiety or panic attacks have a look at my other blog posts on this topic, you might find them helpful.

Further Information;

Images;
1. http://www.buzzfeed.com/erinchack/comics-that-capture-the-frustration-of-anxiety-disorders?sub=2650461_1754234#.wyrJVz32j
2. http://www.buzzfeed.com/annaborges/you-are-not-your-anxiety?utm_term=.toqp7aqWx#.vvn3PNK1G
3. http://www.healthyplace.com/anxiety-panic/
4. http://www.buzzfeed.com/annaborges/20-feelings-that-sum-up-having-both-depression-and-anxiety?crlt.pid=camp.rQ37I0z7gEVS#.hke7MmxqG
5. http://www.bt-images.net/top-20-inspiration-motivational-quotes/

Blog Posts;
Anxiety and Me
Generalised Anxiety Disorder 
How to help someone having a panic attack?
Grounding Techniques

Alternative Therapeutic Techniques

My personal response and treatment of Depression and Anxiety follows a very medical form of treatment; taking medication and cognitive-behavioural therapy. However, some people prefer to look at more natural, holistic forms of therapy to treat anxiety and depressive episodes. Yet, the efficacy of these therapies is still very new and some do not have any post-treatment success rate studies. Some people may see these forms of therapy as feeble and unsubstantiated which is some cases they may be. However, other people may find significant success and may prefer a natural way of treating a ‘natural’ illness. It is wholly dependent upon the patient, and the evidence displayed from the various therapies.

Relaxation

Plain and simple relaxation techniques can relieve feelings of anxiety and can ease overwhelming thoughts within people whom have low mood and negative thinking patterns. A study which compared the successes of alleviating symptoms of anxiety for people whom suffered and was diagnosed with GAD (general anxiety disorders) in 3 conditions; therapeutic massage, relaxation room and thermotherapy (heat based treatment). Found that across all 3 conditions symptoms improved and these improvements were maintained at 6 weeks post-treatment (Sherman, Lundman, Cook et al. 2010). Despite these significant findings the participant groups were fairly small and therefore could not be generalised to the rest of the population.

Relaxation techniques that can be utilised in depressive/low mood and anxiety are;
relaxed breathing (deep breathing for a period of time depending upon severity), deep muscle relaxation (this technique attempts to stretches different muscles and in turn relaxes them in the aim of relaxing tension from the body and relax your mind), meditation (concentrating on your breathing and clearing your mind of thoughts and worries; focussing on a mantra may make this focus easier to achieve) and listening to music. 

The benefits of using relaxation techniques may allow a person to experience a ‘break’ from their overwhelming thoughts, worries and symptoms. They can be used to calm a person before entering known stressful events and situations which may potentially trigger unpleasant thoughts.  Relaxation techniques are fairly simple tools which can be employed in any situation, at any time and therefore are accessible 24/7.

Exercise

When I was suffering from extremely high levels of stress and anxiety someone with
vast experience in this area advised me to try exercise. Nothing too strenuous, a walk for 20 minutes is likely to reduce anxiety to a great deal. I listened and quite quickly it did reduce my overwhelming thoughts and feelings. However, this result may be due to multiple factors exercise allowed me to get of my environment and in a sense a source of stress, I found walking to be extremely relaxing and I also managed to clear my head of some thoughts I was experiencing. So personally finding the true reason to my thoughts subsiding would be much more difficult.

However, evidence pertains that exercise can be beneficial for people experiencing high levels of stress, anxiety and low mood in reducing symptoms (Carek, Laibstain and Carek, 2011). Exercise reduces the stress hormones of adrenaline and cortisol and stimulates the production of ‘feel good’ endorphins. It also uses deep muscle relaxation outlined previously through certain exercise.

Acupuncture

Acupuncture is believed to stimulate the nervous system and cause the release of neuro-chemicals. Resulting in bio-medical changes within the body and in some cases improving physical and emotional well being. Evidence for acupuncture in the treatment of Depression and Anxiety is relatively varied; Lee (2009) found that is helped to regulate certain neurotransmitters such as serotonin. Courbasson (2007) advises that acupuncture should not be used solely in the treatment of these conditions but in combination with other forms of therapy.

Art Therapy

Throughout, my down times I found solace in drawing. I found that it focused my mind on the thing that was right in front of me- what I was drawing not worrying about the past or future. I was very much in the present. Not only did it clear my head of thoughts I also found it relaxing; perhaps this should be a relaxation technique rather than yet, I am not the only person to find some solace in the arts when experiencing
low mood.

