Break the Rules: And Achieve Mental Wellness

By William D. Boyd Ph.D.

Breaking the Rules (BTR) describes a model of cognitive–behavioral therapy that focuses on developing new habits of thinking at the subconscious/automatic part of the mind that are strong enough to take the place of deeply ingrained habits of thinking that can result in negative emotions. BTR focuses on how the habitual use of certain words in subconscious thoughts results in negative emotions and how to establish a habit of using other words in subconscious thoughts that result in mental wellness.

• Language: English
• Publisher: Xlibris US
• Release date: May 16, 2021
• ISBN: 9781664168190

Book preview

Break the Rules

and Achieve Mental Wellness

William D. Boyd, Ph.D.

Copyright © 2021 by William D. Boyd, Ph.D.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Illustrator and Book Cover Designer: Sofia Gold

Rev. date: 05/13/2021

Xlibris

844-714-8691

www.Xlibris.com

823929

CONTENTS

Preface

PART I

Chapter 1     Introduction and Overview of the Break the Rules Model

Chapter 2     Flexibility and Fidelity

Chapter 3     Three Levels of the Mind

Chapter 4     Values and Rules

Chapter 5     Developing Habits

Chapter 6     The ABC Model

Chapter 7     Progress Within This Model

Chapter 8     The Therapeutic Process (How to Do BTR)

Chapter 9     Resistance to Progress

PART II: THEORETICAL, PHILOSOPHICAL, AND

PHYSIOLOGICAL UNDERPINNINGS OF BTR

Chapter 10   The Cognitive–Behavioral Approach

Chapter 11   Limits of Knowledge

Chapter 12   The Role of Language

Chapter 13   The Role of the Autonomic Nervous System in the Experience of Negative Emotions

Chapter 14   The Learning Process

Chapter 15   Philosophical Underpinnings

Chapter 16   Comparison of Models

Chapter 17   Default Tendencies and Built-In Rules

PART III: APPLICATION OF THE MODEL

Chapter 18   Depression

Chapter 19   Anxiety and Posttraumatic Stress Disorder

Chapter 20   Abuse and Neglect

Chapter 21   Personality Disorders

Chapter 22   Physical Trauma and Medical Conditions

Chapter 23   Substance Abuse and Addiction

Chapter 24   Modalities

Epilogue

References

Preface

The Break the Rules (BTR) model was initially introduced at the 1997 conference of Division 29 of the American Psychological Association. This author and Ed Cotgageorge were the presenters. There were only a handful of psychologists attending the symposium as it was 8:00 a.m. at a conference being held at a beach resort. The presentation of the model did not have much impact at first, but since that time, a number of psychologists and psychotherapists have been trained in the application of this model.

The BTR model is also known as the cognitive–behavioral–expectant therapy (CBET) model. The word expectant in this model refers to the expectations you have for yourself, others, and the world. Expectations can be in the form of values or rules. An expectation can be violated if it is in the form of a rule, but it cannot be violated if it is in the form of a value. The violation of rules results in negative emotions.

The underlying concept of BTR is not new. Karen Horney (1950) coined the phrase "tyranny of the shoulds, and Albert Ellis (1994) came up with phrases and words such as shoulding on one’s self and musterbation. However, neither one of these people fully explained why certain words, referred to as rule words" in BTR, are so toxic. Rule words were described as irrational, and it was the irrationality of those words that was the focus of treatment in Ellis’s rational emotive behavior therapy (REBT) model. It was the difference between the real self and the ideal self in Horney’s model that explained emotional problems such as anxiety and depression.

The idea for developing BTR started while this author was in graduate school at Texas Woman’s University. At that time, the author lived in Dallas and commuted to Cleburne to work as a music therapist and school psychologist, to Denton for classes, and back to Dallas pretty much on a daily basis. There was nothing to do during these rather lengthy commutes except to listen to the radio and contemplate what was being learned in doctoral studies.

A second impetus was reading books regarding the search for a grand unifying principle of physics. The author started thinking about a grand unifying principle of psychotherapy. In other words, what is the basis or core mechanism that accounts for the effectiveness of psychotherapy?

A third catalyst was the sport of distance running. As a distance runner, which included marathons and ultramarathons, the author had much time to think about the development of a unifying principle of psychotherapy. The ideas underlying BTR were tested in the clinic while applying cognitive–behavioral and rational–emotion psychotherapy methods to people with a variety of psychological, behavioral, and personality issues.

