Cognitive Behavioural Therapy For Dummies. Rob Willson

find non-threatening. As you write down the situations, practise distracting yourself by focusing on your internal sensations and thoughts. Now read back through the list of these situations, but this time try refocusing your attention outwards. For your second list, write down ten or so examples of situations you find threatening. Arrange the situations in a hierarchy, starting from the least anxiety-provoking and graduating up to the most anxiety-provoking. Now you can work through your hierarchy by deliberately entering the situations while practising task concentration until you reach the top of your list. This means you can start to practise mastering your anxiety in real-life situations.

      Concentration exercise: Taking a walk

For this exercise, walk through a park, paying attention to what you hear, see, feel and smell. Focus your attention for a few minutes on different aspects of the world around you. First, focus your attention mainly to what you can hear. Then shift your attention to focus on smells, and then on to the feel of your feet on the ground, and so on. You can move your attention around to different sensations, which can help you tune your attention onto the outside world. Switching between your five senses can also help you realise that you have the ability to direct your attention as you choose.

      After you’ve practised directing most of your attention to individual senses, try to integrate your attention to include all aspects of the park. Try to do this for at least 20 minutes. Really let yourself drink in the detail of your surroundings. Discover what hooks your attention. You may be drawn to water or have a keen interest in birds, plants, or perhaps even woodland smells. Notice how you feel much more relaxed and less self-conscious as you train your attention on the world around you.

      Tuning in to tasks and the world around you

      If you’re suffering from anxiety, you’re probably self-focused in many situations and fail to notice the rest of the world. On top of feeling unnecessarily uncomfortable, your self-focus means that you’re likely to miss out on a lot of interesting stuff. Luckily, you can change your attention bias and overcome much of your anxiety.

      

You can also use re-training your attention onto the outside world to help interrupt yourself from engaging with the stream of negative thoughts that accompanies depression, which will help you to lift your mood.

      Here’s an example of how you can use task-concentration techniques to overcome anxiety, specifically social phobia (see Chapter 9 for more on social phobia).

      Harold was particularly worried that people would notice that he blushed and sweated in social situations. He believed that people would think he was odd or a nervous wreck. Harold constantly self-monitored for blushing and sweating and tried very hard to mask these symptoms of his anxiety.

      Here’s Harold’s list of situations, with each one becoming gradually more challenging:

      1 Having dinner with his parents and brother

      2 Socialising with his three closest mates at a local pub

      3 Using public transport during quiet periods

      4 Eating lunch with colleagues at work

      5 Going to the cinema with a friend

      6 Walking alone down a busy street

      7 Socialising with strangers at a party

      8 Going to the grocery shop alone

      9 Going to the gym alone

      10 Initiating conversation with strangers

      11 Using public transport during busy periods

      12 Eating alone in a restaurant

      13 Going for an interview

      14 Offering his opinion during work meetings

      15 Giving a presentation at work

      Harold used the principles of task concentration to increase his ability to focus deliberately on chosen external factors in non-threatening situations. When Harold was at the pub with his mates, he focused his attention on what his friends were saying, other people in the pub, the music and the general surroundings. Harold also deliberately distracted himself by focusing on whether he was blushing and sweating, and then he refocused his attention again.

      Harold then used the same techniques in more-threatening situations. In the grocery store, Harold found that the more he focused on his blushing and sweating, the more anxious he felt and the less able he was to pack up his shopping. When he paid attention to the task of packing his groceries, made eye contact with the cashier and even made a bit of small talk, Harold’s anxiety symptoms reduced, and he became more aware of what he was doing and what was going on around him.

      Harold worked diligently through his hierarchy of feared situations and now feels much more confident and relaxed in social situations.

      

Imagine that you’re going to be called on by the police to act as an eyewitness. For a few minutes, try to take in as much information as you can about the environment and the people around you. What are people doing? What do they look like? Could you give a reliable description of someone an hour from now? Notice how much more detail you can recount when you choose to focus outwards, compared with when you’re concentrating on your thoughts and physical sensations.

      Tackling the task concentration record sheet

You can keep an account of your task-concentration practice, and note the results, by using a task-concentration record sheet; the one in Table 5-1 uses Harold’s example from the preceding section. The brief instructions at the top of the sheet are there to remind you how to do your concentration exercises. You can find a blank copy of the form in Appendix B.

TABLE 5-1 Harold’s Task-Concentration Record Sheet

Who were you with? Where were you? What were you doing?	Record your focus of attention. Note what you focused on most. 1. Self % 2. Task % 3. Environment and other people % (Total = 100%)	Use task concentration to direct your attention outwards. Remember to focus on your task or environment. Note what you did.	Record how you felt.	Record anything you learned from the exercise. Note how the situation turned out, changes in your anxiety level and your ability to complete the task.
Eating by myself in restaurant. Lunchtime.	1. Self 40% 2. Task 35% 3. Environment and other people 25%	Took my time to eat rather than rushing. Made eye contact with waiter. Tried to eat my meal mindfully and enjoy it. Observed other diners. Kept my head up and didn’t hide away at a corner table.	Anxious. Scared at first.	My anxiety lessened as I ate. No one seemed to think I was odd for eating alone. I felt less awkward than I expected to feel.