Month: March 2024

You may have heard of the word ‘cognitive defusion’ or come across it when reading something. Or someone may have used the term ‘cognitive defusion’ in a conversation because mental health is increasingly becoming a topic of real interest for many people.

The term comes from the third wave of Cognitive Behavioural therapies and Acceptance and Commitment Therapy is less about challenging and breaking down thoughts patterns in order to change them (classical CBT work), but more about accepting the thoughts, feelings, emotions and perceptions as they arise; accepting that they come and go, accepting that they may come back in the future, but that they will diminish, and accepting that you are ultimately in control of how much these thoughts diminish in the future by disengaging with them and reducing their energy. Any reduction in the ‘stickiness’ of ruminatory thoughts gives individuals the time to enjoy, engage with and be present within the moment.

Acceptance and Commitment Theory therefore includes the element of cognitive defusion within its structure as a tool that allows individuals to create some distance between the thoughts and their actions. In other words, creating the space so that the action can be adapted and amended from previous ones which re-enforced the initial negative belief or troubling thoughts and feelings.

It is also important to stress that cognitive defusion is a tool that can be practised on feelings and bodily sensations. So, for example, some people with anxiety and OCD may feel muscle tightening in their bodies associated with specific ruminatory thoughts or they may tense and twitch certain muscles. In this instance, cognitive defusion means disengaging from tensing muscles so that ruminatory thoughts do not continue to elicit actual physical reactions which add further weight to the ruminatory process.

Cognitive defusion therefore means what ‘it says on the tin’. This is about disengaging, mentally ‘stepping back’ and having the mental capacity to change previous actions and in doing so, to change the outcome of negative or ruminatory thoughts on your mood and general well-being. So, ultimately, this is about using cognitive defusion to change the lens and the filter through which you may view yourself, the wider world or the people around you.

For some, using the tool of cognitive defusion has been life-changing, and underpinning this process is the following premise; that you are not your thoughts. They are a stimulus, learnt reactions to the past and from what may have  happened to you or how you may have mentally reacted to events in the past and they do not reflect the here and now, the present. Therefore, ruminatory or negative thoughts are symptoms of impacts and events that happened in the past and the automatic replaying of such thoughts does not do justice to the present and also leads people away from the values that matter to them and how they want to lead their lives.

So let us take the example of someone who has consistent ruminations that they are a ‘bad’ person. This leads to their disengagement from social discussions and withdrawal from the present moment, so they become quiet. The action of ‘being quiet’, sustains the heavy meaning of the thought and re-enforces the whole cycle. Cognitive defusion is about training yourself to accept that the thought happens, understanding that it is just a thought and that it will pass, and then making an active decision to carry on with a discussion that adds value to your day and keeps you anchored in the present.

So, what can we do to weaken and move away from the mental filter that funnels us into engagement and mental fusion with negative and ruminatory thoughts. Well, we can:

• Notice and be aware of the thought. If the thought is ‘I am bad’, then give it a name, sometimes humour works and takes the energy and oxygen out of the thought or alternatively saying, “here comes my usual thought that I am bad”, just minimises it.
• Sometimes saying the thought also takes its energy away rather than maintaining its internal pull. So, you may want to say the statement, ‘Bad’ repeatedly for about 30 seconds and notice how the word starts to become meaningless and that it is just a sound and a word.
• Remember that our minds are attuned to look at things through somewhat of a negative lens or risk funnel so that it can protect us. This behaviour has not changed and evolved from the millions of years that we have been on this earth and when we were at risk from dangerous animals on the savannahs. Our minds therefore naturally look at risk as a precautionary mechanism to protect us and in its own way, is trying to keep us safe. It is important to reflect and recognise this.
• Remember that whist you may have thoughts that highlight risk or threats to you, you are not inherently ‘different’ to many people. The key is being aware, giving yourself space to reflect to disengage from the thought and then carrying on with your engagement with the present moment.
• Anything that takes the energy out of fusing with the thought is positive. So, saying a word repeatedly that shows you that it is just a noise, a word and that it actually has no meaning without you, is one tool that you can use.
• Finally, remember that the thought will pass. The less you engage with it through cognitive defusion, the quicker it will diminish and the stronger you will feel rooted in the present moment.

Post Traumatic Stress Disorder or PTSD is a disorder that is caused by internal bodily and emotional reactions to stress situations which seem overwhelming for an individual. The threshold of what seems ‘overwhelming’ is different for each person and depends on a range of factors, including their biochemical make-up, their experiential history, their genetics and how they interpret stress. For some, stress is energising and seen through the lens of having some benefits for performance, whilst for others it is anxiety inducing and with corresponding negative impacts on their health and well-being. For those negatively affected by stress, it has the ability to narrow and limit the mental bandwith and the focus of those affected, creating the possibility of ruminatory thoughts, a sharpened and heightened focus on catastrophic thoughts and hyper-accelerated thoughts about the future or the past that focus on danger and risk. Allied to this comes a disconnection or detachment with the self and a focus on mentalisation over time. In other words, people ‘withdraw’ into their heads.

