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Other Problems Addressed


Resistance to Change | Irritable Bowel Syndrome
Procrastination | Anger Management


Resistance to Change

Although cognitive therapy attempts to empower patients to help acquire the skills to make their lives better, many people are hesitant to make changes because they are stuck in self-defeating patterns. Dr. Leahy is recognized as a leading authority on resistance to change, having written a book Overcoming Resistance in Cognitive Therapy and edited another book, Roadblocks in Cognitive-Behavioral Therapy. There are many reasons why we get stuck--and cognitive therapy can help you overcome these problems. You may get stuck because you need to acquire new skills in how to challenge and change your negative habits of thinking---or you may need to acquire new skills in communicating and relating to other people. Your therapist can help you make these changes and learn self-help skills.

But there may be other reasons why it's hard to change---what we might call your "hidden agendas". For example, you may get stuck because you view change as invalidating your feelings or you may be stuck in feeling like a victim that is powerless. You may feel stuck because you are committed to proving that you are right or you may be following habitual patterns of thinking (that we call "schemas") that keep you from seeing things differently. Or you may fear change because it appears too risky. You may also be stuck because you feel a sense of loyalty to someone whose behavior keeps you from getting your legitimate needs met.

To learn more about resistance to change you can read excerpts from Dr. Leahy's book, Overcoming Resistance.
An additional except is available here.
Or for more excerpts by Dr. Leahy click here.

You may also read a sample chapter from

Ambivalence in Psychotherapy: Facilitating readiness to change
- David E. Engle and Hal Arkowitz

Cognitive Therapy for Challenging Problems: What to do when the basics don't work
- Judith S. Beck


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Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) consists of a series of gastrointestinal (GI) problems, which aren’t caused by a physical illness.  People with IBS may suffer from stomach pain, extreme abdominal tenderness, diarrhea, constipation, bloating, nausea and other symptoms.  Medication has proven relatively ineffective in treating this disorder (Blanchard & Malamood, 1996).

However, psychotherapy has been demonstrated to be more effective in reducing the symptoms of IBS than regular medical treatment (Blanchard, 1993). Among different types of psychotherapy, cognitive-behavioral therapy (CBT) stands out as the treatment of choice.

People with IBS may also experience anxiety and mood disorders. As a result, CBT for IBS uses relaxation training as well as changing negative thoughts, treating both physical and psychological symptoms.

Patients begin by learning how to monitor IBS symptoms and negative thoughts by using a diary form. During early treatment sessions, patients learn about bowel functioning, IBS, and how their symptoms are not "all in their head."  Patients then receive training in muscle relaxation to increase their control over their body’s response to stress.  Home practice of these techniques is important, and an audiotape may used to assist in guided relaxation.  Gradually, patients are taught to use rational self-talk to change the negative thinking that can lead to increased anxiety and IBS. In the final step, they learn to identify and change negative core beliefs that are related to their IBS symptoms.

Although the discomfort of IBS is difficult to treat with drugs and general medical treatment, it can be treated through CBT.  For more information, please contact us at AICT.

Blanchard, E. B. (1993). Irritable bowel syndrome. In R.J. Gatchel & E. B. Blanchard (Eds.). Psychophysiological Disorders (pp. 23-62) Washington, DC: American Psychological Association

Blanchard, E. B., & Malamood, H. S. (1996). Psychological treatment of irritable bowel syndrome.  Professional Psychology: Research and Practice, 27, 241-244.


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Procrastination

Most of us have experienced problems with procrastination-we put things off until another time and then feel pressured to get it done at the last minute. Procrastination is often accompanied by worry, depression, regret, and stress. It can be both a cause and a consequence of these problems. For example, you might end up worrying and criticizing yourself because you procrastinated. You might procrastinate because you worry you won't get the job done or that you think it will make you too anxious.

Areas of procrastination

There are several areas of your life where you might procrastinate. For example, you might procrastinate in your social relationships---you don't call friends, you don't initiate interactions with people, and you don't show up on time. Or you might procrastinate about your health---you don't see the doctor or you put off diet and exercise. People procrastinate at work---putting off more unpleasant things until later or not doing the things that the boss wants you to do. And, finally, you might procrastinate about your finances---not getting your tax information in, not getting proper insurance, and not paying your bills.

What are the costs and benefits of procrastination?

In cognitive therapy we look at the motivation to change your behavior. Your therapist can help you address these problems. But, let's take a look at the costs and benefits of procrastinating. For example, Susan is procrastinating getting her tax information ready. The "costs" to her of procrastinating include greater pressure to get things done at the last minute, possibility of penalties for being late, and self-criticism about procrastination. The "benefits" that she gets in procrastinating are that she can avoid doing something that she finds unpleasant, she can "wait to feel ready" and she can do other things that are more interesting to her.

The dilemma of procrastination

Consider the following train of thought and ask yourself if something like this seems familiar to you:

  • When I think of doing my taxes I feel anxious.
  • When I begin working on my taxes I feel even more anxious.
  • If I avoid working on the taxes, I feel a reduction in anxiety.
  • Therefore, if I want to reduce my anxiety, I can avoid doing things that make me anxious.

but

  • When I procrastinate, I criticize myself and things don't get done.
  • This eventually makes me depressed and even more anxious.
  • Therefore, I am even more inclined to avoid anxiety.

Procrastination Predictions

When we procrastinate we are often making predictions about the behavior we are avoiding. Do any of these seem familiar?

  • It's too hard.
  • I don't have enough time right now.
  • I don't know how to do it.
  • I'm too far behind already. I'll never catch up.
  • I'd rather do something else.
  • I'll feel worse if I start doing this.
  • I should wait until I feel like doing this.
  • Something even worse will happen if I get this done.

