COGNITIVE-BEHAVIORAL THERAPY FOR BDD: OTHER POTENTIALLY HELPFUL CBT TECHNIQUES – ACTIVITY SCHEDULING AND SCHEDULING PLEASANT ACTIVITIESActivity Scheduling: This approach is often used in the treatment of depression. It consists of scheduling activities throughout the day by writing them down in an appointment book and then doing them. This approach doesn’t directly target BDD symptoms, but it minimizes idle time, leaving less time for BDD obsessions and rituals. It can also improve your mood. Activity scheduling may be especially useful for people with severe BDD and depression who find it hard, for example, to even get out of bed.Scheduling Pleasant Activities: This approach is similar to activity scheduling. It consists of scheduling and then doing pleasant and enjoyable activities—ideally every day. This technique, too, can minimize idle time, so there’s less time available for BDD obsessions and rituals. It can also improve your mood.Some people find that additional techniques may also be helpful for them, such as relaxation techniques (like deep breathing, progressive muscle relaxation, or meditation). Other people find it helpful to learn assertiveness training or how to accept compliments.*327\204\8*

The most important hurdle is to identify why you cannot sleep. Is it stress? Is it situational insomnia? Is it pseudo-insomnia? Knowing the cause of your insomnia is half the battle. Since it is impossible for me to identify the cause for you, it is important that you read the rest of the book, which discusses all aspects of sleep, including normal sleep pattern, your expectation of what is a good night’s sleep, common causes of insomnia.

From my experience, over 50 per cent of the general population who are taking sleeping pills are in fact suffering from pseudo-insomnia. ‘Pseudo’ means imposter. These people are healthy and normal in all other aspects; they have just lost the confidence to sleep. They may have some false belief of what is normal good sleep, and for some reason have become dependent on drugs to help themselves sleep. We all have a natural in-built mechanism in our brain that controls our sleep. Pseudo-insomniacs are unable to operate the natural in-built mechanism inside their brains and so cannot switch off at night and fall asleep. It was said that Elvis Presley had pills to make him sleep and pills to wake him up.

*88\174\4*

You may say to yourself, “I am not a religious person, so this section does not concern me.” But the idea which I wish to discuss is religious in the widest sense, and applies to us all. It is like this. We have within us a number of very simple, primitive ideas which form a basis of our conduct of life as humans. Our sense of right and wrong is one such idea. The question of the origin of these ideas is beyond our present study, but they are ideas that are common to people of all religions including atheism. The particular idea that concerns us now is the feeling that sin is punished. I have referred to this as a- feeling, because, with many of us, it is vague and

ill-formulated, and is never really thought of in clearly logical terms. In fact, when we come to examine the idea logically, we are inclined to think that it is not sensible, and that we never really held such an idea. But it is there within us just the same. Our wickedness is punished. Wrongdoing brings pain. Then when we suffer pain, we think back, and ask ourselves, “What have I done wrong?” The idea is reflected in the expression which all doctors hear every day, “But what have I done to deserve this? Why should this happen to me?”

*110\57\2*

Incompatible workmates

“It is just that we are different. Not really one of them. And it makes things difficult. It’s there all the time. Ill at ease with them, when there is really no need to be.”

Cultural differences may make it hard. The individual from a disadvantaged home background may feel out of it with the others.

Even differences of interest can have the same effect. If the talk is all horses, or football or golf, and those are not our interests, we are not at home in that milieu, and that feeling of fellowship, which binds workmates, one to the other, eludes us. Our brain is crowded with trivial but disturbing thoughts which form a background on which any major problem, at home or elsewhere, can easily produce stress.

The individual who, by the advent of circumstance or by active endeavour on his own part, has learned something of inner security does not suffer in this way. And this same inner security of the individual allows his companions to be more at ease and more friendly towards him.

The difficult boss

“It’s not that I don’t like him. He is decent enough in his way. But he drives me mad. He has no idea, no idea at all, that I feel like this. He would be terribly shocked to know it. Supervises everything I do. Checks over the simplest things. Feel I could tell him to get on with his business, and leave me to mine. Bottle it up. Then some small thing upsets me at home and I blow up.”

This story is common enough. Maybe you are personally familiar with it. He only needs some real problem in any field of life, and the additional input to his brain will bring him properly under stress.

Some people tolerate discipline and unnecessary supervision without the situation adding in any way to the inflow of disturbing impulses to their brain. Others are psychologically intolerant of such a situation. This occurred in its simplest form among recruits in the armed forces during World War II. Some adjusted easily, some did not. Those who have had little discipline or supervision in their early home life are likely to find it difficult. So also are those who have been brought up strictly in a highly disciplined household. They reach adult life and have the feeling they have left all that behind. The strict boss reactivates their memories of childhood. They feel they are being treated like children, and they have to contain the aggression which the situation arouses.

Unfortunately, the individual’s knowledge of the cause of his reaction is little help in coping with the circumstances in which he is placed.

The cloak that protects us from the chill wind of stress must be tailored to our own individual needs. The first step is to get rid of the tension. And this is not as difficult as you might think. Five or ten minutes effective meditation in the morning will make an extraordinary difference.

*4/98/5*

The word technique

The first meditation technique I will discuss is derived from a yoga discipline called mantra yoga. While hatha yoga uses breathing and physical exercise to enter the meditative state, mantra yoga uses a mantra—a sound or a devotional word or phrase which we silently repeat to ourselves. ‘Om’, which is spelt ‘aum’, is a mantra most of us have heard of.