Despite my personal use of the arts in relaxation
group art therapy exists and is recommended my NICE in treating some mental health issues. Group art therapy allows expression and communication through any form of art; it allows the person to explore what they are creating and discuss in a safe environment these creations; it facilitates self-expression. Art therapy allows the person to talk about themselves through the medium of art. The art helps to open communication channels and self-awareness. Expression of emotions can also offer direct relief from feelings that otherwise could be overwhelming if left unexpressed. These images can be abstract and messy, like people whom are experiencing overwhelming emotions. There is no definitive or correct way for a person to express themselves which also may make it easier to process some emotions and thoughts.  *Drawings are my own from the period when I was ‘clinically depressed’ clearly they represented the lack of colour in my world.

Conclusion

Personally I believe in the power of multi-faceted forms of therapy in the treatment in challenging illnesses such as; Depression and Anxiety. Using only one form of therapy may be affect the success of potential treatment for the individual, it’s similar to the age old saying of ‘putting all your eggs in one basket’ so to speak. Patient beliefs however must be taken into account when creating a treatment plan giving medication to a person whom opposes medical intervention would be ridiculous as they would most likely not even pick up the prescription for the medication. The severity of their condition must also be taken into consideration as medical intervention is often the quickest way of implementing treatment and quite quickly gives medical professionals the ability for further therapy due the easing of certain symptoms. However, using these techniques outlined above alongside other therapies may be beneficial to the individual greatly. It just depends upon the person. Some people may prefer to express themselves through drawing? Some people may fear needles which would cause friction if acupuncture was advised as the only form of therapy…It quite possibly is one of the hardest balancing acts; meeting the needs of the patient, ensuring that safety is paramount, improving symptoms all within a fairly short space of time.

Further Information; 
Relaxation;
http://www.nhs.uk/news/2010/03March/Pages/Relaxation-therapy-for-anxiety.aspx
Sherman KJ, Ludman EJ, Cook AJ, et al. Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depression and anxiety 2010
http://www.nhs.uk/conditions/stress-anxiety-depression/pages/ways-relieve-stress.aspx
http://www.webmd.boots.com/stress-management/10-relaxation-techniques-reduce-stress?page=2

Exercise;
Carek, PJ., Leibstain, SE. & Carek, SM. (2011) Excercise for the treatment of depression and anxiety. International Journal of Psychiatry Medicine. 41 (1) pp15-28
http://psychcentral.com/blog/archives/2013/07/17/3-tips-for-using-exercise-to-shrink-anxiety/
http://psychcentral.com/blog/archives/2014/01/15/3-ways-to-beat-depression-through-exercise/

Acupuncture;
Lee B et al. (2009) Effects of acupuncture on chronic corticosterone-induced depression-like behavior and expression of neuropeptide Y in the rats. Neuroscience Letters. 453 pp.151-6.
Courbasson CM. et al . (2007) Acupuncture treatment for women with concurrent substance use and anxiety/depression: an effective alternative therapy? Family & Community Health. 30(2) pp.112-2

How to challenge your thoughts?

Challenging your thoughts can be extremely hard especially when what you think permeates your life. A persons thoughts can not only be insightful but destructive to their sense of self and self-esteem. Negative thinking can immediately impact a person’s life, a negative thought can; hinder achievement, make the person feel worse and adds negative value to a persons’ life. To put as basic as possible; negative thinking also prevents the person from enjoying any benefits that positive thinking has to offer.

Where do negative thought patterns come from?

Negative thoughts are caused by ingrained patterns related to our own beliefs: about self-esteem, security, money, people, life, and everything else. Often these beliefs are formed throughout our interactions with our environment and others over our lifetime.

What is the effect of negative thinking on a person?

The most common affects of negative thinking is;

Feeling down; the extent of negative thinking can vary greatly in individuals. Some may experience unpleasant feelings such as; anger, irritability, anxiety and depression.

Physical effects; a person’s negative emotional state can substantially impact on a person’s physical needs. The individual may find it hard to look after their personal hygiene and meeting other physical needs such as hunger.

Closing ourselves down; when we are in a negative emotional state we close ourselves down to the people and situations around us. We no longer engage with our environment and instead of seeking opportunities we close ourselves down and avoid opportunities due to fears and the negative thoughts we have.

Thought Diaries

Throughout my time in cognitive-behavioural therapy I was taught various different activities that help in challenging your thoughts. The most effective technique for me was the ‘thought diaries’. These particular diaries take into account the use of FACT vs OPINION. It specifically asks you to provide evidence for and against the unhelpful thought.

When recording your thoughts you have to describe different events within a given situation such as; feelings rated from 0-100 on bodily sensations, unhelpful thoughts and images and evidence to support or against the unhelpful thought. It then asks the person to stop, take a breath and draw a more balanced view, conclusion or perspective. The individual is then asked to re-rate their emotion. This strategy helps the person get into a habit of paying attention to your thoughts and potentially challenging them. Although these thought diaries look like a lot of work after a few times this process becomes learned and then challenging thoughts becomes like an automatic process. This strategy is advised to be used after anxiety/depressive invoking situation.

