How Fragile is Worry?

How Fragile is Worry?

Copyright © Donald Robertson, 2012.  All rights reserved.

Perhaps your worry is more fragile, or easier to “break” than you’ve previously assumed…  Here are some experiments to carry out. 

Rating Beliefs

Start by rating how strongly you currently hold the following beliefs about worry (0-100%):

  1. My worrying is uncontrollable and I can’t stop it
  2. My worrying is dangerous or scary (my worry itself is worrying!)
  3. Worrying about my main concerns is necessary or helpful in some way

Some Worry Experiments

Worry-DollsPick several of the worry experiments below to try and them for a few minutes each, then quickly re-rate the beliefs about worry above after each:

    1. Plan coping with worst, best and most-likely scenarios.  Pick the main problem that you worry about.  Briefly write down a description of the worst that could realistically happen and the best you could do to cope even if that did happen, rate how much actual harm would be done in the long-term (0-100%).  Then write down a description of the best that you could realistically hope might happen, how you could best cope, and rate how much actual harm would result in the long-run (0-100%).  Finally, do the same for the most likely (probable and realistic) scenario, and focus your attention on how you could best cope with this, and how much actual harm would be done in the grand scheme of things (0-100%).

    2. Try to imagine all three alternatives simultaneously: worst, best, and most-likely.  Perhaps list them one after another on a sheet of paper and picture this in your mind for a minute, focusing on entertaining multiple perspectives on the same situation, to create a sense of mental flexibility.

    3. Imagine that you have a dial, marked 0-10, that controls how absorbed you are in your worries and how seriously you take them.  Imagine that to begin with it’s set in the middle, at five.  Turn the dial slowly up to ten, one number at a time, and notice what happens as you become more and more absorbed in your worry, and how you do that.  Then do the opposite, and slowly turn the dial all the way down to zero, as you become more and more detached from your worrying, and notice what happens as you do so, and how you become more detached.

    4. Worry mindfully and slowly, viewing thoughts as merely thoughts.  Allow yourself to worry but slow down a little, introduce some pauses, and observe yourself as you worry, noticing that your thoughts are just words passing through your mind.  Try to maintain a sense of mindfulness and self-awareness while worrying.

    5. Worry with relaxed face and jaw.  Tense your forehead muscles for about thirty seconds and then relax them completely and utterly, for a minute.  Do this twice.  Then do the same thing with your jaw muscles.  As you keep relaxing your forehead, jaw, and facial muscles more deeply with each exhalation of breath, try to worry with these muscles remaining completely relaxed.

    6. Worry with general relaxation.  Count from ten down to zero, and allow your whole body to relax more deeply, with each number.  Then keep relaxing your whole body more deeply with each exhalation of breath, as you try to worry while remaining completely physically relaxed.

    7. Worry with sense of yourself as observer.  Imagine that your thoughts are just one small corner of your mind and that you are not your thoughts or feelings but the consciousness observing them, or the space within which they occur.  Try to worry while retaining an awareness of yourself as separate from your thoughts and feelings.

    8. Worry visually, picturing worst-case scenario.  Picture your underlying worry or the worst that could happen, and focus on that image for as long as possible, ideally until you begin to get bored with it.

    9. Worry with expanded attention.  Rather than concentrating on your worry, or trying to distract yourself by concentrating on something else, instead expand your attention beyond your worry, broadening its scope, to “dilute” your experience of worrying.  Take a minute to describe to yourself as many things as possible that you can see or hear in the environment around you.  Then, with your eyes open, try to worry for a minute or so, aware of your thoughts but also aware of your environment and noticing as many aspects of the present situation as possible.

    10. Worry aloud with mindfulness of facial expression, eye movements, and muscles of speech.  Speak slowly and clearly and really try to notice how you use your breathing and the muscles in your body as your pronounce the words, to expand your awareness beyond the thoughts themselves and take in more of your present-moment experience.

    11. Worry as if you’re observing your thoughts and behaviour from outside.  Close your eyes and picture yourself as if seen from the outside and imagine that you can see and hear yourself worrying “over there”, i.e., picture yourself worrying aloud.  Then imagine walking around the image of yourself worrying and inspecting it from a detached perspective, as if it’s an exhibit in a museum or art gallery.  Alternatively, imagine you’re listening to and watching yourself on television talking aloud about your worries

    12. Worry in different accents.  Try worrying in a Jamaican accent, or an Irish or Scottish accent, or in someone else’s voice.  Perhaps experiment with different accents or voices and compare these different experiences of worry.

    13. Try to lose control of worry or induce panic, etc.  Worry as “hard” as you can and try to see if you can make your worry spiral out of control on purpose.  (Don’t do this without the supervision of a therapist.)

