Cognitive Interventions for Depression & Anxiety Treatment | Cognitive Behavioral Therapy Tips

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@allceus.com counselortoolbox you hi everybody and welcome to today's presentation, 100 Practical Tools to Defeat Depression. Today we're going to be talking about cognitive interventions. We're going to start out by defining cognitive interventions and then explore activities to address perceptions, attributions and locus of control, cognitive distortions, the ABCs. We're going to look at shoulds and optimism and cognitive restructuring and how to help clients with affirmations, time management and goal setting. So Tuesday we talked about emotional interventions, and that's really looking at those emotions that keep people from feeling their happiest and keep people feeling depressed or stressed or whatever and helping them attach address those feelings but also infuse happiness. And we talked about how it's important not to just eliminate the bad, but add in positive so you don't end up with somebody who's just feeling kind of flat. Eeyore ish, if you will. Cognitive interventions are used to help people change how they think about things. So when I'm trying to explain this to clients, I ask them, you know, when you look at something like glass of water, is it half full or is it half empty? And you know, everybody just kind of rolls their eyes at that because everybody's heard that one. When you look outside in the morning, is it partly sunny or is it partly cloudy? You know, those types of things. The way you're envisioning and the way you're viewing the day really has an impact on your mood. We also want to look at encouraging clients to ask themselves, is whatever is going on really important to me? Having a rich and meaningful? Because sometimes things happen and it just, it is what it is. It's not an ideal situation, but it because it's not there anymore, it's not going to mean that you can't have a rich and meaningful life. It's not crucial to you having a rich and meaningful life. And when we look at things like, you know, for example, job changes, that's something that can happen that we may not really want. But if we have to change jobs, is it going to keep us keep clients from having a rich and meaningful life? So we really want them to look at the impact of whatever they're thinking about instead of catastrophizing. Another question clients can ask themselves is, what is the yang to this Yin and Yang is the energetic, optimistic, positive, you know, Bright, sunny side to the yin, which is damp and dark and cold and blah. So you want to have them both balance out. Just like when you run a bath, you want to have hot and cold water. Too much hot, you can't get in. Too much cold, you don't want to get in. So you need to have a little bit of both. So when something bad happens, encourage clients to embrace the dialectics, to use another term, and have them identify, you know, what are the good things? What can I take out of this? Can I look at it as a lesson? You know, can I find some positive in it? Sometimes, for example, with job changes, people end up going to a job they like more. When a relationship ends, maybe they have some lessons from that relationship, but they also end up learning more about themselves. And how can this make me stronger? What can I learn from this? It's another thing that clients can ask themselves, because sometimes things, you know, just stink. However, this learning opportunity was placed in their path, and instead of looking at unpleasantness as hurdles or obstacles or barriers, even encourage them to look at them learning opportunities. They can learn about themselves. They can learn about other people. They can learn what not to do. Again, there's a lot of things they can learn. Okay, so the first thing I want you to think about is how do you help clients recognize the impact of their thoughts on their mood? And some clients buy into this right away, and other clients really struggle with it. So I'm curious, what types of things do you do to help your clients understand the impact of the way they perceive things? Obviously, one of the things I usually do is I put this graphic on the whiteboard, and we talk about situations. And, you know, I'll start somewhere, usually not with thoughts. So I start with feelings. When you're feeling bad, how does that affect your thoughts, your ability to concentrate, whether you're positive or negative, whether you see the glass has half empty or half full, how does it affect you? When you're feeling sad, how does it affect your physiology? Do you have pain? Do you hold tension? Do you feel worn down, stressed out, fatigued? When you're feeling sad, how does that impact your behaviors? What do you do differently? I know when I get sad and depressed, a lot of times it's like needing a crowbar to get me to go to the gym. And I just don't feel like cleaning as much. And the stuff that I usually love doing, I'm just not really there to do. You know, I'm kind of going along to get along. So that's one thing and then I move over to let's look at behaviors. Because a lot of times people don't think about behaviors. And I say, let's take sleep, for example. Maybe you've been doing a lot of stuff, you've been burning the candle at both ends, working 16 hour days, not getting much sleep. How does that affect your thoughts, your ability to concentrate, the way you perceive things, how does that affect your feelings, how you perceive things, your emotions, whether you're happy, whether you're sad, whether you're stressed out or, you know, if I do too many 16, 20 hour days, I'm just kind of in a fog and I don't feel much of anything. I'm just kind of a zombie, so I'm not feeling, I'm numb. And how does that affect your physiology if you're not getting enough sleep? So then after we go through those things and we do physiology, you know, think about when you're sick or when you're in pain or when you're healthy, you know, how does that affect your feelings, thoughts and behaviors? And then finally we go up to thoughts, and I usually save that one for last and say, you know what, let's talk about how your thoughts affect things. Two people can look at the same situation and Cassandra gives good example, good suggestion to give examples of positive and negative situations and, you know, things that you consider positive or