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Articles & Ideas


How this therapist uses Cognitive Behavioral Therapy (CBT) and EFT together

Important Note: This article was written prior to 2010 and is now outdated. Please use my newest advancement, Optimal EFT. It is more efficient, more powerful and clearly explained in my free e-book, The Unseen Therapist™.  Best wishes, Gary

Hi Everyone,

This article by Harry Galina, PhD is designed for professionals who are familiar with Cognitive Behavioral Therapy (CBT).

Hugs, Gary

Part 1
Part 2
Part 3

By Harry Galina, Ph.D.

Part 1

For most of my clinical life I have used Cognitive Behavioral Therapy.  I was trained in this wonderful tool and have helped many clients through the past 20 something years.  Two years ago I discovered EFT and my life and the lives of my clients have improved significantly.

In order to retain my cognitive training even while doing EFT I had noticed that on Gary's DVD series he is very often using the principles of cognitive therapy combined with his own unique and powerful ways.  His reframes are cognitive which lead to a change in behavior and emotions.  EFT is a wonderful tool, even though it has not been fully recognized by mainstream psychology, and here I would like to share one aspect of how I use both the principles of Cognitive therapy and EFT together.

Dr. Jeffery Young has written a marvelous book in which he details what, in "cognitive" terms, are called Schemas.  I cannot do justice to Dr. Young's formulations in this short space but will give just a taste of how I use it.  Schemas are characteristic ways of looking at things, and shape our attitudes and beliefs.  Our environment and physiology create a structure to use as a filter to view the world.

This structure comes from our unique physiology and our unique experiences; therefore everyone will have different schemas and therefore experience and perceive the world in different ways.  Schemas act as filters; and often these filters hamper our development.

Because EFT "taps" (pun intended) into both physiology and cognitions at the same time and leads to counter-conditioning and desensitization according to Classical conditioning, it becomes an elegant and efficacious tool for helping ourselves and others.

Dr. Young has enumerated, through his excellent research what he calls: Early Maladaptive Schemas.  He has developed a questionnaire that ferrets out these maladaptive belief systems so the client and clinician can make the necessary cognitive changes.  I have had my clients fill out his questionnaire so that we can see what is "written on their walls".  

Dr. Young uses a 6 point scale but I prefer to use the 0-10 intensity scale so often used in EFT and other excellent therapies.  As the client and I explore the answers we use EFT to reduce, reframe, and more often than not, remove the unwanted maladaptive schema so the client can move forward in their lives.

Let me give you an example: If the client has a mistrust and abuse schema we explore the various reactions to the statements in Dr. Young's questionnaire.  We collapse each belief and move to the next.  Often deeply rooted memories of mild to severe abuse are encountered and we may use the Tearless Trauma Technique or the Movie Technique to easily and consistently reframe and reduce the emotional charge that the memory represents.

It is also a useful way of "Sneaking up on the problem" as you go through their answers to the questionnaire.  You can start with the general statement of "Even though I have these issues of mistrust and abuse and I do not want to go through those memories again..."  Even though I am not sure when I'll be ready to..."  Eventually, the schema is laid bare and desensitized and EFT counter-conditioning take place.

I hope to give more insight into the intimate connection between cognitive therapy and EFT over the next few weeks and would like to thank Gary and his DVDs for elucidating this wonderful tool for all.  I also owe a debt of gratitude to David Rourke and his marvelous live exposition of EFT that I attended.  Isn't it interesting that any EFT practitioner that I have read, watched, or met has a sense of humor which so ably enables other people?!

Z. Harry Galina, Ph.D.

Create a nice Day!

Part 2

In this continuing set of articles about the use of EFT and Cognitive-Behavioral Therapy I would like to talk about relieving anxiety and panic attacks.  I once read that most cases of anxiety or panic are first referred to a General Practitioner who will often give medications for temporary relief but usually does not solve the underlying problem.

Alternatively, many sufferers go to the emergency room because they feel that they are having a heart attack or are dying.  Tests are taken, results are usually negative, and the patient is sent back out into the world temporarily (though not completely) relieved.

Cognitive therapy (and in particular through the work of Gary Emery) will teach the client to use the acronym of A.W.A.R.E. The letter A stands for Accept the anxiety.  This usually goes counter to what the client believes.  The client usually believes that they have to “fight” the anxiety. However, this simply exacerbates the anxiety because you are continuing to “fire up the nervous system.”  

You will also notice that when using Gary’s type of EFT setup phrase, that we actually say the negative first - Even though I have this panic… followed by the acceptance phrase. My contention is that the acceptance in the A.W.A.R.E. Strategy and the acceptance in the Setup phrase accomplish roughly the same effect. One may call it dealing with the “psychological reversal” or on a more basic level that the person will accept themselves with their symptoms.

The second letter in the A.W.A.R.E. Strategy stands for “Watch the anxiety”.  In this part of the strategy the person rates their anxiety level on a scale of 0-10 and then is supposed to watch it go up and down in a detached way.  They are to watch this anxiety level go up and down and It can take people many practice sessions before they “get” this and the anxiety begins to go down.

Notice how Gary utilizes the 1-10 level of intensity scale and then, usually with one or two rounds of tapping and using key phrases can quickly bring down the anxiety level. Though the A.W.A.R.E. Strategy has been used very effectively with my clients in the past, Gary's reframes and tapping are much quicker at bringing the intensity level down.

The other day I had a new client who I’ll call Mary who is in her seventies and somehow made it to my office “even though the walls in the corridors were closing in on her.”  Mary wouldn’t come into my office because she could see from the door that I had a big window and this also scared her.  I asked Mary if I could teach her a “weird” technique that very likely would relax her.  At one point while we were tapping, I said to Mary, who was repeating and mimicking everything I said, “And here I am tapping on my face with this crazy psychologist.”  Well that did it; she broke into laughter, had a big sigh, and relaxed enough to come in.  

