6 Tips for Anxiety and Depression Relief REWIRE

I'd like to welcome everybody to this presentation of Rewire for Anxiety and Depression, an ICBT add on. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to define what ICBT is and how it's done. We'll discuss why most ICBT apps alone are insufficient. And finally, we'll learn how to rewire in order to address distress. ICBT stands for Internet Based cognitive Behavioral therapy. Apps require the person to be aware of their distress, which often prevents early intervention. So think about it. If you've got an app on your phone, well, that's all well and good, but you need to notice when you're feeling distressed. Remember it's there, open it up and then follow the prompts. So that's not always going to happen. But when it does happen, the apps generally don't provide a rationale for why something is causing distress or something else might help you make you feel better. The app would also often say something like, check which of the cognitive distortions you are using now and what might be a better way to restate it. But they're not looking at the root cause. What was it that triggered you to have that unhelpful thought or that distressful thought at that moment? And for this reason, therapist assisted delivery is really helpful in working with ICBT apps. The apps themselves are great tools. You know, they are what we call a therapist extender, but they aren't designed to replace a therapist or replace someone to help you understand what triggered that thought and what do I need to do to address it. We're going to talk about some of that today. So the first thing that is really important in cognitive behavioral therapy of any sort is mindfulness. You need to start becoming mindfully aware of early warning signs, triggers and vulnerabilities. If you wait until you're in full out crisis, it's going to be harder to think clearly and harder to get into your wise in order to process the cognitive behavioral interventions. So start out by making a list with coping tools of your early warning signs of anxiety or depression. What does that look like for you? Is your heart racing? Do your palms get sweaty? Do you start getting tired? Do you start getting agitated and restless? What does it look like for you and how can you best cope with those particular symptoms? Recognizing them and saying, okay, I am starting to get anxious. What can I do right now? In order to feel more centered, more grounded, Make a list of your triggers again with coping tools. What things do you know? Trigger your anxiety, trigger your depression, and you can add to this as you go, but it's helpful to have a list of those and associated coping tools that have worked for you in the past already handy. That way, when you are triggered, you don't have to think, crap, what should I do here? What should I do here? It starts becoming more second nature. And finally, your vulnerabilities. Many times we don't talk about vulnerabilities, we talk about triggers and what to do when you're stressed, when you are triggered, or when you become distressed. But we don't talk about vulnerabilities. And those are the things that make you more likely to get triggered, like being in pain or over tired or heaven forbid, intoxicated. So it's important for you to recognize what situations make you more vulnerable to being triggered. Maybe you don't like being in crowds, so you're more likely to be triggered, have your anxiety triggered if you're in a big crowd, like at an airport court or a concert. If that's true, okay, that's fine. That is who you are, that is how you are now. What can you do if you're forced to be in that kind of situation in order to best deal with it? In order to manage your distress, the next thing I encourage you to do is use what I call mindful planning. Each morning before you get out of bed, think to yourself, what do I have to do today? What is it that I need to use my energy for? What vulnerabilities do I have? What triggers might I encounter today? And how can I deal with these vulnerabilities and these triggers? And finally get an app to remind, remind yourself to check in with yourself. I have a app on my phone that's I supposed to be used to remind people to take their medication. And I use it to remind myself to do mindfulness check ins. And the medication apps tend to be a lot more difficult to ignore than other types of apps out there because they will just keep buzzing until you actually clear them. So once you are aware of all these things and you're becoming mindful, that's great. When you notice you're starting to become distressed, what do you do? Rewire is the mnemonic that we're going to use for this. Recognize your signs of distress. When you start noticing them, don't wait till you're in full out crisis. Recognize them and say, okay, I, I need to do something about this. Just like when you're starting to get a cold or when your car's starting to act a little wonky, you don't wait until you're broke down on the side of the highway. You hopefully take it to the mechanic or somebody who can take a look at it and figure out what's going on. So recognize the signs of distress. Explore the causes of your distress in that context at that time. What is causing me to feel anxious? Helpless? Hopeless? Angry? Whatever you're feeling, write down your thoughts related to the event that are causing you distress. And this is something that you would be prompted to do in an ICBT app, but it would often not go through the rest of this I stands for identify cognitive distortions, r reappraise using facts in the current context and e explore schema that contributed to the distortion and we're going to talk about each one of these. But recognizing the signs of the distress early on and exploring the schema that contributed to the distortion are really where Rewire rounds out or complements the ICBT apps help us continue to make practical tools available to everybody by supporting the channel. You can donate any amount@docsnipes.com donate or on cash app Doc Snipes. You can become a member of the YouTube channel and get perks@doc snipes.com join. You can purchase a super thanks on any videos that are particular help particularly helpful and you can even earn ceus@allce.com our classes there are based on these videos. So let's start out with R Recognize signs of distress Often you may notice feelings or sensations before you know what caused them. You start feeling kind of edgy, you're clenching your fists, you're grinding your teeth. We whatever it is that you do, it's important to know what that looks like for you and write down your signs of distress so