Theoretical Background to Thought Diaries 

Albert Ellis was the first psychologist who proposed the ‘ABC’ model of behaviour. Which is utilised within the thought diary strategy. The ABC model outlines that an activating event (A) triggers beliefs and thoughts (B) which results in consequences (C). Thought diaries allow the individual to take an active presence in processing their thoughts and the behaviour which results from this perception of a given event.

Do they work? 

Like I’ve stated in previous posts CBT is hard-work, you can’t expect to get better from doing nothing. You actively have to take part in activities that have been provided by therapists.  I found that thought diaries seemed to be a pretty easy and understandable way to challenge your thoughts. This technique does quite quickly become an almost automatic thought pattern which can dispute your thoughts.

Actively trying to challenge your thoughts, is an attempt and positivity and the strive to get ‘better’. A word of advice, try not to take your thoughts as fact our minds are very powerful tools and can make us believe in almost anything. Just be aware and make sure you are looking at evidence rather than opinion.

Further Information;

http://www.moodjuice.scot.nhs.uk/challengingthoughts.asp

Cognitive Thinking Errors

On my previous post I discussed the power of maladaptive thinking errors. Now, you don’t have to suffer from any form of mental illness to experience thinking errors and many of them that I will discuss may make a lot of sense to you. These thinking errors have been developed by varying cognitive psychologists since the 1950’s. Aaron Beck first proposed these notions and they were later popularised by David Burns.

Cognitive distortions/ maladaptive thinking errors quite simply are ways in which our minds convince us of things that aren’t necessarily true or accurate. These inaccurate thoughts often reinforce our negative thinking and emotions. Cognitive distortions are at the core of CBT as many activities attempt to restructure the cognitions of a person. By accurately identifying false thinking patterns and cognitive distortions a person can challenge these thoughts and refute them. By challenging common negative thinking will slowly diminish it’s impact and therefore existence.

Filtering

This form of cognitive thinking error quite literally means the person filters out all the positive thinking and magnifies negative details of the particular situation. For example, a person may obsess over a negative detail of a situation and dwelling on this for a significant period of time may become their version of distorted reality.

Polarized Thinking or ‘Black and White’ Thinking

In this form of thinking things are either black or white, there is no middle ground. We have to be perfect or we are a failure. The person places others and situations in categories of ‘either’/’or’. For example, if a person doesn’t achieve the best grade possible an A but receives an B they are a failure despite recieving a very good grade. Personally, I am a perfectionist and I am well aware of this. I commonly used to utilse this thinking error especially when discussing academic or voluntary work. If some things worked out yet if one particular area the thing that worked well wouldn’t matter.

Overgeneralisation

In this error a person draws a general conclusion based on a single event or single piece of evidence. If something bad only happens once, the person may expect it to happen again. A person may see this form of thinking as a never-ending defeat in their eyes.

Jumping to Conclusions or Mind Reading

Without others saying so, we know what we they are feeling and why they act in particular ways. In particular we are able to know how a person thinks or feels
towards us. We jump to conclusion about how others view us and often this assumption is wrong. A person may convince themselves on how a situation will turn out, often negatively and this is taken as fact.

Catastrophizing or Magnifying and Minimising

This thinking pattern convinces the person that disaster will strike in any particular situation. We hear about a situation and we use ‘what if’ statements always focusing on the negative in the situation. For example, a person might exaggerate the importance of insignificant events (such as their mistake) and minimise the magnitude of significant events (what the person is good at).

Personalisation

This form of thinking error causes a person to believe that what others do or say is a direct reaction to the person. For example, people laughing at the back of the bus
the person would assume that they are laughing at them. When in reality, it has nothing to do with you and they probably haven’t even noticed you. You may also blame yourself for everything and anything that goes wrong, even when it’s not your fault or responsibility.

Unreal Ideal 

Another common thinking error is making unfair comparisons to others. When you do this you compare yourself to others who you feel have an advantage to you or are better at something than you. These unfair comparisons leaves the person feeling inadequate and can reinforce negative thinking about themselves and may strengthen self-hatred.

Fact vs. Reality

Sometimes we confuse our thoughts with reality. We may assume that our perceptions are correct and seek evidence to reinforce these perceptions rather than challenge what we believe to be accurate.

All these cognitive distortions can affect how we view ourselves and the world around us. Negative thinking can impact greatly on a person with low mood, often you are unable to see the lightness through the darkness. It’s hard to imagine that what your thinking isn’t the truth you constantly put yourself down, make you feel guilty and obsess over what someone said and what they meant and were you to blame? It’s awful when it’s you telling yourself that you’re worthless, people are better than you and you will never get out of this cycle of negative thinking. But, putting it bluntly there is light at the end of the tunnel challenging your thoughts asking what is fact or opinion is the greatest gift. Once you challenge you’re thoughts you are most definitely on the way to improving your thinking patterns and increasing your self-esteem and self-worth.