I have worked with clients who have had PTSD reactions because of accidents, the death of close family members, the loss of their careers and also from negative press articles being written about them. It is the sense of profound shock and loss, the sense of disconnection with something that is important in their lives, followed by the associated catastrophic thoughts because of the shock event which echo in PTSD related events.

So, for example, some people who have had negative press stories about them firstly ruminate about the story and then can go into a state of detachment and ‘shut down’, or they can become hyper-anxious and intensely worried about their future, their reputations, income and the way that they will be perceived. The brain enters a stage of trying to reflect on the risk, though given the overwhelming nature of the shock, people entering this stage of shock feel a sense of narrow focus on the catastrophe ahead, rather than being able to step back and assess the reality of the risk to them. With this narrowing of focus, comes the ‘overwhelm’, the feeling and sense that what is happening to them is insurmountable.

Take the example of someone waking up to find a major news story breaking about them. They may enter into three potential states, the ‘fight, flight or freeze’ reactions. In other words they can go into a state of detachment and just sit for hours or lie down. This can be associated with wanting to sleep and with the desire to stay in bed in order to detach oneself from what has happened. Other individuals may become angry, energised with adrenaline and stress hormones and react to the story with some form of action. Others may seek to ‘pigeon-hole’ what is taking place, that they don’t really want to address it and that they find other tasks to do, minimising its impacts. Either way, feelings of overwhelm, catastrophic and ‘black and white’ thinking do creep in and slowly deplete the body’s capacity to sustain itself during this crisis, which further adds to the cycle of negative and catastrophic thinking.

It is therefore essential at times like this to undertake simple activities like walking, breathing exercises, the use of critical thinking and in realising that the body may be reverting to the patterns I have highlighted. It is also important to carry out an activity that can reduce the stress hormones and the adrenaline that becomes raised within the body and to keep connections with loved ones. We must not underestimate how important personal connections are at this time and how much these can support the rebalancing of our sympathetic nervous system that goes into overdrive when there are traumatising situations that affect us. Additionally, cold water therapy has become a form of therapy that many say helps them to overcome PTSD over time and it helps in activating the parasympathetic nervous system. This is the body’s brake system on many organs in the nervous system.

It is important for people who have suffered such traumatic incidents to seek therapeutic help and assistance and to be able to work through these high stress events. This allows them to reflect and to introduce alternative behaviour patterns that can disrupt PTSD symptoms and allow them to feel that they are resilient and able to cope. This is absolutely key to the healing process.

People with social anxiety can really benefit from counselling and therapy with the right therapist; someone that they can feel connected to and who empathises, supports, informs and accepts.

Social anxiety affects people in a wide variety of ways. Firstly, it affects the confidence of the individual involved, and its affects their belief that they can engage with people on an ongoing basis, whether that be on a personal or group level. It also affects ‘connectedness’ something that we know which maintains anxiety and which impacts on self-esteem. Social anxiety can also strengthen and maintain a core belief of feeling and ‘being weak’, of being ‘unable to cope’ and in supporting associated thoughts that the ‘world is not safe’ and is threatening. In other words, there are many maintaining factors for such fears and these include safety behaviours such as avoidance of going to small, medium or large social events, sitting near the exits in theatres and cinemas so that people feel that they can exit the room quickly if they need to and in meeting people only on a one to one basis. Sometimes this can mean repeatedly meeting only ‘safe’ people – people who they deem make them feel safe and assist them if they have a panic attack or any other perceived future catastrophic event.

We know from a variety of research reports and pieces of social research evidence that such safety behaviours maintain and keep social anxiety going. They also maintain the strength of fearful thoughts around social engagement, and they re-enforce the depth of feelings associated with the thoughts. It is therefore essential that counsellors and therapists work on getting clients to understand their safety behaviours, the core beliefs that they have carried with them and never really challenged and the associated thoughts that have developed like a web from the core beliefs. In doing this work, it allows clients to see what is at the root of their thinking and how fearful thoughts connect with each other and the types of safety behaviour that they are undertaking which are maintaining the social anxiety.

There are two other core pieces of work that counsellors must undertake and these include gentle exposure work with the individual. This is work that slowly and surely builds their trust in their capability, resilience and ability to cope with stressful and anxiety causing conditions. The other piece of work includes psycho-educational work around how and why the anxiety may have developed during early childhood and what trauma and experiential impacts exacerbated anxiety reactions. This is also essential in giving the client an understanding of the history of the issue that roots and centres them in gaining control over the issue through a personal reflection of why the social anxiety may have developed.