HOW TO COPE WITH STRESS, ANXIETY AND PHOBIAS USING COGNITIVE-BEHAVIOR THERAPY

Monday, 13. August 2012 1:03 | Author:


HOW TO COPE WITH STRESS, ANXIETY AND PHOBIAS USING COGNITIVE-BEHAVIOR THERAPY


William L. Golden Ph.D.

If you are looking for proven techniques pertaining to how to cope with stress, anxiety and phobias this article can help you. According to the cognitive-behavioral model, situations do not automatically cause anxiety. Anxiety-producing thoughts lead to anxiety. Cognitive and behavioral techniques capable of modifying our thoughts and feelings provide the treatment for the various anxiety disorders

How to cope with stress, anxiety and phobias using Cognitive Therapy

Albert Ellis and Aaron Beck are the originators of cognitive therapy. The basic concept in cognitive therapy is that it is not just the event or situation that causes emotional upset. Our thoughts, attitudes and beliefs cause or contribute to disturbing emotions such as anxiety. In cognitive therapy, patients are taught to identify and change self-defeating thoughts.

Coping self-statements can be used to reduce anxiety.  Coping self-statements are constructive thoughts which can be used to prepare you for stressful situations or when in stressful situations. Using imagery, you can mentally rehearse coping self-statements while imagining how you will cope with a stressful situation.

Logging

Logging helps you to identify your anxiety triggers and the negative thoughts that lead to anxiety. You can begin a log or diary to identify the situations in which you feel anxious, as well as those situations that you avoid. Also identify and monitor your anxiety-producing thoughts.

The Two-column Method

The two-column method is a self-help tool that you can learn to use on your own. Start by dividing a page in half. On one side of the page, list your anxiety-producing thoughts. On the other side of the page, constructive thoughts are listed. The goal is to generate a set of coping thoughts that can be used for reducing anxiety.  Here is an example of the two-column method, as it was used for generating a set of coping thoughts for a patient receiving therapy for social anxiety:

 

Anxiety-producing Thoughts

       Coping Thoughts

 

1) I’ll get rejected. 1) I’m jumping to conclusions. If I don’t try, I won’t succeed. So I might as well take a risk. I really have nothing to lose. If I keep trying, I will have some success.

 

2)  I’m a loser.

 

 

 

3)  If I get rejected,

it will prove I’m a loser.

2) I’m not a loser. I’m good at some things and not at others. Social skills are not one of my strengths, but I can learn and get better at it with practice.

3) Acceptance and rejection from other people does not determine my self-worth. I can accept myself and stop calling myself names like “loser.” I can feel good about trying.

 

Imagery

Coping self-statements, developed through the two-column method, can be used during imagery for the purpose of anxiety reduction.  For example, using the social anxiety example described above, I suggested the following while having the patient visualize going to a social situation and interacting with people:

“Now imagine that you are going to a social event. And as you enter, you are thinking, you really have nothing to lose. Rejection from other people does not determine your self-worth. So take a risk. If you keep trying, you will get better at socializing and will be more successful, and you can feel good about trying, no matter what the outcome. Now imagine talking to people, feeling more confident and more comfortable”

This imagery technique, in combination with social skills training and role-play, helped prepare the patient for social situations and interactions.

Cognitive-behavior Therapy Techniques

Cognitive and behavioral techniques can be combined. Cognitive-behavior Therapy, also known as CBT, includes the use of relaxation techniques, imagery and exposure therapy techniques. Exposure involves facing your fear in a systematic manner where you learn to master your fear. Relaxation techniques and coping self-statements can be used to reduce anxiety both during imagery and exposure therapy techniques.

Relaxation procedures

The various relaxation techniques can be combined to create a procedure that is tailored to the needs and preferences of a given individual. Experiment and find out which ones work for you.