Psychotherapy can have different goals, including personal growth, the amelioration of mental health problems, support for someone with chronic problems, or to decrease negative emotions. The main goal of BTR is to help people lessen or get rid of negative emotions. The BTR model presumes that ridding one’s self of negative emotions impacts the other goals of psychotherapy in a positive way. In other words, decreasing or getting rid of negative emotions is what underlies the effectiveness of psychotherapy and can result in a sense of personal growth, the lessening of mental health problems, and a sense of support. The next step was to determine the cause of negative emotions.

It seems that human language is important in the practice of most models of psychotherapy. Perhaps the only exception is the use of behavior modification strategies to work with people who have no language, such as those with severe mental retardation or severe autism. Language not only allows humans to communicate with one another but also allows people to create meanings and interpretations for the self. It is likely that some of the meanings and interpretations created with the use of language are responsible for much human misery and suffering. The question was what aspect of language plays a role in the genesis of negative emotions?

The idea that certain words negatively affect human emotions is not new (Beck, J., 1995, 2011). According to the BTR model, the use of certain words in thoughts and language results in negative emotions, and eliminating these words from thoughts and language underlies psychotherapeutic effectiveness no matter what model of psychotherapy is used.

Cognitive–behavioral approaches to psychotherapy have been shown to be effective in addressing a myriad of psychological, behavioral, and personality problems (Hofmann, Asnaani, Vonk, Sawyer & Fang, 2012). So it seemed sensible that a unifying principle of psychotherapy would fit in the cognitive–behavioral camp. BTR is a cognitive–behavioral approach to psychotherapy as it uses behavioral strategies to deal with cognition.

BTR offers skills that involve establishing new habits of thinking and language. It does not matter how someone can establish new habits of thinking and language but only that the person does so. Certainly, a therapist may be helpful in establishing a new habit of thinking and language; however, the assistance of a therapist is not required to establish new habits. If you practice the skills described in this book, you can experience a profound improvement in your psychological well-being without the help of a therapist. On the other hand, if you go to a therapist who practices BTR but you do not practice the skills offered, you will not likely experience any benefit from this model. The key to this model’s effectiveness is sufficient practice. Therefore, the BTR model lends itself to helping you get rid of negative emotions and enhance your psychological well-being whether or not you see a therapist.

Psychotherapists may find the BTR model to be very helpful because it is easy to apply and can be very effective. However, it is important for the therapist who uses this model to practice the skills themselves sufficiently to establish the thinking and language habits that are offered in this model. A therapist may have difficulty practicing BTR unless the therapist has mastered the strategies offered by the model.

This book is divided into three sections. The first addresses the nuts and bolts of BTR. The second addresses the theoretical, philosophical, and physiological bases for BTR. The third describes the application of BTR to various psychosocial problems.

Chapter 1, titled Introduction and Overview of the Break the Rules Model, contains all the information and skills that are important for this model to be effective. It is a good idea to review Chapter 1 every so often to make sure that you remain true to the BTR model. The rest of the book expands on the introduction and overview sections, which may be helpful for the sake of motivation to continue practicing the skills offered but is not critical for BTR to be effective. There is no magic in this model, and it is not that important for the BTR therapist to be thoroughly trained in other models of psychotherapy or psychological theories for BTR to be effective in its application. It simply takes much hard work to establish new habits that are strong enough to take the place of old toxic habits.

Not only does the BTR model attempt to provide a unifying principle for psychotherapy, but also, it is considered transformative. Your life may not be the same (in a positive sense) if you can develop the skills offered in this book.

Chapter 1

Introduction and Overview of

the Break the Rules Model

This chapter contains all the information that is important for you to use and benefit from BTR. It is helpful to review this chapter at times to make sure you are maintaining fidelity to the model. The ideas and concepts presented in this chapter are expanded later in the book.

What is the goal of psychotherapy? People seek psychotherapy for a variety of reasons, including the following: to alleviate symptoms, such as symptoms of depression or anxiety; to achieve better psychological adjustment related to problems and issues in one’s life; to change a personality structure that is causing problems; to resolve transference neurosis; to increase self-awareness; to understand the influence of the past on present behaviors and emotions; to examine unresolved conflicts and symptoms related to past dysfunctional relationships; for recreation; and to change everyday experiences and social interactions (Westenberger-Breuer, 2007; Kohut, 1984; Malan, 1979; Budman & Gurman, 1988; Chessick, 2002; O’Leary & Wilson, 1975).

The BTR model considers four goals of psychotherapy that take into consideration the goals already mentioned. The four goals include personal growth, the amelioration of mental health problems such as depression and anxiety, the provision of support when the person has a chronic condition, and the elimination of negative emotions. The focus of BTR is the elimination of negative emotions; however, people who are able to eliminate negative emotions frequently report a sense of personal growth, decreased depression and anxiety, and a sense of support.

