Cocaine and the Brain

Cocaine is a very addictive stimulant drug made from the coca plant, it is believed to be more psychologically than physically addictive because of the chemical impact it has on the brain and the pleasure symptoms it produces. The cocaine produces very high levels of dopamine in the body, this impacts on the chemicals effect on the brain, too much dopamine builds up and stops the normal chemical communications in the body, the dopamine, doesn’t get correctly used or recycled producing the much desire symptoms, but also causing the brain to need more and more cocaine or dopamine to have the same impact, thus creating an addiction. The effects of cocaine use are alertness, feeing intensely happy and excited, increased confidence, extremely awake, increased attention and energy levels, increased sensitivity to sound, sight, and touch. It makes you chattier, at the top of your game, more animated, arrogant, agitated, restless, less hungry and sometimes an increased sex drive. It also makes you feel hot (increasing your body temperature), increase anger or irritability, anxious, paranoid, panicked, feel sick and makes your heart beat faster, it can slow down thinking and reaction times, plus making it harder to sleep. These effects last about 10 to 30 minutes depending on the ingestion method.

What Happens If You Do Cocaine Once: Side Effects & Risks

However, side effects can include heart attacks, stokes, headaches, convulsions, seizures, and mood issues. Physical issues due to the ingestion method can be loss of nose cartridge and loss of smell if snorted, lung disease and swallowing issue if smoked, hepatitis, HIV, ulcers, abscess if injected. The withdrawal or comedown effects include: Paranoid, Run Down, Depression, Anxiety, Fatigue, Trouble concentrating, Increased hunger, Cravings for the drug, Nightmares, Chills, Nerve pain, Muscle aches. Most effective treatment is detox or rehabilitation and counselling, there are currently no medical alternative replacement drugs to help with withdrawal as there are for heroin addiction.

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Heroin, Opium and the Brain

Over the next few weeks I will explore the impact of different drugs on the brain and body.

Heroin and Opium have almost identical affects on the brain and body during use and withdrawal because Heroin and Opium are both opioids made from the poppy plant. The slight difference is that heroin is enhanced in its impact on the body: “Heroin is a semisynthetic narcotic drug, which uses opium as the source of the narcotic during processing. Opium is converted into morphine, which is then synthetized into heroin. It is chemically changed and enhanced in a lab in order to increase the potency of its effects.”  (www. For this reason I shall discussed them both together.

Heroin Overdose | Signs, Symptoms & Risks of Heroin Abuse

They are highly addictive drugs often because of the euphoric feelings that result from there use, it is believed that they can become psychologically and physically addictive after just one or two uses. The pleasurable experience heroin and opium offers is a relaxed, happy euphoria that makes you feel warm and sleepy, some even say you get a brain fuzz and feel contentment. People report that they and the world slows down and they feel no pain (this is because the heroin blocks the pain receptors in the brain). However there is a side effect to these drugs that is deadly, because they depress the central nervous system and slow down the chemical messages in the body this leads to suppressed respiration rates, heart rate and blood pressure as well as making them sleepy some users fall into a coma and their breathing slows so much they stop breathing altogether and die. This overdose is common if users stop taking the drug for a few days, consistent use builds a tolerance to the drug, however, only a few days without it this tolerance is lost, so if they were to then take their usual dose they risk overdose, coma and death. Both the drugs, which are derived from the same source as morphine (medical use painkiller) bind to the receptors in the brain that feel pain but that also receive dopamine and other feel good chemicals. This means that more is needed each time as the receptors are full so the brain demands more and more of the drug to feel the same, it becomes physically addictive, however, this can be undone with a replacement drug and detox, but the psychological addiction of the feelings and reasons why someone became addicted can be tougher to deal with, therapy often helps to ease this issue. Not only do users feel cravings, muscle spasms, confusion and itching while they are taking heroin and opium they are at risk of serious blood poisoning and infections like HIV and sepsis, malnutrition, abscesses, lesions, dental and skin issues. It can also cause serious financial and social issues for the user who’s lifestyles often change focusing on nothing but the next fix, leaving them friendless, estranged from family, poor and with self-worth issues. Other issues occur during withdrawal from use, symptoms include: Nausea, Diarrhoea, Abdominal pain, Sweating, Shaking, Nervousness, Agitation, Depression, Muscle spasms, Bone pain, Cravings for the drug, Insomnia, Cold Flushes, Suicidal thoughts, Isolation. People use heroin or opium for many reasons but it is believed some are psychological such as Post Traumatic Stress, Anxiety, Depression and well as because it is part of the life style they crave, these issues will need to be dealt with as well as the withdrawal issues if the user is going to get clean of the drug. Another problem is that heroin and opium use can change the structure of the brain due to continued use.