    14. Picture a tiger in your mind’s eye and let go of any attempt to control or influence it, just let it do whatever it likes.  If it stays that’s fine, if it goes away that’s fine, if it changes that’s okay too.  Just do nothing.  Now allow yourself to have one of the thoughts you normally worry about and just do nothing in response to it, like you did with the tiger.  Practice having the thought and doing nothing in response, neither trying to get rid of it nor trying to hold onto it.  Don’t have a conversation with yourself or worry about it.  Just allow it to fade naturally from your mind and be replaced by other thoughts in its own time.  Repeat this a few times if necessary.

    15. Repeat your main worry aloud rapidly.  Try to sum up your main worry in a short sentence (“What if I lose everything?”) and repeat this aloud, quite rapidly, for about 45 seconds, as you pay attention to the sound of the words and the sensation in your mouth as your pronounce them.

    Best Prices for Books by Donald J. Robertson

    Best Prices for Books by Donald J. Robertson

    Books on therapy can sometimes be expensive, particularly for students.  However, if you shop around online you can find cheaper versions available.  Here are suggestions for websites that currently (October 2012) offer some of my books at discounted prices.  If you notice these books in paperbook or electronic format available cheaper elsewhere please feel free to post a link in the “comments” sections below…

    Teach-Yourself-ResilienceBuild your Resilience (2012)
    Normal Paperback List Price £10.99

    New versions of the same book in paperback are available at the Amazon Marketplace from about £4.80

    Build your Resilience (2012) on Amazon UK Marketplace: £4.80

    This normally costs £10.99 in paperback but you can currently purchase the Kindle version of the book from Amazon UK for just £5.99

    Kindle version of Build your Resilience (2012) on Amazon UK: £5.99

     

    Philosophy-of-CBT-Karnac-Cover-TitleThe Philosophy of Cognitive-Behavioural Therapy (2010)
    Normal Paperback List Price £24.99

    You can buy new versions of the same book in paperback at the Amazon Marketplace from about £20.80

    The Philosophy of CBT (2010) on Amazon UK Marketplace: £20.80

    This normally costs £24.99 in paperback but you can currently purchase the Kindle version of the book from Amazon UK for just £12.99

    Kindle version of The Philosophy of CBT (2010) on Amazon UK: £12.99

     

    Practice-of-CBH-Cover-3The Practice of Cognitive-Behavioural Hypnotherapy (2012)
    Normal Paperback List Price £45

    You can currently order the print version from the publisher, Karnac, at the discounted price of £37.24

    The Practice of Cognitive-Behavioural Hypnotherapy on Karnac’s website: £37.24

    However, Book Depository are currently selling the print version for just £33.75

    The Practice of Cognitive-Behavioural Hypnotherapy at Book Depository: £33.75

    New Book: The Practice of Cognitive-Behavioural Hypnotherapy (2012) by D. Robertson

    The Practice of Cognitive-Behavioural Hypnotherapy

    A Manual of Evidence-Based Clinical Hypnosis

    Donald J. Robertson

    Practice-of-CBH-Cover-3

    ISBN: 9781855755307.  Available for pre-order now from the publisher Karnac or Amazon.

    “Donald Robertson goes back to basics and describes the development of hypnosis and cognitive-behavioural therapy. This book provides an excellent introduction to the theory, research and practice of cognitive-behavioural hypnotherapy.” – Professor Stephen Palmer

    The Practice of Cognitive-Behavioural Hypnotherapy is a major new clinical textbook on evidence-based practice in clinical hypnosis, written by psychotherapist and hypnotherapist Donald Robertson and published by Karnac, the UK’s leading specialist psychotherapy publishing house. Based on extensive background research, it contains references to almost 250 different scientific journal articles and clinical textbooks on hypnosis and CBT.

    Table of Contents

    Part I: The Cognitive-Behavioural Approach to Hypnosis
    Chapter 1: Introduction to Cognitive-Behavioural Hypnotherapy
    Chapter 2: James Braid & the Original Hypnotherapy
    Chapter 3: Cognitive-Behavioural Theories of Hypnosis

    Part II: Assessment, Conceptualisation, & Hypnotic Skills
    Chapter 4: Assessment in Cognitive-Behavioural Hypnotherapy
    Chapter 5: Case Formulation in Cognitive-Behavioural Hypnotherapy
    Chapter 6: Socialisation & Hypnotic Skills Training

    Part III: Cognitive-Behavioural Hypnotherapy
    Chapter 7: Applied Self-Hypnosis & Coping Skills
    Chapter 8: Affect: Hypnotic Exposure Therapy
    Chapter 9: Behaviour: Problem-Solving Hypnotherapy (PSH)
    Chapter 10: Cognition: Cognitive Hypnotherapy
    Chapter 11: Conclusion & Summary

