Change

We live with and accept a lower quality of living and can become accepting and comfortable with our status quo and overlook the fact that we do live and function below our full potential for long periods. Excuses to Change are usual. An excuse is an enemy to change. Excuses are the nails that are used to build a house of failure. Changed thinking leads to changed feelings, leads to changed action, leads to changed life. If you can renew your mind, you can change your life.

Knowledge alone is not power. Knowledge has value only in the hands of someone who has the ability to think well. We need to learn to think well. When we learn to think well, we can achieve dreams and reach our full potential. If your thinking is poor, then you have placed a lid (a ceiling) on your life and your ability to achieve and attain. Where your thinking is limited, so your potential is never allowed to attain higher heights.

A change of thinking can help you move from survival or maintaining the status quo, to real progress. 95% of achieving is knowing what you want and a willingness to pay the price to get it. (Not just a willingness to pay the price – but actually then paying the price).

You need to have belief. A belief is not just an idea, but also something that holds great power and the ability to change expectations. People are more willing to embrace change when:

  • They hurt enough – such that they are at a point of willingness to change.
  • Learn enough (through education and knowledge) – that they now want to change.
  • Receive enough information – which they are able to change.

Achievement comes from the habit of good thinking. The more good thinking, the more good thoughts you will continue to think. Every person has the potential to become a good thinker. Unsuccessful people focus their thinking on survival.

Our belief can be the very thing that stops us achieving desired change. Challenging our belief (cognitions), by supplying new information on which to base new learning – can effect change. Challenging the evidence for a particular belief may show the belief to have no proper foundation and result in revised thinking. That is called cognitive restructuring. Cognitive restructuring (by challenging a particular belief) alongside behavioural change can be more effective in effecting change.

There are three factors that cause dysfunctions. They are the following:

  1. Predisposing factors: They are general upbringing experiences (from childhood) that includes cultural, social, religious norms and the attitudes and beliefs those experiences create. A particular behaviour that we have observed can predispose us (set down a script in our minds) that cause us to behave in that particular way. The behaviour predisposes us to behave in that way.
  1. Precipitating factors: There may be experiences, events or expectations that we have which set up an anticipation of failure because the circumstances seem to be the same as a past situation when failure occurred. The fact of similar attributes sets it up as a script in our mind to expect and anticipate failure.
  1. Maintaining factors: The fact of a first and subsequent failure sets up repetition and repetition maintains the behaviour, making it more likely to be repeated.

We have all learned inappropriate pairings and associations that have predisposed us, precipitated and caused us to maintain certain types of behaviours. If we can learn more about those predisposing, precipitating and maintaining factors, we are someway towards changing our cognition. As we change our cognition (the way we think, feel and believe), then we start to change our behaviour. In order words, as we change our mind (our cognition) we can change our life (because we start to change our behaviours as well).

What we think is who we are. Where the mind is, the heart will follow. Changing what the mind thinks will also change what the heart follows.

Recognise that if a stimuli has been present for a long time and behaviour follows, constant repetition means reinforcement has been taking place over the years and habit has set in. Habit is not just something we do. It is based on a stimulus that creates automatic thoughts, beliefs, feelings and then behaviours.

For Cognitive Behavioural Therapy (CBT) the focus wherever possible, is actually to ignore the old behaviour. By ignoring it you are removing all stimulus that kept the behaviour going, with the intention of extinguishing that old behaviour. At the same time/simultaneously – a new focus of thought, feeling, belief and behaviour in another direction, will positively reinforce a new behaviour. The old and the new will have difficulties continuing side by side. One must get less as the other gets more.

 

Belief theories in CBT

The underlining theory behind CBT suggests that we have three levels of cognitions. They are core beliefs, intermediate beliefs and automatic thoughts.

Core beliefs are the most fundamental level of belief. Global, very rigid and over generalised. For example, I am a failure; no-one likes me; everything goes wrong when I touch it. The person may not always consciously be aware of holding such beliefs.

Intermediate beliefs are attitudes, rules and assumptions which come out of the influences of the core beliefs above. For example, if I come second it shows I am a failure. If I win anything there must be something wrong with the prize. They are also not always consciously aware of these beliefs.

Automatic thoughts are generated in given situations and stem out of the core belief and intermediate beliefs. This is as conscious as the awareness will get. For example, I must not do this. It is wrong.

 

Motivations to Change: Stages of Change

Change interventions are sometimes necessary in life to aid lifestyle modifications. Understanding a person’s readiness to make change, appreciating the barriers to change and helping individuals anticipate relapse, can better improve outcomes and reduce frustrations.

