Cognitive Behavioral Therapy Essentials | CBT Tools for Stress, Anxiety and Self Esteem

Foreign. I'd like to welcome everybody today's presentation of integrative behavioral health care. I'm your host, Dr. Donnelly Snipes. Today we are talking about cognitive behavioral therapy essentials, specifically cognitive processing, the ABCs, and self talk. The first thing I want to talk about though is how cognitive behavioral therapy helps. Some people think that mental health, illness, mental disorders, distress, whatever you want to call it is, are caused exclusively by chemical imbalances. Other people think it's caused exclusively by unhelpful thoughts. Other people think it's caused by unhelpful behaviors. Well, the answer is it's caused by all three. And in, in cognitive behavioral therapy, one of the things or one of the main tenants is this triad here. Our thoughts, our feelings and our behaviors, they're all interrelated. Our thoughts can either trigger or down regulate our HPA axis, our threat response system, which impacts our physiology. When that HPA axis is down regulated, when we're able to relax, then we have increases in serotonin, we have, you know, regulation or better regulation of our gonadal hormones, our thyroid functions more effectively. Our pain levels tend to go down because our pain perception goes or our pain tolerance goes up, our immune system is improved. You know, there are a lot of benefits to down regulating that HPA axis. And the only way to do that is when we are not feeling and thinking that we are under threat. Affectively, when our HPA axis is upregulated, we tend to have feelings of anxiety, anxiety and anger because it's the fight or flee reaction. When our HPA axis is down regulated, we tend to be able to feel more feelings of relaxation. We tend to be able to feel a wider array of feelings because we don't have that tunnel vision that is caused when we are in that fight or flee state. Cognitively and behaviorally, when we are more relaxed, when our HPA axis is down regulated, when we are having more positive, positive thoughts, we tend to also notice more positive things and be able to be more flexible in our thinking and our choices of behaviors. All of these things, our physical health and our energy levels, our emotions and our thoughts, impact our environment and our relationships. So I just want to go through a few scenarios before we get in the, into the things for today. So let's go over here to this little triad. The one I have up here is somebody has something bad happen, whatever it is, they experience distress and they tell themselves, I cannot tolerate this. And that's one of those things we call distress intolerant thoughts. So they have one of those distress, intolerant thoughts, saying, I just, I can't do it. I can't survive this. Well, what does that do to their emotions? If I think that I can't survive something, it's going to scare the bejesus out of me. So I'm going to be more terrified. When I am feeling powerless and terrified, guess what? My behaviors are probably going to be geared towards trying to make that go away. And if I feel powerless, then I may not be willing to fight anymore. So I may retreat and do that by either, you know, getting drunk or going back to bed and just trying to pull the covers over my head and pretend that life is not going on around me. None of those are helpful. Okay, so let's take it from any, any place in this triad, no matter where you start. And I have some examples. Let's just say you choose to stay up late. You know, there's a good movie on tv, and then after that is another good movie on tv. You got to work in the morning, but you choose to stay up really late, you get like, no sleep. How does that affect your mood the next day? Are you as happy? Are you as carefree? Are you as energetic and enthusiastic? Probably not. How does that affect your thoughts throughout the next day? Well, we know that when we don't get enough good quality sleep, we don't clear out the adenosine, which means we're going to have sleep pressure throughout the day and it's going to imp. Impair our cognitive abilities. Now, that being said, we know it's going to affect us that way, but it also may make us a little bit more cranky or pessimistic or negative in our thought processes. I don't know. But it's interesting for people to take note of these things and figure out how different behaviors impact them. Another example would be I agree to help somebody do something, maybe to move this weekend, even though I know I don't have the time. So I am choosing a behavior. I am choosing to do something that I know is going to add stress to my life. So how is that going to affect my thoughts? I'm probably going to be a little bit more irritable, a little bit more stressed, because now I have this excessive time pressure. I may even feel resentful towards that person because I really didn't have time and I really didn't want to help. On the other side, when we do things that are positive for ourself, like we choose to eat a healthy diet, and I know some of you are Rolling your eyes, going, eating healthily doesn't impact my mood. I would challenge you to do it for a week and see how it helps or doesn't, you know, see what it does for you. When I used to do this experiment with my class at the University of Florida, a lot of people would choose to make one behavior change and that