Rationale and focus
The idea of a `diseased' brain and chemical imbalances as the cause(s) of mental health problems is often a puzzle to mentally ill clients, like nuclear physics to the general public. It is hard for them (or even for some profes- sionals) to understand what it means. As a result of not knowing what to do that could make a difference to their problems, they may develop feelings of helplessness and hopelessness, which can worsen their mental health problems.
They often `forget' that the brain can function as a centre for processing information or data and not just as a `complex factory' for making chemicals which are essential to a range of human activities, such as reasoning, analysing and muscular coordination. There is evidence to support the view that the way in which information is processed (positively or negatively; accurately or inaccurately) by the brain (e.g. the way we analyse information Drug treatments 95
or data) can affect the mood (good or bad), which can in turn affect how the brain works: processing information and making chemicals. It means that there is a reciprocal relationship between mood and the ways in which the brain works. In CBT terms, we have a choice of what to think (positive or negative; helpful or unhelpful) and that choice comes about because we have control over the way we think about things. Once clients understand that they have that choice too and learn to choose a more helpful or realistic way to perceive self, others and the world, it would surely have a bene®cial effect on how the brain works: making chemicals (Figure 10.2).
In using this technique, the therapist and the client can talk about the concept of choice in general, and then relate this concept to thinking, behaviour and mood. For example, do we have a choice of what to think and how to behave?
Making chemicals Mood/feelings Thinking Realistic (Logical, rational, philosophical) Negative Helpful Unhelpful Behaviours
Mood can affect chemical production
• Self-criticism • Approval seeking • Perfectionism • Procrastination Coping better in personal and interpersonal situations Maintain realistic thinking Feel better and in control Thinking even more negative Cause mood to go down
Process
Therapist: We all have a brain, including animals. Isn't it true? Caroline: Of course.
Therapist: How long have you been suffering from depression?
Caroline: Almost all my life. I have had three major episodes of depression. My mother also suffered from it, as did my uncle.
Therapist: How do you feel about it?
Caroline: I don't like it. In fact, I am frightened of it and hope that I will never have it again. But I just don't feel that I have control over it. Therapist: It is not good to suffer from it, especially when you feel that you do not have control over it. I can understand that feeling. Coming back to the brain, we all have one. What do you think the brain is for? Caroline: Oh. I don't really know. I know it is very important. Without it, we will die. My doctors said to me that my depression is due to chemical imbalances in the brain. It worries me and I don't know what it is and what I can do. I just feel so helpless.
Therapist: So the brain makes chemicals that are important to our mood ± such as your depression, isn't that so?
Caroline: True.
Therapist: What else is the brain for? Caroline: I don't know.
Therapist: How about thinking? Can we think? Caroline: We do, of course.
Therapist: Would you say that the brain is also for thinking, helping us to process information/data? For example, we look up a map to decide how to go from A to B, or we read instructions on how to operate a computer, a television or a washing machine.
Caroline: True.
Therapist: What would you say the brain is for? Caroline: Making chemicals and thinking.
Therapist: Absolutely. Do we have control over the quantity of chemicals the brain makes?
Caroline: No, I wish I had.
Therapist: Do we have control in the way we think about things? Caroline: Yeah. Oh. I suppose we have. Yes, we do have.
Therapist: Does it also mean that we also have choice in what we do? Caroline: Yes.
Therapist: Ask yourself: Do you have a choice about what to wear, where to go on holiday, what to buy in a supermarket, who you want to be friends with?
Caroline: Yes, sure.
Therapist: By the same token, we do have a choice in what we think and how we behave, don't we?
Caroline: Yes.
Therapist: In CBT terms, the way we think (positively or negatively; ration- ally or irrationally) can affect our mood, which in turn affects the functions of the brain. The brain is responsible for making chemi- cals and for thinking.
Caroline: Oh. I can see that my mood can be affected by my negative and irrational thinking. My doctors and family have been telling me this for years. But I did not know that the mood can also affect the way in which the brain works.
Therapist: Of course it does. For example, when you feel bad, how does it affect your thinking (or the way your brain works)?
Caroline: Even more negative and irrational.
Therapist: How about when you feel good and that you are on top of the world?
Caroline: Great, I feel more con®dent and my thinking is good.
Therapist: It is true that we do not have control over the quantity of chemicals the brain makes, but we do have control and choice over the way we think and behave. This means that we also have a choice over the way we feel. Logically, what does that imply about the amount of chemicals being made in the brain, when we feel good?
Caroline: It means that more chemicals can be made in the brain which in turn helps with the mood.
Homework
Caroline was asked to:
·
Keep a diary for a month on her mood relative to her thinking to see if there was a relationship between thinking and mood.·
Write a conclusion on the functions of the brain.Other techniques
Other relevant techniques include `Rewriting assumptions', `Daughter', `Acceptance' and `Read it out loud'.