Breathing Techniques

The breathing technique that I use with most of my patients is diaphragmatic breathing. You will know you are breathing diaphragmatically if your stomach rises as you inhale and flattens as you exhale. A good way of checking this out is by lying down on your back with a book or a box of tissues on your stomach. As you inhale make the book, or box of tissues, rise as you inhale and lower as you exhale. If possible, breathe in and out through your nose. Try to breathe at a rate of four seconds to inhale and four seconds to exhale. Only a few minutes of slow diaphragmatic breathing are needed to produce relaxation.

Relaxation Imagery

Imagining a pleasant relaxing scene is another relaxation technique. Pick one of you favorite places, maybe somewhere you went on vacation. It could be a beach, a park, a garden, a stream or brook. Use as many of your senses to imagine it. Imagine what you would see, hear, feel and smell. Imagine it as vividly as you can with as many details as possible.

If you are having trouble identifying an image, try this exercise. Experiment and see if you can respond to any of these questions:

Can you imagine walking along the beach?  Can you imagine the warmth of the sun? Can you imagine seeing the waves? Can imagine the sound of the ocean? What do the waves sound like? Can you imagine the sound of seagulls?

Can you imagine a sunset?  If you can imagine the sunset, what colors is it?

Can you imagine floating in warm water? Can you imagine drifting along? Can you feel light and buoyant?

Can you imagine walking in the woods during autumn? Can you picture the colors of the leaves? What colors can you picture? Can you imagine the sound of leaves crunching as you walk along the path?

Can you imagine sitting in a garden?

Can you imagine some flowers?

Can you imagine a particular flower? What color is it? How many petals does it have?

Can you imagine a butterfly in flight? What does it look like?

Progressive Muscle Relaxation

First find a comfortable position with your eyes closed. Let your breathing slow down, so you are breathing slow and easy. With each exhalation, you can start to let go, one muscle group at a time.

Starting with your toes, as you exhale, find a comfortable position for your toes, letting them spread apart in a comfortable position. Feel the relaxation spreading to your feet. With each exhalation, you can let go more and more. And with each exhalation, you can feel your toes and feet becoming more relaxed…

Feel the relaxation spreading. As you exhale let go of any tension and feel the relaxation spreading, more and more. Feel the relaxation spreading to your ankles…calf muscles…knees…and thighs.

And now, let your back go loose and limp, head and neck in a comfortable position. … And as you exhale let go of any tension and feel the relaxation spreading, more and more. You can feel the relaxation spreading up and down your back…all the way up to your shoulders and neck.

And as you continue to breathe slow and easy, you can feel the relaxation spreading to your arms and shoulders. Let your arms hang loose and limp and as you exhale feel the relaxation spreading down your arms… hands open, fingers apart. Feel the relaxation spreading down your arms, all the way down to your fingertips.

And now let your jaw hang slack, in a relaxed position, teeth slightly parted, and feel the relaxation spreading to your facial muscles…to your lips… cheeks… the muscles surrounding your eyes… your forehead…the relaxation spreading to all of your facial muscles.

Feel the relaxation spreading throughout your body, spreading to your stomach muscles… and to your chest…spreading and deepening… more and more…deeper and deeper, with each exhalation.

And to deepen the relaxation, you can imagine your relaxation image… using as many of your senses as possible, imagine your relaxation scene…Imagine what you would see…what you would hear…what you might smell…how you would feel.

And as you continue to enjoy your peaceful scene, and continue to breathe slow and easy, you can feel yourself becoming even more relaxed, calm and relaxed. Arms and legs, more relaxed.

The relaxation spreading and deepening… with each exhalation…Shoulders hanging comfortably…Back and neck, loose and limp….Jaw hanging slack…Facial muscles, smooth and relaxed…Stomach, calm and relaxed. All the muscles of your body relaxed…and your mind feeling calm and peaceful…As you continue to imagine your peaceful serene and continue to breathe slow and easy, you can feel yourself becoming more and more relaxed…feeling calm and very relaxed.