    Dr. Michael Heap, co-author of Hartland’s Medical & Dental Hypnosis, 4th Edition, has contributed the following Foreword:

    Over the last 30 years, the most significant development in the field of psychotherapy has been cognitive behavioural therapy (CBT). In terms of the standards and criteria that any system of psychotherapy is nowadays evaluated, CBT ticks all of the boxes: a clear rationale with a solid grounding in mainstream psychology and its related disciplines; a rational and informed understanding of the problems and disorders that come within its scope; a coherent, and structured approach to treatment that is informed by rigorous assessment, formulation and clear goals; a commitment to continuous research into theory, process and outcome; and many more. This is not to say that CBT is uncontroversial and without critics, but over the years it has proved flexible and able to incorporate new ideas and variations, thus extending the legitimate scope of its application over an astonishingly wide range. This progress continues unabated.

    What about hypnotherapy? It may be argued that hypnotherapy as it is practiced today has been with us for much longer than CBT. Yet it has struggled to establish itself with anything like the same success as CBT. One reason may be that over the years, many publications concerning hypnosis and hypnotherapy – articles and, particularly books – have often been of poor or indifferent quality, their authors frequently failing to acknowledge the importance of the above standards and criteria for developing a psychological therapy. But there is another likely reason. It is often said that hypnosis is, for most purposes, not a therapy in itself; it is an adjunct to therapy, whether that therapy be psychodynamic, humanistic, behavioural, cognitive, and so on. And now that hypnosis is well-established as a real psychological phenomenon with a sound evidence base, we can make that statement with due confidence.

    It is natural therefore that psychotherapists should look to ways of integrating hypnosis with CBT that enhance the scope and effectiveness of the latter, and thus establish what may be justifiably called ‘cognitive-behavioural hypnotherapy’. And in this book, Donald Robertson proves that he is the right person for this task. First and foremost he approaches the subject matter with the same high standard of scholarship that is evident in his previous publication The Discovery of Hypnosis, and this includes careful attention to the historical context and to theoretical matters that inform the rationale of his approach. Readers who are already practitioners of CBT will appreciate the author’s emphasis on therapy as a collaborative process and the importance of a thorough assessment and a careful formulation, without which therapy lacks a firm anchor. Due regard is also paid to preparing the patient for therapy. The author describes in detail how hypnotic procedures may be integrated with CBT, demonstrating this with a range of cognitive and behavioural methods such as exposure, reality testing, cognitive restructuring, and covert behavioural methods. His approach is well structured, but flexible, and he demonstrates a firm grasp of his subject matter, which is considerable in scope. In particular, I believe he will convince readers who are already CBT therapists that learning how to include hypnosis in their repertoire of skills will pay them and their clients significant dividends. And those hypnotherapists wishing to incorporate CBT into their practice will be amply rewarded.

    With The Practice of Cognitive-Behavioural Hypnotherapy the author has demonstrated the exacting standards by which all books on therapeutic hypnosis should be judged. I commend it to the reader.

    About the Book

    Hypnotherapy is arguably the oldest modality of psychological therapy, at least in the modern sense. Psychologists have long attempted to conceptualize hypnosis in terms of cognitive and behavioural processes and the term cognitive-behavioural approach to hypnosis was first coined in 1974 by Theodore Barber, and his colleagues, one of the most prolific and influential researchers in the field of hypnosis. Since then cognitive research on hypnosis has continued to evolve alongside the assimilation of modern cognitive-behavioural therapy (CBT) techniques within the framework of hypnotherapy and vice versa. This book explores the historical and conceptual relationship between hypnotherapy and cognitive-behavioural therapies (CBT).

    It proceeds to offer a modern cognitive conceptualization of hypnosis, based on the writings of James Braid the founder of hypnotherapy and drawing upon modern cognitive-behavioural research on hypnosis. The author carefully explores the combination of hypnosis with both cognitive and behavioural interventions and ways in which methods can be adapted in the light of therapeutic principles derived from both fields. The book aims to provide a comprehensive core text for the practice of cognitive-behavioural hypnotherapy and to facilitate further dialogue between practitioners of hypnosis and CBT.

    Available for Pre-order Online

    Worksheet: Re-evaluating Coping Behaviour

    Worksheet: Re-evaluating Coping Behaviour

    CompassCopyright © Donald Robertson, 2012.  All rights reserved.

    These questions are designed to help you re-evaluate and perhaps challenge your existing ways of coping when anxious, or dealing with similar problems.  Feel free to skip questions that don’t seem relevant (especially in the “optional” section).  Your goal is to develop more awareness of your behaviour and the underlying beliefs that may be maintaining it, and to begin questioning these beliefs and exploring alternative ways of coping with the same problems and situations.

