Sunday, July 3, 2011

When You're Stuck -- Attention and Repetition

A big focus in therapy is a patient's beliefs: beliefs about self, about other people, and about the world.  Everyone has beliefs; as humans, it's how we organize and make sense of the world.  Individuals vary in terms of how aware they are of their beliefs.  Whether aware or unaware, an individual's beliefs influence everything that person does, says, thinks, or feels. 

Many of my patients have developed problematic beliefs that are contributing to feelings of depression, anxiety, panic, anger, etc.  A lot of the work in therapy involves identifying those beliefs, recognizing the negative consequences of maintaining them, examining their validity, and ultimately, generating alternative, more balanced beliefs.  This is definitely a process that unfolds over time.  It is not always an easy process and there are a few places where people tend to get stuck.

Sometimes it's in the very beginning; the patient and I are not able to put our fingers on the belief that seems to be driving their symptoms.  (This is probably the least common place people become stuck, at least in my experience).  Other times, people have trouble recognizing when the belief has been activated.  This makes it difficult to see the impact the belief has on the person's emotions (which is what typically builds that person's motivation to change the belief).  Some people get stuck on the belief itself.  They have trouble considering that the belief might not be accurate, even when there is no evidence to support its validity.  

Then, there is one place that almost everyone seems to struggle (in my experience).  They have identified the problematic belief and have recognized its negative impact on their thoughts and feelings.  They have looked at the evidence and have determined that the belief is inaccurate.  They have developed an alternative, more balanced belief.  Now, they say to me, "I know in my mind that [the old belief] isn't true but I still feel like it's true."

The head and the heart are sending two different messages.  What do you do?

In my view, this is actually the most difficult part of the process.  For whatever reason, it seems to take the heart a lot longer to figure out what the head already knows.  Really, I think that emotions tend to operate on habit; when you get used to experiencing a particular emotion your body keeps generating that emotion by sheer force of habit.  The task, then, is to gradually change the body's habitual way of feeling.

This is where attention and repetition come in.  Attention means noticing every time the old belief is activated and recognizing the feeling(s) associated with the belief.  Repetition means that every time you see the old belief activated you say to yourself, "Oh, there's that old belief.  I know it's not true."  You then cognizantly replace that belief with the previously identified alternative belief (even if you have a hard time really feeling like it's true).  Finally, you behave as if you fully belief this alternative belief, even if you still feel like you believe the old belief. 

This requires both patience and diligence, among other things.  Over time, though, if  a person keeps reminding herself that her old belief isn't true and then consciously behaves in a manner consistent with her new belief, she will eventually find that her feelings start to catch on.


  1. spldbch
    interesting information
    Greetings from
    Abstract text and Reflection.

  2. Hardest thing in therapy is getting thru the stuck parts! Takes courage to change ones thinking to push thru fears and make the changes needed to move ahead.

  3. Belief part sounds like the buddhist teaching on fixed view... Holding on to a world full of impermanence.
    You might be interested in Bentinho's Awareness teaching used in psychotherapy:


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