Beautiful flowering poppy in green grass in field. (papaveraceae) Free Photo

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Avoiding Dependency in Therapy

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Previously I have written a brief explanation about emotional dependency and its symptoms in a relationship, I will now explore how a counsellor working with a client with emotional dependency issues can negate the client becoming dependent on them.

“In truth, for psychotherapy to be effective, a degree of emotional dependency is inevitable” (, this comment makes it clear that no matter how careful counsellors are at some level a client, even one without dependency issues can come to rely on a counsellor, sometimes it can even be beneficial for them to do so, after all they need to feel safe and secure for the therapy to as productive as it can be, especially in Person Centred therapy, the relationship is key to the healing process. However, in good therapy this is a temporary, understood and controlled dependency. The aim of therapy is to use the relationship to help the client become more emotionally resilient and dependent on themselves instead of other relationships.

To help with this it is useful for the counsellor to have a clear set of rules, or counselling contract they can explain to the client about their role as a therapist, when they will be available, the rules around booking and cancelling session, answering the phone/emails/texts outside of the therapy session, and a clear conversation about ongoing reviews and a planned ending.  This will hopefully avoid the counsellor becoming the one who allows the client to become dependent on them, they will only adapt the clear rules if it is clear the client’s dependence has found a way around them. It is also helpful for the counsellor to directly recognise any dependency they notice and have open discussion with the client to aid healing and growth. Reviews will help the client to see development and build self-worth, good techniques of cognitive behavioural therapy homework will be to help the client build self-reliance and thus learn techniques to minimise dependency, to help the client build an inner therapist. Most importantly it a clear structure to sessions and a clear limit to counselling may be important when working with cases where emotional dependence may be a therapy issue.

Hopefully this has clearly explained emotional dependency and its symptoms when it is present in a relationship and how a therapist could prevent the development of emotional dependency on themselves as a therapist.

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Emotional Dependency

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Emotional dependency (sometime call co-dependency) and love look very similar at the outset and to the inexperienced, in reality however, they differ greatly. In a healthy relationship love, caring, understanding, helping, supporting, giving and getting, being with and doing things with your partner are all normal, however, so is having independence and differing activities, so are minor disagreements and differences. In contrast in an emotionally dependent relationship one person becomes more and more in need of the other persons company and attention. They can no longer feel happiness without being in the presence of their partner. They cannot self-sooth or validate their own actions, feelings, or thoughts, they need their partner to fulfil this role. They usually have low self-esteem and self-worth, they seek security and trust in another because they don’t trust in themselves. This becomes a constant need over time, because the partner offers soothing and fulfils the need for validation and closeness they want to spend more and more time with their partner, they ask more and more from them. Any time they are not with the partner or the partner wants to do something alone they feel rejected and seek to avoid this feeling, so they become needier, eventually this becomes a fear that their partner will reject them, that their partner is cheating or pulling away because they don’t want to spend all their time with them. The lack of constant security and risk of loss becomes a fear, this fear creates anxiety and other emotionally charged difficult behaviours.