    Situational Analysis

    • What are the typical situations in which you become upset?
    • What feelings or symptoms do you experience in those situations?
    • What are the initial thoughts that lead you to become upset?  What do you go on to worry about?  What’s the worst that you imagine might happen in these situations?
    • What do you actually do?   How do you try to cope with the situation or with your upsetting thoughts and feelings?
    • What thoughts do you subsequently have, during these situations, about your behaviour and how you’re coping?

    Self-Rating Beliefs

    • At the time, how helpful do you feel your current way of coping is (0-100%)?
    • At the time, how much control do you feel you have over your behaviour (0-100%)?
    • At the time, how strongly do you believe something bad would happen if you completely stopped that behaviour (0-100%)?
    • At the times, how strongly do you believe that your thoughts or feelings would be unbearable if you didn’t engage in that behaviour (0-100%)?

    Evaluation of Consequences

    • What are the advantages of your current way of coping?  Are they short-term or long-term advantages?
    • What are the disadvantages of your current way of coping?  Are they short-term or long-term disadvantages?
    • Overall, how’s your current way of coping working out for you, in the long-run?

    Optional Questions about Consequences

    • What are the potential costs of that behaviour in terms of any additional distress caused to you?
    • What are the potential costs of that behaviour in terms of your quality of life and relationships?
    • How might it prevent you from “getting better” in the long-term? How might it potentially keep your distressing thoughts and feelings going?
    • Might that way of coping prevent you from discovering anything about your own feelings? What would happen over time if you repeatedly did nothing but actively accept your upsetting thoughts and feelings?
    • What’s the worst that could happen if you keep engaging in that behaviour? How likely is that?
    • What’s the worst that might happen if you stopped that behaviour permanently and completely? How likely is that?
    • How might that way of coping possibly distort your perspective on things?
    • If that way of coping seems to prevent a problem, is there evidence that problem is actually real or likely to happen?
    • How might you distinguish helpful from unhelpful ways of coping?

    Evaluation of Control

    • Why don’t you just stop doing what you’re doing if it’s causing problems?
    • You must stop sometimes, so how does that happen?
    • What evidence is there that your behaviour is beyond your control?
    • Are there any flaws in that evidence?  Could it be interpreted differently?
    • What evidence is there that you could change your behaviour and do something else?
    • How could you learn to develop more control over your behaviour?

    Alternative Coping Strategies

    • What alternative ways of coping could you employ in that situation?  (Try to identify as many as possible.)
    • What would you advise someone else to do in a similar situation?
    • How might people you admire cope with similar problems?
    • What do you think experts might advise you would be the best way to cope?
    • What has worked for you in the past in similar situations?
    • What have you never tried that might be worth doing?
    • What would be the opposite of what you’re currently doing? 
    • What might block or prevent your current behaviour?
    • What would it be like for you to do less, perhaps even do nothing, in response to similar situations?
    • What do you think would be the best alternative way of coping?

    Re-Rating Beliefs

    • How helpful do you now believe your previous way of coping would be, if continued long-term (0-100%)?
    • How much control do you now believe you have over your behaviour in similar situations (0-100%)?
    • How strongly do you now believe something bad would happen if you completely stopped your previous behaviour (0-100%)?
    • How strongly do you now believe that your thoughts and feelings would be unbearable if you didn’t engage in that behaviour (0-100%)?

    What’s the point checking things?

    What’s the point checking things?

    pros_consCopyright © Donald Robertson, 2012.  All rights reserved.

    One of the most common problems people report in relation to anxiety is the compulsion to check things excessively, e.g., checking that lights are turned off, emails have been sent correctly, or checking up on other people without their knowledge.  People often have mixed feelings about their checking behaviour and wish that they could control it, although they may also feel that it’s necessary or helpful in some ways.  Sometimes it is necessary or helpful to check things in life but it’s seldom helpful to do so more than once or if checking won’t change anything at a practical level.  People check different things, in different ways, for different reasons.  Some people check to reduce uncertainty, to reassure themselves that they are safe from harm, because they don’t trust someone else, or because they don’t trust their own memory.  To help you re-evaluate and challenge your behaviour try to answer the questions below as carefully as possible. (Just ignore any that don’t seem to make sense in terms of your own problem.)

    Self-Assessment

    1. What are the typical situations, times, or places, when your checking behaviour occurs?
    2. What are the initial thoughts or feelings that immediately precede or trigger your checking behaviour?
    3. What do you actually do?  What do you check and how?  Do you check anything in a “special” or unusual way?   How do you know when to stop checking?
    4. How many times in a row do you check things on average?  How long does that usually take in minutes?
    5. How many times per week do you check things in this way?