negative. But in this, you can also encourage clients to, you know, look at both the positive and the negative so they can get different perspectives and ask them how that affects their feelings. You know, if you're looking at a situation as the end of the world, how is it going to affect your feelings, your behavior and your physiology? If you're looking at a situation as unfortunate, but a learning opportunity, and you know, maybe that just means one door's closing and another door is opening. You know, however you look at it, you know, how does that affect your feelings, behaviors and physiology? If you're waiting for a test from the doctor, you know, we've all had that where we go get a biopsy done or something and the doctor's like, yeah, I'll get back to you in about a week. And. And you're like, oh my gosh, a week? I can't wait a week. So we do want to help clients think about, you know, how can they look at that? Because during that time they can get themselves all riled up and stressed out about what if it's this, what if it's that catastrophizing getting on WebMD, you know, feeling like the sky's gonna fall, or they can look at it as, whatever it is, I caught it early, and there's a good chance for intervention, yada, yada. So encouraging clients to really think about their thoughts and how those thoughts impact them. Another thing they can do is look at their perceptions, because life is 10% reality and 90% what you make of it. So encouraging clients to realize that their past experiences created their schemas. And most clients are like, what? What in the world are schemas? So explaining to them that schemas are basically your shorthand way of interpreting situations, you're like, I've been here before, been similar situations. I know what to expect. For example, a dog charging the fence, barking. Now, if you've been bitten by a dog or, you know, cornered by a dog, been frightened by a dog before, if a dog comes flying up the fence barking at you, you're probably going to back up and not be too happy about it. Me, on the other hand, I've grown up around dogs. Big dogs, little dogs, happy dogs, you know, cranky dogs. If a dog comes charging up the fence at me, I see that as a cute little puppy doing his job to defend his territory. And I'm like, oh, good boy. You know, so two different people perceive the exact same situation very, very differently. The 10% reality is the dog was charging, and he probably was defending his territory. Now, I looked at it as a positive thing. You know, he's going to stop at his boundary line, I'm going to stop at mine. But another person may look at it as. He may just keep on going. Flying is another one, that 10% reality. Some people love flying. Some people are indifferent about flying, and some people are terrified of it. Well, you're getting on the same airplane, so what's the difference? And a lot of it is people's schemas and whether they've been on a bumpy flight before and hit a lot of turbulence and been scared, or they've just heard a lot about airplane crashes, and they're like, you know, if God intended for me to be 30,000ft in the air, he would have given me wings and an air mask. Different perceptions of the situation. Another more mundane thing is angry faces. If you grew up in a household where people were often disgruntled and unhappy, then when you see an angry face, or if a child grew up in that situation and internalized, you know, took those angry faces personally, well, now, you know what? When they see angry faces, they may still take those faces personally. And go, what did I do to make that person angry? Or, you know, what's going on here? So we want to help people recognize that even things like a person walking by them and making a scowly face impacts their mood. But it's all about their perception. Yes, that person was making a scowly face. That's the 10% reality. 90% is what you make of it. Was the person thinking about something else? Did they just come out of a bad meeting? Did they, you know, stub their toe when they were coming around the corner? We don't know. So the schemas are helping us interpret it, but it sometimes makes us interpret it in a way that, you know, makes us unhappy or stressed out. Creaking floorboards is another one. And, you know, I'm not going to go into a whole bunch of detail there because we've already gone through three. But for people who have been, you know, in a situation where they were the victim of a break in or, you know, child abuse, if they hear creaking floorboards, it may remind them of a time that was much less pleasant and that can stress them out. Other people may hear creaking floorboards and think, oh, this is a nice old house. So it's your perceptions. Everybody's perceptions are accurate based on their prior learning. Now we can look at, you know, your prior learning when you were six and you heard creaking floorboards. That was bad. You know, that was worth being stressed out about. Now that you're 26 and you're living in your own apartment and you're in a safe place, when you hear creaking floorboards. Yes. It triggers those memories. You know, we're not going to discount that. Are you safe now? Because then people can start reprogramming their automatic thoughts to say, to help them realize that they're safe now. So one activity individuals can do is flip a coin. And if the coin lands on heads, they need to be as optimistic. They need to fart rainbows. And, you know, everything that happens, I want them to look at it through an optimistic lens and catch themselves. If they start looking at something negatively or grumbling, they need to catch themselves and find the opposite, find the happy. And if it lands on tails, they can be kind of their normal self and whatever that means, and then we can process with them in session. How did you feel differently on those optimistic days? One thing I like to do is have clients do this for about a month where they're flipping that coin. Why? Because they have a 50, 50 chance of having to be optimistic. But if they're forced to be optimistic 12 or 15 days out of the month, guess what? That starts becoming more of a habit. And I mean, I'm not saying we're going to turn them into somebody who's wearing rose colored glasses all the time, but often if they start looking at the positive and start seeing the positive, then they're going to continue seeing the positive at least a