would be to start drinking more water. And they figured it wasn't going to do anything. And I think they were trying to prove me wrong. And ultimately every single one of them, no joke, every single one of them ended up finding that it had positive benefits for them in their mood and in their, in their thinking. When we have, when we're hydrated and our bodily processes can happen like they're supposed to, when we are, you know, not having difficulty with cognition, then it can also help our mood. We don't feel as frustrated and we know that even 1% dehydration can lead to difficulty in learning and cognitive processes. So let's jump over here to feelings. You know, maybe you're going to start in the triad in feelings. When you are angry, what are your thoughts like? Are you thinking happy, positive, courageous thoughts? Probably not. When you are angry, what do you want to do? Do you typically want to do something proactive and healthy, or is your knee jerk reaction sometimes to just try to escape or avoid that feeling? Likewise, when you're excited, you know, when you get up in the morning and it's a beautiful day outside and maybe you're looking forward to something, you are excited, excited to get started with the day. And so how does that affect your thoughts? You know, I know when I'm excited, when I'm in a good mood, I tend to be more optimistic, I tend to be more creative, I tend to be more enthusiastic about most everything, and my behaviors tend to follow suit. When I'm in a good mood, I tend to do the things that I need to do and it doesn't feel like it's as much drudgery. So I do encourage you to investigate the triad. When you're in a bad mood, you know, notice how it affects your behaviors and your thoughts. When you're having negative thoughts, notice how it affects your feelings and your behaviors. And when you are doing things that are, let's say, good for yourself, notice how when you treat your body well, when you engage in behaviors that are proactive, pro social, how does that affect your mood and your thinking? I think you may be surprised at how intimately these three things are connected. So let's talk about the ABCs of cognitive behavioral therapy. This is Cognitive Behavioral Therapy 101. And you can go much deeper than this on evaluating situations. But this is a really nice, quick analysis of what's going on. And we've talked about this before, so I'm not going to spend a whole lot of time on it. But a is the activating event. It is what happens. You get cut off in traffic, for example. Okay, most of us have gotten cut off in traffic. So you can relate to that. You get cut off in traffic and you feel something and that's the consequence. You know, almost instantaneously. You may feel angry, you may feel scared, you may feel frustrated. However, you feel that is the consequence. But in that microsecond between the activating event and the consequence, you had a litany of automatic and often unhelpful or exaggerated or out of context beliefs. And it's important to go back and recognize those and we're going to talk. A lot of cognitive behavioral therapy involves evaluating your thoughts in the present context for their accuracy and their helpfulness. And that's really what it comes down to. Because if your thoughts are accurate and they're helpful, it doesn't necessarily mean that it's going to make you feel better right away if you're in the middle of, you know, a very distressing situation. But they're also not going to keep you stuck. So going back to getting cut off in traffic, your beliefs may be that the person was rude. I could have been killed. They were intentionally doing this. Well, think about it. Have you ever accidentally cut somebody off in traffic? Maybe not recently. Maybe you're a super defensive driver now. But think about when you were younger. You were first starting to drive. I know I did. And you know, I feel bad, bad about it. In retrospect, I wasn't trying to be rude. I just hadn't developed the driving skills at that point in time. So it's important to evaluate the beliefs, to adjust any beliefs that are overly exaggerated and eliminate the beliefs that are just not on target for this situation. You know, if somebody cuts in front of you and you have to slow down a little bit, is that, you know, could you really have almost been killed? No, you had to apply your brakes. Now if you have to swerve over into the shoulder and slam on your brakes to avoid going off into the ditch, that's something different. But it's important to use perspective. So that's our A's, our and our Bs and our Cs. Then you want to dispute the beliefs Based on facts. You know, we just talked about that. And evaluate the effectiveness of your reactions for helping you use your energy and time for achieving a life that's important to you. And that takes us to road rage. Yes. We get cut off in traffic sometimes. Yes. It's possible that, you know, bad things could have happened. We could have been killed. I think most of us have been in a position at one time or another where we've been cut off, and we actually have had to swerve into the. Into the shoulder and try to avoid rolling off in the ditch. And that can be extremely terrifying. So it's important to accept, you know, the beliefs when they're there. But does getting angry about it and staying angry about it, is that an effective use of your energy? The person who cut