Emily Holmes: My inner CBT therapist

Imagine you are about to give the "best-(wo)man's" speech at your friend's wedding: vast audience, huge hall, microphone, lights, wine, flowers, expectant faces ... but words fail you. Worse than that, I was consumed with an overwhelming feeling of nausea. I'd just found out I was pregnant and not told the world yet. I could see myself about to vomit at the photographer and over the bridal couple ... looming panic. "I've given hundreds of speeches, it'll be fine". But reassuring words alone didn't help. More nausea. "OK! Stop the internal focus" - my inner CBT therapist suddenly kicked in. "This isn't real - this is just an image of vomiting". The inspirational CBT work on mental imagery and social anxiety (David Clark, Ann Hackmann, Colette Hirsch and others) zoomed in. "Focus outwards! Look at the audience ". OK, deploy "cognitive science" - "external perception will compete for resources with internal images. Focus on the flowers". Oh, and a bit of image restructuring - "mentally photoshop that image of myself, I'm not looking nauseous at all, just moved by emotion at the happy couple". Here we go ... External reality started to win. I was smiling and dinner was staying down. "Good evening everyone ..."

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Emily Holmes is Professor in Clinical Psychology and Wellcome Trust Clinical Fellow at the
Department of Psychiatry, University of Oxford. She is co-author of the Oxford Guide to Imagery in Cognitive Therapy.

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