The stages of change show that for most people, change in behaviour occurs gradually. A person moves from being uninterested, unaware or unwilling to make a change (pre contemplation), to considering change (contemplation), to deciding and preparing to make a change.

Genuine determined action is then undertaken. Relapses are almost inevitable. Relapse actually becomes part of the process of working towards life-long change. Failure to know what stage the individual is at, is the reason that many fail. The right skills must be used at the right stage.

These are the stages of change:

  1. Pre contemplation: Individuals at this stage are not even thinking about changing the problem behaviour. They may not even see the behaviour as a problem or believe that it is problematic. They may be addicted to the behaviour and there may be resistance or a block towards change or be in denial. The four R’s of Reluctance, Rebellion, Resignation and Rationalisation apply. There are different types of pre contemplators.

The reluctant pre contemplators may lack knowledge or inertia to do what they want to do to even consider change. Information about the problem or its impact may not have been fully considered. They are reluctant to change..

The rejecting pre contemplators have a vested interest in maintaining the problem area. They are resistant to being told what to do. They may appear hostile and quite resistant to change. Very set in their ways. It can be quite easy to spot the rebels. They argue with even the questions. They make it clear that they will participate and even attend, as long as they are not going to be forced to try to change. Interestingly enough, such individuals use a lot of energy maintaining the problem by resisting any attempts at being told what to do. If that energy can be utilised in another way they actually have a lot of energy that can be put into the process of effecting change. They become good candidates if the rebellion can be overcome.

The rejection of change may be a resistance arising from childhood insecurities and fears. A strategy may be to ensure they are given choices and that when they make a choice, it is perceived as coming from them. That may include the provision of more information to assist in making an informed decision

The resigned pre contemplators are very much the opposite. They lack even energy. They have given up on the possibility of change. They are overwhelmed by the problem. They can count how many attempts they have made in the past to overcome and have failed. They feel hopelessly addicted and that the problem is somewhat out of control. They know they have a habit and a tendency and that the habit is actually in control and they are out of control. They see ways to avoid the problem occurring to other people, but have lost heart that change will ever happen for them. They think it is too late.

The motivational interviewing skills that can be used with this type is to instil hope by exploring the barrier to change. Without some hope of the possibility of change the resigned pre contemplators can never be motivated to move to the next stage of contemplation of change.

The rationalising pre contemplator has all the answers (very different to the resigned pre contemplator who has none). Rationalising pre contemplators are not considering change because they have weighed up all the risks and odds or have plenty of reasons why the problem is not really such a big problem for them. What happens is that they have a conversation within themselves and you can frequently hear it being voiced in discussions with others, including in the therapy room.

Discussions feel like a debate and scoring points. It may feel like rebellion or even resistance, but the difference is in their thinking. They may think they are not at much risk of adverse consequences because things are not so bad. For example, a smoker may be convinced that they are not really at any major health risks from starting smoking at 21, because they have reduced the number of cigarettes and have only been smoking for 10 year or they can point to a 90 year old that has smoked all of their life and is still healthy. These issues may turn into a discussion and a debate which only serves to strengthen their side of the argument. The very fact of a discussion, debate or argument is what feeds their rationalising.

The skills to be used here are empathy and reflecting back to the client what they are saying, so that they can reflect and consider the stance they are taking.

  1. Contemplation: This is often a stage with paradoxes. There is a willingness to consider the problem and the possibility of change offers hope, but ambivalence is present. Change is wanted, but often something is awaited (an extra push, a piece of information or something) – just one final piece of information that will compel the move to change. Very importantly, contemplation of change is not commitment to change. This must be understood.

The ambivalence (a conflict between two opposing choices) is that the behaviour actually served a purpose. There will be a sense of loss if it changes or goes, despite the perceived benefits. There is knowledge of the benefits of change and the need for change and the advantages of change, but there are disadvantages.

The hope is that some final piece of information will help to tip the scales and the balance and make the decision for change. The fact is, however, that it is the individual that needs to make the decision and not the information that is awaited. Therefore the person can remain in this contemplation stage for a very, very long unproductive waiting time.

When one piece of information comes, it may shift to needing something else and moving towards change becomes elusive. Ambivalence is the main enemy to commitment to change and a prime reason for remaining stuck at the contemplation stage. Motivational strategies at this stage is to help individuals work through ambivalence; anticipate barriers to decreased desirability to overcome the behaviour; to gain an increased sense of self confidence and self belief and to put in place effective strategies.

  1. Determination/Preparation: This stage is marked by a definite decision to take steps to overcome the problem behaviour. It is a determination to commence the process to effect change and the intention to commence that programme in the near future. There is an appearance of being ready for and commitment to action. Preparatory steps are being taken in a concrete way.