you off may not even realize they cut you off. But even if they do, do you think they really care? Probably not. And does your getting angry, will that do anything to change their behavior or to change their perception? Probably not. Therefore, is holding on to this anger. You know, anger is a natural emotion. It tells you there might be a threat. It happens. You notice it. You check out the situation. You say, is staying angry going to be a good use of my energy? Is it going to change anything for the positive in this situation? And in this case, I think 99.9 times out of 100, the answer is no. Now, sometimes your reactions and what you do, your re, your thoughts and your behaviors can be helpful. You can ask yourself, what is the best thing that I can do with my energy right now to improve the next moment? And in the case of, you know, the person that cut you off and maybe driving erratically, well, back off. You know, don't get too close to them because they're clearly either not good drivers or they have a lack of consideration for others or whatever's going on. But instead of tempting fate and getting up next to them again, probably better just to give them some space. Challenging questions. And this comes along with cognitive processing therapy, which is exactly what it says. We are processing our cognitions. And the mnemonic I use for this is face palm. And I like mnemonics because it makes it easier for people to remember. But this is another way of saying what we just talked about, but differently. So F stands for facts, for and against your belief. So sticking with the scenario of getting cut off in traffic, what are the facts that I was almost killed? What are the facts for and against that? You know, look at what's actually there. Not my feelings. Did I feel Terrified? Well, yeah, possible. Were there any facts to support it? You know, let me give you another scenario. Semis. I really detest being by semis, especially on the interstate, but generally anywhere, because I feel like I'm this little bug right next to them that they may not see and they may squish at any moment. That is my emotional reasoning that I don't have any facts for that because I stay out of their blind spot and that sort of thing. So I know that they can see me, I know that they know I'm there. So there are no facts supporting my fears when I am, you know, in. Not in their blind spot that they are going to not be able to see me and they're going to squish me. So, you know, that's the difference between factual and emotional reasoning. When we fear something, sometimes we try to convince ourselves that it's true, but we need to look at the facts and say, is this actually true? Flying on an airplane is another example. Some people are terrified to fly on an air airplane because it's, quote, so dangerous. And they have convinced themselves that flying on an airplane is very, very dangerous. When you look at the facts, it's far more dangerous to drive in a car than it is to fly on an airplane. But we pay more attention to when airliners go down because those, those things get all kinds of, of, of media attention. When Jim Bob's driving down the road in rural Arkansas and has a one car collision with a tree and kills himself, that usually doesn't get any press. So we don't recognize, we don't realize how many more accidents, how, how much more likely it is, unfortunately, to be in danger when we're driving in our vehicle than in a car. So looking at the facts, and we can go through this, you know, all day long, you want to talk about spiders, you want to talk about snakes, you want to talk about whatever. These are fears that a lot of people have that are based on emotional reasoning and not grounded in fact. So the first thing in facepalm is to look at the facts and see if your belief has any factual basis to it. Then you want to look at additional factors. A lot of times people are, when they're feeling stressed, they have that tunnel vision, they have those blinders on because the adrenaline is coursing through their veins. So they have a hard time considering additional factors that may be important to consider in the situation that may be contributing to this situation. A snake slithers across the path, the hiking trail that you're on, and stops in the middle of the hiking trail. Now you get scared because oh my gosh, it's a snake. Snakes are dangerous. It's going to kill me. And it came out so it can attack me. Okay, well that is a line of thinking. Now let's look at additional factors. It's a cold day, that spot on the trail is sunny. The snake probably didn't even really realize you were there. But we don't know that. That's not a fact, that's an assumption. And the snake does not have the notable head shape of a poisonous snake. So that those are additional factors that we want to add to the facts. I use this process a lot when I work with people in couples counseling as well because it does consider. It makes you look brought more broadly than sometimes the ABCs do. If people are in a relationship and let's say one partner cheats on the other partner or they need, they start getting a divorce or whatever it is, there's discord. What are the facts for and against your belief? So if one cheats on the other, this person, you know, it's all their fault. Okay, what are the facts for and against that belief? What are additional factors that contributed to