BTR provides a simple and yet effective approach to cognitive–behavioral treatment. Although it may be evident that this model is simple, the implications of this model are quite profound.

Values are what provide the impetus for decisions and behavior according to BTR. Values are those things that a person wants, wishes for, likes, hopes for, desires, or chooses. Values tend to be subconscious, but they can sometimes occur at the level of conscious awareness. Values are turned into rules when certain words are used in language or thoughts, and the violation of rules results in negative emotions.

Negative emotions are emotions that create sadness, misery, suffering, or other such negative emotional valence. Negative emotions can be harmful and forceful (such as anger and irritation), lack control (such as anxiety and fear), or be passive (such as sadness and despair) (Smith, 2015; Myers, 2004). According to BTR, the violation of rules underlies all these negative emotions.

Language is one of the things that make humans different from other creatures. Humans exist in a universe of language. Dogs bark and wag their tails, cats meow and purr, and humans talk. Talking is heard whenever there are two or more people gathered together—it is just what people do.

Thoughts involve language, and language is used for people to communicate their thoughts to one another. You can think without using words, but it is very likely that most of your thoughts involve words in some way. You interpret things and make meanings out of things with language. Language is the filter for your perceptions and experiences.

The Christian Bible emphasizes the importance of words in the human experience. The beginning of the Gospel of John starts with the following: In the beginning was the Word, and the Word was with God, and the Word was God (John 1, King James Version). The writer of this gospel indeed recognized the importance of words, as do cognitive–behavioral psychotherapists.

Words used in thoughts and language affect emotions and moods. Words are the way that humans make meaning of the world, how they define things, how they relate to others, and even how they relate to the self. Words have the power to affect emotions negatively or positively.

You are only aware of conscious thoughts and are not aware of subconscious thoughts. Words are involved in thoughts whether they are subconscious or conscious. Although you may sometimes be consciously aware of your thoughts, you are generally not aware of the particular words you use in your thinking except for rare cases when you purposefully pay attention to the words you use in your conscious thoughts or language.

You are not consciously aware of most of your thoughts. Most thoughts are under the level of conscious awareness or what is called your subconscious. You do not lie to yourself in your thoughts even when your thoughts are subconscious. Whatever you think is true, correct, and real is true, correct, and real to you, even though it may not be true, correct, or real to others. The reality created within thoughts (the ideal) may clash with the reality out there (the real) and result in negative emotions.

Thoughts are put together with words at the subconscious level of the mind before the thought ever reaches the conscious level. As far as you are concerned, however, the only thoughts you have are the ones you are consciously aware of. You actually have many more subconscious thoughts than conscious thoughts. Whatever words are used in thinking, whether conscious or subconscious, create a reality that may result in negative emotions. The goal of BTR is to eliminate the habit of using certain words that result in negative emotions by replacing those words with words that are not going to cause problems.

Rule words are words that suggest that there is no choice. Rule words include should, must, have to, got to, ought to, need to, and supposed to. The use of these words in your thoughts makes you feel pressured, as if you have no choice. These words rob you of your autonomy and sense of free will. If you have to do something, then you must do it. If something should not happen, then it must not happen. The imperative obligation becomes a reality for you whether or not the imperative is real to others. For example, a thought such as "I have to go to the store" does not give you any choice. If you have to do something, then you must do it. A negative emotion occurs when this reality, which you created in your thoughts with the use of the words have to, is violated.

Rule words turn values into rules, and the violation of rules results in a negative emotion. Thus, the focus of BTR is on getting rid of rule words that occur automatically in the subconscious. Your habitual use of rule words in your subconscious thoughts makes you emotionally vulnerable. As long as you have rule words in your thoughts, others can violate your rules and create negative emotions without your permission. The ultimate goal of BTR is to make the use of value words rather than rule words a strong habit in the subconscious level of the mind. Once the use of value words is a strong enough habit, it can take the place of rule words in thinking, and negative emotions can decrease.

Value words include words such as want, wish, like, hope, prefer, desire, choose, and it’s important. Value words may be used in place of rule words. The idea is to make the use of value words a habit that is strong enough to take the place of the habit of using rule words. It would be challenging to get into the habit of using all these words at one time, so it is important to select just one word that can be practiced until the use of that word becomes a habit. Also, some value words may sometimes not work very well.

Value words are of two kinds: those with positive emotional valence and those without emotional valence. Want, wish, like, hope, and prefer all have positive emotional valence. Sometimes the use of a value word with positive emotional valence does not make sense. For example, in the case of the thought "I have to go to the dentist, you can say or think, I want to go to the dentist," but this may not be true because you may not want to go to the dentist. As an adult, you frequently do things that you do not want to do, so words with positive emotional valence will sometimes not work.