Eventually the emotionally depended person plans their entire life around their partner, they feel no satisfaction or worthiness without it coming from their partner. They alter their behaviours and actions to make sure they are useful and needed by their partner, they become entirely self-sacrificing in order to meet their partners needs so that they are never alone. This often means, changing behaviours, doing things at any cost –emotional or physical but also tolerating behaviours they know they shouldn’t such as emotional and physical abuse, they feel guilty about doing anything for themselves, ignore their own morals, it can include doing everything for a partner even if they don’t need to. “Within the context of a marriage, emotional dependence is a state where one spouse’s self-worth becomes far too tied into the actions and attention of their partner.” (

Some of the symptoms or behaviours that are exhibited on both sides that may be looked out for in first therapy session or formulation session can be lack of self-respect, manipulation, possessiveness, jealousy, insecurity, abuse, false affection, obsessiveness over the partner, worthless feelings, guilt that they don’t give enough (even though they do everything for the other person), anxiety. Sometimes you may hear what the other partner (the one who isn’t emotionally dependent) feels because they have suggested their partner gets help, these include worn down by the neediness and constant need to be giving love, that they have lack of time alone, that they feel inadequate even though they are giving love, inpatient at the constant demands, frustrated an drained or burnt out. If you recognise these you may be thinking about exploring emotional dependency.

Things that may possibly be causes or reasons emotional dependency may arise to discuss with your clients or be aware may relate to clients behaviours from their childhood or other relationships they have been in. They may have been in past abusive relationships, or had a damaging relationship with their parents or caregivers, they may have been a carer for someone with emotional or physical needs and be unable to adjust to a different type of relationship other than feeling needed when giving or caring. They may have poor attachment issues from childhood, lack of feeling loved, or needed, left out or another sibling is preferred over them, failed to build self-esteem, jealous or needy parents, told they are a failure, only praised when doing something or providing for a parent or loved one, bullied by someone, experienced emotional or physical abuse. This leaves the person emotionally depended on recreating these behaviours as an adult because it is all they know and how they feel needed, they become submissive and accept abuse more easily as they are used to this as normal behaviour that gives love and attention.

Some potential helpful techniques for therapists with clients who are presenting with emotional dependency are: identifying the fear that may cause them to worry their partner will leave, figuring out how and why these fears exist may help the client reduce dependency. Other options are to try to encourage the client to increase their independence through time alone, own hobbies without their partner, increase self-worth, self-identity and encourage love for themselves. Help the client to take responsibility for their own emotions, needs and life goals, create their own schedule and encourage a social circle outside their partner. These would all be reasonably achievable with behavioural experiments common in cognitive behavioural therapy. Inner child work can also help to ease some of the learnt behaviours from childhood, particularly learning to sooth the inner child and rewriting the history. This is only a very brief explanation of emotional dependency and its symptoms in a relationship that may be indicators to a therapist that the client may be struggling with dependency issues. I will now explore how a counsellor working with a client with emotional dependency issues can negate the client becoming dependent on them.

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Cortisol and Stress

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Cortisol is a hormone produced by the adrenal glands that is mainly used as a stress or alarm hormone in the body, but can also regulate metabolism and immune responses. Cortisol is produced when the hypothalamus and pituitary glands fail to sense high enough levels in the blood, they release their own hormones to stimulate the adrenal gland to make more cortisol, once enough cortisol is present in the correct hypothalamus receptors they cancel the production hormone and cortisol ceases being released.

It is used in the body for many reasons, it is fundamental in the body’s natural fight or flight response, as well as in regulating blood pressure, blood sugar, use of carbohydrates, proteins and fats, metabolism, foetal development, memory, reducing inflammation, controlling sleeping and waking, even boosting energy levels when needed. These are a lot of functions and almost every cell in the body has cortisol receptors in it, it is a very important hormone.

What is key is that in times of stress or fear it is released into the body where it can control whole systems. When under threat it can shut down digestion, reproduction, growth and immune systems to use the energy and resources the body has elsewhere, such as it increases blood pressure and heart rate.