little bit more than they did before. A group activity that you can have people do. Remember I talked Tuesday about the beach ball. Love those beach balls because it's fun and you can toss it around and nobody feels like they're necessarily right on the spot. Write 20 things on that beach ball that can be irritating or scary. Toss the beach ball to a group member. They have to find at least one optimistic or non threatening way to look at whatever item they see when they look down at the ball. So like I said, the dog, I presented two different ways to look at it. Going to the doctor, that can be scary. Going to court, that can be scary. You know, there are a lot of those things that can be intimidating. But what are some ways you can look at it? If you're going out on first dates can be really intimidating for people. So if you see that on there, all right, you know, what is an optimistic way to look at it? You know, chance to meet a new person. If you really don't like them, you never have to see them again. But you're going to have a good meal, yada yada yada. So try to find the roses in the situation and just keep doing that throughout class. And some people may get the same exact scenario and that's okay. You know, if they get the same thing, we can talk about another example of going on a first date or something. And as I go through, if you guys have other suggestions, other things that you do to help clients identify any of these things, please share. I love to learn new tools. So attributions, we just talked about perceptions. Attributions are how you perceive things and where you think it happens from, if you will, what you attribute it to. Internal versus external attributions are basically the same as locus of control. Do you control your own destiny or does everything just happen to you? And some of us are thinking back, I haven't heard that concept in 40 years. Well, we need to think about that. If it's an internal locus of control, all right, that means you can control things. And if they're like really internal, then this is somebody who tries to control everything. If it's really external, this is somebody who feels like their fate and their destiny has been completely written. And it doesn't matter what they do, it's just, it's going to happen to them. So they might as well sit back for the ride. Both of those. And you know, I ask clients first, first off, which is better and have them argue kind of both sides. And then we talk about how both ends of the spectrum are extremely stress producing. Because if you think you can control everything, you're wrong. If you think you can control absolutely nothing, you know, that's probably not real accurate too. And we talk about what choices did they make today that they had control over. They had control over whether they got out of bed, whether they went to work, whether they came to group, and so on. So I want to try to encourage people to come towards the middle so they can start recognizing what they do and don't have control over. Because that helps relieve a lot of stress and anxiety for a lot of people. Global or specific attributions, these are statements about where it comes from. It's either global means all people or I as a person am fill in the blank. And specific means it pertains to a particular situation. You know, you can say the weather is in Tennessee is awful, it's oppressively hot. Well, that's not true all the time. You know, that would be a global statement. I could say this summer in Tennessee, it has been oppressively hot. So that makes it more specific. When people aren't doing well at something, you know, at work, at school, instead of saying I'm stupid or I'm dumb, that's a global statement. I am not good at math. That's a more specific statement. So we don't want people to overgeneralize. And I encourage them to go through particular statements that we can throw out there. And is it stable or changeable? You know, some things are stable. You know, I will always be 5 foot 4. That's just the way it's going to be. But I will not always weigh the same. That's changeable. I will always be, you know, good reader probably. I don't see that going away. Math, you know, that waxes and wanes. If I've been using it, I'm pretty good at it. If I'm not using it, it's not so much. So we want to encourage people, if there's something about themselves or the situation that is controllable, that's specific and that's changeable, I want them to Feel empowered to take control of that. If it's something that is out of their control and, you know, it's stable, like their height or another person, then they need to look at it from that perspective and instead of trying to change that person, change their feelings about it. When we do attributions and perceptions, dialectics regularly come up. There's almost always positives and negatives or good and bad in everything. So if clients are really honing in on that bad, that negative, you know, I want to identify what are some positives that balance it out. When it's a rainy day, you know, it's pouring down rain. Well, the downside is I'm going to have a bad hair day. The downside is traffic is probably going to be crazy because people can't drive in the rain. It seems. The upside, I'm not going to have to wash my car this week. The upside, I'm not going to have to water my garden this week. So I try to look at the upsides. Depending on where you are, a rain may cool things off or it may heat it up. So that one's up for a good toss. But encouraging people to really balance out, so if they start feeling negative, instead of going down that rabbit hole, they can bring themselves back to more of a midline. They may not be happy about it, but they don't feel like the world is crashing down on them. So principles that we can have people apply to statements. I believe I can control my own destiny. So internal versus external locus of control. How much of your destiny do you control? All of it. Some of it. You know, we can talk about this global or specific. Do you control? You know, is everything in your control or are certain parts in your control? And of those things that are in your control, can you change them? And generally we start looking at things that are addressable. I blame other people for making me happy. So internal versus external. Obviously, that one is a very external locus of control. It's your fault that I'm