Cognitive-Behavioural Therapy (CBT) is a short-term form of behavioural therapy. It focuses on the relationship between beliefs, thoughts, feelings and behaviours. The assumption behind CBT is that by changing one corner of the triangle, you can change the other corners of the CBT triangle (see image below). For example, by changing the thought you have in a situation you also can change the emotion and behaviour you have in that situation. In cognitive behaviour therapy, there is awareness brought to the pattern of thoughts or emotions and then there is an effort to change that pattern. This is done with short manageable goals.
CBT can be used to better manage and cope with chronic conditions such as Chronic Pain, Chronic Fatigue Syndrome, Diabetes, and Irritable Bowel Syndrome.
CBT has been found to be effective for:
Depression
Anxiety
Mood Issues
Post-traumatic stress
Obsessions and compulsions
Chronic fatigue syndrome (CFS)
Irritable bowel syndrome (IBS)
Chronic Pain
Sleep Issues
Phobias
Disordered eating
Substance dependency
Sexual issues
Anger management
It can be very effective to lessen the suffering of people who have negative thought patterns or are prone to anxiety. It complements other modalities as well.
This is the website of the institute of one of the biggest influencers of Cognitive Behaviour Therapy. This website has a lot of information about CBT, possible trainings, and other resources.
Mind Over Mood – Christine A. Padesky & Dennis Greenberger
This is a great book on how to use CBT to improve the quality of your life by changing your thoughts and emotions. It has worksheets included with the book and has step-by-step plans that you can use.
Emotional Neglect is not about what happened to you but what did not happen. It is about your parents or caregivers not adequately responding to your emotional needs. This can happen from a parent having unrealistically high expectations and not listening attentively to invalidating a child’s emotional experiences to the point she/he feels self-doubt. Most of the time, it is not intentional. There are a lot of parents who do not adequately respond to their children’s emotional needs because their parents did not respond to their needs, trauma got in the way of their emotional development, or they got too busy or exhausted to be able to respond adequately to their children’s emotional needs.
In emotional neglect, children learn that their feelings are not important. With childhood emotional neglect the Amygdala (part of the brain that has a primary role in memory processing, decision making, and emotional responses) becomes bigger and more reactive. Emotional neglectful families often look normal, but members of the family may not receive the aspects of family that allow children to develop properly, this can result in:
Depression
Anxiety
Insecure-avoidant or disorganized attachment patterns
Failure to thrive; poor academic performance
Aggression
Low self-esteem, low self-compassion
Apathy
Hyperactivity; disruptive & impulsive behaviour
Developmental delays
Substance misuse and risky behaviour; suicide attempts
Withdrawing from friends and family; anger towards parent; negativity during parent-child interactions
Appearing uncaring or indifferent
Shunning emotional closeness or intimacy; poor peer relationships and the avoidance of interaction with other children; significantly less positive social interaction
Self-blame, shame, humiliation, feelings of worthlessness
Less emotional knowledge; difficulty recognizing angry faces
Some effects of childhood neglect in adulthood include:
Post-traumatic stress disorder (PTSD)
Emotional unavailability, numbing out, or being cut off from one’s feelings; difficulty identifying or expressing feelings
Shunning intimacy
Depression
Feeling empty or hollow inside
Poor self-discipline
Anger and aggressive behaviours towards self or others
Difficulty trusting others or relying upon anyone else; trouble asking for help or support
Feeling deeply, personally flawed; hiding behind a mask; disconnected from self
Guilt and shame; easily embarrassed
Feeling like there’s something missing, but not sure what it is
Easily overwhelmed or discouraged; frequent feelings of worry, excessive fears, and dissatisfaction
Perfectionism with acute sensitivity to feelings of failure
Pronounced sensitivity to rejection
Lack of clarity regarding others’ expectations and your own expectations for yourself
Feel the need to people please
Lack of ability to empathize
Blame, judgmental, and critical towards self or others
Please note that the effects of emotional neglect can range from mild to severe and you might only have some of the previously noted effects and symptoms.
What can you do to recover from Emotional Neglect?
Work on emotional intelligence
Become aware of your emotions as you are experiencing them
Listen to music or watch TV shows/films that expose you to more emotions and become aware of how you feel watching/listening to the music/TV show/film
Identify your needs and take steps to meet them.
Check the Facts on any beliefs that you are not good enough, you don’t deserve to have your needs met, and/or you can’t trust anyone.