Medical conditions causing high or low cortisol are: Cushing’s syndrome is when there is too much cortisol in the system causing increased weight gain, muscle weakness, diabetes, brushing of skin, high blood pressure, mood swings, low sex drive and loss of sleep. Addison’s syndrome is when cortisol is too low and causes skin discolouration, muscle weakness, diarrhoea/vomiting, loss of appetite, weight loss, low blood pressure.

However, in terms of therapy prolonged exposure to the hormone can have negative side effects on the body. This is usually caused by increase in long term stress reactions (like work place stress, monetary stress etc, or post-traumatic stress disorder) which continually tell the body that there is a risk and to release cortisol to be ready with the fight or flight response. This can lead to long term complications in health that are not purely caused by medical conditions as noted above, these are anxiety, depression, headaches, memory issues, heart disease, weight issues, sleep problems, digestive difficulties, and poor libido.

Therapy can help with excessive or repeated exposure to cortisol by assessing in the formulation stage of cognitive behavioural therapy what may be causing the increased cortisol and suggesting the following ways to deduce it as well as improving the causing factors where possible with behavioural experiments and exposure therapy.

Cortisol is known to be influenced by sleep patterns it is higher in the mornings and needs to be lower in the evenings. Regulated sleep patterns will help the body know when to produce or reduce the cortisol hormone (shift work can be very hard on cortisol and it is believed napping can help regulate it), thus low caffeine intake, reduced lighting and reduced stimulation in the evenings should reduce cortisol production aiding better sleep and regulating production. Exercise, either regular intense exercise (it increased production at the time but lowers it by evening) or moderate exercise can reduce cortisol levels. Recognising stressful thoughts and increasing relaxing can also regulate cortisol levels, this can be achieved by mindfulness (to recognise and regulate stress thoughts), meditation, breathing exercises, writing down positive thoughts in a diary, massage, calming music, yoga or tai chi, can all help with relaxation. Reduction of feelings such as guilt and shame which increase stress, replace them with love, forgiveness, anger reduction reduce cortisol and can all be brought about by well practised mindfulness.  Having fun can release positive hormones into the body to counteract the stress reaction such as doing hobbies, gardening, being outside, spirituality, being social with friends, good relationship, reduce arguments and avoid conflict, support and affection from a loved one have also show good cortisol reducing evidence. Pets have been shown to significantly reduce cortisol production especially studies with dogs. Eating healthily is also important, , fish, fatty acids, omega 3, probiotics, fruit, water, black or green tea, even dark chocolate can all lower cortisol. However continued high sugar levels can be detrimental to the over production of cortisol.

Overall it is the therapist job to ascertain the areas causing the clients increase cortisol production and suggest ways in which the client can reduce this, it is a holistic therapy combining all parts of the body, mind and emotions to reduce the behaviours, triggers, symptoms, and thus cortisol production.

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Let it RAIN

Mindfulness is about self-compassion, self-awareness, recognition and understanding of our thoughts, emotions and senses, it is about quietening our thoughts and taking them under our control. Two mindful exercises are referred to by the acronyms RAIN and STOP aid in the learning of mindfulness. Below I will explore each in detail, including how to practice the technique, why it works and the purpose of it.

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RAIN is widely attributed to Michele McDonald, the acronym stands for R – Recognition. A- Acknowledge or Accept or Allow. I – Investigate. N – Non-identification or Natural Awareness. Although A and N are referred to slightly differently in some sources they have the same meaning of the action attached to the word.

R – Recognise or notice what is going on for you. Step back internally and consciously observe your thoughts, feelings and senses.

A – This is about accepting or allowing your thoughts, feelings and senses to just be. Acknowledge your current experience and be compassionate to yourself, do not attribute blame, reason, cause or self-judgement to your thoughts, feelings and senses.

I – Investigate your thoughts, feelings and senses, do this neutrally from your judgement less, accepting position. Wonder about the thoughts, feelings and senses, think about them, how they rest in your body, what sensations are there? What reactions do they call forward without conscious thought? What responses would you usually give?