unhappy. And my goal is generally to get people to realize that someone else may have done something that triggered an unpleasant emotion in you. You have the ability to improve the next moment. You have the ability to choose to stay stuck and to struggle with that emotion or to improve the next moment. Is it global or specific? I blame all other people for making me unhappy. All my unhappiness is due to other people. Probably not. You know, we've probably done things that have made ourselves unhappy. So encouraging people to look specifically in this situation, when your colleague at work, threw you under the bus, that made you unhappy. That is, you know, totally get that. That's a specific situation. If people think that, you know, everybody else makes them unhappy, then it's going to be hard to get good social support. When I fail at something, it means I'm stupid. Well, we talked about that one on the last slide. Encouraging people to look at failure as a learning opportunity. There's the positive in it and to look at the something that they failed at and remember that they've succeeded at other things in their life. Now, again, with any of these cognitive interventions, when somebody is, you know, initially telling you this and they're really struggling and they're really hurting, we don't want to invalidate them by going, it ain't that bad, or, yeah, you failed at that, but you're so good at all these other things. They've heard that from other people, and that's just invalidating. So there's a time and a place for cognitive interventions, but it is important at some point to help people try to step out of the situation and look at it more objectively. And finally, I am depressed. That is a very global statement. And for many people, it feels somewhat stable. They may feel like they're always depressed. So we want to help them identify what parts of this situation are changeable. You know, your mood, you're feeling really depressed right now. What can you do to improve the next moment? It could be a biological thing, it could be a medical thing, it could be a situational thing, and some of that may be changeable, and some of it may be stable. Encouraging them to take. Feel empowered, to start taking chances and start making forward progress is what I want to do with attributions and locus of control. Have them look at it from a different perspective so they see it from a positive, empowering standpoint and encourage them to get motivated to change the things they can. So cognitive distortions, and I really hate this word, I usually call them unhelpful thoughts when I work with clients because cognitive distortions sound so pathological. But that's what the research calls them or the literature calls them, so we'll stick with that for now. And we go through these, and there are lots of them. I hit the highlights. Arbitrary inference means making assumptions without all the facts. And I'll ask clients when they've done something like this. Or I'll go in with scenarios like John comes home after work and he smells like perfume and it's not his wife's perfume, and she gets angry in what way could that have been? Arbitrary inference. What facts might she be missing? You know, maybe she missed the fact that he went to the. To the mall to get her a birthday present and he walked through the perfume place and he got spritzed by one of those people who stands out there and spritzes you. You know, it's possible. Or maybe a colleague came up and gave him a hug because he got a promotion. Who knows? We don't know necessarily where the perfume came from. So we talk about other. After we go through that one, I talk about what other types of situations have you maybe jumped to assumptions and not had all the facts and then learned later that if you would have had all the facts, it wasn't worth getting upset about. Another one that comes up often is when somebody doesn't return a phone call, doesn't return a text, or is late getting home or for an appointment or a date. People can start having all kinds of. Making all kinds of assumptions, and they really don't know what is going on in that other person's life. Selective abstraction, only seeing what you want or don't want to see. And this goes back to that perception thing. If you want to see the good in people and, you know, they say love is blind. So a lot of times when people are in love, that. Especially that first six months, that honeymoon period, all they see is the good and all you hear is the good. And that's selective abstraction. They're not seeing the little idiosyncrasies that they start to notice about six months later. And the other side of it is seeing what you don't want to see. If you want to see somebody as being unpleasant and unfaithful and all these things, that may be all that you focus on, or if you see somebody, an employee, and you really, for some reason want to see them as a bad employee or a colleague, that you don't want to get promoted above you. So you just focus in on all of their faults and you miss the good things that they do. So selective abstraction is again, an example of that polarization that we need to help people come back towards the midline. Overgeneralization. Generalizing things about one situation to similar situations. So talking about the dog that was running down the fence line, I use that example because a lot of people have fears of dogs, so they can, you know, relate to that. But the dog that chased you when you were 6 and riding your bike is not the same dog that's, you know, running around on the fence right now, encouraging them to recognize that, you know, in general, you know, dogs may be a little bit scary. You know, that's their right to feel that way. But also recognizing that each dog, for example, is an individual, just like each person is an individual. We don't want to say all people, you know, that have blonde hair fit this particular Persona, because there's a lot of people that have blonde hair that don't fit whatever that particular Persona is. I'm willing to bet money on it. Magnification and exaggeration. Blowing something out of proportion. If somebody finds that they've got, you know, this itchy little mole on their arm, and all of a sudden they've decided that they've got melanoma and they're gonna die, you know, that's. That's kind of, you know, blowing it out of proportion before we even know what it is. It could be