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CBT Explained

July 28th, 2016

Cognitive Behavioural Therapy is a therapy that works on three levels:

  • Thoughts,
  • Feelings and,
  • Actions.

It’s a practical therapy that takes a problem in the present and helps people break the problems down into manageable chunks with specific exercises to try and change it.

As the name implies, CBT has two main therapy components, Cognitive and Behavioural therapy. Behavioural therapy is a form of action learning. Behaviourists pay virtually no attention to what someone is thinking or what their childhood was like and instead focus on what someone is doing. A behaviourist would say that you can think and try and understand how to ride a bike for as long as you like but you probably won’t make a fraction of the progress of someone who is given stabilisers and encourage to start practicing the *behaviour* of riding a bike. Some years ago I was lucky enough to hear one of the co-founders of CBT, Albert Ellis, tell a story of his shyness as a young man in New York and how the only way he could overcome this was to make himself gradually talk to more and more strangers in the park until he overcame this shyness. As someone who had previously trained as a classical analytical psychotherapist (therapists who focus on trying to understand the ‘why’ of personality and behaviour from childhood), Ellis really made quite a reversal in his thinking at this time. He realised it didn’t really matter *why* he had been shy. What mattered to him was that when he took the ‘action’ of talking to strangers his shyness lessened.

Thus CBT is fundamentally a practical therapy with action or ‘Behaviour’ at it’s core.

Cognitions are what CBT therapists call thoughts and Cognitive therapy focused on recognising how to recognise certain types of automatic thought and change them before they go on to escalate into damaging feelings and actions. It is the repetition of these damaging thoughts feelings and actions which form damaging ‘core beliefs’. Albert Ellis formulated extensive ideas about how beliefs and personal philosophy contributed to emotional pain. In CBT this came to be thought of as ‘core beliefs’ He believed that our personal philosophy such as thinking that ‘life should be fair’, for example, could cause us pain. As a therapist, he would directly confront people about their beliefs and philosophy, saying, for example, ‘who says life should be fair?’ He is amusing to watch because his forthright style (he is every bit a New Yorker!) can seem a great odds with our traditional impression of what one might expect a therapist to look and sound like but behind this apparently brash front (and great sense of humour), Ellis would get people to challenge beliefs that would otherwise have kept them stuck in pain and thereby offered them another way of looking at life as it is, and not necessarily how they expected it should be.

The other cofounder of CBT was another disaffected ‘analytic’ psychotherapist, Aaron T Beck. He integrated his observations that many automatic thoughts were not unconscious (as analytic therapists like Freud had taught) but were in fact accessible so people could practically work on them and change them. Ellis’s Rational Emotive therapy combined with Aaron Beck’s Cognitive Therapy that combined to form the ‘Cognitive’ component of CBT.

CBT holds that all of a person’s core beliefs can be categorised into three components:

  • self,
  • other and,
  • future.

You can see right away that, unlike most therapies, there is no reference made to the past.


Cognitive distortions


CBT helps us recognise unhelpful patterns of thinking. As we become depressed our thinking style can become altered so that new unhelpful patterns of thinking become prevalent which drive us further into the depression. By recognising when we are falling into such a patterns of thinking we can use CBT tools to change them so they don’t damage us further. Indeed, we can even replace some of these negative patterns with positive ones. Even just recognising that a painful thought has come from a distortion can give us some relief. The process of changing a distortion into the positive is called Cognitive Restructuring.


Some examples of unhelpful distortions are:


This isn’t a definitive list by any means and I’m sure you can find your own personal distortions. There are many different types of distortion and it really helps to bring these into our awareness and then practice turning them around (Cognitive Restructuring).

A good way to recognise these patterns is to keep a diary of behaviour thought and feelings. These can then be analysed to discover possible distortions and create restructuring cognitions.


Modern developments


CBT was an evolution of the ideas of Behavioural therapists and the development hasn’t stopped there. In the 80s and 90s a ‘third wave’ of behavioural therapies have appeared such as DBT (Dialectical Behavioural Therapy) and ACT (Acceptance and Commitment Therapy). CBT has rightly gained a lot of popularity but it is interesting to see how these other therapies have evolved some of these principles further and so they shall be the focus of our next article.

Transactional Analysis – Understanding Ego States for Better Communication

May 25th, 2016

Have you ever noticed how it feels that some conversations seem to be following some sort of automatic script? How sometimes the way that you are being spoken to seems to evoke an automatic response that you might regret?


This could be explained by a relationship theory known as Transactional Analysis.

Most of psychology and therapy revolves around us as individuals but TA focuses on the relationships between people.