N – Non-identification. This should come as a natural stage, which is why it is sometimes called natural awareness. I find it the hardest to put into words. This is the recognition that our sense of self is not intrinsically linked to our thoughts, feelings and senses. Our responses are not fused with our thoughts, feelings and senses. We do not have to be angry because we have felt angry. Do not identify with the automatic response.

 For example: we Recognise that we have felt the emotion anger, we feel physically hot, we clench our jaw or fists, we want to shout. We Accept this feeling, we allow it to be felt, to happen, we don’t try to push it down or cover it up, but we do not react to it either. We Investigate it, we wonder what about the situation called something in our learnt behaviour, or response system, we investigate our physical response too. Finally we Non-identify, or we know we felt anger but we do not respond with anger.

Over time our bodies will hopefully stop offering us the learnt behavioural responses automatically and we will be calmer and more analytical about our responses, thoughts, feelings and senses.

STOP is attributed to Jon Kabat Zinn, the key letters stand for S – Stop, T – Take a breath, O – Observe, P – Proceed. The aim of this technique is to introduce Mindfulness naturally throughout your daily routine and reduce the amount of auto-pilot behaviours or automatic negative thoughts that occur.

S – Stop, stop what you are doing, and pause for a moment.

T – Take a breath, breath in and out, notice your breathing, notice its speed, slow it down, relax into breathing for up to a minute if you like, anchor yourself to the present moment.

O – Observe, take a look at your thoughts, feelings and senses or behaviours. Name them, recognise them, be curious about them, what are they, inside and outside your body. Are you judging, are you reacting, assuming, are you sensing, feeling, thinking?

P – Proceed, you can now return to your activity, you can continue the same if you want to or you can adapt your behaviours and thoughts based on your observed moment, do you alter your action or reaction or are you happy with what you noticed?

For example if you Stop and pause just before entering a meeting, Take a few deep calming breaths, be aware of your breathing for a while, Observe your emotions and physical sensations and notice that you are sweaty, heart racing, and feeling anxious. Proceed by changing your plans, or adapting your thoughts or by recognising you were anxious you may be calmer and more productive in the meeting. You may even realise meeting anxiety is something you wish to take to your next therapy session.

Overall the aim of this technique is to increase awareness of activities, emotional and physical response to them and to notice our judgements or automatic thoughts and behaviours, then adapt them if necessary to help us be calmer, more relaxed and more self-aware and self-compassionate.

Both these techniques work well with cognitive behavioural therapy because they are about the recognition of the key elements in the cognitive triangle of our thoughts, feelings and behaviours and learning to recognise and adapt them.

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Holistic Health

Holistic health may be seen as relatively new in terms of the word or phrase but the techniques and meaning behind it have been around for over 3000 words, ancient China and Greece practised therapies that follow holistic paths as well as the Indian concept of Ayurveda, “according to Ayurveda, one is considered as healthy when body, mind, and spirit are in the state of equilibrium, comfort, and bliss”. (

Mind, Body, Spirit - Visit Belvoir

Overall the meaning of Holistic Health or Holistic Therapy is when the body is seen as a whole rather than the individual parts that it is made up of, it focuses on the wellness of a person as a whole rather than on a specific aliment, symptom, body part or diagnosis. It believes that you cannot understand the individual parts of a person alone but must see them as making up the person as a whole, they are all interconnected and in conjunction with the other parts of the body. Optimal health in holistic therapy is about balance, all sources suggest that the Mind, Body, Spirit, (or physical, mental, emotional) need to be observed and treated to treat the whole person. To do this it is suggested that certain areas are looked at including: physical, emotional, mental, social, and spiritual. The body is a working system and not a collection of organs, everyday medicine needs to be used in conjunction with looking at the above factors, and complimentary therapies or treatments. These can include: reiki, herbalism, massage, yoga, therapy/counselling, meditation, mindfulness, surgery, medication, nutrition, unconditional love, emotional support, sleep, self-care, environment, physical therapy and exercise.