Be gentle with yourself. Know that the patterns took years to establish so it will take time to change them.
Know that you are a unique, beautiful person but you just cannot feel it because you have either not learned to connect with that part of you or you have not had that belief instilled in you.
Further Reading or Activities
Dr. Jonice Webb – Running on Empty
Running on Empty is a good book for describing how emotional neglect happens and what it is like. It can be a very validating book for people who have been emotionally neglected in childhood.
Eye Movement Desensitization and Reprocessing (EMDR) therapy was developed by Francine Shapiro and is a body-mind integrated therapy that has been proven to be highly effective for people who have experienced trauma. It was founded on the basis that trauma interferes with the brain’s processing and that during trauma, our brain processes and stores memories incorrectly. This incorrect storage makes it so that past events seem to be in the present. These memories can be triggered by emotions, negative cognitions, and physical sensations.
EMDR uses bilateral stimulation (eye movements, tones, or taps) to access memory networks in order to move them from a place of emotional activation to a more rational, logical place.
EMDR is an effective, evidence-based form of treatment for Post-Traumatic Stress Disorder (PTSD) and is recognized for its effectiveness by the American Psychiatric Association, the Department of Defense and Department of Veterans Affairs (US), and the World Health Organization. With EMDR, it is not necessary to discuss the details of a traumatic experience.
EMDR can be used for more than just PTSD, it can be used for:
Anxiety
Panic attacks and phobias
Depression
Chronic Pain
Substance Dependency
Various kinds of trauma (intergenerational, developmental, etc.)
Abuse and Assault (Physical, Emotional, and Sexual)
EMDRIA is the international association for EMDR. It has guidelines for official trainings, reports on EMDR research, explanations of EMDR, as well as a place to look up EMDR trained therapists.
Getting Past Your Past – Francine Shapiro
This is a great book for people who aren’t mental health professionals. It has good explanations about trauma, EMDR, and techniques to use for trauma.
Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan at the University of Washington while trying to find an effective treatment for suicidal and borderline personality disorder patients. She started with Cognitive Behaviour Therapy but found that it was lacking in certain areas, so she added aspects to the treatment and made changes to improve treatment results. This resulted in what is now known as DBT. Some of the changes she made were a balancing act between acceptance and change, adding validation, mindfulness, and interpersonal skills.
The focus of DBT is to “build a life worth living” and it is a collaborative type of therapy where the therapist and the client work together to enable the client to build a better life through collaboratively decided goals, therapy techniques, and skill-building.
Behind the DBT is biosocial theory, which believes that invalidating environments are at the root of emotional dysregulation. Emotion dysregulation involves being emotionally sensitive and emotionally reactive and having a slower return to baseline. There are several reasons for emotion dysregulation, such as biological disposition, attachment problems, loss, trauma, and invalidation. When people have frequent prolonged intense emotional reactions, they tend to create neural pathways that are sensitized to these types of reactions. These reactions can become more automatic as time goes on. The emotional reactions can become more and more intolerable as time goes on it can become more difficult to cope with them and choose effective behaviours to deal with them. DBT can help point clients in the right direction of choosing better behaviours to deal with intense emotions and learn how to tolerate them.
DBT works by moving back and forth between acceptance and change. It validates your past experiences yet encourages you to move forward. It offers skills that you can learn to deal better with the world around you and better manage your emotions. These are often skills that people who grew up in supportive environments learned, but people who grew up in less supportive environments did not learn or have deficiencies in their skills.
The skill-building in DBT can really help people to be able to better cope with their emotions, tolerate distress, improve their relationships, and better understand how they can improve how they feel about life. I find this modality really works well with people who have had emotional neglect or developmental trauma because it focuses on the skills that were neglected in their childhood. There are other modalities that work well with the actual inner wounds from childhood, so this form of therapy works well complementing those.
Trauma is what happens when the nervous system gets overwhelmed. When the nervous system is overwhelmed, things (emotions, thoughts, self-beliefs, etc.) do not get stored in the brain properly, and everyday things trigger them to manifest like they are happening in the present when the emotion, physical sensation, and/or perception is actually coming from the past.
Traumatic memories are “less likely to be recalled in a clear, coherent narrative” and more likely to be “remembered in the form of sensory elements without words, ” such as emotions, changes in breathing or heart rate, body sensations, tensing, or feelings overwhelmed (Fisher, 2021).
