Cognitive Behavioral Therapy and Understanding Cognitive Distortions: Dr. Dawn Elise Snipes

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@Allce.com Counselortoolbox I'd like to welcome everybody to today's presentation on cognitive distortions, understanding and addressing them. This is one of my more favorite topics presentations, if you will. So if I sound even more hyper and excited than normal, I probably am. What we're going to do is define thinking errors and explore the different types of thinking errors that a lot of people, not just our clients, but a lot of people, experience. And my personal as well as professional experience has been that by addressing, identifying and addressing a lot of these thinking errors, we can greatly reduce stress. If we reduce stress, then we reduce how much, how often we're hyped up, stressed out, using extra energy, have that HPA axis going and it improves sleep, improves mood. There's a whole bunch of stuff I have never met yet not to say it won't happen. Someone who doesn't have or occasionally use a couple of cognitive distortions, they are not unusual. That is kind of one of those things that if you aren't regularly mindful and on top of it, it can kind of sneak up on you. So we're going to talk about how to encourage clients to be aware of that. We're also going to talk about how thinking errors and cognitive distortions specifically can play into our basic fears of rejection, isolation, the unknown, loss of control, and failure, which, you know, generally are the big ones that trigger that fight or flight reaction. So we have cognitive distortions that are increasing our fear, our sense of our need to fight or flee. It's going to increase our stress, which is probably not going to be good in the long term in our on our health or mood. And so then we're going to go on to identifying ways to increase awareness of thinking errors, address them, and maybe even start addressing some of those basic fears like fear of abandonment. So the cognitive distortions aren't as powerful. If somebody, for example, interprets something as a rejection, if they've already dealt with their fear of abandonment, they may be able to kind of let that one go and say, you know what? Not worth my time. So why do we care? How does it impact people's recovery? Thinking errors or stinking thinking as we call in substance abuse, plays a large part in keeping people miserable. If you see things in extreme terms, if you personalize things, if you make judgments based on feelings rather than facts, I feel scared. Therefore this must be Terrifying. It's going to tend to probably add a lot of additional stress. Most of the stuff that we call mood disorders and addictions are made worse by faulty thinking. I'm not saying that faulty thinking causes depression, anxiety, all that, but it certainly doesn't help. So if we can help people start identifying this, this is something small, this is something they can start doing the first day they walk out of your office, which can give them some hope and a little bit more awareness of what might be going on that's keeping them stuck. We can help clients not make mountains out of molehills, focus on the things that they can change and identify and eliminate thought patterns that are keeping them stuck. Most of my clients, my experience has been that they have three or four cognitive distortions that kind of are their go tos. And there are themes within those thinking errors that help me understand why they react certain ways to certain events. And a lot of times, you know, interpersonal process stuff, we can go back and see where they learned that and then we can talk about whether whatever they learned in the past still applies in the present. So cognitive distortions take a thought and manipulate it to fulfill people's expectations of a situation or to conform to their current headspace in general. So if people are using all or none, thinking, you know, they are taking an event and making it conform to this, all or none, this person never, ever does this or always does this. And generally when they're using those terms, it's not a good thing. So we want to encourage people to look at finding exceptions. Cognitive distortions, like it says on here, also helps people or impacts people by encouraging them to look selectively and notice things that conform to their current headspace. So if they are in a bad mood, they're going to notice the negative things. Think about it. It's easy to fall into this trap if you get up in the morning and it's kind of gloomy and rainy outside and you know you've got a meeting that you don't want to go to, so you're not in the best mood getting up. Do you notice how good breakfast tastes? And are you thinking about all the exciting things and whatever, you know, the fact that you're not gonna have to water your garden or are you focusing on hot crap, I'm gonna have to drive in this. People drive like idiots when it's raining. A lot of times we focus on the things that conform with our mood. That's just human nature. By being mindful, we can stop ourselves and we can say, you Know what? No. There are some really challenging things today, and I wish it weren't raining. However, I'm going to force myself to try to walk the middle path, focus on the fact that I have a job. And yeah, this meeting is not the most pleasant, but I'll get through it and figure out optimistic ways to view the rain and all that kind of stuff. Okay, maybe people do drive like idiots, so maybe you want to take the back roads in order to get to work today so you don't have to drive on the interstate where it's a little more dangerous. But instead of focusing and getting stuck and dwelling on stuff, you're making solutions and you're trying to focus on at least something of a silver lining. Irrational thoughts, which we're going to talk more about next week, are beliefs or thoughts that you may hold that are generally extreme. I must have love and approval from everyone all the time. So they usually involve some sort of a cognitive distortion. A lot of times, all or non thinking, they tend to be unrealistic. Is it realistic to think you're going to have love and approval from everyone all the time? No. You know, not everybody's going to like you. So figuring out how you're going to deal with that and helping clients realize how unrealistic certain thoughts are is helpful. And sometimes when I'm working with teenagers or people who seem to be resistant to this concept, I might ask them, you know, okay, tell me somebody that you really look up to. Tell me somebody you favor. And then I ask them, you know, are there people that don't like them? And, you know, thankfully, so far I haven't been able to get an affirmative to the question of are they liked by everyone generally, even if it's, you know, Tom Cruise or whoever the popular