Treatment of Phobias

Desensitization

Systematic desensitization is an exposure therapy technique that was developed by Joseph Wolpe for the treatment of fears and phobias. This technique provides patients an opportunity to confront their fears in a gradual systematic manner, one step at a time. Relaxation techniques are used to reduce anxiety during exposure to the feared situations.  The specific anxiety “triggers” are identified. An anxiety list is then constructed. The fear or phobia is broken down to specific anxiety-producing triggers, which are then rank ordered from least to most anxiety producing. Systematic desensitization can be done in imagination and/or in reality. Here is an example of an anxiety list that was used for a patient with a fear of flying:

1-Plane landing

2-Thinking about flying

3-Watching planes on TV

4- Watching planes landing and taking off

5- The night before the flight

6- Driving to the airport

7-Boarding the plane

8-Plane taxiing on the runway

9-Plane on runway waiting to take off

10-Hearing sounds of the plane

11-Airplane hatch closing

12-Seatbelt light goes on

13-Plane banking

14-Takeoff

15-Turbulence

In the above case, I had the patient imagine each item while in a relaxed state, only going onto a next step after the patient was able to imagine the prior step comfortably. This desensitization technique enabled the patient to fly successfully. Research has shown that desensitization is about 80 – 90 % successful in the treatment of phobias. Research has found that Cognitive-behavior therapy is the most effective psychological treatment for stress, anxiety and phobias.

 

References

Beck, A.T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.

Chambless, D.L. & Ollendick, T.H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.

Dryden, W., & Golden W.L. (1986). Cognitive-Behavioral Approaches to Psychotherapy. London: Harper & Row.

Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.

Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Oxford: Pergamon Press.

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HYPNOTHERAPY FOR ANXIETY, FEARS, STRESS AND PHOBIAS

Monday, 13. August 2012 1:02 | Author:

William L. Golden PhD

There have been a number of clinical applications of hypnotherapy in the treatment of anxiety, fear, phobias and stress-related disorders. Hypnotherapy can be used to treat generalized anxiety disorder, job interview anxiety, test anxiety, sexual performance anxiety and posttraumatic stress disorder. Hypnotherapy has been found to be very effective for stress-related disorders such as headaches and irritable bowel disorder.   In addition, it can be used in the treatment of phobias such as airplane phobia, school phobia and agoraphobia.

 

Stages of  Hypnotherapy
In  hypnotherapy, five stages of treatment can be differentiated:

1) Orientation – history taking and assessment take place, expectations are assessed, patients are educated about hypnosis and misconceptions about hypnosis are clarified.

2) Hypnotic induction – a hypnotic induction procedure is selected and used.

3) Deepening of hypnosis – following a hypnotic induction, one or several deepening techniques are used.

4) Utilization of hypnosis – during hypnosis, therapeutic interventions are utilized, such as positive suggestions and visualization.

5) Termination of hypnosis – using one of several methods, hypnosis is terminated and the individual returns to a fully alert state.

Common Myths about Hypnosis

  1. Hypnosis is sleep – Hypnosis is not sleep. It is a relaxed state.
  2. Only weak or gullible people can be hypnotized – There is no negative personality trait associated with hypnotic ability.
  3. Only people with low intelligence can be hypnotized – The opposite is true. There is a positive association with intelligence and hypnotic ability.
  4. Hypnosis makes you dependent and weakens the will – The opposite is true. Hypnosis can be used for personal growth in addition to being used to overcome weaknesses, fears and phobias.
  5. There is a danger that you might not wake up from a trance – Hypnosis is a relaxed state. Even if you did drift off to sleep, you would eventually wake up on your own.
  6. You can be cured in one session of hypnosis – Hypnotic suggestions need to be repeated and reinforced, which is why self-hypnosis is so important.

Hypnotic Induction Procedures

There are various hypnotic induction procedures. The most widely used ones are the eye-fixation method, hand levitation the hypnotic relaxation induction. The easiest one to use is the hypnotic relaxation method. What follows is a transcript of it. Recordings can be made for the purpose of self-hypnosis training. For detailed descriptions of various other hypnotic induction procedures, the reader is referred to my book, Hypnotherapy: A Modern Approach that I coauthored with Thomas Dowd and Fred Friedberg.