dermatitis of some kind. Same thing in relationships. If somebody calls their significant other and their significant other doesn't answer the phone, oh, my gosh. Does that mean that that person is cheating on you or has left you? Not necessarily. It could mean they were in the bathroom and they didn't want to answer the phone while they were going pee. And yes, I usually use examples like that to help people recognize that, you know, sometimes there are very legitimate reasons for not answering the phone or a text or whatever. And polarized thinking that all or nothing. This person always does this, or they never remember our anniversaries, or they never remember my birthday or whatever it is. Taking those extreme words out of their vocabulary can be helpful. So if you're doing individual counseling, I have clients look at current stressors, and when they talk, as we're doing session, if I hear a cognitive distortion, I'll call a timeout. And, you know, I let them finish their sentence, and then I say, all right, let's take a timeout. And what I heard you say was blah. I'm wondering if this fits in any of these categories. For cognitive distortions, you can also have them journal at night if they're willing to journal. And then they go back and look over their journal and try to identify examples of cognitive distortions. And sometimes you can have them journaling. Maybe they've been journaling for two months, and so they've got a lot of material to work with. Well, they can go back retrospectively and see if they can identify any unhelpful thoughts that they have or cognitive distortions in group. We want to encourage clients to define and identify, Define these cognitive distortions. And identify interventions. So arbitrary inference, you know, I talked about John who came home smelling of some other woman's perfume and his wife got all mad. Okay, so in these particular situations, what types of things could you do in order to have a more helpful thought? So I'll put flip charts up all around the room and I'll have them go around and each group will add one or two examples of this particular unhelpful thought. And then we'll talk about, you know, what that means and, and the types of things that you might do in order to correct it. And I have them go back around to those stations and for each example that they gave of that unhelpful thought, identify specifically what the person could do to have it. Be more helpful, if you will. And usually it's with arbitrary inference, it's getting more facts with selective abstraction, it's stepping back and looking at the positives and the negatives, looking at both sides of the situation. With overgeneralization, it's recognizing the past as it's impacting your present and really looking objectively at this present situation for facts that are supporting your thoughts. That all dogs are going to attack me, for example, okay, what are the facts for that? And have them use those challenging questions, magnification and exaggeration. Have them step back and talk about again the facts of the situation. What exactly is going on? What exactly do you know for sure versus what do you feel? Because feeling based thoughts, you know, thoughts that are based on feelings are often inaccurate. Thoughts that are based on facts are often a lot more accurate. And like I said, for polarized thinking, eliminating that all or nothing and finding exceptions. If you say, well, you always leave your dirty underwear in the middle of the bathroom, well, start trying to look for exceptions about when they've actually picked up their dirty underwear or you never remember our anniversary again, try to look for exceptions because generally people don't do things always or never. There are exceptions to the rule and encourage people to look at themselves, you know, because generally people will make some mistakes. We don't always or never do anything. So sometimes you can have clients create an emergency card and with mobile devices, they can just put it on their mobile device now on a notepad sheet if they want to. But I encourage clients to keep this with them. Do I have all the facts? Am I seeing the whole situation? Am I using moderate words like sometimes, occasionally, or even often? Am I making sure not to devote too much attention and energy to something that really won't matter in a few days or Weeks. And have I considered possible explanations besides it being all about me? Those are the top five. There are lots of other questions they can ask themselves, but I want to keep it, you know, short and to the point. Generally, when people answer these questions, they find that they can de escalate themselves. So this unhelpful thoughts, emergency card, cognitive distortions, whatever you want to call it, can be helpful for clients to get some perspective when they're in their emotional mind, to help them get back into that wise mind place. So the ABCs, you know, we've all done this with our clients. The activating event, the consequences, you get upset or maybe you get happy. Who knows? B is the automatic and often unrealized unhelpful beliefs. Have each person share something. If you're doing this in group or in individual, have the person share something that makes them happy or proud. And. And apply the ABCs. You know, a lot of times we start out with the negative stuff, but I try to look at some of the positive stuff too. That throws them for a loop. The activating event, you come home and you see 15 cars in your driveway. The consequence, you get happy. The automatic beliefs. As soon as you saw those cars, you're like, I bet they planned a surprise party for me. There are people waiting in there and we're going to have cake. You know, those are automatic beliefs that can happen. And other beliefs would be like, oh, it's so touching how much they care about me, yada, yada. But have them look through and recognize how events, those A's trigger the emotional reactions or the C's. And it can be happy, mad, sad, glad, afraid, whatever. You know, we have those reactions and they're often supported by, by these beliefs that just come in in rapid fire before we realize what's going on. If you're driving, I'll share with you guys. My husband used to be a cop. And I told him in no uncertain terms that he. If he ever pulled me over, there would be hell to pay. And so it was about 11:30 one night. I had worked a double shift