    Self-Rating

    1. When it happens, how strongly do you believe that your checking behaviour is beyond your control? (0-100%)
    2. At the time, how strongly do you believe that your checking behaviour is helpful? (0-100%)
    3. At the time, how strongly do you believe that if you didn’t check things something bad might happen? (0-100%)
    4. At the time, how strongly do you believe that if you didn’t check things your discomfort or anxiety would be unbearable? (0-100%)

    Some Problems Caused

    Typical problems caused by excessive checking behaviour include the following:

    1. It can prevent you discovering what would happen if you didn’t check.  For example, you may discover that even if you abandon checking things, nothing bad ever happens as a result.
    2. It can prevent you discovering that your anxious thoughts and feelings are harmless.   For example, you may find that if you’re patient your anxiety reduces naturally, without having to check things to remove anxiety, and you may discover that distressing thoughts can be handled in better ways.
    3. Checking may have an impact on your quality of life or relationships, it may upset other people, or waste your time and interfere with your daily routine, etc.
    4. Checking can fuel worry and rumination and keep you thinking for even longer about your concerns, which means they take up more and more time.
    5. You may learn to focus more and more attention on possible causes for concern in a distorted way, e.g., if you go looking for trouble, you’ll often find it where it doesn’t really exist by taking information out of context or interpreting ambiguous things in an alarming way.
    6. The more often you check things in response to anxiety, the stronger the urge to do so again will become in the future: checking can become “addictive”.  (This is because it sometimes temporarily reduces anxiety, which tends to strengthen the force of a habit, making it feel harder to control.)
    7. You rob yourself of the opportunity to learn how to cope with upsetting thoughts and feelings in more natural and healthy ways, which can lead normal coping skills to become forgotten or weakened through neglect.
    8. It encourages you to get into the habit of treating the (perhaps irrational) thoughts that precede checking as very important and meaningful.
    9. If you’re checking up on other people, they may realise and begin checking up on you, or trying to conceal more things from you, which can slowly undermine trust in a relationship.
    10. The act of checking may interfere with natural emotional processing and prevent feelings from running their course and fading over time.
    11. Repeated checking is often an attempt to reduce uncertainty or ambiguity but it can never eliminate uncertainty completely and may instead prevent you from learning how to live with and accept a normal degree of uncertainty or risk in life.
    12. It may conflict with your personal values in terms of the type of person you want to be in life, which can affect self-esteem.
    13. Repeated checking can cause an increasing range of situations to act as reminders for upsetting thoughts and feelings, e.g., if you check your partner’s mobile phone messages you may begin to be automatically reminded of suspicions by association whenever you use your own mobile or see other people using theirs, etc.

    What are Pros and Cons of Checking?

    1. When it happens, what do you feel are the advantages (pros) of checking?  Are these short-term or long-term?
    2. What are the actual disadvantages (cons) of checking?  Are these short-term or long-term?
    3. Overall, how is your checking behaviour actually working out for you in the long-term?

    Additional Questions About Consequences

    1. What are the potential costs of checking in terms of any additional worry or anxiety caused?
    2. What are the potential costs of checking in terms of your quality of life and relationships?
    3. What effect does checking actually have on your sense of uncertainty in the long-run?
    4. How does checking help you “feel better” in the short-term?
    5. How might it prevent you from “getting better” in the long-term?  How might it potentially keep your worry and anxiety going?
    6. Might checking prevent you from discovering anything about your own feelings? What would happen over time to your worry and anxiety if you repeatedly did nothing and actively accepted the uncertainty?
    7. What’s the worst that could happen if you keep checking?  How likely is that?
    8. What’s the worst that might happen if you stopped checking permanently and completely?  How likely is that?
    9. How might checking possibly distort your perspective on things?
    10. If checking seems to prevent a problem, is there evidence that threat is actually real or likely to happen?
    11. Are there any other potential costs of checking, in the long-term? Does it potentially cause any other problems?
    12. How might you distinguish helpful from unhelpful checking behaviour?

    Evaluate Control over Checking

    1. Why don’t you just stop checking things if it’s causing problems?
    2. What evidence is there that your checking is actually uncontrollable?
    3. Is that good evidence?  Can you think of any criticisms of those pieces of evidence?
    4. What evidence is there that your checking might be controllable?

    Alternative Behaviours

    What might be a more helpful alternative to your current checking behaviour?

    Which of the following alternatives seem like they might be workable:

    1. Do nothing, just sit still while you actively accept your feelings and watch your thoughts from a detached perspective
    2. Instead of checking, read aloud a “reasons to stop” cue-card, with the disadvantages of checking, three times
    3. Postpone checking along with thinking about things until a specified time of day
    4. Picture the worst-case scenario until your anxiety reduces naturally
    5. Make it physically impossible for yourself to check things
    6. Tell other people and make an interpersonal agreement to stop checking
    7. Habit-reversal, clasping hands or clenching them for 1-3 minutes, to block the behaviour, until the urge to check has gone
    8. Can you think of any other alternative strategies?