person is right now, there is someone who dissents. So then we can talk about, well, that person is super talented, super popular, super popular, and has all these things going for them, but there are still people that don't like them. Does that make them worth less of a person? And irrational thoughts creates feelings of failure, inadequacy, and disempowerment. If you're setting yourself up to this bar that nobody can hurdle, you know, nobody's liked by everybody all the time. So you're setting yourself up for depression, anxiety and frustration. Causes of thinking errors can also include information processing shortcuts. We use schemas when we interpret things, so when something happens, we check back with our memories and go, have I experienced something like this before? What can I interpret about it instead of having to start from, from jump to figure out what's going on here. Is this safe? Is this dangerous? The example I always give because I talk with my hands a lot. My Garmin thinks I run three miles every time I teach because I'm moving my hands and that just comes from the environment that I grew up in and you know, whatever. But I am a very demonstrative person and I tend to be kind of loud too. And that's just kind of the way I am. If you were raised in an environment, especially one characteristic of domestic violence, seeing or observing that may be intimidating, especially if you can't hear what I'm saying. You can just hear that I'm talking loudly and I'm using big gestures and might freak some people out. That would be an information processing shortcut error. Because they're interpreting something in the present based on a past experience and the two are not the same. We can help people work through those mental noise. My son, bless his heart, he's a teenager and I think part of it's just being a teenager. But I will be talking to him and, and he'll just like start off on some diatribe on something else. He's been busy thinking about something else while I've been talking and his mind is just all over the place constantly. And part of that is him being gifted. His mind works a lot faster so he gets bored with what I'm saying pretty quickly. Part of that's just being a teenager, but helping people calm down the mental noise so they can focus on what's being said and hear everything instead of just the first part or little glimpses here and there so they can understand the entire situation of what's going on. You may notice it if you've been in a meeting and you're just kind of, you're drifting off, you're half paying attention and all of a sudden you hear something about budget cuts and all of a sudden you're paying attention. Now the mental noise was going on first and now you're not sure. You're having to try to play catch up and figure out what they're talking about and how it applies to you. And we also have thinking errors that are caused by the brain's limited information processing capacity. And you're like, well, we've got huge brains. Yes we do. But a two year old does not have the experiences or even the ability to process information in the same way that a 22 year old does. So things that you learned as a child may not Be accurate or even helpful. Now, when you were a child, it was really important to listen to your parents and you know, because you were dependent on them for survival. As a 22 year old, you know, theoretically you're living on your own, so it's less important. You can get groceries for yourself, you can tend to your own basic needs, if you will. So taking those, that same experience, is it good to be respectful of your parents and yada, yada, yada. Of course, you know, generally that's what we want to kind of strive for. But not all families are functional. So in really dysfunctional families, sometimes the adult, the 22 year old who doesn't rely on mom and dad to change their diaper and feed them, is able to set some boundaries and say, you know what, this is what's important to me. And crisis. When we're in crisis, we do not process information nearly as well, which is why it's important to write things down for people who are in crisis. And it doesn't just mean victims of crime. It means someone who got fired from their job, who got into a car accident, who just got a diagnosis of some sort of long standing, not necessarily even terminal disease. Anything that's going to throw them for a loop, if you will, is going to prevent them from hearing and taking in all that information. So it's important to help people process things all the way through for the like. With the example of someone who gets a diagnosis of some sort of long term illness, they're going to hear that and they're just going to probably zero in on that and not hear 60% of what's said after that. So it's important for somebody else to be there with them or for the care provider to write it down to make sure they understand. Okay, yes, this is the diagnosis, but these are our options and this is what we need to do. This is the treatment plan. Emotional causes of thinking errors I feel bad, therefore must be bad act. I hate my job, therefore this must be an awful place to work. Possibly, but possibly you've got other stuff going on. I'm scared, therefore this must be a scary event. This is one that when I work with clients who have fears of flying, you know, kind of what we talk about is emotional reasoning. Let's look at the facts and see if it supports the fact that you're scared. Let's see if it supports the fact that this is a terrifying experience. Now obviously we talk about the emotions ahead of time and where it came from. I'm not just going to go well, that doesn't make sense. But at a certain point, we might start exploring the factual basis to their emotional reaction. Moral causes of thinking errors. Sometimes you can convince yourself it was the right thing to do or it was the wrong thing to do and make judgments on yourself and other people based on your moral reasoning and social causes. Well, everybody's doing it so. Or nobody's doing it so. If you're thinking that because you see something plastered across social media or plastered across the Internet seemingly 247 and you're thinking, well, everybody thinks this way or likewise, you're not seeing something, you're like, well, nobody thinks this way. You want to examine that because it may not be. You're only getting one perspective and that's whatever you're seeing there. Have you talked to people? Have you gone in your local community and examined, you know, from your peer group? Is everybody doing it? Is nobody doing it? What does the data say? We use this type of reasoning a lot when we're talking to youth about substance abuse prevention and sexual practices. So what is the impact of thinking errors? And I alluded to this earlier, they trigger, fight or flee most of the time. So when we do that, we