and I was coming home from work and. And lo and behold, I got pulled over. And I'm not a night person. Anyway, so I got out of the car and I was grumpy. And because I hadn't been doing anything, I was just sitting at a light. And as soon as I. As soon as the light turned green, his lights went on. I'm like, what's up? And my husband was working that night. And so I get out of the Car. And the guy shines his flash, you know, spotlight on me so I can't see a dagum thing. I'm like, all right, you know, this is it. And I look back, and I'm like, what are you doing, jackass? Whoops. And I heard dead silence. I start getting a little nervous, and I said, chuck, that's you back there, right? And I hear this little voice coming from the back. No, ma', am, it's not Chuck. Oops. I'm sorry. So the activating event of me getting pulled over triggered my irritation, but it was at my husband. And I had this automatic thought that he was playing a prank on me, and that led me down a really bad way. Thankfully, the guy who pulled me over was one of his former trainees. And, you know, I had known him for three years, but he let me twist for quite a little while before, you know, he let me know what was going on and that I had an expired tag. But I still feel bad to this day for calling him a jackass anyhow. But when unpleasant things happen, you know, you get fired, you get pulled over, and you get a ticket. You want to encourage them to follow the ABCs with the D's and the E's. Determine if your beliefs and your consequences are rational and constructive. Sometimes getting upset about something is rational and constructive. Okay, then what are you going to do about it? The E is evaluating whether the situation is worth the energy of your continuing reaction. So evaluate. What do you do next to improve the next moment? And I encourage clients to share silly stories. If you want to call what I just told you a silly story about how sometimes something happens. You know, if you want to go to arbitrary inference, that's what I used. Things happen, and our beliefs are not necessarily accurate. Who says people can be miserable because. Because they think they're doing, feeling, and thinking the way they should be. Remember we talked about this with the guilt Bill of Rights? Well, we're talking about it again from a slightly different point of view. When kids are about two, they go through the why phase. And sometimes as parents, we get so frustrated, and eventually we're just like, because I said so. That's the way it is. I don't know why. I just. It is what it is. And children just stop thinking sometimes, and they're like, okay, it is what it is. I'm not supposed to ask why. There isn't a logical explanation. It just is, which teaches them not to think. So I encourage clients to brainstorm a list of shoulds and apply the following Questions. So, for example, I should keep a clean house at all times so people don't look down on me. Who says, well, that's something my mother taught me. What is my alternate belief, if any? You know, if I. If I look at that and I say, you know, I agree with that, then hold on to it, by all means. That's your. That's your prerogative. But if you look at it and go, you know what? Now, that might be a little too extreme. What's an alternate belief that's a little more moderate? A clean house is not the ultimate priority and needs to be balanced with other life demands. Okay, that might work. So going through that shoulds list and helping clients figure out, what do they really think? You know, what did they think? Not what did their mother say they should think or their pastor or the guy down the road, what did they think? Optimism and cognitive restructuring. Optimism is a way of changing the perception of a situation. So have clients describe the day you know, and, you know, some of us will describe that. Depending on how your day went and your mood, you probably describe the day one way or another. And it's important to process how this feeling impacts the person. You know, after they describe the day, you can paraphrase and say, wow, it sounds like it was a really exhausting, frustrating day or whatever. But then what's the next step? I asked other people in the group after hearing about John's day to day, how do y' all feel? And some people will be like, I feel relieved. I didn't have such a bad day. But other people will be like, oh, my gosh, I can relate. I just feel exhausted now from hearing all that. Why is this important? Because I want people to see how their perceptions and how they come off not only impacts them, but impacts the other people around them. Have somebody describe an absolutely awesome day where they were giddy and things went well and they were excited. A lot of times, if somebody describes that kind of a day, other people feel more energetic. They're like, wow, that was awesome. Let's, you know, let's go. Go team. So our optimism can be contagious. Our pessimism can also be contagious. And I want people to recognize that because it's contagious to their family and who they live with and who they work with. So if they want to be surrounded by happier, more optimistic people, what's one thing they could do be contagious? Worry and regret are two byproducts of pessimism that drain people's energy. Worry Is energy tied up in the future, regret, Energy tied up in the past, and it's just stuck there. So you're not able to use it. Instead of having all your energy to use in the now, and neither one of them serve a functional purpose, you feel regret, you do something about it. But if you just keep nurturing it and you have regretted something for 20 years, is it still doing you any good to regret it? So, again, for this, we can either do stations with the flip charts. You can use the beach ball, which can be fun. You can do Jenga, where each block has either the word worry or the word regret on it, and somebody pulls it out. And if they get worry, then they've got to tell something that they are worried about and an optimistic restatement and pass the hat. Another thing people can do is write down their worries and regrets on little sheets of paper. And we put them in a hat and we mix them up and we pass it around, and everybody pulls out one as it comes to them. They get it. It may or may not be theirs, probably won't be. And they identify a possible optimistic restatement. We don't know exactly what's