Hypnotic Relaxation Induction

 You can close your eyes and find a comfortable relaxed position. Let your body go limp and let yourself sink into the chair.

Let your breathing slow down, so that you are breathing slow and easy. A comfortable, relaxed breathing pattern, where you are breathing in slowly, and breathing out slowly… a comfortable rhythmic breathing pattern…

And as you continue to breathe slowly and deeply, your body will start to relax…starting with your arms and legs. As you exhale, you can feel the tension flowing out and relaxation flowing in. Your arms and legs are starting to relax. Arms and legs hanging loose and limp. Hands open, fingers apart, wrists loose and limp… With each exhalation, the relaxation is spreading… Feel the relaxation spreading up and down your arms, all the way up to your shoulders. Let your shoulders hang comfortably…Feel the relaxation spreading, more and more, with each exhalation…

And your legs…Let them hang loose and limp… Toes spread apart, in a comfortable position. And you can feel your toes and feet relax… Feel the relaxation spreading. As you exhale the relaxation spreads, more and more. You can feel the relaxation spreading to your ankles…calf muscles…knees…and thighs.

With each exhalation, you are becoming more and more relaxed. Breathing slowly and deeply, and with each exhalation the relaxation is spreading and deepening, more and more… breathing slow and easy.

And now, let your back go loose and limp, head and neck in a comfortable position. Letting the chair support your body, sinking into the chair… and you can feel the relaxation is spreading up and down your back…all the way up to your shoulders and neck.

And as you continue to breathe slow and easy, you can feel the relaxation spreading, spreading throughout your body, spreading to your stomach muscles… and to your chest…spreading and deepening…permeating your body, more and more…deeper and deeper, with each exhalation.

And now let your jaw hang slack, in a relaxed position, teeth slightly parted, and feel the relaxation spreading to your facial muscles…to your lips… cheeks… the muscles surrounding your eyes… your forehead…the relaxation spreading to all of your facial muscles.

And to deepen the relaxation, you can imagine a peaceful relaxing scene… using as many senses as possible, imagine your peaceful place. Imagine what you would see…what you would hear…what you might smell…how you would feel.

And as you continue to enjoy your peaceful place, and continue to breathe slowly and deeply, you can feel yourself becoming even more relaxed, calm and relaxed. Arms and legs, more relaxed. The relaxation spreads and deepens… with each exhalation…deeper and deeper…Shoulders hanging comfortably…Back and neck, loose and limp….Jaw hanging slack…Facial muscles, smooth and relaxed…Stomach, calm and relaxed. All the muscles of your body relaxed…and your mind feeling calm and peaceful…As you continue to imagine your peaceful serene scene and continue to breathe slowly and deeply, you can feel yourself drifting, drifting off into a deeper, and deeper state of relaxation, feeling calm and very relaxed…calm and peaceful….more and more relaxed…..

(At this point, hypnotic suggestions can be given while in the deeply relaxed state. Then, after completing the therapeutic suggestions, you can return to the fully alert state.)

And now, at your pace, you will begin to return to the fully alert, wide-awake state. Take your time… Allow a comfortable transition between the deeply relaxed state and the alert state…. Go at a pace that is comfortable for you… Take it slowly, and at your pace, starting to move a little, like moving you fingers and your toes… maybe stretching…and when you feel ready… starting to open your eyes, slowly… starting to return to the fully alert state…feeling relaxed, refreshed, and wide awake.

Self-hypnosis

I use various methods for teaching self-hypnosis.  As I mentioned already, hypnotic inductions can be recorded on CD or digital format. I can email recordings as attachments for my patients to listen at home. Most people are able to induce self-hypnosis after listening to the recording several times. Alternatively, scripts (such as the one from above) can be memorized or be used for making recordings in one’s own voice. One can also learn self-hypnosis by employing the basic skills of hypnosis (relaxation, imagery, suggestion).

You can use self-hypnosis to prepare for anxiety-producing situations. During self-hypnosis, you imagine handling upcoming stressful events and apply hypnotic suggestion to reduce anxiety and build confidence. With enough practice, eventually you can also apply self-hypnosis skills when you start to feel anxiety.