Trauma can be very individual and unique. So what works for one person may not work for another. It should involve both top-down (thinking/brain-based strategies) and bottom-up (somatic/body-based) strategies. There are some strategies like EMDR that involve both top-down and bottom-up strategies that have evidence to work for different types of trauma.
The problem with top-down approaches (CBT, some DBT skills) is that they don’t work when someone is hyperaroused or hypoaroused because when you are in those states, you cannot think properly. If someone is hyperaroused or hypoaroused they need to come back to a place where they can think clearly before using these skills. These skills can be useful to people who have been traumatized but they need to be used at the right times and be complemented with bottom-up strategies.
Recommended Reading
Peter A. Levine – Healing Trauma
This book has a good summary of trauma plus it comes with a CD that has 12 Guided Somatic Experiencing exercises.
Bessel Van der Kolk – The Body Keeps the Score
This is an incredible book that describes the experience of trauma, how trauma affects the brain, and different treatments for trauma that have been successful. Bessel Van der Kolk is one of the top experts in trauma. This book has been an NYT bestseller and can probably be borrowed from your local library.
Transforming the Living Legacy of Trauma – Janina Fisher
This is an incredible workbook that has the essential psychoeducation about trauma as well as step-by-step strategies to start to heal the trauma and cope better with triggers. Janina Fisher is one of the top experts on trauma.
There are many definitions for Chronic Pain, but essentially it is pain that remained after an injury is healed or should be healed. It is different from acute pain and needs to be treated differently. The nervous system is much more involved in chronic pain. Chronic pain is a holistic condition and can be affected by many things, such as physical activity, problems within muscles and joints, nutrition, sleep, stress, temperature, past trauma, emotions, and thought patterns.
Chronic pain is often increased or caused by an overactive nervous system. The body uses pain to alert you to danger, but for many with chronic pain, the alert system is extra sensitive and either overreacting to stimuli (intense pain from stepping off a curb) or reacting to stimuli that are not dangerous (seam of pants rubbing against leg with no skin damage). With Chronic Pain, a person often has to pace themselves and plan ahead to avoid pain increases.
How can counselling help with Chronic Pain?
Counselling by helping a person figure out how to cope with the pain, plan strategies to minimize pain increases, figure out priorities, change thought patterns, identification of the cause behind pain increases, manage emotions, create boundaries to better manage pain, learn skills to help them communicate their needs, and find validation for the struggles with chronic pain.
Pain BC is a non-profit based in BC. It is has a huge number of resources for self-management of pain, education opportunities for health professionals, and supports for those with chronic pain. It is a truly amazing website to support those with chronic pain.
Tame the Beast is a website that is a collaboration between a pain scientist (LM), a pain physiotherapist (DM) and a professional communicator (SC). It shares a number of pain stories as well as providing pain education.
Pain Revolution is an Australian website that has a lot of information for pain education, as well as handouts explaining pain. It has a good number of resources on it.
Chronic Pain Centre of Excellence for Canadian Veterans is has monthly webinars about chronic pain, resources for those with chronic pain and those supporting those with chronic pain.
Further Reading
Rethink Chronic Pain – Dr Gaetan Brouillard
Rethink Chronic Pain is a book written by Dr Gaetan Brouillard, who is a Pain Specialist based in Montreal. This book takes on a multifaceted approach to pain including an explanation of pain, the biological and environmental causes of pain, nutritional influences of pain, natural supplements for pain, ways to treat pain through complementary health approaches (reflexology, acupuncture, etc.), and psychology.It is great in offering some ideas of what next to try and educating on what could be going on with your pain situation.
Change Your Brain, Change Your Pain – Mark Grant
Mark Grant is a Psychotherapist that has specialized in EMDR treatment of chronic pain. This book is great of educating the reader on the connection between chronic pain and trauma. It also offers 15 audio downloads that readers can use to help heal their pain. Headphones are required to get the most out of the audio tracks as they are set up for bilateral stimulation (different sounds to each ear). There are a number of tracks that are set up for using with a trusted partner, for those tracks you may not get as much out of the experience if you don’t have a trusted partner.
Explain Pain – David S. Butler & G. Lorimer Moseley
Explain pain is an excellent book by one of the top researchers in chronic pain. It does a good job on explaining the mechanisms behind chronic pain and what adjustments a person with chronic pain can make to reduce their level of pain.
Madeleine Eames is a psychotherapist and mindfulness teacher in Kelowna, BC and has many videos about the chronic pain and psychological and mindfulness resources.
Leona Westra, RCC 