You could use the word choose because this word does not have positive emotional valence. Instead of the thought "I have to go to the dentist, the thought would then become I choose to go to the dentist." This phrase works and shows that you are going to go to the dentist even though you do not want to. However, the use of choose may not work in some instances. For example, if instead of telling somebody, "You have to take out the trash, you say, You choose to take out the trash, you may get a response such as No, I don’t. Therefore, the word choose" may not always work as a replacement for rule words.

The phrase it’s important is not a rule word and can almost always take the place of rule words. Instead of the thought "I want to go to the dentist, you can think or say, It’s important to go to the dentist." You can make a choice not to go to the dentist even though the consequence of not going to the dentist could be quite negative, such as getting cavities in your teeth. You do things because you choose to, not because you have to. If you choose not to do something that is important, such as going to the dentist, at least you do not have negative emotions piled on top of the consequences that choice may bring. So the main strategy for getting rid of rule words is to get into the habit of using the phrase it’s important and to make it a strong enough habit so that it can take the place of rule words at the subconscious level of the mind.

The idea that the use of rule words can cause problems is not a new one. Karen Horney coined the phrase "tyranny of the shoulds (1950). Albert Ellis described the use of words such as must, ought, and should" as unhealthy psychological constructs (1994). Although problems related to using these words were apparent in Horney’s and Ellis’s work, the elimination of rule words was not the focus of their therapeutic models.

BTR asserts that rule words turn perfectly good values into rules and that the violation of rules then results in negative emotions. So the goal is to eliminate rule words from thoughts and language. The goal is not to change your values.

People are universally in the habit of using rule words in their language and thoughts. The habit of using rule words is very strong because it begins very early in life with phrases such as "You have to pick up your toys, You need to eat all your vegetables, You must not leave your clothes on the floor," and so forth.

Most, if not all, human languages have rule words, and people who speak different languages are in the habit of using rule words. Rule words can be violated no matter what language one speaks. It is a premise of the BTR model that the violation of rule words underlies many, if not most, of the problems that people have in their relationships with one another, that cultures and religions have with one another, and that countries experience in their relationships with other countries. It is proposed that people would get along much better with one another if they did not automatically use rule words in their thinking and language.

The use of rule words is deeply ingrained in the subconscious level of the mind. The use of rule words is not only subconscious but also automatic. It is not possible to simply stop using rule words because rule words occur at the subconscious/automatic thought level. You cannot consciously control what you are not consciously aware of. You can, however, establish a new habit that is strong enough to take the place of the habit of using rule words.

You do not live according to imperatives even though you use rule words in your thinking and language. You are a free-will being. You live according to values, not rules, yet you use rule words in your thinking and language as if you live according to rules. Rule words turn values into rules, and even though you do not live according to rules, the violation of rules results in negative emotions.

There are two types of rules: rules that are placed on you by outside entities, such as the legislature; and internal rules that you place on yourself, on others, and on the world. Consequences such as fines or imprisonment may result if you violate rules placed on you by outside entities, and you may choose to follow those external rules because you do not want to suffer the consequences. However, it is the violation of the rules you place on yourself, others, and the world that results in adverse emotional reactions.

Internal rules are values that are turned into rules with the use of rule words. You are acting purely according to your values if you do not use rule words in your thoughts. Your values are perfectly okay and right for you. BTR does not try to change values but only helps you get rid of rule words from the subconscious level of your mind so that your values are not turned into rules.

BTR helps you develop a new thought habit that can take the place of rule words at the subconscious/automatic thought level. The ultimate goal of BTR is to replace rule words with other words that reflect values rather than rules. The goal of BTR is as simple as that.

Like other cognitive–behavioral models, a core principle of BTR is that events, conditions, and situations do not cause negative emotions. Events, conditions, and situations violate rules, and it is the violation of rules that results in negative emotions according to BTR.

The Cognitive–Behavioral Model

Figure%201.jpg

Thus, when a value is turned into a rule with the use of a rule word and when the violation of a rule occurs, then a negative emotion results. It is important to stop using rule words in thoughts and language to get rid of negative emotions.

The BTR model represents a genuinely cognitive and behavioral approach toward therapy. Cognitive–behavioral approaches presume that cognitions precede emotions. Your cognitions include the use of certain words because they are habits of thinking. Thought and language habits are behaviors that are developed and strengthened through practice, repetition, and rehearsal. Thus, behavioral strategies are applied to help you practice the use of new words, called value words, to take the place of rule words at the subconscious level of the mind.