this ultimate behavior? What else fed into that? And it's really important to, to consider, especially when you're dealing with people, that the fact that a lot of times everybody has an effect on everybody else and vice versa. So what was your part, what was their part, what was the environment's part in what was going on? Which takes us to context. When you are evaluating the facts and the additional factors, what is true and maybe happening in one context, maybe very dangerous, but in another context, not so much. You know, when you were, if this happened when you were six or if you're a six year old and you're experiencing this, it may be very threatening. Because six year olds can't survive on their own. Six year olds need the support of their caregivers. If you're 26, theoretically you have a lot more tools and resources at your disposal. So in that context, as a grown up, it may not be as big of a deal. So we do want to consider context and asking yourself in this context at this time, given the facts at hand, am I safe? Which takes us to. Then we want to look and see if we're using extreme language like this always happens to me or I can never be safe. All right, so if your belief is that you can never be safe, what are the facts for and against that? What additional factors might contribute to your safety? Or your unsafeness in this context that you're in right now, Are you. Is that statement still true? Is it true that you are never safe? So you want to look at those different words and you can say, sometimes you may not be safe if you feel that way. But it's important to examine extreme language because very few things happen all the time or never. Then we want to go over to P, which is probability or likelihood given the facts of the situation. In this context, once you adjust your language to be more reasonable, to be more on point, what is the probability or likelihood that the worst case scenario that your worst fears are going to come true? A stands for what are some alternative explanations and that can overlap some with additional factors? For example, that snake. What is an alternative explanation for why it slithered across your path and stopped? Well, could be sunbathing. What are some alternative explanations for why the person may have cut you off in traffic? You know, maybe you were in their blind spot, maybe. And that's also an additional factor. Maybe they were on the phone, maybe they were changing their radio, who knows? But what are some alternative explanations besides that they were being intentionally rude and they were trying to hurt you? L stands for learn. Learn from the situation. Once you process this, you're changing your mental schema, your mental shortcuts, if you will. So learn from this and remind yourself the next time it happens. So the next time you're out hiking and that a snake slithers in front of you, you can refer back to this. You've learned from it because you've already done all the processing and you can say, okay, I've been through a situation like this before in which it actually wasn't threatening. So let me, you know, not automatically go into fight or flea mode and recognize the facts, the additional factors, the context, etc in this situation. Because every time we go through a situation we learn from modifies our schema just a little bit so we can anticipate how to react. We can anticipate the outcome when we encounter it in the future. Which brings us to move forward. Once you have experienced it, once you've processed it, once you've learned from it, then use that information. So the next time you encounter that situation you can make a, you can adjust your thoughts accordingly more quickly and avoid over, over, act over over triggering your HPA axis and leading to, leading to HPA axis dysregulation. And when you are going through these, a lot of times, the facts for and against your belief, you identify your belief by asking yourself what am I Telling myself right now. And a lot of times it's not overt. You're not sitting there telling yourself that this is terribly dangerous or what have you. You're often starting with a feeling you're terrified to go on an airplane. Okay, well, let's look at why. You're terrified to go on an airplane, or you see a snake and all of a sudden you're terrified. Which takes us back to these ABCs. There's that activating event, and then they're the emotional reaction, the physical reaction, the thought reactions. But in that millisecond, in between the activating event and the consequences, there is a litany of those automatic, subconscious, and often unhelpful, exaggerated or out of context beliefs. And those beliefs are the ones that you've got to run through what I call your fact filter to distill it down, you know, if you don't want to remember face palm all the time. Although I think going through each one of these can really help you drill down. When you start feeling distress about something, ask yourself, what are the facts for and against my. Whatever thoughts I'm having that are contributing to my distress in this context, at this point in time, am I safe? And what can I do to improve the next moment? And if I take action, if I do those things that I have the ability to do in this context to improve the next moment, what is the probability of or likelihood that my fear will come true? So facts, what things do I have control over in this