going on with that other person. But hearing some possible optimistic restatements sometimes gives people something to chew on. And they're like, you know what? I never thought about it that way. And it avoids putting everybody on the spot saying, what are you worried about? We just throw it out there. And we find, or I've found, doing these groups, that people often share similar worries. So that also develops social support in the group. Affirmations are positive statements that encourage you to feel empowered and optimistic. So encourage people to use the words I am, I can, and either I will or I choose, such as, I'm allowed to take up space. My past is not a reflection of my future. I am smart enough to make my own decisions. I am in control of how I react to others. I will choose or I do choose peace. There's lots of others that you can find. But affirmations are really awesome tools. And if you're really old, you can think back to the old Stuart Smalley. You know, I remember Stuart Smalley from the Saturday Night Live where he would look in the mirror and say, I'm good enough, I'm smart enough, and gosh darn it, people like me. Well, those are affirmations. If clients don't believe them, then there's no point in saying them. So they need to find affirmations that they believe in. Which takes me to my Next activities, the affirmation journal. Have them write an affirmation to themselves that they believe every day. A lot of times, if they start the day with their affirmations, like, I can get through this day or I will be more positive. It's a good way to start the day. Have them do online affirmation research, find lists of affirmations that they can read through and go, yeah, I believe that one. Yeah, I like that one. To give them ideas because sometimes clients are like, I have no idea what to say now. Affirmation envelope pass is one of my favorite. Have everybody give them little strips of paper. You don't have to do index cards because that gets expensive. Little strips of paper, pass it around. Or you can have it on a sheet. But I prefer strips because it allows more anonymity. Every person in the group writes an affirmation on a strip of paper about every other person in the group. And you put each person's affirmation statements in the envelope. So we have Sally, Jane, and John. We. Well, Jane and John will write affirmation statements about Sally. You are awesome. You can do whatever. You put your mind to, whatever. And they will put him in Sally's affirmations envelope. So Sally gets back this envelope of affirmations that other people have written about her, and she gets to take those home and she gets to see and hear more about what people think she can do. And it's empowering and she recognizes her impact on them. You can also start each group with a positive affirmation sign in. So when people come in and they sign in for group, they have to add an affirmation after that, such as, it was a tough day, but I made it or I'm grateful that yada yada, encouraging them to punctuate the day with something positive. Time management is one of the most elusive and devastating of all the coping skills. Because when we don't manage our time well, we stress ourselves out, we stress other people out. It can lead to poor evaluations, friends getting mad at you, or just failing to take care of something important like you missed a doctor's appointment or you're late picking your kid up from daycare. And that gets expensive. Let me tell you. How does poor time management affect your life? This is the first thing I want people to think about. And some people are like, eh, it doesn't. And other people really see it. So we start talking about times that they have been over committed or have failed to get things done or they've run late. How does poor Time management affect your relationships. Most people have a time conscious person their life and a time flexible person in their life. So you want to talk about how that relates. My daughter, for example, is a time conscious person. She's like Johnny on the spot. If you tell her we're going to leave at 7:30, she's ready at 7:20. If you tell my son we're going to leave at 7:30, if you haven't prompted him, it may be 7:45 or 8 before you get out the door. And you know, trying to work on that in terms of what that communicates about his respect for the family and how it's going to impact him when he, when he has to work, when he has to go to a job, he can't just show up 30 minutes late. So we want people to start thinking about this because this impacts their sense of power and helpfulness. When people are distressed because they have too many things to do and not enough time, it often causes them to feel depressed, angry, resentful, frustrated, or if they have to cancel out, guilty. And those are a lot of unpleasant emotions that could have been avoided with good time management. So having clients learn about their time management styles is one of the first steps. Have them describe different time management styles and group people accordingly. So I will get in my book, I have different excerpts that describe each time management style. And I have people go to different places in the room based on what time management style they most identify with to encourage them to recognize that everybody has their own style. And then have them give them, once they're in their groups, give them, give them a description of the characteristics of that style, like type A, for example, and that group that has identified themselves as type A people. Have them brainstorm solutions for some of the pitfalls of type aness. Another activity we do is called eliminate, delegate, combine, simplify and prioritize. I need to find an acronym. We make a list of somebody's weekly to dos, you know, and it's usually a long list. And then we go through and we eliminate the things that, you know, there are going to be no major consequences if this doesn't get done this week. You know, we're paring things down. What can you delegate to other people? You know, if you've got kids at home, what can they do in terms of helping relieve your load for house cleaning and chores or cooking or whatever? What things can you combine? So if you've got to make phone calls, you know, maybe you've got to, you call your mom every week and what can you combine that with. Maybe you can call her while you're driving to work. What things can