set off our HPA axis, secrete a bunch of cortisol and create a cascade of excitatory reactions to prepare us to survive. It makes sense if there is something to survive. Most of the time, I would say, you know, just spitballing it. 85% of the time we are making threats or perceiving threats when there are none there or there aren't any that are really worth our energy. But thinking errors cause depression, anxiety, emotional upset, behavioral withdrawal. Some people may try to escape by using addictions because they their thinking errors are so ingrained that they perceive the world as a really scary, hostile and welcoming place and they feel hopeless and helpless to change anything. When your stress response is activated, you're not going to sleep as well. And so you're going to feel tired a lot, which will change your sleep patterns, which breaks down your ability to get quality sleep. Eating changes may occur because when you're not sleeping and maintaining your circadian rhythms, your eating hormones also get out of whack. But also some people just eat in response to stress. Physically we know there are a bunch of stress related illnesses, but even if you don't have a stress related illness, if you're under a lot of stress, you may get more headaches, backaches, upset stomach, GI distress, that kind of stuff. And socially, you may just not have the energy or desire to interact with people. So kind of putting yourself in the position of someone who has a lot of cognitive distortions, you can see how it impacts every aspect of their life. Thinking errors and interventions, emotional reasoning. Feelings are not facts. You know, your feelings are your feelings and they're coming from somewhere. Your brain is telling you there may be a threat. I hear you. So let's figure out if there is one. Encourage people to learn to effectively identify feelings and separate them from facts. So if the person says, I'm terrified about flying, so we know why you're terrified, what's the evidence that you're in danger when you go up in the sky? You know, and a lot of times people just have memories of what they saw on tv. That availability, heuristic, things that may be big but not frequent, really kind of stick with us. You know, right after 9, 11, you know, big event, very scary, stuck with you about, you know, whether you were safe or not. So asking the person, what is the evidence that this is dangerous? In what ways is this similar to other situations that you've been in? You've had to fly or do something that is terrifying. So give me another situation that's been like this, and how have you dealt with that? Because most of the time people have been terrified of multiple things. You know, it's not just, not just flying. So we'll talk about other situations where they have dealt with fear, and that will give us an understanding and that will remind them of their strengths about how they most effectively deal with fear. And we can start talking about that. And if they can't come up with anything, you know, go back to a less intense emotion. Like, well, when you're scared, what do you do? When you're worried about something, what do you do that helps you feel less worried? You know, I don't want dwelling on it, pacing around in a circle, things that intensify it. I want to know what helps, because most everybody, and you know, I'm sure there's people out there who haven't, but everybody I've encountered so far has always had one or two things they can do that help them feel a little bit less stressed. Not always the healthiest, but we try to start from there and work forward. You know, some people smoke a cigarette, some people go work out, some people drink, some start there, figure out what they've done before and build kind of from there to figure out what to do. Encourage them to develop distress tolerance skills, whole other presentation, but recognizing that fear and the urge to escape comes in Like a wave and goes out usually in about 20 minutes. If they can deal with it, give them things to do in order to not focus on their distress. For my clients with airplane phobias, when they have to fly, I encourage them to do that game. Remember when you used to fly in. Not fly, but drive with your parents, you know, long drives and you would look at billboards and you would find things that something that began with the letter A and then the B and C and D or something with certain colors or whatever it was. We always played these inane little games when we were driving in the car to keep us from being bored. But you can use the same sort of mental games and hijinks to keep you focused and not focused on your anxiety. The other thing you can do is, you know, mindfulness exercise. Identify four things that you can hear or see, three things that you can hear, two things you can smell, one thing you can touch. The other one is using guided imagery. Encourage them to try to focus on wherever their happy place is. What does it smell like? What does the sun feel like? What does it feel like? Temperature wise, yada yada. So they can distract their brain, if you will, until that urge, until that fear passes. And they may need to use it a couple of times, depending on, you know, if they hit turbulence. I know when I'm flying, I'm not particularly afraid of flying, but when I hit turbulence, I'm saying a few Hail Marys and it's just kind of an automatic reaction. And then I kind of get grounded again. And encourage people to develop emotional regulation skills. Prevent as much distress as possible by preparing ahead of time. If you know you've got a fly, what can you do to get good rest? What, what can you do to minimize the possibility that you're going to react with strong emotions? And again, that's a whole other presentation. We've got videos on it on our YouTube channel, YouTube.com allceducation and you can also Google it. These are basic dialectical behavior therapy skills. Cognitive bias, negativity, mental filter, kind of all in together. When you focus on the negatives and worry about the future, the cognitive bias means focusing on things and always interpreting things to a negative or to a positive extent. Generally a negative cognitive bias is the one that our clients experience or they wouldn't be feeling depressed and anxious. But this mental filter also encourages you to only see and focus on the negative aspects of something. So questions you can ask people, what's the benefit to focusing on the negative? What are the positives? To this situation. And they may look at you like you've got three heads. And it may take some, you know, cajoling to get some positives out of a certain situation. If somebody gets fired, that's not a happy experience. Alright, so what positives can we find in this situation? Well, you have an opportunity to find another job. So we want to look at what happened, what