    Re-Rating

    1. How strongly do you now believe that your checking behaviour is helpful? (0-100%)
    2. How strongly do you now believe that your checking behaviour is beyond your control? (0-100%)
    3. How strongly do you now believe that if you didn’t check things something bad might happen? (0-100%)
    4. How strongly do you now believe that if you didn’t check things your discomfort or anxiety would be unbearable? (0-100%)

    Excerpt from Build your Resilience (2012)

    Approaches to Resilience-Building

    Teach-Yourself-ResilienceExcerpt from Build your Resilience (2012).  Copyright © Donald Robertson, 2012.  All rights reserved.

    Order a copy now from Amazon UK or Amazon.com

    So how is resilience built? The American Psychological Association (APA) has published its own research-based public information leaflet entitled The Road to Resilience, developed by a team of six psychologists working in this area. Their ten recommendations for developing and maintaining resilience can be paraphrased as follows:

    1. Maintain good relationships with family, friends, and others
    2. Avoid seeing situations as insurmountable problems and look for ways forward where possible
    3. Accept certain circumstances as being outside of your control, where necessary
    4. Set realistic goals, in small steps if necessary, and plan to work regularly on things that are achievable
    5. Take decisive action to improve your situation rather than simply avoiding problems
    6. Look for opportunities for personal growth by trying to find positive or constructive meaning in events
    7. Nurture a positive view of yourself and develop confidence in your ability to solve problems
    8. Keep things in perspective by looking at them in a balanced way and focusing on the bigger picture
    9. Maintain a hopeful and optimistic outlook, focusing on concrete goals, rather than worrying about possible future catastrophes
    10. Take care of yourself, paying attention to your own needs and feelings and looking after your body by taking healthy physical exercise and regularly engaging in enjoyable, relaxing and healthy activities, perhaps including practices such as meditation

    This Book’s Approach

    The self-help approach to resilience-building described in this book draws upon established resilience training programmes but also incorporates many elements from more recent research on mindfulness and acceptance-based approaches to the treatment of common psychological problems. The specific form of acceptance-based therapy most relevant to resilience-building is perhaps Acceptance and Commitment Therapy (ACT), which later chapters will discuss in more detail. The central goal of ACT is increasing general “psychological flexibility”, a concept quite similar to psychological resilience.

    Subsequent chapters will look at the ACT approach to psychological flexibility and resilience and how more traditional cognitive-behavioural skills can be incorporated with a mindfulness and acceptance-based approach. Their contents might be summed-up as follows:

    1. Psychological flexibility skills (Mindfulness and valued living)

    • Clarification of personal values
    • Commitment to valued action
    • Defusion of unpleasant or unhelpful thoughts
    • Willing acceptance of unpleasant feelings
    • Awareness of the self as observer
    • Connection with the present moment

    2. Additional skills and strategies

    • Worry postponement
    • Progressive muscle relaxation
    • Applied relaxation
    • Problem-solving
    • Assertiveness and other social skills

    Some of these headings may seem a little cryptic at first but they’ll become clear as you read the following chapters. In a nutshell, this approach shares certain elements with established resilience-building approaches. The main difference is that it places greater emphasis upon your relationship with unhelpful thoughts and beliefs rather than attempting to dispute them. It also emphasises the role of clarifying and acting in accord with personal values, which is similar, however, to the emphasis on “signature strengths” adopted in Seligman’s more recent work.

    In the final chapter, we’ll also be looking at perhaps the oldest Western system of resilience-building, the classical Graeco-Roman school of philosophy known as “Stoicism”, which is derived from the teachings of Socrates and influenced the development of modern CBT (Robertson, 2010). The Stoics are, in a sense, the ancient forebears of most modern resilience-building approaches. Indeed, Epictetus, the Stoic philosopher who has most influenced the field of psychotherapy, has been described as “the patron saint of the resilient” (Neenan, 2009, p. 21).

    Developing a Personal Resilience Strategy

    A good way to start resilience building consists in reviewing your past experiences to identify what you can learn about coping with stress and developing a personal resilience plan or strategy for the future. This approach is recommended by the APA in their guidance on resilience and similar exercises have been used in CBT for resilience-building.