you combine to save time? What things can you simplify? You know, I love to cook, and I love to cook dinner every night, but sometimes it just ain't going to happen. So there are occasions where we have takeout on more than one consecutive day. Does it make me thrilled? No. But, you know, we've got to prioritize, and that's the last one. Prioritize what things absolutely have to get done. You know, I have to get ready for class and I have to make sure everything's prepared. So, you know, if something else got in the way or if I have to devote more time to that, I may not be able to cook tonight. So the kids are going to get to celebrate and have pizza for a second night in a row. But I encourage people to go through their list, and we do this with one or two people in a group. And then I have each individual person make up their own time management list. Goal setting must be purposeful and people must be motivated to do it. So I encourage people to practice by using a decisional balance exercise. And here I've kind of illustrated it. I have them identify the benefits of staying the same. Let's talk about somebody who wants to start working out. You know, they want to get in shape. All right, that's great, Great goal. What are the benefits of not getting in shape? You know, more time because the gym takes time. Less pain because the gym, you know, can be painful. And have them brainstorm that, okay, those are the benefits of staying the same. What are the drawbacks to change? And some of them will overlap with the benefits to staying the same, and some of them won't. We want to try to eliminate those. So if they're worried about time, how can you fit getting in shape in with your current schedule? Maybe you could bike to work. You know, for me right now, I love going to the gym, but I've got so much to do in the garden that I usually spend my mornings I go out about 5 o' clock and I'm moving mulch and I'm hoeing and mowing and doing all that other stuff that, you know, it burns a lot of energy. Is it bench pressing? No, but I'm exercising, so, you know, I'm staying in shape, just not the way I normally would have. And then you want to look at the drawbacks to change, you know, pain. Well, I don't mind pain, so that's not such a drawback. For me. But encourage people to try to figure out how to minimize these things. Because we don't want it to be rewarding to stay the same and we don't want it to be punishing to change. Then have them identify the benefits of change. What are all the reasons that you want to do this? Alright, great. What are the drawbacks to staying the same? You know, if you decide you're not going to get in shape, what are the drawbacks to that? You know, maybe your blood pressure goes higher, you don't live as long, I don't know. But we want to emphasize the positives of change and minimize the negatives. So have people say when they're goal setting the change I want to make is, and have them be specific, including goals that are positive, such as wanting to increase their reading or improve their skill act or do more of something. Instead of negative goals like stop overeating or avoid drinking or whatever it is, I want to know what they're going to do. Instead have them identify by saying my main reasons for making this change are what are the likely consequences of action or inaction? That's that decisional balance exercise. Which motivations for change are most compelling? They're not all weighted the same. You know, there may be a lot of reasons that I don't want to go to the gym, but the biggest one that's holding me back is time. For example, okay, how can I work with that? The first steps I plan to take in changing are and I will do this when, where and how. Some things that could interfere with my plan that's really important to look at. Anything that might stop progress. How will I stick with the plan despite these particular problems or setbacks? Other people could help me changing in the following ways. So, you know, maybe your, your neighbor could pick the kids up from school so you could go to the gym right after work. Who knows? And I will know my plan is working. When and if they answer all of these, then they're going to have a pretty good goal set in front of them. So the way people think and perceive situations has a huge impact on how they feel. Helping people embrace the dialectics, both sides, the good and the bad, can help them feel more positive and empowered. Just like it's imperative to add happy emotions, it's imperative to add happy thoughts. We have to have some optimism in our life. By practicing optimism and addressing unhelpful thoughts, people can reduce their overall stress, sleep better because they're not as stressed, get more energy because they're sleeping better and they're not as stressed and feel less hopeless and helpless and depressed. So we really want to help people look at their thoughts. And some other suggestions that y' all threw out to help clients think of positive things is ask them the magic wand question. If I had a magic wand and I could wave it and make this problem go away or, you know, something positive would happen, what would it be? And Cassandra had another good suggestion for replacing the word should with want or hope. And that's similar to. It was either Rogers or Beck. I can't remember. Sorry. But one of them really smart people said that instead of saying should, say I choose to or I will because that gives you more power. Are there any questions? Alrighty everybody. Thanks for being here. Have an absolutely amazing weekend and I will see you on Tuesday. We're going to be talking about, ooh, physical interventions. I like those. Sleep, nutrition, exercise, tai chi, massage, like massage, acupressure, acupuncture. It'll be a fun class. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. If you want to attend and participate in our live webinars with Dr. Snipes, you can subscribe at. 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. You can use coupon code counselortoolbox to get 20% off of your current order. If you are a podcast listener, especially on an Apple device, it would be extremely helpful if you would review Counselor Toolbox. To do this on your Apple device, go to the podcast app, search for Counselor Toolbox, select the icon for the podcast, tap the Reviews tab in the middle. 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