Utilizing Hypnotic Suggestion

During hypnosis, you can prepare yourself for dealing with stressful situations by imagining yourself successfully dealing with them. While in the relaxed hypnotic state you visualize yourself being successful. You can replace negative thoughts with positive hypnotic suggestions.
For example, in the case of anxiety about an upcoming job interview, one can imagine oneself being calm and confident and thinking,
“I have the qualifications and I’m ready for this interview. But even if I don’t get this job, I’m not a failure or worthless. And eventually I’ll get a job.”
Hypnotherapy can be used for most fears, phobias and stress-related disorders. When hypnotherapy includes imagery and positive suggestions it is a powerful tool in combating anxiety.

References

Golden, W.L. (1983). Rational-emotive hypnotherapy: Principals and techniques.  British Journal of Cognitive Psychotherapy, 1, 47-56.

Golden, W.L. (1985). Commonalities between cognitive-behavior therapy and hypnotherapy. The Cognitive Behaviorist, 7, 2-4.

Golden, W.L. (1986). An integration of Ericksonian and cognitive-behavioral hypnotherapy in the treatment of anxiety disorders.  In E.T. Dowd & J.M. Healy (Eds.), Case Studies in Hypnotherapy. New York: Guilford press.

Golden, W.L. (1986). Another view of choosing inductions.  In B. Zilbergeld, M.G. Edelstein, & D.L. Araoz (Eds.), Hypnosis: Questions and Answers. New York: W.W. Norton & Co.

Golden, W.L. (1986). Can hypnotized patients be persuaded to do almost anything? In B. Zilbergeld, M.G. Edelstein, & Araoz (Eds.), Hypnosis: Questions and Answers. New York: W.W. Norton & Co

Golden W.L. (1994). Cognitive-behavioral hypnotherapy for anxiety disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 8, 265-274.

Golden, W.L. (2006). Hypnotherapy for anxiety, phobias and psychophysiological disorders. In R. A. Chapman (Ed.) The Use of Hypnosis in Cognitive Behavior Therapy. New York: Springer Publishing Co.

Golden, W.L. (2007). Cognitive-behavioral hypnotherapy in the treatment of irritable-bowel-syndrome-induced agoraphobia. International Journal of Clinical and Experimental Hypnosis, 55, 2, 131-146.

Golden, W.L. (2012). Cognitive hypnotherapy for anxiety disorders. American Journal of Clinical Hypnosis, 54, 4, 263-274.

Golden W.L., Dowd, E.T., & Friedberg, F. (1987). Hypnotherapy: A Modern Approach.  New York: Pergamon.

Golden W.L., & Friedberg, F. (1986).  Cognitive-behavioral hypnotherapy. In W. Dryden & W.L. Golden (Eds.), Cognitive-Behavioral Approaches to Psychotherapy. London: Harper and Row.

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Overcoming Rumination Syndrome

Monday, 13. August 2012 1:00 | Author:

Overcoming Rumination Syndrome

William L. Golden PhD

Rumination syndrome is a gastrointestinal disorder where patients regurgitate food and/or liquids without any effort. The regurgitation is involuntary and not deliberate. Many rumination syndrome patients have been misdiagnosed as having bulimia. However, regurgitation in patients with bulimia is voluntary and intentional. Rumination syndrome patients are also frequently misdiagnosed as having Gastroesophageal reflux disorder (GERD). GERD is when stomach acid backs up into the esophagus and mouth. With rumination syndrome, solid food and/or liquid, that one just ingested, is regurgitated. The time span is different with these two disorders. Regurgitation, as a result of rumination syndrome, occurs shortly after eating, usually within 30 minutes to an hour of eating or drinking something. Acid reflux from GERD occurs hours after eating. Another difference is that GERD responds to medications, whereas rumination syndrome does not respond to any medical treatments.

