28th March 2023 Newsletter
Welcome to the second newsletter for March 2023. We have a lot to share with you today: a new series alert, a brand new ‘All-or-nothing thinking’ resource, and a reminder of our two free audio tracks for developing compassion.
In our research roundup, we highlight a recent paper which argues that intolerance of uncertainty is a form of somatic error, arising from a cognitive appraisal of an internal feeling. We also look at a pilot study which challenges the necessity for exposure to traumatic memories in the early stages of treatment for PTSD. Enjoy!
New Series Alert – Cognitive Distortions
Identifying cognitive distortions and reappraising biased thinking is a core element of traditional CBT. Recognizing the presence and nature of biases is a useful way of introducing this concept – clients are often quick to identify with the concept of ‘unhelpful thinking styles’ and to recognize their habitual biases.
We are putting the final touches on a new series covering 21 of the most clinically-relevant cognitive distortions. It’s designed to help clients and therapists work more effectively with common thinking biases through a combination of psychoeducation and practical elements. This series will be available to all members with a paid account, whether you have a Basic, Advanced, or Complete membership plan.
As an introduction to the series, we are releasing the first resource, which focuses on this very common cognitive distortion. The handout includes an introduction to thoughts and biases, a client-friendly description of all-or-nothing thinking, and a selection of the most effective techniques for addressing it. You can also download this resource with therapist guidance, which contains practical instructions, prompts, and everything else you might need to work effectively with clients who see things in all-or-nothing terms.
Works Well With
Evaluating Unhelpful Automatic Thoughts
The Evaluating Unhelpful Automatic Thoughts guide is the ideal companion to the cognitive distortion series. Written for clients who struggle with negative automatic thoughts, it provides a comprehensive introduction to what thoughts are, and how they can be linked to feelings and behavior. It also teaches fundamental CBT skills, including how to identify and evaluate automatic thoughts.
Free Audio Tracks
Compassion Focused Therapy Audio Tracks
We recently released two free audio tracks in anticipation of the launch of our Compassionate Mind Training (CMT) audio collection with Dr Chris Irons. The first of these is an introduction to core principles of CMT, and the other is based around cultivating a compassionate tone of voice when engaging in self-talk. For a limited time only, you can download both tracks without an active subscription.
The Somatic Error Theory of Intolerance of Uncertainty
This is a great paper from Mark Freeston & Jessica Komes describing their somatic error theory of intoleranace of uncertainty (IU). They propose that IU is a mechanism leading to various forms of distress. But what is intolerance of uncertainty? Freeston & Komes describe IU as a ‘felt sense’, arising from a cognitive appraisal of an internal feeling, drawing upon the somatic error hypothesis of anxiety to understand IU, and to make a number of predictions for further research.
Although many interoceptive processes can and do happen below our awareness threshold and thus drive decisions and behaviours subconsciously, there are instances in which an interoceptive signal automatically captures awareness. Interoceptive signals can be (deliberately) attended to and serve as a source of information.
[According to the] somatic error hypothesis of anxiety (Khalsa & Feinstein, 2018) ... anxiety is seen as the result of the discrepancy between the anticipated or predicted and the actual body state. Whereas small discrepancies or somatic errors are both normal and needed in order to improve future predictions and optimise self-models, large mismatches between actual and anticipated body state, require corrective action in order to decrease the discrepancy. If interoceptive processes are already dysregulated, the attempt to reduce a somatic error often results in symptom amplification across a number, if not all mental health disorders.
A situation involving some unknown-ness, elicits (or is accompanied by) an interoceptive percept, or somatic discrepancy ... experienced with a sense of un-ease to capture attention, thus enabling an orienting response to possible unsafety with the potential for adaptive behaviour. Some people may be intrigued by and even encouraged to engage with the bottom-up felt sense of ‘not knowing’. It may then be experienced as an opening into a new space, unexplored territory, with the potential for possibility and fresh choices – inviting creativity and new ways of being in the world ... Other people, especially those with longstanding difficulties characterized by anxiety, may conclude that the signal and concomitant appraisal communicates that “something must be wrong”.
Freeston, M., & Komes, J. (2023). Revisiting uncertainty as a felt sense of unsafety: The somatic error theory of intolerance of uncertainty. Journal of Behavior Therapy and Experimental Psychiatry, 79, 101827.
Early Intervention in PTSD Without Exposure to Trauma Memories
A fascinating pilot study from Graham Thew, Jennifer Wild & Anke Ehlers has just been published in The British Journal of Clinical Psychology. Conventional wisdom often holds that effective treatment for PTSD should involve direct work with trauma memories, but this study with clients who had experienced recent trauma instead focused on modules of psychoeducation, ‘reclaiming your life’, and trigger discrimination. The protocol was for six sessions of therapy to be delivered by the internet, with brief weekly calls from a therapist.
For reclaiming your life, the findings suggest it may have allowed participants to stop and review how things may have changed since the trauma and crucially to regain a sense of control over their activities and begin to reestablish a normal routine. ... For trigger discrimination, it appeared that the early implementation of this technique was highly valued by participants, in that it gave them a tool to cope in the face of trauma reminders.
Thew, G. R., Wild, J., & Ehlers, A. (2023). Early intervention in post‐traumatic stress disorder without exposure to trauma memories using internet‐delivered cognitive therapy: A pilot case series. British Journal of Clinical Psychology.