context to improve the next moment? And if I do those things, what's the probability? So I, I abbreviated fcp and that's. I just can't make a mnemonic for that. Finally, loving kindness meditation. Because our thinking thoughts impact our HPA axis and impact our emotional reactions. They imp. They actually do impact the neurotransmitter balance in our brains. It can be helpful to practice a loving kindness meditation. Now, the loving kindness meditation in its entirety starts out with focusing on ourselves, then focusing on somebody we love, then focusing on some stranger, then focusing on somebody that we have a beef with, and then maybe focusing on the universe. But just a shortcut, you know, in order to help get you in a, into a positive mental space each day, I encourage you to start out the day by meditating briefly a minute. You know, when I say briefly, I mean briefly. Meditate for a minute on loving kindness and ask yourself, or say to yourself, in this moment or for this day, may I experience the joy of being alive. Just sit with that for five or ten Seconds. May I feel safe and secure. Sit with that for five or ten seconds and imagine what it feels like to feel safe and secure and notice the things in your life. You know, kind of do a mental checklist of the things in your life that keep you safe and secure. May I be filled with love. Another 10 seconds. Feel yourself being filled with love from those who love you and from yourself. It's. It is okay to love yourself. That's actually really important. May I feel calm and connected. Take that 10 seconds. Feel the stress, feel the irritability, you know, draining, and notice what it would feel like to feel calm and connected. And may I accept myself just as I am now. If you go through each one of those and spend 10 seconds meditating on each one, that's one minute. You can do one minute. You know, a lot of people say, well, I don't have time to meditate. Okay, maybe you're not willing to take 20 minutes a day out. All right, that's. That's your choice. But I think everybody can find one minute. Now, throughout the day, you may find yourself getting irritable, getting frustrated, getting what I call dysphoric, having unpleasant feelings. And obviously, you want to check and make sure you're safe. You know, kind of run through the. The ABCs, making sure that you're safe and doing, you know, whatever you can. But sometimes, you know, you just. You're in a funk, and it's. You can repeat to yourself throughout the day, May I feel safe, loved, grateful, and content, just as I am. And if you're having an issue with another person, add on to that. May you feel safe, loved, grateful, and content just as you are. So send positive vibes to that other person. And you can even do this maybe before you go into a meeting with somebody in order to try to set up that positive mind space for yourself. This is another one of those things I would encourage you to try. And in cognitive behavioral, one of the tricks or tools or activities, whatever you want to call it, we have is called the coin toss. And you get up in the morning and you toss a coin. If it lands on heads, you practice the tool throughout the day, and you notice how it impacts your life, if at all. And, you know, hopefully it does. If it lands on tails, just go about doing your normal stuff. At the end of the week, compare the days, the days that you practice the tool versus the days that you weren't very mindful, and identify which days seem to go better, which days were filled with less anxiety, with more physical comfort, with more energy. Practice it. Try it for yourself. Not every tool works for every person, which is why, you know, it's important to try these things. And if it works for you, great. If it doesn't work for you, okay, let's find something else. Ultimately, it is important to recognize the impact of our thoughts, of our cognitions, on our attitudes and our feelings and our behaviors. The impact of our behaviors on our feelings and our thoughts and the impact of our feelings on our thoughts and our behaviors. Are there questions about cognitive behavioral therapy now on the YouTube channel, I have started a series that I'm calling Cognitive Behavioral Therapy Nuggets. And each one of those videos is about six minutes long, and it teaches a single cognitive behavioral therapy tool. So if you're interested in CBT and you want to explore different tools that might be able to be helpful to you, I would encourage you to check out some of those videos. They don't take long, and it's something you can look at in the morning and then maybe try to practice throughout the day. Congratulations on your new job, Jamaican Barbie. I'm glad to hear that you've got that. It is definitely important to recognize that distress may happen. And. And I don't want you to get into a situation of what we call toxic positivity where you're telling yourself you should feel better and you're ignoring your distress. But it is important, and I see lots of you are doing that, and I think that's such a blessing to recognize that some things in your life can be really crappy right now. However, there may be other things in your life that you are actually very grateful for. And it's important to embrace the dialectics and find the. And notice the good and the bad. Alrighty, everybody. Have a fabulous day, and I will see you tomorrow, same time, same station.