BTR’s mechanism of change is simple; however, the underlying theoretical and philosophical bases of BTR are not simple. Because it is simple, BTR can be used to effectively help those with relatively low levels of intellectual and academic abilities. BTR can also be used to treat highly intelligent and educated individuals. The only thing it takes to benefit from BTR is sufficient practice of the strategies offered.

BTR may be used to treat people who speak different languages—with the help of an interpreter, of course. It seems that all languages have rule words and that the speakers of those languages are in the habit of using rule words. Therefore, non-English speakers apply the same techniques and strategies that are applied by English speakers. Thus, BTR is applicable across languages and cultures.

BTR is considered to be a unifying model of psychotherapy because the idea that negative emotions result from the violation of rules applies to other models of psychotherapy as well. The underlying concept proposed by BTR is that the violation of implicit rules is at the root of negative emotions, so any model of psychotherapy is effective in decreasing negative emotions to the extent that it decreases rules that occur at the subconscious level of the mind. BTR provides a more direct way of getting rid of rules than many other psychotherapeutic models.

The BTR model can be used to treat people in individual and group psychotherapy settings, but BTR lends itself to a self-help approach as well. BTR is useful no matter how the skills described in this book are attained. It is helpful, however, to have a BTR-trained psychotherapist to help you with the skills offered by this model.

In formal treatment with a trained therapist, BTR provides all the skills during the first treatment session; therefore, any sessions beyond the first session are spent encouraging people to practice the strategies and attempting to eliminate the barriers that interfere with their ability to practice the BTR strategies.

You can use the phrase "I don’t like it, but it is, and I’ll do the best I can while you get into the habit of it’s important at the subconscious/automatic level of your mind. This phrase can be used at the conscious level to deal with problems and issues right away. The phrase I don’t like it, but it is, and I’ll do the best I can can be used, kind of like a mantra, right away to respond to problems and issues in your life. There are no rule words in this phrase, and therefore, the use of this phrase does not result in the violation of a rule. Many people treated with BTR find this phrase to be very helpful; however, the ultimate goal of BTR is to get into the habit of it’s important" at the subconscious/automatic thought level and to make it a strong enough habit that it can take the place of rule words.

To summarize, the conceptual basis of BTR is that people have expectations regarding the self, others, and the world that are in the form of either values or rules. Values and rules are the same things except for the words used to think about or talk about values. Rule words change values into rules, and the violation of rules creates negative emotions. The BTR model aims to help you get in the habit of using it’s important instead of rule words in thoughts and language. You are encouraged to respond to problems with the phrase "I don’t like it, but it is, and I’ll do the best I can at the conscious level until the habit of it’s important" becomes strong enough to take the place of rule words at the subconscious level of the mind. Accomplishing these two things is what results in the amelioration of negative emotions, which is the goal of BTR.

The BTR model has deep philosophical and theoretical bases despite its simplicity, and these are explored later in this book. However, no understanding of the philosophical or theoretical bases of this model is necessary for it to be useful for decreasing negative emotions. This book goes into some degree of depth regarding the profundity of this model, but it is important to note that the ultimate goal of treatment is the elimination of rule words from thoughts and language by getting into the habit of it’s important.

BTR strategies can be applied to negative emotional responses to problems, relationship issues, business and education issues, and even sociopolitical issues. The BTR model presupposes that the violation of rules underlies the problems that people have in getting along with others; therefore, getting rid of rules from one’s thoughts and language allows people to get along despite differences between them and others. The idea is that the violation of rules underlies the problems that people, cultures, religions, and countries have in getting along with one another.

The BTR model is didactic and based on skill development. Many other therapies rely on psychodynamic processes or relationships between the therapist and the patient for effectiveness. Although it is not a requisite for BTR to be effective, a positive relationship between therapist and patient frequently results from the application of BTR. Many people treated with this model either love it or hate it (and love or hate the therapist) depending on whether they practice the skills. The positive emotional reactions that result from BTR occur because of a decrease in negative emotions that occurs with the elimination of rule words from automatic thoughts. As negative emotions are decreased by getting into a new habit of it’s important, the person begins to feel good and may attribute this improvement in mood and emotions to the therapist. However, it was the person and not the therapist who had done the work that resulted in the positive emotions; therefore, it is erroneous to attribute the benefits to the therapist when the person starts to feel better. Those who practice the skills offered in BTR experience the benefit of decreased negative emotions, and those who do not practice the skills do not experience the benefit of decreased negative emotions. The benefits derived from BTR are often ascribed to the therapist when in actuality, any benefit a person gets from BTR is simply a matter of how much the person practices using it’s important.

People who do not want to get better emotionally do not like this model. About 80 percent or more of