Motivational strategies are still significantly important at this stage. Commitment and determination to change does not necessarily mean that the change will occur automatically or that the method used will work or the attempt will be successful in the long term. It does not mean that all ambivalence has to be resolved. The decision making process – to commence change – is a continuous process and continues throughout this determination stage. The determination to change is an on-going determination, not a once and only decisive decision.

Motivational strategies include determining the strength and the levels of the commitment and increasing and bolstering up the commitment to start the plan towards change. Being adamant about the determination may not truly indicate the strength of commitment. Frequently the determination is more about trying to convince oneself, rather than a definite strong determination.

Strong commitment alone does not guarantee commencing change or achieving change. Enthusiasm will not make up for poor attempts. Willpower alone will often not be sufficient to stay the course and then to maintain the change. Willpower can become a drain on energy. Commitment without appropriate coping skills and activities can create a tenuous action plan.

  1. Action: The decision, plan and strategy are in place and implementation is the next step. It is easy to get ahead of self and overly confident and so cancel further therapy sessions because of a sense of having conquered it, when in fact the journey is still in its infancy towards change.

It is amazing what a change of mind can achieve; what people are capable of doing once sufficiently motivated and invest in a realistic goal. Despite an inherent ability to change, barriers can prove to be major obstacles. A part of the strategy in the action stage may include recognising triggers; triggers for addictive behaviour to predict outcomes before they occur; to intervene to avoid relapse. Motivational strategies seek to engender a sense that success is possible, to reaffirm decisions and offering insights into success.

Continuous repetition of the good behaviour will after a time, make that better behaviour a good automatic programme. Talk back to negative thoughts. Challenging urges include considering the environment, planning ahead and avoiding triggers. It includes talking back to urges. Learning to nip an urge early on when it is just materialising makes it easier to control, than later on. When immersed in the urge for an hour of so, it is more problematic to stop it. Pressures from others and the influence of family and friends can be a detrimental and have a tremendous influence on the attempts to change and also they contribute to the likelihood of relapse.

Life style enhancement needs to be considered. Giving up a particular addictive behaviour may result in more free time. How to spend that free time needs to be thought about and planned. Perhaps attending a 12 steps group meeting will be necessary. Attendance might add quality to life and even become a social outlet. It is important to take up other interests to replace the compulsive/addictive behaviour and build new neural pathways of more positive behaviours.

  1. The final stages are maintenance, relapse and recycling: The action stage might take between 3 – 6 months to complete. Any addictive behaviour requires a new pattern of behaviour to be built in before effective change can be maintained and a new neural pathway is being formed. It takes a while to establish a new pattern of behaviour. The real test as to the extent to which it is long term sustained change over several years.

The next stage is therefore “maintenance”. The threat of relapse or return to the old pattern becomes less frequent and less intense where the new behaviour is maintained. Within the maintenance stage, new practice needs to become automatic. Just like learning an instrument requires practice, so it is that repeated implementation of a new behaviour will make the past addictive behaviour become less and less and the new behaviour takes centre stage.

Relapse is always possible in the action stage or in the maintenance stage. There may be a strong unexpected urges or temptation that are triggers which the individual fails to cope with successfully. Sometimes the guard may be relaxed or testing oneself too far can cause the relapse. Sometimes the cost (in terms of amount of work involved in maintaining the change) is not well calculated. Often the relapse is a gradual process. It may be at this point, that reassurance is needed and a review of the cycle of change undertaken.

Understanding the cycle of addiction is important. Relapse may uncover problems with commitment, emotions, coping or environmental stresses. Exploration, information, feedback and empathy are all important elements within continued motivational interviewing work even at this stage. In relapse, motivational interviewing must ensure that there a slip-up does not mean being back at the beginning and all is lost. That is just not true and must be challenged. A slip-up or relapse should not mean throwing in the towel. It is important to assess what has been achieved to date and build on that. Beating oneself up will de-motivate and actually cause the old behaviour to flood back in because of a strong level of shame and sense of needing to soothe to feel better.

(Some content taken from the book, CBT for dummies and Renewing the Mind by Casey Treat)

 

Gary McFarlane BA, LLM

Gary was a clinical negligence solicitor practising in Bristol, London and Manchester for over 20 years and knows well the pressures of legal life. Practising from his central Bristol office, he is a Relate trained and experienced Relationship counsellor, Mediator and undertakes Sex Therapy & Sex Addiction treatment – all of which are undertaken by Skype, telephone and face to face with clients from all parts of the country and the world. He is also a member of BACP and the Association for the Treatment of Sexual Addiction & Compulsivity and Accredited by ACC.

 

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