There is a lot of misinformation about rumination syndrome. It is frequently reported to be most common in mentally handicapped people. My experience, and that of my collaborating gastroenterologist, has been that most of our patients are normal functioning individuals, who may have some stress-related factors, or may have no emotional factors at all contributing to their symptoms. My experience in treating numerous patients with rumination syndrome is that the main contributing factor is hyperventilation. Hyperventilation is either the result of rapid or thoracic breathing, as opposed to slow relaxed diaphragmatic breathing. Another contributing factor is rapid eating. Sometimes what I have observed in patients, with rumination syndrome, is that they eat too fast, swallowing without fully chewing their food and not taking breaths in between swallowing food and liquids.  Some patients with rumination syndrome have underlying medical conditions such as hiatal hernia. For most patients, rumination syndrome is probably the result of unconscious learning.

There is a very simple behavior modification treatment available for rumination syndrome. It involves slow relaxed diaphragmatic breathing. You will know you are breathing diaphragmatically if your stomach rises as you inhale and flattens as you exhale. A good way of checking this out is by lying down on your back with a book, or a box of tissues, on your stomach. As you inhale make the book, or box of tissues, rise as you inhale, and lower as you exhale. Try to minimize or eliminate thoracic breathing. Thoracic breathing is chest breathing. You will know you are engaging in thoracic breathing if your chest is rising, instead of your stomach, when you inhale. So, keep your chest flat as you inhale and exhale. All of the movement should come from the abdomen. If possible, breathe in and out through your nose. Try to breathe at a rate of four seconds to inhale and four seconds to exhale.

The first step is to practice and master the diaphragmatic breathing under ideal conditions; alone, without distractions, lying down. Practice it for two minutes at a time, twice a day under the ideal conditions. After you can breathe diaphragmatically lying down, the next step is to practice breathing diaphragmatically sitting upright. This step is harder because our stomach is naturally more constricted in the sitting position. This may be the reason why people learn bad breathing habits in the first place. Thoracic breathing (chest breathing) is easier than diaphragmatic breathing when in a sitting position. What can make it even worse is if you have a tendency to lean forward, you will constrict your diaphragm even more.  So, make sure you sit upright when are eating.

The next step is to apply diaphragmatic breathing to eating and drinking. This will take conscious effort and attention at first, until you practice it enough. Eventually it will become more natural and easy. Before eating or drinking, while seated at the table, start with a few slow diaphragmatic breaths. Then start to eat. Eat slow, chewing your food fully.  After you swallow, breathe diaphragmatically. Do the same after every swallow of food and liquid. When you complete the meal, take a few slow diaphragmatic breaths before leaving the table.

You should start to see results fairly quickly. The success rate of this simple behavior modification technique is 80- 90%. If you have trouble in controlling the regurgitation, despite using the technique, contact a gastroenterologist. It would be a good idea to contact a gastroenterologist anyway, as a first step, if you have digestive system symptoms. After medical consultation and if you still need help with rumination syndrome, consult a professional with expertise in treating rumination syndrome behaviorally.

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Steps to Overcoming Aerophagia

Monday, 13. August 2012 1:00 | Author:

Steps to Overcoming Aerophagia

William L. Golden PhD

In order to overcome Aerophagia we first have to understand what it is. Aerophagia is also known as air swallowing, a gastrointestinal disorder where patients have excessive gassiness and belching as a result of swallowing too much air when eating, drinking, talking or in general. Aerophagia patients are sometimes misdiagnosed as having Gastroesophageal reflux disorder (GERD). GERD is when stomach acid backs up into the esophagus and mouth. Sometimes belching accompanies acid reflux.

My experience in treating numerous patients with Aerophagia is that the main contributing factor is hyperventilation. Hyperventilation is either the result of rapid or thoracic breathing, as opposed to slow relaxed diaphragmatic breathing. Another contributing factor is rapid eating. Sometimes what I have observed in patients with Aerophagia, is that they eat too fast, swallowing without fully chewing their food and not taking breaths in between swallowing food and liquids.  For most patients, Aerophagia is probably the result of unconscious learning.