One of the interesting theories of TA is that we each of us have three possible ‘ego states’ from which we communicate with others. These are the Parent, Adult and Child ego states. In a Parent ego state our communication might be rather authoritarian, as if being a parent talking down to a child. In the adult ego state we will address people in a reasoned and logical way. In the child ego state we might be defiant or jokey.

We move through these different ego states depending on who we are talking with and can even switch states within the same conversation. If you think about a recent conversation you have had with someone you might be able to break it down into the parts that were spoken to and from these different states.

It seems that if we adopt a particular state, the person we are talking to will be drawn to talk back to us in the same way, so if we address someone from a parent ego state, they will tend to respond back to us in the same way. I’m sure you can imagine these situations. Someone orders you to do something (Parent ego state), you may well order them back (also Parent ego state). If someone is having a laugh and a joke with you, you may find yourself inclined to have a laugh and a joke back (you are both in child ego state). There is an interesting exception to this which is that with either the child or the parent ego state, it can either elicit the same ego state in the other, or it can force the opposite. So a child ego state can either elicit a child ego state response or a parental one and visa versa. So someone might give you an order (parent ego) and you might respond telling them where to stick their order ( child ego state – rebellion) or make fun of them (child ego state – humour). So the rule of thumb is that being in an ego state is likely to evoke the same or opposite ego state in the other.


This knowledge can be useful for is in communicating with others. If we want to get a message across to someone, it can be preferable to stay in an adult ego state while communicating.

If we are having a difficult discussion with someone, it is possible the the person we are talking with might want to sabotage our conversation by ordering us from a parent ego state or making fun of us in a child ego state. Our instinctive response may well be to either talk back in the same state or in the opposite state but if we can resist this pull, and keep our communication in an adult state, we stand our best chance of bringing that person back to our preferred ego state, adult, in which to get our message across.

Robin Lefever

Follow up of Channel 5 show ‘I’m An Alcoholic: My Name Is…’

January 15th, 2016

channel5-alcoholic-documentaryEarlier this week we wrote about an upcoming TV documentary on Channel 5 called “I’m An Alcoholic: My Name Is…”, which has since aired. Straight off I have to say I found this to be an excellent programme for so many reasons.

First of all It’s great that the show gets away from the stereotypes of either celebrities or down and outs that we used to be regaled with years ago. Don’t get me wrong, it has been massively helpful that celebrities came out and supported the destigmatisation of our problem and very generous and brave of them to do so. Equally it was also helpful that the media covered alcoholism at all, even if it was with extreme down and outs if not celebs, but it did run the risk that people would look at the coverage and either say, I’m not a down and out or that excess is all part of celebrity culture or the creative process. What was great about this show is it had a pretty reasonable cross section of ordinary people, including a couple of professionals, but still ordinary people that the general public can relate to.
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Alcoholism in the Media

January 13th, 2016

At the end of this morning’s BBC Radio 4 flagship Today programme you may have heard there was a segment discussing recovery with former Sun Editor David Yelland and journalist and author AA Gill. Both have contributed to a TV programme being aired tonight at 10pm on Channel 5 called “Hello, my name is…”.  You can view the radio interview on the Radio 4 website and you can also see a preview of tonight’s TV show here:

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Helping Patients Suffering from Trauma using Eye Movement Desensitization and Reprocessing

March 9th, 2015

Introduction to EMDR

The precise neural mechanism for how eye movements affect emotional status is unclear, but the fact is they do. It is almost as though a broad view of the horizon from left to right, and right to left also helps the mind to place events within the broader context, or for both hemispheres of the brain to work together.

Iemdr-eye-movementn some respects this is nothing new. We have all experienced the calming effects on a stressful day of going for a stroll in the countryside, enjoying the view from a hill-top or from looking out over the sea. However, in some instances such as child abuse, sexual assault, physical assault or other severe traumatic events the experience can become mentally ‘blocked’, and unless worked through – or ‘processed’ can become utterly debilitating.

EMDR now has an excellent evidence-base for demonstrating its effectiveness, in the right safe, therapeutic environment for treating patients who have suffered from these forms of trauma. Some senior psychologists have explained the therapeutic effect of eye movement in technical terms such as, “tasks, such as eye movements, that tax working memory during recollection of stressful memories attenuate their vividness and emotionality during subsequent recollection”. In plain English this means that EMDR therapists can help their patients to re-visit the situation without causing undue stress.

Is EMDR really different from CBT?

The World Health Organization (WHO) describes the difference between Cognitive Behavioural Therapy (CBT) and EMDR. As EMDR is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories, treatment involves focusing simultaneously on the following:

  • Spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and,
  • Bilateral eye stimulation.