was going on, what contributed to the firing, and help the person learn from the situation. So maybe in the next job it can work out a little bit better. And we want to have them look at what are all the facts, you know, because sometimes somebody will come to you and go, I got fired from my job for absolutely no reason at all. And there was no warning. Okay, well, knowing what I know, you know, and I'm not going to tell somebody this, but there has to be a process of verbal reprimands and stuff unless you're on your probationary period. So we might start talking about, well, tell me a little bit more about what was going on and how this happened and what reason they gave you. So let me start getting an idea about what were some more of the facts and you know, what could we take away from this? Another activity I do, completely different from the questions, is a coin toss activity. If somebody tends to be a negative Nelly, that's fine. However, I want you to just experiment for a week. In the morning when you wake up, toss a coin. If it lands on heads, you need to proceed as if you were the most optimistic person in the whole world and put on those rose colored glasses and act as if. And then on the days that it lands on tails, you can just be normal, be yourself. And at the end of each day, I have them fill out a diary, if you will, a journal to describe how their day went when they were negative versus when they were positive. How did people interact with them? How did their day seem to go? And it's going to be a little bit exhausting to be happy for an entire day if that's not your normal mode. So I'm not expecting them to go, oh, that was the best thing in the world. But I do want them to start noticing that things may go a little bit easier. And I also want them to notice that on the days that they were optimistic, there were things to be optimistic about. They actually found the good things. So then the next week we can go more towards dialectics and walking the middle path. So when they have a negative thought, I want them to think of a corresponding positive thought to balance it out. Disqualifying or minimizing the positive. A lot of our clients do this. You know, you say, wow, that was. Congratulations on your promotion. That was no big deal. Great job achieving that goal. Anybody could do it. So a lot of times they don't feel good about themselves because they've always minimized their own accomplishments. They make it a month sober, they may minimize that accomplishment. Well, it was only one month, or I've been here before, you know, just waiting for the other shoe to drop. I asked them questions like, would you minimize this if it was your best friend's experience or your child's experience? You know, if they got this award, would you be like, anybody could have done that. Just put it on the shelf somewhere? Probably not. So encourage them to be more kind and compassionate to themselves and treat themselves the way they would treat other people that are important to them. We talk about what's scary about accepting the positive. If I accept that I got a really good job and this is an awesome experience, it's intimidating. You know, people are expecting things now, and if you mess up, you know, people may judge you. Yeah, all those things are true. However can you handle it? So a lot of times we may get. Spend a lot, a fair amount of time talking about what's scary about success, because oftentimes success is kind of like climbing to the top of that mountain and then looking over the edge. Terrified of heights. Absolutely terrified of heights. So I don't look over the edge. And I can understand how someone who, you know, just like somebody who is kind of coming out of depression if they're in a bipolar episode, especially. But if they're coming out of that deep depression, the most dangerous period for them is when they're starting to feel better and they're starting to accept that things are getting better and they're happy again because they're like, crap, I don't know that I can fall from this. I don't know if I can endure the fall. So we talk about, how do you prevent that? What would happen if, you know, you failed or you started to get depressed again? What. What steps would you take? Sometimes we disqualify the positive because it fails to meet someone else's standards. So asking the person, might that be true here? You know, when I got my degree, I was met with, well, congratulations, you're not a real doctor. But a PhD is a good accomplishment. Excuse me. So sometimes the people that you think you need approval from may not be able to give the kind of approval that is important to you. So Encouraging people to be able to give themselves positive feedback and be proud of their accomplishments despite other people's judgments is really important to helping them accept themselves and again, get away from that fear of abandonment because they know that they're good enough, smart enough, and gosh darn it, people like me. Availability heuristic is remembering what's most prominent in your mind. So, like I said about the airplane crashes, whenever an airplane crashes, we always hear about it. Whenever an airplane doesn't crash, we don't hear about that. There's like 20,000 flights in the USA every day, and none of them crash. But every once in a while one will, and that's what we hear about. So we zone in on that and think about it as being dangerous. So asking people, what are the facts? It seems like this is a really dangerous thing to do. Fly in the air 30,000ft above the ground. What are the actual facts about it? And, you know, are there other things that you do, like driving on the interstate, which are similarly dangerous or more dangerous? And I don't always throw that part in there because I don't want them to become afraid of driving in addition to flying. But we do look at facts about whatever the prominent fear is. Egocentrism. My perspective is the only perspective. So what I see is what happened. And I don't care what you say, you don't necessarily know what happened. And if you've been a parent, you know this is true because you may walk in and go, I can't believe you just did that. But you don't realize that before you walked in, the other child had done something else that was equally as bad. So figuring out everything and seeing the entire picture is really important and not getting stuck on, well, I saw this, and. And this is the way it is. So, bada bing, when you go into a grocery store and you interact with a cashier who is just terribly unpleasant. And you know, I was a cashier before. It is a challenging job. I loved it. But you can meet some challenging people. So thinking in terms of, all right, this person is being really unpleasant, but. But is it about me? You know, my initial perspective might be, you're being really rude to me. However, if