Procrastination Assumptions

When we procrastinate we may often have certain assumptions or rules that guide us. These rules keep us from doing things that might turn out to be in our interest. Consider some of the following reasons to procrastinate:

  • Entitlement - I'm too good to have to do this. I shouldn't have to do this. These rules shouldn't apply to me.
  • Rejection Sensitivity - If I do this, I'll get rejected. It's terrible if I get rejected. If I get rejected, it means I'm undesirable, worthless.
  • Dependency - Someone else will solve my problems. I should wait for someone to rescue me.
  • Control - I don't like being told what to do. I shouldn't do anything unless it's on my terms when I want to do it.
  • Perfectionism - I shouldn't do anything unless I can do a perfect job of it. I should only start it if I can get the whole thing done.
  • Passive-Aggressive - Why should I do this if it will please someone else? I can deprive them by not doing it. If they really valued me, they'd accept the fact that I don't do this. I can show them who's the boss.
  • Emotional Reasoning - I need to feel inspired--excited--to do this. If I feel it's going to be terrible, then it will be. I should wait for the right feeling. I should wait to be "ready".
  • Low Frustration Tolerance - I can't stand doing things that are unpleasant. If I do this, I'll be depleted and exhausted. I'm too tired. It's too unpleasant. It's terrible to do this.
  • Personal Inadequacy - I am helpless and unlovable. Therefore, I can't do this. If I fail, then I should criticize myself.
  • Past Determination - Since I haven't succeeded in the past, nothing will work. I may as well give up.
  • Self-Defeat - I really don't deserve to succeed, so why bother? If I get this done, then I'll have to do other things after that I'll fail at. I should quit now.
  • Fear of Increased Expectations - If I succeed at this, people will expect more of me and then I'll fail in a big way. I should quit now.

Do any of these reasons sound familiar to you? Perhaps you have more than one reason to procrastinate. Your therapist can help you identify the roadblocks that you have that keep you from getting things done.

Questions to ask yourself about procrastinating

Future-time perspective: Am I focusing on short-term benefits rather than long-term benefits? What are the long-term costs of procrastinating?

Cost-benefit: What are the two alternatives? What are the costs and benefits of each? How do they balance out? How about the long-term costs and benefits?

Self-discipline: Am I willing to do things I do not want to do? Am I willing to make myself uncomfortable in order to make progress? Am I willing to be consistent and monitor my progress regularly?

Assign what, where, when and how much:

  • What--am I willing to do?
  • Where--will I do it?
  • When--will I begin this task?
  • How much-- time will I spend on it?

Focus on progress not perfection: It is more important to get started than to be perfect. If it's worth doing it's worth doing at least an average job on it.

Self-reward: I should praise myself and reward myself for each step. This will increase my behavior.

Be willing to learn: I can revise my behavior--if I start a task and learn I'm not doing well, then I can learn from it.

Sample Chapters from Guilford Press on Procrastination:

The Procrastinator's Guide to Getting Things Done
- Monica Ramirez Basco

Blog Posts on Procrastination:

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Anger Management

All of us can lose our tempers and even get hostile with those around us who we care about. During the holiday season we experience added stress from traveling, shopping, the pressure of shopping and spending time with family and friends. Here are some valuable tips for handling your anger.

Identify the signs of your anger
Are you feeling tension in your body, is your pulse rising, and are you noticing yourself feeling an urge to "get out"?

Examine the consequences in the past when you  have gotten angry and hostile. Have you yelled at people and later regretted it? Have you driven too fast? Have you gotten into arguments?

What are the costs and benefits of getting angry?

You may think that you are "standing up for your rights" or "It's a matter of principle". But is it? Or is it acting out in ways that you later regret?

Examine your angry thoughts

Your anger may be due to certain distortions and biases in the way you think. This can include:
  • Personalizing: You think that someone else's behavior is directed toward you---but it is not.
  • Catastrophizing: You think it's awful or intolerable that something has happened---but it is really an inconvenience.
  • Labeling: You label someone as a "bad person" or "nag"---when they are simply being human.
  • Shoulds: You have your own set of rules for how the world should be run and how other people should be.
  • Mind-reading: You think that people are intentionally offending you.

You can change your anger by doing the following:
  • Accept Limitations: in yourself, others and the world. You may not be able to get everything you want on your terms and others may disappoint you. Accepting the limitations of reality helps you live in the real world.
  • Don't take things personally: View the world as something that goes on without you--- and that is not personally directed against you.
  • Take a few moments to think before you act: Stand back, breathe slowly, and think--- Reflect on how unpleasant it feels for you when you are angry and hostile.
  • Stretch time: If you are blocked in getting things done---like blocked in traffic or blocked in line--- think about how this moment will pass and you will be relieved. Frustration is momentary.
  • Become an observer: Don't try to change reality or other people---if it seems frustrating to you. Stand back and observe and accept --- think of yourself as a journalist observing what is going on rather than trying to change it.
  • Turn "catastrophe" into "inconvenience": Think of what is happening as a small inconvenience that doesn't really matter.
  • Reward yourself for managing your anger: Take pride in having more control over your negative moods.


Sample Chapters from Guilford Press on Anger Management:

Taking Charge of Anger: Six Steps to Asserting Yourself without Losing Control
- W. Robert Nay

Blog Posts on Anger Management:

 


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Keywords: validation, self-handicapping, resist, roadblocks, digestion, GI track, upset stomach, bloating, urgency, writer's block, time management, efficient, perfectionism, anxious, nervous, worry, worries, worried

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