you can notice them and understand them when they happen. Instead of going okay, I feel icky, don't know why, don't know what's going on. Let's start labeling it shakiness. Muscle tension in your neck, back, jaw or fists sweating, upset stomach, headache, restlessness, sleep changes, eating changes, including the quantity or type of food or reduced sex drive. These are just some of the physical symptoms of distress affectively and cognitively. Difficulty concentrating, difficulty problem solving, mind going blank or pessimism or negativity can be a indication that you are experiencing distress. Being impatient, withdrawing from other people, or being hyper vigilant, where you're constantly scanning the environment for issues can be another sign of distress. A sign that you don't feel safe, or a sign that you're just completely exhausted over it. Can't Take any more input, you're at your max tolerance. And finally, irritability, hopelessness, helplessness, anger, fear, worry, guilt, apathy that just, I don't care, I just, just don't care attitude or numbness where it's not that you don't care, you're just not feeling anything, you're just kind of numb now. There are other signs of distress, but these are some of the more common ones. When you're recognizing your symptoms on a scale of one to four, identify the intensity of your distress. One is barely noticeable, two is noticeable, but you can still function. Three, it's getting pretty intense and hard to stay focused. And four, you're just plum overwhelmed. You are not doing anything else until you address this issue. The next step is to ask yourself, am I safe at this moment? If yes, all right, then proceed to the next, you know, questions that we're going to talk about. If no, then get to a place where you're safe. Whether that means you need to excuse yourself from a meeting and go to the bathroom in order to just get away from people for a minute, or you need to go to your office or your car or whatever it is or, or wherever it is that you can feel safe. Once you're safe, practice your distress tolerance skills. You need to get out of that fight, orf flight state and into your wise mind. Grounding can be really helpful. Identifying three things you see, three things you smell, and three things you feel. That is pretty simple. You can do it pretty much anywhere, and it keeps you focused in, in the moment. Some people, when they practice square breathing, or that slow breathing where you breathe in for four, hold for four, exhale for four, and hold for four. Some people, when they practice that square breathing, tend to dissociate. And if that's you, that's not what we want to do. So grounding can be an alternative. Either way, you are readjusting your focus at that moment. You're noticing that you're safe. You're down regulating your HPA axis so you can get into your wise mind. Once you're grounded, then step back and describe, what emotion am I feeling right now? You know, I've identified the intensity of my distress and that I feel kind of icky. But what emotion am I feeling? Anxiety, anger, depression, guilt, grief. Then explore the cause. So you're recognizing sources of distress, and then you're exploring the cause of your distress at this moment. So what happened that caused your distress, and in what way did this cause me cause you to feel powerless, rejected, or unsafe? If somebody made a snide comment to you, for example, and it triggered your anger, okay, so in what ways did that person's comment or their attitude toward you make you feel powerless, rejected, or unsafe? And, and just exploring where is this distress coming from? Distress is generally either anger or anxiety, sometimes grief. So we want to explore where that sense of threat came from or where that sense of loss came from. Write down the thoughts that you had and self talk about the situation. What are my thoughts in this situation at this time? I encourage people to use a notebook to do this and make a table in their notebook with three columns. And I generally turn it so it's landscape because I write big. But however you want to do it, make three columns. The first column is your thoughts, and you're going to write down all the thoughts you're having about this particular incident. You'll fill out distortions and restate. Restatement or reappraisal in a few minutes. So once you have all those thoughts written down, you're going to identify the distortions. And we've talked about cognitive distortions or unhelpful thoughts in multiple other videos, so I'm not going to spend a lot of time on them here. But it's important for you to review each thought and write any distortions that apply to that particular thought in the second column. If you're personalizing, if you're taking something too personally, assuming that somebody's attitude or what happened had something to do with you and it didn't, or taking responsibility for something that is completely out of your control, then that's a cognitive distortion. All or nothing. Thinking. Thinking something always or never occurs, or it has to be all one way or another, like I love you or I hate you, it's my way or the highway. That's another rigid thinking pattern that often causes a lot of distress. Catastrophizing is assuming the worst. Assuming that, okay, this happened, therefore the sky is going to fall. Mind reading. Oh, this is another one. Assuming you know what somebody's thinking just because they gave you a dirty look this morning in the elevator, you think that they're angry with you, or they're judging you in some way, or they think that they're better than you, they may have been thinking of something else that was bothering them and that's what that look was about, and they didn't even notice you. But I digress. So were you mind reading? Were you assuming you knew what was going on in somebody else's head, or were you jumping to conclusions without all of the evidence. Kind of like mind reading, but sometimes a little bit different. If something happens like your significant other comes home and they smell of perfume, you may jump to conclusions about what they were doing. They may have gone to the mall and gotten spritzed by one of those people in the kiosks as they walked by. You don't know. But if you jump to conclusions, it can add additional distress. And then the next column and the next step is reframe or restate. Reframe each of the distortions associated with each thought and rewrite the thought in column three based on the facts, what you actually know. In the current situation, each thought can have more than one distortion. For example, you can personalize something that you're