In this way EMDR reduces distress whilst also strengthening positive attributes that are related to the traumatic event. However, unlike CBT, EMDR does not involve detailed descriptions of the event, direct challenging of beliefs or extended exposure, or even the need for homework. Read the rest of this entry »

Gifting Connectedness

December 2nd, 2014

First prize: Help those less fortunate


season-to-giveAn extraordinary Catholic priest in Australia, Father Bob Maguire, is running a competition with a top prize that ‘guarantees happiness.’ 


He is is offering a third-placed prize of five nights in a chain of high-end hotels, with the second-placed prize being five flat-screen TVs. However, it’s the top prize that we applaud, and which resonates so strongly at this time of year:

The chance to work in one of the soup kitchens run via the Father Bob Foundation, which aims to feed and provide educational support to the homeless and disadvantaged.


Genius! Although the initiative is meant to draw attention to the serious homelessness problems in wealthy nations like Australia, there is also, within it, a timely acknowledgement of the value of getting out there and helping someone.

This is something we weave into the very essence and grammar of our work with our patients at PROMIS: meaningful, rewarding connection with others as the sunlight ready to break through the clouds of isolation and a sense of worthlessness.


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Movember shines a light to another worthy but unspoken cause

November 3rd, 2014

We are delighted to hear that the organiser’s behind the Movember movement are turning their focus this year to men’s Mental Health. See

It is our considerable experience that physical and mental health are not separate matters but two aspects of well-being and resilience that overlap and have a clear cause and effect relationship; they affect and contribute to each other.

In building resilience to mental health, and in treatment for Mental Disorders, we need to accept that both areas of our lives need focus and attention. Poor physical health increases the risk of people developing mental health problems, while poor mental health is associated with an increased risk of diseases such as cardiovascular disease, cancer and diabetes.

Hence our enthusiastic support of Movember’s excellent decision to include men’s mental health within the focus of a charity dedicated to men’s health. Read the rest of this entry »

“Nothing About Us Without Us!” – Moving Away From Criminalisation Of Addiction

October 30th, 2014

Addiction in the NewsIt has been impossible, today, to ignore the important findings of a recent Home Office report, which compared the UK’s approach to drug misuse with that of 13 other countries and concluded that there is no evidence that the criminalisation of drug use leads to a reduction in the problem. See, for example,

In simple terms, there is no evidence that punishing people for having a drug problem will actually stop them using. Those of us who work in this field have a responsibility to those who suffer from addiction, and their loved ones and our communities, to focus the debate on what does work.

Awareness, understanding, tackling the grass roots of addiction in our homes, schools and towns must not be derailed, and works, but, as we all know, so does treatment.


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Looking In From the Outside

January 19th, 2014

An experienced Recovery Coach from the States paid our Hay Farm clinic a visit and gave us an account of his observations that we are happy to share with you. We thank Dr. Ronald W. Hill for his kind and insightful thoughts.

ReHayFarmcently I had the privilege and pleasure of visiting the PROMIS residential treatment facility in rural Kent. As a counselor from New York City, I was curious about how drug and alcohol treatment was approached and carried out in the UK, as compared to treatment in the United States. I was delighted at what I witnessed at PROMIS for several reasons. However, before I go into the details of my experience at PROMIS, permit me to digress a little to give some idea of my background, working in treatment.


During my 20 year career I worked in a variety of treatment centers, with diverse patient populations. Those treatment centers included Hazelden and Cornerstone Medical Arts in Manhattan. Before moving to New York I worked in Portland, Oregon on the west coast at Lakeside-Milam, The Springbrook Institute and the DePaul Center. I also spent 3 years as a counselor at a treatment center located inside a prison, and 3 years as an Assessment Specialist for NADAP, also in Manhattan. I mention these treatment centers to indicate that I have had quite a variety of experiences working in treatment.


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Horticultural Therapy

March 26th, 2013

Orange tulipsSpring is hopefully just around the corner and so is a great prompt to introduce Horticultural Therapy to Hay Farm. We have such a beautiful setting here, with 12 acres of farm land, so it is perfect for those who feel that this therapy might help them.

Horticultural Therapy is an active process which engages individuals to connect with nature as a way of healing themselves. It is the use of gardening as a client-centred therapeutic tool to promote physical, cognitive, emotional and spiritual well-being.

Throughout time, gardens have always been revered as a place of tranquility and peace and also considered as aesthetic expressions of beauty through art and nature. Just as we feel refreshed when walking through a forest or a field of flowers and experience a sense of joy when spring blooms, it is not hard to imagine how helping things grow and transforming an empty pot, field or land to a place of beauty can be very rewarding.

Among the many listed benefits of Horticultural Therapy such as enhancing positive mental attitude, reducing stress, alleviating depression, enhancing self-confidence, promoting gratification, developing cognitive skills and improving decision making, you are sure to discover your own unique benefits. Read the rest of this entry »

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