I step back, what other perspectives might be going on, you know, what else might have happened that might be explaining this other than this person is just rude personalization and mind reading. What are some alternate explanations for the event that didn't involve you? And I put this on the same page because they're really related. Thinking about, you know, Again, that cashier, maybe they had two really rude customers leading up to that. Maybe they were supposed to get off three hours ago and their relief didn't show up, so they're having to work mandatory overtime. There's a lot of things that could have happened. Maybe their dog just died, I don't know. But I don't know what's going on in someone else's head. So I have to assume, or I choose to assume 99% of the time that it's not about me. You know, I checked my own self and I was like, okay, was I rude? Did I do something? No. Okay, if there's not anything obvious, then I assume that something else may be going on with them. How often is it really about you? So encouraging people to think about that. How many times was somebody in a bad mood or grumpy or passed you in the hallway and didn't say hi? How many times was that a slight against you versus they were off in la la land or something else had happened and you know they were in a bad mood before they even really realized you were there? Magnification. Ask people, are you confusing high and low probability outcomes? If somebody is saying that this is the worst thing ever, okay, how much will it matter six months from now? We know that sometimes people get into arguments about leaving the toilet seat up or the cap off of toothpaste, or not putting their dishes in the dishwasher. When you live in the house with somebody, there can be arguments, arguments at work, arguments other places. But a lot of times the things that we get upset about, we may get more upset than we need to be because we've got other vulnerabilities going on back here. We've let stress build up. We didn't get enough sleep, we haven't eaten in 12 hours. Whatever it is, there could be a lot of reasons for it. But encouraging yourself, when you start to feel yourself getting upset, think, how much will this matter six months from now? And is it worth my energy? Is kind of what I put on the end of that. Because it may matter a little bit six months from now, but is it worth dumping a bunch of energy into it right now, or is it something you've just got to let play out? What have you done in the past to tolerate events like these? You know, ask somebody nicely to change a situation or, you know, how have you handled other situations where you didn't have to think it the worst thing in the world that was just going to devastate and ruin your day, similar to Magnification is all or nothing. So I have people look at things like love and hate, perfection and failure, all good intentions or all bad intentions. Most of the time, you know, people are not totally perfect or totally failures. Most of the time, people don't have all good intentions or all bad intentions. Now, sometimes they may have all good intentions for a particular episode or event, but I think most of us are guilty of, you know, not necessarily always doing the next right thing. So encouraging people to look for exceptions in Love vs Hate. I love this person this week, next week, I hate this person. I never want to see them again. What exceptions are there? What do you love about them? What do you hate about them? We look at behaviors versus people. We also look at, you know, imperfection versus failure because a lot of people get stuck on this. If I'm not perfect, then I'm a total failure. Do you hold other people to that standard? And what things have you done that have been really awesome? And encourage people to focus on the things they can control, Remembering what's most prominent. We already talked about the availability. Availability, heuristic belief in a just world or a fallacy of fairness. Identify four good people who've had bad things happen. You know, I encourage people to realize that sometimes you may be good, you may be doing all the right things and something crappy is just gonna happen. If they believe that if they do the right thing and then they're always going to have a good life and everything's always going to go well, you know, hear that word always. Which is where another cognitive error bleeds in there. It's important for them to understand that sometimes life just ain't fair. So how do you deal with it and accepting the fact that life isn't fair? Help from an early age helps people deal with it. When something happens that's unfair and they don't go, oh my gosh, I didn't expect that to happen. They can go, well, yep, Mama always told me life ain't fair, as she told me to go up and clean my room anyway. Attributional errors, labeling yourself, not a behavior. And a lot of us and a lot of our clients tend to do this, such as, I am stupid versus I don't have good math skills. So global attributions are things that apply to the whole person. Individual agency, the that is the worst agency ever versus that agency has some really bad managers, but it has some really good line staff. Encouraging people to be specific about things that they have issues with, with themselves or with other people. That person that lives across the street is just totally crazy and unreasonable about what? You know, if they're totally crazy and unreasonable all the time about everything and in your face, okay. But most of the time that's not going to happen. So it might be about a certain thing that the person across the street is totally crazy when my dog goes over and uses the bathroom on their yard or something. So encourage them to be more specific. Stable means it's something that's not changeable at all. So, you know, I am stupid means I am and always will be versus you know, I am ignorant to this particular skill, but I can learn it. So, you know, I can learn to do math. I've had to learn to do math again as my son's exceeded my math abilities and internal it's about me as a person versus about a skill or skill deficit. One of the common things that we use to give an example of this is if you see somebody walking down the street and they trip and fall, do you say that they are a total klutz or do you think initially that person must have lost their balance because they tripped on something on the concrete? When you trip, it's a single event. It's on the concrete. It's external. It's not that the person's clumsy, it's that they tripped or they weren't paying attention because they were playing on their phone versus they are a total and complete klutz. One can be changed. One is more durable. So questions for clients encouraging them to understand that beliefs are the combination of thoughts and facts plus their interpretation. Reality plus