jumping to conclusions about, think that it always happens that way and will result in unbearable misery. So that's four, I think four distortions all in one thinking pattern. So as I said, personalization is taking something too personally. What can you do? Ask yourself, is it possible that it's not because of you? What are two other explanations that don't involve you? All or nothing. Thinking Instead of thinking it's always or never or the best or the worst, think of exceptions, ways to compromise, or how two things can coexist. For example, somebody can love you but really hate a behavior that you did, or they can love you and be angry about a behavior. How can you compromise instead of saying it has to be all my way. What? Where can you find that middle ground where you both kind of get your own way met? Catastrophizing. It's important to play the tape through based on the facts in the current situation, based on what's going on right now, how likely is it that this worst case scenario is actually going to happen? How likely is it that you are going to suddenly become homeless and pen penniless and living under a bridge? That was one of my, one of my friend's worst catastrophizing thoughts. Mind reading. Assuming you know what somebody's thinking. So it's important to figure out what you actually know versus what you are assuming and then ask the person for clarification. Don't assume you know that they were intending to slight you when they forgot to call you on on your birthday. Don't assume they had a particular intention without asking them. You know, something else could have happened, and I'm going to give you some examples in a minute. And then jumping to conclusions without all the evidence. It's important always come back to identify the facts that you have and get more information is needed in order to make relatively accurate conclusions. Okay, so here's this example. Sally's boyfriend went an entire day without texting her or responding to her texts. She assumed that he was dumping her because her relationship, all her relationships always fail and she's destined to always be alone. So you hear some distortions there, personalization. She assumed his failure to text her was because of her. What happened in reality? He lost his phone on the way to work and had to go go to back to back meetings all day long. So he couldn't get a new one until after work and just didn't think about emailing her or using somebody else's phone. He just didn't think of it. Mind reading. She assumed he was dumping her. In reality, he was just completely overwhelmed. He was in that fight orf flight state. I mean that's a pretty bad day when you find that you have lost your phone and then you've got back to back meetings and for most of us we feel very naked without our phones with us. So he was overwhelmed and stressed out and was not clearly thinking of helpful options. We don't think clearly when we're in that stress mode. All or nothing thinking she tells herself that all of her relationships always end in disaster. Reality. Well, only Sally can really evaluate whether that statement is true. If it is true, if she looks back in every single relationship she's had has ended in disaster, then she may need to try to make a plan to figure out why. Why is it when I get into these relationships they end up becoming toxic or dysfunctional and catastrophic? Thinking she believes she's destined to always be alone. The reality most people go through several breakups before they find a long term partner. Even if her boyfriend were to dump her, she has friends and family that care deeply for her. Now this is not something that I would probably say to her. I would encourage her to think about the facts in the situation and play the tape through. How true is it? How likely is it that you will actually be alone forever? Explore schema and beliefs from prior experiences. And this is where we start exploring why is it in these particular types of situations I get triggered Because a lot of times it traces back to a prior experience, a prior trauma that has been unresolved. And until you resolve that it's go similar situations in the future are likely going to continue to trigger you. Which is why I say we really need to do more than just, you know, help people restructure a statement in the present. We need to understand where that came from so asking yourself when was the first time you remember feeling this way? How is this situation similar and different to that situation? How are you stronger, more capable and or safer now than you were then? What prior experiences have you had that were similar to this one and contributed to your faulty conclusions? So you're not only remembering the first time you felt this way, but you're thinking about several prior situations when you felt this way and how using that original schema contributed may have contributed to faulty conclusions. What do you need to do to process those past experiences to help you feel safer and more empowered in the present? Additional Section Remember I talked earlier about recognizing your vulnerabilities? It can be helpful to also explore when you're going through this what vulnerabilities are making you more reactive on that particular day? Are you tired? Hungry in a stressful environment, Overwhelmed with all the things that you've got to do? Other problems? Maybe you got into a fight with your sister and you're really upset about that, so you're kind of on edge. You're already at your distress max. So. So anything else is going to kind of blow the top off the pressure cooker. What can you do to address those vulnerabilities and reduce your stress load? Sometimes it just means being compassionate with yourself. Other times there are things you can do only you can answer that. There are many apps out there that can help you address anxiety and depression on the fly, but they often fail to help you learn how to apply the skills yourself and address the underlying issues. In addition to using those apps, which again, they're great as therapist extenders. They're great tools that you can use immediately in the moment. But consider maybe in the evening applying the Rewire approach, using the worksheets to get to the root of your distress so you can address it and feel safer, more empowered in the present and stop being triggered or as triggered by similar situations, I will note that I have uploaded a worksheet to the Google Docs folder that's available for Silver members. So if you're Silver member you there's a link to the Google Docs in the on YouTube that you can click on and go to the Google Docs folder. Have a great day.