    Try it now: Evaluate your previous resilience strategies

    1. Identify a specific time in the past when you have shown resilience in the face of adversity or coped well with stressful life events
    2. What was your goal?
    3. What was the actual outcome?
    4. What obstacles did you have to overcome?
    5. What unpleasant thoughts and feelings do you remember having in that situation?
    6. Who, if anyone, did you receive external help or support from?
    7. What specific attitudes or skills helped you cope with the situation?
    8. How would you rate your resilience in that situation (0-100%)?
    9. Why wasn’t it 0%? What strengths and personal qualities helped you?
    10. If it wasn’t 100%, how could your resilience be improved during similar situations in the future?
    11. Based on your experience, how might you advise someone else to cope with a similar problem in the future?
    12. If you want, repeat the process above for about three situations in total and look for patterns in your problems and ways of coping

    Order a copy now from Amazon UK or Amazon.com

    Mindfulness and Acceptance-based Exposure Therapy Recordings

    Mindful Exposure Recordings

    Copyright (c) 2012, Donald Robertson.  All rights reserved.

    There are two versions of the recording, one with faint music and vocal effects, and the other with just plain speech.  See the other articles on this site for more advice on self-guided exposure therapy and constructing a hierarchy of images or situations for use in exposure therapy.

    Mindfulness and Acceptance-based Imaginal Exposure Script (no music)

    Mindfulness and Acceptance-based Imaginal Exposure Script (with music)

    Mindfulness Exposure Script

    Mindfulness Exposure Script

    Audio Recording for Mindfulness-Based Exposure Therapy

    Copyright © Donald Robertson, 2012.  All rights reserved.

    [Induction]

    thought-bubbleMake yourself comfortable, close your eyes, and allow yourself to pause for a while and become more mindful, self-aware, and centred in the present moment… Take time to settle down and get comfortable before we begin. Your goal in this exercise is to overcome avoidance by learning to face difficult situations patiently in your imagination, doing so more vividly and for longer than normal. You’re not trying to control or eliminate any of your feelings but simply to stay with them for a while, completely letting go of any struggle against them. You may find by doing this exercise that anxiety and other unpleasant feelings tend to reduce naturally over time, but that’s not your immediate purpose. Rather, your goal here is to learn how to make room for your feelings and respond more flexibly to them, viewing them from a different, more accepting perspective instead of making a conscious effort to get rid of or avoid them…

    Take time to notice how you’re actually using your body and your mind, right now, in the present moment. Take a step back from your thoughts, viewing them as mental ephemera, passing events in your mind. Be aware of yourself as a detached observer, separate from your thoughts and feelings… aware of your consciousness itself as distinct from its contents. Allow yourself continually to acknowledge and accept any unpleasant feelings you might be having, from moment to moment. Throughout life you’ve experienced literally millions of different thoughts and feelings and observed many different things. Your current thoughts and feelings are transient, just what you happen to be experiencing right now, sooner or later your attention will move on to other things… and then sometimes it may return to these experiences again, perhaps in a different way… Most of your thoughts and feelings are automatic and unintentional, they just pop into your mind spontaneously… Think of your internal experiences as like the sound of a radio playing in the background, something you can just acknowledge, without engaging with it or analysing its meaning… Allow yourself to experience your stream of consciousness in this completely disinterested way, seeing thoughts that cross your mind as fairly transient and unimportant things…

    For now, with your eyes still closed, just be aware of what you’re currently experiencing, from moment to moment, without evaluating it, analysing it, or interpreting it any further… You can be standing or sitting, it really doesn’t matter… If your mind wanders, that’s fine, just acknowledge the fact and bring your awareness patiently back to the exercise you’re doing… You’re going to choose a scene to picture throughout this exercise… You can start by working through a mildly upsetting event and then progressively working on more challenging ones… So pick a situation to imagine yourself in right now, if you haven’t already… Turn it into a brief sequence of events, like a video clip, and imagine going through it as realistically as possible… Employing all of your senses, as if it’s actually happening right now, and you’re seeing things through your own eyes… Make it as realistic as possible and pay close attention to the most upsetting parts of the scene rather than trying to avoid them… Stop trying to think positively, stop trying to relax or control your internal reactions… Just observe everything in a detached way and allow yourself to accept and fully experience your internal reactions so that your brain has time to process your emotions naturally…

    [Repeated review]

    Now you’re going to review that whole sequence of events very patiently, a few more times, from beginning to end… Start at the beginning now… going through things slowly and with mindfulness… Don’t try to change anything; don’t try to stop anything from changing… Sometimes things may change spontaneously just by being observed… Instead, as you go through events, practice distancing from your thoughts and actively accepting your feelings… Noticing what you’re thinking, as you think it, and realising that your thoughts are just words and images passing through your mind, rather than the things they claim to represent… Taking a step back, metaphorically, in your mind, and viewing them in a more detached way… You are not your thoughts or feelings… you’re the conscious observer of them… Allow yourself to radically accept your feelings as harmless and transient… opening up and fully experiencing them… Letting go completely of any effort to control or suppress them… just allowing them to come and go naturally…