After that we became a little more conventional continuing with a combination of EFT and Cognitive therapy.  Mary was very pleased with the result, agreed to come again to work on more core issues, and walked out with hope and some self-help techniques of tapping and AWARE.  You will notice on the DVDs that Gary will strategically elicit laughter which will quickly reduce anxiety and help with an instant reframe.  I have often heard that you “can joke with depression, but don't joke with anxiety.”  Well, I beg to differ.  A strategically and carefully placed metaphor or twist can do the client a world of good.

The next letter in the A.W.A.R.E strategy is the second A and it stands for “Act with the anxiety.”  That means that you may slow down your movements but keep on doing what you were doing.  As Dr. Emery points out: if you run from the situations your anxiety will go down but the next time you encounter or think about the anxious situation your fear will go up.  Using the tapping routine one can more easily prepare by asking the client to visualize themselves in the situations (or you can sneak up on the problem).

The fourth letter of the A.W.A.R.E. strategy are Repeat the steps; Accept, Watch, and Act until the anxiety goes down.  Of course, using EFT we make sure that the anxiety level has gone down to a 0 or 1 on a scale of 0 to 10 and do as many repetitions of the sequence as necessary.  If it fails to go down then we know that we may be dealing with another issue that has cropped up.  We then deal with the new issue.  This is the power of EFT.  While the A.W.A.R.E. Strategy is non-specific, the EFT procedure can go from the general to the specific in short order.

And, finally, the last letter stands for Expect a new effect.  In other words, you have gotten through this bout of anxiety, give yourself credit, but since anxiety can come back you now are more prepared.  With EFT, the language patterns that are used imply that we can deal with anxiety because we now have a tool or technique to use any time we need it.  We now have the experience of anxiety reduction and know that it is possible through using the appropriate language and tapping procedure.

I usually give my clients both options and allow them to choose which one they want to use or both together.  They can recite the A.W.A.R.E. while tapping.  The best of both worlds.

I hope that this has been helpful to the therapist out there.  In my next article in the series I hope to elucidate how I use the technique of refuting cognitive distortions and how EFT can do this.

Even though Cognitive therapy can often do the same things as EFT, EFT is usually faster and often more elegant.  Faster and more elegant, what more could we want for our clients.

Z. Harry Galina, Ph.D.

Part 3

This is the third installment of the continuing series about CBT and EFT.  In this article I will show how the identification and breakdown of cognitive distortions within cognitive behavioral therapy (CBT) can be made quicker and deeper.  The cognitive distortions are thoughts or beliefs that have a distortion in them.  Some of the more common ones are: dichotomous thinking, magnification, should statements, over generalization, and others.

For those of you familiar with NLP you can recognize them as such things as universal quantifiers, modal operators of necessity, and others.  Once the distortions are discovered we then use cognitive restructuring to replace them with better operators.

The first step is identification and this may be the hardest step.  That is because they often feel logical to the person engaging in them.  The problem is that they are not rational statements.  They come about almost automatically.  They are automatic habits of thinking that lead, more often than not, into negative emotional responding.  Cognitive distortions are (our) interpretations of reality, they are not reality.

As a therapist, when you hear someone engaging in a cognitive distortion you need to stop the person and get more info from them.  We point out the distortions and ask them to refute them by finding the rational response.  Once we have discovered the distortion in the person’s thought (in their sentence) the person then rates them and some systems use a 0-100 scale.

I use the O-10 scale and then do one or two rounds of EFT on the distortion and its derivatives. This has two excellent results.  One, it reduces the distortion much faster, and two, the resistance to let go of the distortion (because it has been a part of them for so long) breaks down so much easier since we are getting strait to the inner emotion that is maintaining the distortion.

Most people, at first do not believe that they are distorting; they disavow it and may even be offended that you have pointed it out.  Instead of having to assign the refutation of the distortions as a homework task, they can walk out of the office with distortions already reduced.  They can then practice the EFT at home in conjunction with the sheet I have given them on EFT and distortions.  Once people have practiced refuting their cognitive distortions they tend to get better and better at refuting them and preventing them.  Because of the practice it becomes an embedded skill.  By combining EFT into the process we save time and the gains tend to be more "permanent".

Here is a simple example: A recent client was having difficulty with some coworkers.  She felt that they were talking behind her back and saying "bad" things about her.  When I pointed out that there may be a possibility that she is jumping to conclusions, mind reading, and probably magnifying, she claimed that she heard whispering which "proved" that she was right.

We decided to go through each possibility using EFT.  Even though I may be jumping to conclusions…  With each successive round we were able to delve deeper into the distortion and it also lead to her realization that her father had "written on her walls" by modeling without checking the facts, throughout her childhood.  After going through each of the possible distortions in the situation she felt that she had a better understanding of what was going on.

Even more important, she was able to ask her colleagues about her fears and they helped her refute them and give her new meaning to interpret the situation.  It is my contention that the EFT process helped put the situation in perspective and induced the courage for her assertive action.  Of course, at the next session the writing on the wall from modeling her father's behavior was reframed using EFT.

I should also point out that I have never tapped on any of my clients due to provincial regulations for psychologists.  Once I explain the procedure and they accept to try it, I teach them the techniques and then have them repeat what I do.  All clients have accepted it as we intertwine both CBT and EFT and when needed, NLP techniques. More often than not, they ask for more EFT instruction on the second visit.

I also want to thank those who have emailed me and provided support for my exposition.  We need to find a way to get this into mainstream psychology and the CBT/EFT route is one way.

Z. Harry Galina, Ph.D.



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