It is suggested that the main areas to seek balance in and the ways to do so are:
Physical – improve sleep to a 7 or 8 hour period, improve diet to include balance meals, reduced fats and sugars increase nutrients to help brain and body chemistry, well balanced meal timings to maintain blood-sugar balance, minimum physical activity of 30 minutes as day, increase exercise, reduce smoking and drinking which put negative chemicals into the body. Maybe try massage.
Emotional – try therapy or counselling, mindfulness, meditation, journaling, talking, love yourself, and understand yourself better.
Mental – keep mind active, keep learning, solve puzzles, tired out your mind, and use your mind. Social/Spiritual – go outside and enjoy nature, plants inside can help too, make real contact with people, join social groups or activities such as religious groups, village communities, school communities, charities, hobbies. Set boundaries for social activity and who it is with to reduce stress and overtiredness, practise a faith if you have one.

Mental health is an integral part of the holistic health concept, you can see above the mind is one of the key areas that needs to be in balance with the body and spirit, therapy/counselling is also mentioned as a way to address this balance. Two examples of how holistic health can affect mental health are: depression and anxiety.

Depression leaves us feeling miserable, with low mood, it can also leave us with aching muscles, tiredness, slow movements, over sleeping and overeating. The questions on the PHQ-9 usually used to measure clinical depression include questions on: Trouble concentrating, Moving or speaking so slowly that other people could have noticed, Overeating, Feeling tired or having little energy, Sleeping too much.

Anxiety makes us move faster, fidget more, get physical pains like chest pain, breathlessness or tummy ache, eat less, sleep less. The GAD 7 used to clinical measure anxiety asked questions on: Being so restless that it is hard to sit still, Trouble relaxing, Becoming easily annoyed or irritable. (

However, if we take these symptoms in conjunction with the key areas holistic health looks at we can see how improvement in some of the areas these symptoms manifest can improve overall health. If sleeping improves because of better physical activity making us tired and releasing good neurotransmitters into our minds and bodies our sleep patterns should improve. If we eat better diets with better nutrition then our bodies will have the right chemicals to exercise and have energy and to produce serotonin in our guts and brains (the gut brain hypothesis is currently the focus of research ( to help us have more energy and feel less tired and want to exercise or move more, also improving physical aches and pains. If we meditate or practise mindfulness we will improve our stress and anxiety response and improve our mental wellbeing, thus improve our physical responses of tummy ache, chest pains, and headaches. If we attend therapy we may find reasons that make us anxious or depressed, healing these, and again by adjusting one key area we will improve the overall wellbeing of ourselves. It is believed that holistic health and thus mental health is improved if the client is given the power to address their own issues and own self, to look at their body and daily behaviours as a whole and to take control of them for themselves in a positive way. “Holistic Health is actually an approach to life.” ( is a very good way to describe this idea, it fits neatly within the concepts of cognitive behavioural therapy (CBT) which look at the overall behaviours of the clients and make changes in all areas where it is needed to being about lasting and positive change.

Brain Body Mind Lab | Medical School - University of Minnesota

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

CBT Techniques.

I have been asked to discussed how behavioural experiments, homework, self-monitoring, Socratic questioning and systematic desensitisation are used in cognitive behavioural therapy (CBT), I will explore each of these individually before summarising.

Behavioural Experiments in CBT are said to be one of the most significant factors of the therapy. They are experiential activities designed to test or challenge cognitions or beliefs of individuals seeking therapeutic change for certain specific issues. They are used to recognise thoughts, challenge them, adapt existing beliefs and test newly formed ones. These activities use experimentation or observation to obtain new evidence or information to help clients reach positive, self-controlled change. To help clients revaluate negative automatic thoughts (NAT’s) and assumptions and encourage conscious process and give step by step guidance to acquire new skills.

This is done identifying the issue, cognition, behaviour or belief that client feels is causing difficulty, it helps is the problem is precise, and if the strength of the cognition is known. Then an experiment is designed with the client and carried out, this is then reviewed with the therapist and results are analysed and check against original cognition, if it is positive results it is discussed how this positive development may be sustained, if not it is seem as developmental learning and a new experiment based on this learning is devised. The pattern followed is engagement of client in therapy, activity design and scheduling, testing/experimenting, review and future planning.