    As you continue to go through those events slowly, allow your attention to expand and take in the whole situation as you allow your self-awareness to deepen… Notice what you see… Notice any sounds you hear… Notice what you’re saying or doing, and how you experience that… Notice any thoughts, images, or associations that go through your mind… Notice your feelings and the sensations in your body… Just allow yourself to acknowledge each experience as it arises… not trying to get rid of or change anything… Noticing any effort or desire to change your experiences, to avoid certain thoughts or feelings, and gently letting go of even that desire… Just expanding your awareness to allow yourself to fully experience what’s happening in your body and mind… Sometimes your feelings may remain the same… sometimes they may reduce, change, or come in waves… Patiently going through the whole event, using all of your senses, as if it’s happening right now… Whatever happens, that’s okay, just allow yourself to make room for your experiences to unfold naturally, without any struggle or effort to control things… Stay with your feelings for a while, as if you’re creating a space around them, giving them the freedom to come and go naturally… Now gradually draw the scene to a close in your mind, and rate the level of discomfort you felt… From 0-100% how distressing was it to imagine? Just make a mental note of that number. [Wait]

    Okay, now patiently go through the whole experience once again… from just before you noticed the earliest signs… through the peak or middle… to the end, once the scene is over… Again, patiently watching your thoughts from a distance… while you radically accept your feelings… and completely let go of any struggle against them… Don’t try to change anything; don’t try to stop anything from changing…

    Just take your time… Notice any sounds you hear… Notice what you’re saying or doing, and how you experience that… Notice any thoughts, images, or associations that go through your mind… Notice your feelings and the sensations in your body… Just allow yourself to acknowledge each experience as it arises… Noticing even the slightest desire to avoid certain feelings and gently letting go of even that desire… Patiently going through the whole event, using all of your senses, as if it’s happening right now… Expanding your awareness to allow yourself to fully experience what’s happening in your body and mind… [Pause] Now gradually draw the scene to a close… Make a mental note of your how distressing it was this time, from 0-100%. [Wait]

    Okay, now patiently go through the whole experience once again… from just before you noticed the earliest signs… through the peak or middle… to the end, once the scene is over… Again, patiently watching your thoughts from a distance… while you radically accept your feelings… and completely let go of any struggle against them… Don’t try to change anything; don’t try to stop anything from changing…

    Just take your time… Notice any sounds you hear… Notice what you’re saying or doing, and how you experience that… Notice any thoughts, images, or associations that go through your mind… Notice your feelings and the sensations in your body… Just allow yourself to acknowledge each experience as it arises… Noticing even the slightest desire to avoid certain feelings and gently letting go of even that desire… Patiently going through the whole event, using all of your senses, as if it’s happening right now… Expanding your awareness to allow yourself to fully experience what’s happening in your body and mind… [Pause] Now gradually draw the scene to a close… Make a mental note of your how distressing it was this time, from 0-100%. [Wait]

    You will probably find it helpful to repeat this exercise daily, reviewing the same situation in detail in your imagination, 3-4 times, and visualising things more vividly and for longer than you normally would… You can use this time as an opportunity to practice both distancing from your thoughts and actively accepting your feelings… It will probably help if you carefully observe and note down what effect the exercise has upon your problem, both immediately and over time… As your distress reduces, and you begin to feel more confident, you can also consider how you might solve problems and cope differently with similar situations in the future… Don’t make a conscious effort to reduce your feelings, that will often happen naturally if you‘re patient and allow your brain the freedom to process things in its own way… but if you happen to find that your rating of distress has not gone down to half its initial level, or lower, then you should immediately repeat the exercise until it has done so…

    [Emerging]

    Now let go even of the scene you were imagining… and gradually begin to expand your awareness throughout your whole body… and into your current environment… Continue to be aware of your breathing and any internal experiences that you’ve been attending to but, in addition, allow your awareness to begin spreading through the rest of your body… throughout the trunk of your body… your arms… your legs… your neck and head… Become aware of your whole body as one… and continue to accept any sensations you’re experiencing, pleasant or unpleasant, but also begin to notice what else you’re experiencing, more and more, progressively widening the scope of your attention… Rather than trying to avoid or control any remaining feelings, you’re simply accepting them and expanding your attention beyond them…

    Now gradually spread your awareness out further beyond your body and into the environment around you, where you are and what you’re doing right now, in the real world… Continue to notice how you’re using your body and mind as you slowly open your eyelids and look around you… As you finish the exercise and begin interacting with the external world or other people, continue to be mindful of the way you’re using your body and your mind… and aware of how you relate to environment and any tasks at hand… If you continue to notice any uncomfortable feelings, that’s fine… just accept them, let go of any struggle against them, and gently expand your attention beyond them into the world around you and the way you’re interacting with life, right now, as you move forward into action…