interpretation produces what we come to believe. So we ask them, what are the facts for and against my belief? And you can do this with positive things too. Doesn't usually require it, but you can. So you might start out. If your group is somewhat resistant to doing some of these activities, you might start out with positive things. But whatever works. What are the facts for and against my belief? Is the belief based on facts or feelings? So we've already identified the facts for and against. Now we look at this belief and we're looking at these list of facts for and against. And if the belief fits the facts, then the belief is probably based on facts. If the belief doesn't fit the facts, then we might look at, well, what is it based on? Maybe feelings, so we can start exploring it. Does it focus on one aspect or the whole situation? You know, there's generally a lot of things going on. If somebody gets in a car wreck, they oftentimes focus on the person in front of them that put on their brakes too fast or, you know, turned without signaling or did whatever they did, they focus on one aspect of the situation instead of what other drivers were doing, what else was going on, what they were doing in to paint the big context, does the belief seem to use any thinking errors and we've just gone through a bunch of them all or nothing? Thinking, magnification and selective attention, paying attention to the things that fit your hypothesis. What are some alternate explanations for what might have happened? You know, if you've been in a car accident and you've been rear ended, you might think that person wasn't paying attention. True? Could be. Or maybe they were paying attention and they it had just started raining, it hadn't rained for a while and it was really slippery and they didn't judge the distance to stop in enough time. Happened a lot in Florida. So thinking of alternate explanations can help people examine their beliefs. It may not change them, but it helps give them some alternative thoughts. What would you tell your child or best friend if they had this belief? What do you want someone to tell you about this belief? And how is this belief moving you to. Toward what and who is important to you or away from what or who is important to you? So have them really examine. If I hold onto this belief that I am useless, okay, is it based on facts or feelings? Does it focus on one aspect or the whole situation? Are you useless all the time to everybody? And I generally, well, I don't think I would ever ask somebody that question directly. Would ask them, in what ways are you useful to people? And hopefully I have some information ahead of time like I know that they're a parent and they work and yada yada. Then we might start examining some thinking errors that might lead them to think that they are totally useless and so on as we work through these questions. So cognitive distortions, personalizing, mind reading, all or nothing thinking, catastrophizing, making mountains out of molehills, overgeneralization, taking one thing that happens and expecting it to happen in all situations, all the time. Every time I see someone that meets this description, I am expecting them to act this particular way. Shoulds I should do this, but you know, and the recency or availability heuristic, all of these can play into our fears of rejection, isolation, the unknown, loss of control and failure. When you personalize something negative. If you think it's all about me and I am the worst person ever, well, why should anybody like you? And if you feel like you're not lovable like you're not likable. Then you may feel isolated and depressed. So, you know, you can kind of see how those things work together. What do we do? The ABCDEF, which you probably learned as the ABCs, and we've just added, we keep adding letters. The activating event is what happened. You got into a fight with your significant other. The consequences, you got upset, you were devastated, you ran out and you slept at your best friend's overnight. Okay. In the meantime, there were those automatic beliefs. So what are the obvious beliefs? That you had the first things that you can rattle off, that your significant other didn't love you, that they didn't have any respect for you, that whatever it is. Then we want to look at the negative self talk and past tapes and things that you were also telling yourself about, whether you were unlovable and whether you deserved to be treated like this. We go back and we dispute the irrational thoughts. We look at the beliefs, identify any cognitive distortions, any irrational thoughts and dispute those. There are going to be some left. You know, maybe your significant other was completely insensitive. Alright, well, we can't take that away if that's what happened. So we evaluate the most productive outcome. Is staying angry worth my energy? Or is there a different way to approach this? Is there something else I can do? How can I best use my energy to deal with this situation if it's worth my energy or let go of it if it's not worth my energy? Maybe you got into this big old fight because your roommate forgot to clean out the litter box. You know, it happens. Is it worth your energy to get all fired up about it? Coping skills distract. Don't react. Encourage people to figure out a way, and sometimes I call this practice the pause. To take a breath and distract themselves for a minute until they can get into their wise mind. Until that adrenaline rush goes away and they can think clear, clearly. Talk it through to identify cognitive distortions and find the middle path. Sometimes you're not going to talk it through with the person you're angry at. Sometimes you can talk it through with your dog because, you know, Freud used to talk to himself and figure out his own stuff. But a lot of times you can just glean a lot of information by journaling it or talking. If you're an extrovert, you're probably going to talk. If you're an introvert, you may write whatever it works for you. Get it out so you can evaluate it and find the middle path. You know, the good and the bad in it. Encourage clients to practice urge surfing and remind them that their urge to fight or flee will dissipate if they don't keep feeding it. Have clients pinpoint what they tell themselves about an urge that makes it harder to cope with the urge when whether they want to self injure, whether they want to put their fist through a wall or through somebody else's face, or whether they want to scream and yell at somebody and really put them in their place, those are all urges. So what do they tell themselves about those urges that make it harder to not engage that urge? Help them develop a list of empowering self statements to constructively challenge anything that makes it difficult to cope with that urge. Anything that's going to help is going