Some of the types of experiment are as follows: hypothesis testing e.g. doing the opposite to the cognition to see what will happen; discovery e.g. when a specific cognition is unknown but a behaviour is known see if you can find the thought by recreating behaviour; observational e.g. watch others do something and see if this helps you change cognition; survey or research e.g. ask others if they feel the same or what they feel about you.

It tends to follow this pattern ‘Thought – If I do X then Y will happen’, sometimes added is a safety behaviour ‘Thought – If I do X then Y will happen, so I do Z’. To fill this in with an example ‘If I walk into a shop everyone looks at me, so I always try to look inconspicuous, rush to only what I need and leave’. The experiment here would be threefold first the therapist would explore the human nature concept that people look at anyone entering a room out of nosiness and safety; second they would get the client to observe others entering a shop or room and see that everyone gets looked at; thirdly they would use the practical experience of walking into a shop slowly just to browse and prove to the client by review afterwards that nothing bad happens if they don’t do their safety behaviour of rushing out again.

Homework in CBT is a method of helping the client to develop outside the therapy room. Studies show that clients who complete their homework are far more likely to achieve better results from their therapy (, thus it is believed that homework in CBT should not be optional for this reason. The Beck Institute have recently suggested that homework has negative connotations and have suggested a move to calling it Action Plan to help those clients who struggle with homework ( The bulk of work happens between sessions during homework and can be crucial for the next session because it can provided information to base new behavioural experiments on, it can help the client feel calmer and it can create evidence to prove to the client therapy is working. Homework can be breathing or meditation exercises, exercise, diet, journaling, behavioural experiments, record keeping of thoughts and actions association. Homework should be varied and tailored to suit the client’s needs and style, e.g. creative or scientific, with teaching or learning aids if needed, but it should aim to push the client slightly (but safely) out of their comfort zone or to make progress towards their goal and but suited to the stage of CBT the client is at.

Self-Monitoring in CBT can be part of the collaborative homework set by the therapist for the client. It should be routinely monitored to ensure that it does not cause additional anxiety, stress or negative feedback to the client during the recording process or upon analysis of the results. It can be in many forms, but its aim is to help change thoughts, emotions and behaviours of the client. Self-monitoring techniques focus mainly on the cognitive triangle in CBT which looks at the links between thoughts, actions/behaviours and emotions/feelings. It then allows the client and counsellor to be aware of a pattern and make adjustments in one of these areas to improve the clients presenting issue, tis adjustment can be in the form of a behavioural experiment discussed above. Types of Self-monitoring techniques are; making a daily diary, recording audio or visual images (photo or video), tables of the three cognitive triangle components (thoughts, emotions and behaviours), phone apps, fit bits, heart rate monitors etc, tally charts of incidents or feelings. It can help clients to recognise NAT’s, behavioural reinforcement actions, and allow the therapy to move forward when the results are evaluated in therapy sessions.

Socratic questioning in CBT can be used at different stages of the therapy to help challenge irrational or negative thoughts, in homework, to help gather information during formulation, and to help assess the outcomes of behavioural experiments. They can be used by the therapist to gain information or by the client to challenge their own negative thoughts. They are a set of guiding questions aimed at discovering, identifying, or defining a problem/thought/emotion/action/response. lists types of Socratic questions as those that – “identify their cognition and try to really understand their basis for it …ask questions to identify all the reasons their behaviour made sense at the time … and …expand their view of other causes and responsible parties.” (

It helps us to understand how types of questions are useful in CBT by looking at where they stem from, Socrates belief that by questioning assumptions, thoughts and well known beliefs we can reach our own conclusions and developed understanding. It is believed the questions are meant to reveal something the clients does not already consciously know about themselves or have previously overlooked and thus make new connections and conclusions based on answers. Good Socratic questions intend to reveal new perspectives or information. They help with problem solving, revealing new information, and educating the client about themselves. If the client learns the skill it is something they can take away from therapy to continue to use in their future preventing relapse.