There is a very simple behavior modification treatment available for Aerophagia. It involves slow relaxed diaphragmatic breathing. You will know you are breathing diaphragmatically if your stomach rises as you inhale and flattens as you exhale. A good way of checking this out is by lying down on your back with a book, or a box of tissues, on your stomach. As you inhale make the book, or box of tissues, rise as you inhale, and lower as you exhale. Try to minimize or eliminate thoracic breathing. Thoracic breathing is chest breathing. You will know you are engaging in thoracic breathing if your chest is rising, instead of your stomach, when you inhale. So, keep your chest flat as you inhale and exhale. All of the movement should come from the abdomen. If possible, breathe in and out through your nose. Try to breathe at a rate of four seconds to inhale and four seconds to exhale.

The first step is to practice and master the diaphragmatic breathing under ideal conditions; alone, without distractions, lying down. Practice it for two minutes at a time, twice a day under the ideal conditions. After you can breathe diaphragmatically lying down, the next step is to practice breathing diaphragmatically sitting upright. This step is harder because our stomach is naturally more constricted in the sitting position. This may be the reason why people learn bad breathing habits in the first place. Thoracic breathing (chest breathing) is easier than diaphragmatic breathing when in a sitting position. What can make it even worse is if you have a tendency to lean forward, you will constrict your diaphragm even more.  So, make sure you sit upright when are eating.

The next step is to apply diaphragmatic breathing to eating and drinking. This will take conscious effort and attention at first, until you practice it enough. Eventually it will become more natural and easy. Before eating or drinking, while seated at the table, start with a few slow diaphragmatic breaths. Then start to eat. Eat slow, chewing your food fully.  After you swallow, breathe diaphragmatically. Do the same after every swallow of food and liquid. When you complete the meal, take a few slow diaphragmatic breaths before leaving the table.

You should start to see results fairly quickly. The success rate of this simple behavior modification technique is 80%. If you have trouble in controlling the belching, despite using the technique, contact a gastroenterologist. It would be a good idea to contact a gastroenterologist anyway, as a first step, if you have digestive system symptoms. After medical consultation and if you still need help with rumination syndrome, consult a professional with expertise in treating Aerophagia behaviorally.

 

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Quit Smoking: How I Quit and Have Helped Others Quit

Monday, 13. August 2012 1:00 | Author:

How I quit smoking and have helped others quit

William L. Golden PhD 

I was a cigarette smoker for about 15 years.  To quit smoking cigarettes was much harder than I expected. I tried quitting “cold turkey” and failed. I finally succeeded soon after becoming a psychologist. I was then in a position to research and find the best method to quit smoking.

My research determined that there were mainly 3 approaches to treating nicotine addiction; behavior modification, cognitive-behavior therapy and hypnosis. At that time, these 3 approaches were not yet integrated. Research investigations on each method showed some degree of success. Each method by itself had its strengths as well as its limitations. What I discovered through my experimentation on myself was that the most effective treatment to quit smoking is the combination of hypnosis, behavior modification and cognitive-behavior therapy. I employed all three methods on myself, have helped many patients with the same methods and have written and published my work. My published work is listed in the References (See my chapter that I coauthored with Fred Friedberg and my book that I coauthored with Tom Dowd and Fred Friedberg).

I used self-hypnosis and cognitive-behavior therapy for motivation, stress-reduction and for reducing craving. I used several behavior modification techniques. “Wrapping,” logging, or self-monitoring  involves monitoring your smoking, keeping track of each cigarette you smoke, identifying the “trigger,” and noting the time and place. It’s called “wrapping” because the paper on which you are recording this information is folded and wrapped around the cigarette pack, kept in place with a rubber band. Before you smoke a cigarette, you record your information. A delaying strategy is inherent in the unwrapping-logging-wrapping process, but additional delaying is involved. The delaying is systematic and progressive. First, as a result of self-monitoring, you are made aware of the various triggers that are associated with smoking. Some of mine were the wake-up cigarette, the waiting cigarette, the frustration one, the after meal one, the one with coffee, the cigarette while watching TV, the phone cigarette, etc.