The Western adaptation of mantra yoga uses a word instead of the traditional mantra. This meditation technique involves the silent repetition of a word to focus our minds on. This technique is not used in conjunction with a breathing technique. All it involves is the repetition of a word.

Choosing a word

What word to use is a matter of individual choice. As a general guide, make sure the word is short. Some people use ‘still’ or ‘hush’ or, depending upon the person’s religious background, they may choose a word which has a deeper meaning for them. Dr Benson (1975) in The Relaxation Response uses the word ‘one’. Other people use nonsensical words which have no meaning at all.

Choosing a mantra

There is no harm in deciding to use a mantra. ‘Aum’ is the best-known mantra and has been translated as meaning ‘the sound of

the universe’. Two other well known mantras are ‘sharma’, which has been translated as meaning ‘quietude’ or ‘shantih’, meaning ‘peace’ or ‘calm’.

I have found it better to stay away from English words such as ‘peace’ or ‘calm’. We have so many negative associations with these words: ‘Calm down’, ‘Why can’t I get any peace?’ that we may have difficulty in meditating.

The word, or mantra, is used as a focal point during the meditation. As our practice continues we become conditioned to our word or mantra, and over time the word or mantra becomes associated with the deeper levels of meditation. This makes our practice of meditation easier, because the word or mantra will take us directly to the deeper levels of meditation without us having to go through the preliminary stages.

This is why it is better not to continually change the word or mantra. Changing it can lead to frustration with the whole process. We need to become relaxed, not frustrated.

The only exception to this is when a word, mantra or even an image comes spontaneously during the meditation session. If this happens, then use that word, mantra or image. Meditation teaches us in sometimes very subtle ways. It helps us get in touch with our real selves. The spontaneous rising of a word, mantra or image is part of this.

*70\94\8*

In the eastern traditions, open-eyed meditation is an advanced meditation technique, usually only taught to skilled practitioners (Brunton 1965). Yet many of us are unconsciously practising a similar method of ‘meditation’. In many cases we do induce a dissociative state and panic as the result.

Our self absorption can be absolute, and this self absorption is similar to other meditation techniques. We need to be aware that our self absorption can be significant enough to also induce dissociative states. Some people also report fluorescent lighting can also induce these states (Arthur-Jones 1994).

Dissociation can also occur when we begin to relax. In contradiction to the prevailing thought that when we relax we have more time to think about our symptoms, many of us actually dissociate as we relax and then become anxious and/or panic.

One such research paper, which links dizziness to deper-sonalisation, theorises that it is not so much what we are doing at the time we dissociate, ‘it is the magnitude of the change [of consciousness]…which is significant’ (Fewtrell et al 1988).

I, and other people who dissociate, have noticed some shifts of consciousness are accompanied by the ‘surge attacks’; along with a rapid beating heart; difficulty in breathing and dizziness. When we lose our fear of the dissociated state and the ‘surge’ sensations our heart rate and breathing can return to normal in a matter of seconds.

It is interesting to note, nocturnal panic attacks occur, as I have said, during the transition from stage two to stage three sleep. In other words, during a change in consciousness.

Our fear of the dissociated states will not only hold us in them, it will induce further symptoms. To end the dissociated state all we need to is to break our stare, blink our eyes and/or pull back from our deep self absorption. If we wake in a dissociated state it is simply a matter of being aware we are dissociating and giving ourselves a minute or so to let our consciousness return to its waking state. Or if it wakes, us in the middle of the night, we can just be aware we are dissociating and go back to sleep.

*54\94\8*

Darryl’s session with his psychiatrist had not gone well. What had started off as a normal session ended with the psychiatrist telling Darryl that as he had made so much improvement, his sessions could be cut back to once a month. Darryl knew he had made a mistake and he walked out of the psychiatrist’s office feeling totally devastated. What his psychiatrist didn’t know was that Darryl was in fact worse than when he first started seeing the psychiatrist. Two weeks ago Darryl had refused a promotion, as he was already having difficulty with his current job. He had begun to think suicide was his only solution. Darryl thought back to all the times when he wasn’t completely open with his psychiatrist. He hadn’t wanted to explain all the details of what he was experiencing, as he had never met anyone who really understood what was happening to him. He didn’t think this psychiatrist would be any different. Darryl was also afraid that if he told the psychiatrist everything, he would have been committed to a psychiatric hospital. Darryl wondered if he should ring the psychiatrist and explain everything, but felt too humiliated and ashamed.

*35\94\8*

Belinda

It was Saturday night and Belinda was at home with her parents. Her friends were out celebrating the end of their first year at university. They hadn’t been able to understand when Belinda pulled out of university during the second semester. She had always been a straight A student. Now she wasn’t doing anything at all. She refused all invitations to go out and stayed at home most of the time. She went out only occasionally with her parents. Her brother had told her friends that one of their parents had to be with her at all times because she was continually frightened of being alone.

Sam

Sam drove his truck out of the depot and onto the road that would take him to the freeway. He wiped the perspiration from his forehead. His hands were trembling. He had to keep going. This time he couldn’t go back to the depot and say he was sick. Once more and he knew he would lose his job. His stomach was churning. The further away he was from the depot the worse he became. All Sam wanted to do was go home. He didn’t know how much more he could take. Over the last twelve months he had stopped doing most of the things he used to enjoy, playing or watching sport, having a few drinks with friends or going for a drive with his family. Now he just stayed at home. It took all his energy just to get to work and get through each day.

*17\94\8*