Finally I shall discuss Systematic Desensitisation within CBT. This is the process of exposing the client to a fear or phobia while linking a good, calm or positive emotional or physical response to the same fear. It is based on the psychological technique of classical conditioning, and aims to remove a fear response and replace it with a new one. To do this the client must learn calming or relaxation techniques such as breathing exercises, meditation, muscle relaxation. Once the client has learnt these a hierarchy of the clients fears/phobias is drafted, least fearful first increasing in fear until phobia to be addressed is reached. This hierarchy is addressed one by one starting with the least fearful, and the client is asked to use the as breathing exercises, meditation, or muscle relaxation techniques while in the presence of the stimulus to help alter or replace the fear response and become desensitised to the fear or phobia. Then the next fear or phobia in the hierarchy is address and systemically the technique moves up the hierarchy until the clients address the issue that brought them to therapy. This technique needs to be carried out carefully so as not to traumatise the client more or to condition them in a negative way. It can be used as a homework technique or done within sessions.

These are all methods that can be used within CBT to help the client progress through their therapy and reach a positive conclusion, they can be built into the therapy plan between the client and therapist to produce progress.


If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Making Friends

If you are looking to make friends you could try this useful group

Stoke On Trent and Newcastle Under Lyme Meetup Group

Stoke-on-Trent, GB
102 Members

We are a group of people of all ages who enjoy getting together for a wide variety of social activities.We welcome new members. On joining we ask for a clear current photo so…

Next Meetup

A day out geocaching – possibly 3/4 mile walk.

Saturday, Aug 22, 2020, 11:00 AM
6 Attending

Check out this Meetup Group →

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304

Open or Closed – that is the Question?

Taking notes concept illustration Free Vector

Open questioning and closed questioning can be useful in therapy, particularly CBT, because it can give us facts about the client and allow the client to explore in more depth. Mostly open ended questions are used during formulation or assessment process in therapy to allow the therapist to collect as much detail as they can about the client while in the early stages. But sometimes a closed question is needed to find a clear answer. Closed questions are those that have short, often one word answers such as yes, no, last week, tomorrow, mother, father etc or maths type questions such as what is 2+2? Open questions allow the client or answerer to go into depth/detail about the information being sought. They can explore a memory or past event in their own words and give as many details as they like.

Below I have listed 15 questions I would most likely use in a formulation session with a client. They are mostly open ended questions to allow me to find out details about the clients past and experiences so that the client and I can build a clear and detailed picture of the issues bringing the client to therapy and the type of outcome the client would like.

  1. What issues have caused you to seek therapy?
  2. Have you had therapy before, what type was it and did you find it helpful?
  3. When did you first notice this issue? Or How long have you felt like this?
  4. Can you remember if that was the first time you felt like this? Can you describe the event you just recalled?
  5. What events or actions cause you to feel like this?
  6. How is this issue been impacting on your life?
  7. How does this issue make you feel?
  8. What do you do when you feel like this?
  9. Why don’t you like that behaviour/feeling?
  10. Where does this happen – work, home, friends, family, relationships, gym etc
  11. What part of the behaviour/issue do you want to change?
  12. How would you like to feel?
  13. Do you have any specific goals you would like to achieve?
  14. If you can wake up and the issue/problem had gone what would have changed?
  15. Are there any other issues impacting on this issue?

Overall these are the main 15 question I would use during a formulation with a client, mostly they are open questions allowing the clients to explore and understand their life in detail and make links to actions and events. These will help me create a therapy plan with the client and use the correct therapeutic techniques to aid the client to the best of my therapeutic skills and abilities. So if your counsellor seems to ask a lot of questions in an initial assessment this could be why.

If you’d like some face to face counselling in the Stoke-on-Trent, Newcastle-under-Lyme or Staffordshire area please do contact Wright Minds at or on 07598810304