to make them feel better. So some of these statements they can use are what's the evidence that I have to put my fist through the wall? What's the evidence that screaming at this person is going to do any good? Encourage them to give themselves some space and some compassion, recognizing that that person is human, they have a right to make mistakes. Or if they're angry at themselves, you're human, you have a right to make mistakes and you have a right to your feelings. Other empowering self talk is I can do this, I can get through this. This urge will pass. Whatever it is that helps them get through that 20 to 30 minute period where they may still feel that urge. Distressing thoughts Worksheet we already went through a group activity. Have them list thinking errors and you can do it. You know, y' all know I favor putting flip chart papers around the room and breaking my large group and 8 to 12 people or whatever into smaller groups of 2 to 4 and having them go around to the different stations where after we've already defined and discussed thinking errors and how they protected you until now, we might have them go over to overgeneralization and say, let's talk about this. How has it protected you until now? And they can list different ways. For example, if they were victimized when they were younger than anybody, that reminded them of that, maybe someone who is dangerous. So in a way it acted to protect them in without other information, it just kind of served as a great big blanket barrier. So encourage them to look at how has this worked for you? And you know, it may not be working very well, but it served a purpose at one point. A lot of times it's a survival sort of thing, a protection thing. Identify thinking errors that you can currently eliminate and a countering mantra. So I need to be loved by everybody. All the time or I am the worst, most useless person in the world or I will never be happy. Those are all cognitive distortions. Extreme thinking. So what kind of countering mantras can we help them find? What kind of positive self talk? When they tell themselves that, what can they respond with? Help them identify thinking errors that they still hold on to and why and start addressing them. So if there are some things like I can never be happy or everybody always leaves, okay, if somebody is determined to hold on to that, you know, they can't see any alternate explanations, then let's look at what function is that serving for you? How is it protective? What does it do for you and in what way is it helping you? Or how can we start addressing it? Remembering that thought patterns are generally learned over a long period of time and they serve a purpose and are generally more beneficial than the alternative. For example, if someone was emotionally abused as a child, they may have developed issues with authority figures in the present. You know, they are not going to be disempowered again come hell or high water. So we can understand from, you know, an interpersonal perspective how that might have developed and how it might have been beneficial at a certain point in their lives in order for them to feel like they were regaining power. Is it functional now? If they're working with us, it's probably not. So what's a more effective response? A change in outlook means seeing how this thought pattern is now destructive and, and how alternate thought patterns may now be more helpful. So helping people figure out how they can deal with authority figures and helping them see how their verbal and nonverbal behavior may be off putting if they are thinking that people who are in authority are always going to do them wrong. So cognitive behavioral therapy is a technique that helps people understand how their thoughts create feelings and vice versa. We help them identify and address negative self talk. And you know, in negative self talk I put those cognitive distortions, all or nothing. Thinking negative thoughts that fuel the c. The consequence issues and events from the past don't need to continue to negatively impact a person. They can choose to walk the middle path. They can choose to deal with it. They can choose to incorporate it into their life, if you will. You know, if someone was victimized when in the past, you know, I'm not going to say, well that's done. That doesn't impact you anymore. Yes it does. It's something that occurred and something that will affect you henceforth and forevermore. You can choose whether it affects you negatively and keeps you stuck and depressed. And feeling broken or. Or whether you use it as a source of strength to see what you've overcome and use it maybe to help other people or, you know, find some positive uses for it, but it doesn't need to continue to negatively impact you and pull you down. Thinking errors are learned and can be unlearned. Now as children, like I said, children in the pre operational stage in concrete thought, they can't think abstractly, so they can't see alternate possibilities. It's kind of whatever is in front of their face. This is when they're generally thinking in all or none terms. So unless as adults we help them challenge that thinking pattern as they get older, a lot of times everything except for the most rudimentary things like math skills go unchallenged. So we have cognitive distortions carry on into later life. These thought patterns can help to form and maintain a negative or vulnerable self image. And healthy thought patterns can help people feel more empowered and worthy of love. And it also helps them become more able to feel compassionate towards other people if they're not envisioning everyone else, as always out to harm them, hurt them, or take advantage. So before I get to the question part, if you need to go take the quiz, you can feel free to go ahead and go do that. I do want to remind you we've got the Nashville Counseling Unconference coming up in February, February 23rd through 25th. Up to 20 CEUs will be available. The whole conference is going to be $99 in advance. Registration will open in October of 2017 and we do have open right now the call for papers to get a variety of presenters really looking for students who have at least a master's, maybe not licensed yet, and people who are working in the field who want to share their knowledge and experience. This is not a sponsored conference. That being said, I am going to pause this for a second so I don't cough in your ear. Sorry about that. Okay. Are there questions? You know, feel free to type them in the chat window and I can see what I can do to address them. What experience do you have with your clients and cognitive distortions? One thing I like about doing CBT and DBT techniques in group is that they are so ripe for group activities and they're so ripe for group discussion. It's not as abstract as some other stuff that we might talk about