Next you rank order how hard each one would be to eliminate and start with the easiest ones. You start to delay smoking the easy ones for 15 minutes. That means you wait 15 minutes before lighting up.  The rationale for delaying is to weaken the connection between the triggers, or “cues” for smoking and the act of smoking. The term for this technique is called “cue cessation.”  In addition, the delay gives you some skill at resisting giving into the urge to smoke. Some might call that “willpower.”

During the delay, coping strategies are used to get you through the wait. Delaying is easier to handle when you are using relaxation techniques, self-hypnosis, distraction or coping thoughts. Check out my other articles on this website that will teach you these skills. Most of my patients have found the most helpful tool to be the breathing techniques that I describe in my article on Cognitive-behavior therapy. My experience was the same. I found that diaphragmatic breathing reduced my craving better than any other method.

When you can delay smoking for 15 minutes in response to the easy triggers, you are ready for the next step on the road to quit smoking. The next step is to delay the easy ones for 30 minutes and start delaying some of the harder ones for 15 minutes. When you can delay them, you are ready to increase the delays to 45 minutes and eventually an hour. You progress at your own pace.

All of the delaying will result in less cigarettes and increased confidence in your ability to quit smoking. When you feel ready, you set a quite date. Pick one that involves a relatively low stress period. Try to avoid setting a quit date that puts you in the middle of tough times. If you have trouble with quitting on your quit date, be kind to yourself. Maybe you need more time, or medications to help you, or some professional help.

Create a list of reasons why you want to quit smoking. Use positive wording. Better to say “I want to be healthy” rather than “I don’t want to get cancer.” Review your reasons for quitting whenever you need a boost of motivation. Remind yourself of your reasons for quitting when you feel yourself weakening or when you feel craving.

Try to feel good about whatever progress you make.  Sometimes we need to go through this process of quitting several times before we eventually succeed. That’s what I experienced when I quit smoking.

References

Golden, W.L. (1983). Rational-emotive hypnotherapy: Principals and techniques.  British Journal of Cognitive Psychotherapy, 1, 47-56.

Golden, W.L. (1994). Cognitive-behavioral hypnotherapy for anxiety disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 8, 265-274.

Golden, W.L. (2012). Cognitive hypnotherapy for anxiety disorders. American Journal of Clinical Hypnosis, 54, 4, 263-274.

Golden, W.L., Dowd, E.T., & Friedberg, F. (1987). Hypnotherapy: A modern approach. New York: Pergamon Press.

Golden, W.L. & Friedberg, F. (1986). Cognitive behavioural hypnotherapy. In W. Dryden & W.L. Golden (Eds.), Cognitive-behavioural approaches to psychotherapy (pp. 290-319). London: Harper & Row.

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Trouble sleeping: 7 Guidelines for Getting Better Sleep

Monday, 13. August 2012 1:00 | Author:

Trouble sleeping? Follow these 7 guidelines for getting better sleep

William L. Golden PhD

1. Usually, avoid using your bed for wakeful activities such as reading or watching television. However, if reading or watching television has helped you to sleep in the past, you may continue to use them.

2. Lie down in bed only if you are sleepy.

3. Feel free to use relaxation techniques. Relaxation techniques can help you to get into a state that is conducive to falling asleep. But, since one cannot force sleep, don’t try to use the relaxation techniques to make you go to sleep. No matter what method you use, the harder you try to go to sleep, the more you will stay awake. Just focus on feeling relaxed.

4. If you start to toss and turn in bed or get anxious, get out of the bed and go into another room. Do anything you want that is pleasurable, relaxing or constructive. Stay up until you feel sleepy and then return to the bedroom.

5. If you still have trouble sleeping, get out of the bed and repeat step 4.

6. Set your alarm and get up the same time as you normally would each morning, regardless of how much sleep you got. This will help you to develop an internal clock that will eventually lead you to feel sleepy at bedtime.

7. Do not nap during the day, as that will interfere with your development of an internal clock. Developing an internal clock will eventually lead to you getting better sleep.

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