and it can really help people grab on to a particular tool. Even if they only identify with one cognitive distortion, they can walk out of the group that day and go, okay, I see how I might think in all or nothing terms a lot. So from now on, when I hear myself say every time, always, or use an extreme word, I'm going to use a different one. It's a simple change, but it can help people start feeling a little bit better and a little more empowered to change what's going on and what it feels like in their own head. Alrighty. Well, it doesn't seem like y' all have any questions. Okay, wait a minute. Yes, journal work is awesome for thinking errors. And if somebody doesn't like journaling. I know I'm not great at journaling, like prose longhand. If you can give them question and answer sheets. I have a cognitive distortions checklist that I have people go through and if they're having an unpleasant thought or if they're in a really bad place, I have them just kind of go through and try to fill out examples of thoughts they're having that fit the current cognitive distortions. But yeah, getting people to write it down and get it out and become aware of their thinking patterns is so awesome. Okay, so I will do another presentation or do a presentation on aging issues. So that's excellent. The presentation is in your classroom. It's in a PDF that you can download if you're looking, if you want to have it out to review for, you know, future reference or whatever. Channel. Oh, Ms. Sandy, I think you were talking about putting the journal worksheet on the website and yes, I can do that. I will put it in additional resources. I understand what you are asking now and yes, it is Thursday today. Tuesday? I thought it was Thursday. I guess I was getting my getting ahead of myself. So it is Thursday, everybody. Have an amazing long weekend. Try to enjoy it, stay safe whatever you're doing and I will see you on Tuesday. Welcome to this week's Book Review. Each week I review a book that I believe would be helpful to the general public and or clinicians. I'm never paid to do the reviews. However, in some instances I may receive a small commission if you purchase the item, which helps defray the cost of our podcast and providing the free educational videos. The cost to you however, remains the same. Today we're going to be talking about self esteem and this is the fourth edition. I actually started out using this book when it was back in the third edition and I absolutely love it. It's a very comprehensive guide to helping people improve their self esteem. In the book you're going to learn how to uncover and analyze negative self statements. So talking about that internal critic Create new, more objective and positive self statements. Let go of judgmental self attacking thoughts and act in accordance with what matters to you most. So the book is 300 and some odd pages and it goes on for a while. But what it does is walk you through step by step, understanding what self esteem is, because it's kind of one of those terms that we talk about, but we may not really know what it is and why just telling yourself that you're okay may not work. Well, the key is you have to believe it. So he starts talking about why people don't believe they're okay even if they tell themselves they are. Then he introduces you to the pathological critic and encourages you to explore why you listen to it and learn how to disarm. Moves on from that point to creating a balanced self description, accepting weaknesses and embracing strengths, recognizing that we're not perfect, but nobody's perfect. So embracing yourself and cherishing yourself as you are, he moves on from there to identifying and combating cognitive distortions that keep you feeling bad. Because a lot of times when we start looking at our weaknesses, we, we magnify them and when we look at our strengths, we minimize them. And that keeps us feeling bad about ourselves. So McKay goes into great detail about how to combat some of those cognitive errors or thinking errors. He encourages you to explore your thoughts about compassion and developing self compassion. One of the reasons that many people have difficulty developing self esteem and being kind to themselves is because somewhere along the way they were taught that having compassion for themselves or being kind can be seen as weakness or failure or something negative. So he really challenges you to look at your beliefs about self compassion and self acceptance. He explores how to reframe mistakes and accept fallibility. Because again, even though we know we've got strengths and weaknesses, we're also going to make mistakes. So accepting those and learning from them and not turning them into something huge, but accepting that everybody makes mistakes. Then he talks about what to do with the constructive and destructive criticism that you receive, sometimes on a daily basis, to help you respond in a meaningful way. And basically it boils down to a bunch of techniques that will help you learn how to take what's useful and leave the rest. Accepting that sometimes criticism is not as much about you as about that other person's stuff. And then he ends with helping you clarify what you want and need and using your skills to get those needs met more effectively. So creating win win situations and learning how to assertively communicate with the people that are important to you. This book is written in really plain language with practical tools, which is one thing that I love about it. You can read three or four pages, get something really useful and insightful and work with that for a while, then come back the next day or the next week and read another three or four pages. So it can be really useful for self help or as a tool to guide individual or group therapy sessions. Visual learning clients like to have it as a reference to review, markup and bring for discussion in the next session. So a lot of times when I do self esteem groups, I'll have each clinical client get a copy of this book. We go through it page by page, activity by activity. We do them sometimes in class, sometimes as homework and then we talk about what they learned and then they can go back and review over the week between sessions what we talked about and get those visual cues that help them remember the important skills. I hope you've enjoyed this book review and please feel free to log on It's Self esteem by Matthew McKay. It does have a Google preview so you can read a little bit more about what's in it and see for yourself and see if it resonates with you as a good tool for self improvement. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com counselortoolbox this episode has been brought to you in part by allce.com providing 24.7 multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006. 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