Pro Tips for Overcoming Cognitive Distortions | CBT Tools
Dr. Dawn-Elise Snipes explains how cognitive distortions like catastrophizing and mind-reading fuel depression, anxiety, and addiction. She connects these thinking errors to core fears and walks through CBT tools clinicians can use: the A-B-C model, behavioral experiments, exposure work, and urge-surfing.
Chapters
Okay, welcome, everyone, to today's presentation. We'll be going over thinking errors, understanding and addressing them. So over the next 45 minutes to an hour, we're going to define thinking errors, explore different types of thinking errors to include cognitive distortions and irrational thoughts, evaluate how thinking errors can play into our own basic fears of rejection, ideas, isolation, the unknown, loss of control, and failure, and identify ways to increase awareness of our thinking errors because we all have them. It's just a matter of becoming aware of them so we can address them. And then we'll talk about how to address the thinking errors as well as the basic fears. And when we talk about our basic fears, like this fear of rejection, everybody has them. We can't make them go away. So a lot of their power is sort of wound up. The irrational thoughts, for example, my world will end if I get rejected, so why do we care? And how does this impact people's recovery? These thinking errors or stinking thinking plays a large part in keeping people miserable. When we work with clients who are experiencing depression, anxiety, grief, and addiction issues. I'm trying to go through the mood disorders real quick. A lot of what helps keep them miserable is their thinking errors. A lot of the cognitive stuff that they've developed probably over time, either in reaction to neurochemical imbalances or in reaction to things in their life they have taken. And it's become an ingrained way of thinking. Instead of seeing the glass as half full, they see it as half empty. Instead of seeing the day as partly sunny, they see it as partly cloudy. Addiction, depression, anxiety, anger, and guilt often stem or are made worse by faulty thinking. So when we talk with our clients, we want to say, what are these irrational thoughts? What are these automatic beliefs that you have? And are they rational? You know, sometimes life just sucks, and that's just the way it is. But most of the time, we can look for that silver lining. We can find that our clients are looking more in all or none terms, instead of looking at, you know, shades of gray. So we'll want to take a look at that, and then we'll want to address these thought patterns in order to help people not make mountains out of molehills, Focus on the things they can change and identify and eliminate thought patterns that are keeping them stuck. A lot of us have very habitual thought patterns. You know, there's four or five of them that are fallbacks, and sometimes they're good, sometimes they're bad, but. But they're habitual for us. So if we can identify the negative ones and address those, then it'll be a lot easier to free up energy and yada yada. Will there be moments that we have irrational thoughts and cognitive distortions? Certainly it's going to happen. But if we can catch ourselves, if we can be mindful and aware and address those when they occur, then we can keep it from tying up energy. So cognitive distortions take thought and manipulate it to fulfill the expectations of a situation. If you expect it's going to be a crappy day, then cognitive distortions will have you see all of the things that are crappy that day and sort of ignore all the things that are good, or at least not crappy. Cognitive distortions play a large role in what we pay attention to and our expectations, and they often conform to our current headspace. So if you get up and you're in a bad mood, you're probably going to look at the negative stuff. If you get up and you're in a good mood, you're going to notice the good stuff. So you know that tells you what's one thing you can do from the very beginning. If you get out of bed and you're on the wrong side of the bed, Tell clients if they get out of bed, there's an activity called the coin flip. They flip a coin and if it lands on heads, they can behave, act, think, whatever, just how they are. If they're in a grumpy mood, if they're on the wrong side of the bed, that's fine, they don't need to do anything. If it's on tails, then they've got to act as if the day is good, and they've got to try to look at all the things with an optimistic point of view. And then you have them look at how the day went in retrospect to see if they did notice there was a change in the way that they approached things, that they interpreted things and their energy levels based on whether they were grumpy or whether they were somewhat optimistic. I mean, they don't have to be obnoxiously cheerful, but we want them to look at and try to find good things. Irrational thoughts are beliefs or thoughts that people hold. Usually they're extreme. I must. I always. I never. I must have love and approval from everyone all the time. That's one of the ones that they give as an example. Why must you? Would you like to? Yes. But do you have to? No. And are you going to have it from everyone all the time? Highly unlikely. What does that mean? If that statement, or negating that statement makes a person uncomfortable. We have to say, what does that mean to you? Irrational thoughts are often unrealistic and create feelings of failure, inadequacy, or disempowerment. If I have to do it all the time, or if it never works out for me, then I'm going to feel very disempowered and, you know, it's going to reflect in my mood and the way I interpret everything else that's going on. We want to pay attention to what clients are saying. When we hear cognitive distortions, we want to stop them and say, okay, now I hear you saying that this happened and this always happens to you. So give me another example of how this has happened to you, and then give me another example. Then take that information and say, okay, now see if you can find an exception to when this could have happened but didn't. Like every time I wash my car, it rains as soon as I'm done, and I can think of three or four times when I've washed my car, and lo and behold, three hours later, it rained. It's almost like it predicts the rain. But I can also think of some times when I've washed my car and it hasn't rained. And that's obviously not really going to affect most people's moods that much. But when you take a look at some of the things that they're talking about, my boss is always in a bad mood, or every time I get called into my boss's office, I'm in trouble. Figuring out exceptions to that. Give me an example of sometime you were called into your boss's office that you weren't in trouble. What was different? Or when you don't get called into your boss's office, what's different? Because there are some bosses that only call you in when you're in trouble. So what's the difference when you're not in trouble. So some of the favorite cognitive distortions. Personalizing, making it all about me. Somebody walks down the hall and they're grumpy and they grimace, and I take it personally. Ooh, I must have offended them. That's personalizing. That person probably didn't even see that I was there, or they didn't recognize, you know, kind of that I was there because they were lost in their own little world. It's like in the notes that I said before the class started. I'm not wearing my glasses today because, you know, viewing the screen and viewing the little type, I'm just not able to focus on both. So I may squint When I read the chat window, that's not personal. You know, if I squint, it's not a comment on anything that's being said except for the fact that I'm trying to read it. So personalizing. We want to identify times when our clients take stuff and make it about them, when it's not. And this is so common in people who grow up in addicted households, especially because everything revolves around the addict. The addict tells you how to feel, how to think, what, when to talk. And it's always walking on eggshells. So whenever anything happens with the addict, it becomes your fault. There's a lot of blame. And people who come from backgrounds where there's a lot of blame will tend to blame themselves for anything and everything. It's a sunny day. It's. Well, it's sunny. That's good. So it can't be my fault. It's a rainy day. That must be my fault. Mind reading, assuming you know what somebody is thinking is a huge cognitive distortion. Assuming that you know that your roommate is mad at you for this, that, and the other, or assuming that somebody can read your mind and that your roommate knows you hate it when she does, when she leaves her stuff out in the living room. Well, if you haven't told her, she might not know, because guess what? It's not all about you. So both of these are kind of opposite sides of the same coin of being all about you. If something is bothering you or you think something's bothering someone else, don't assume, don't guess, ask or say something. Mind rating doesn't work. All or nothing thinking. I talked about that earlier, and a lot of our clients will see things as it has to happen every time. Or they'll take one example of something happening and saying, well, it happens all the time. You hear about these things all the time. You know, it's probably not that common. So if they say people get in car crashes all the time and it's not safe to drive, well, let's look at the data. Yeah, car crashes are pretty darn common. However, how many cars are on the road that don't get in crashes? So we want to look at both sides of it. We want to take away the extreme nature of it and look at conditions. When is it more dangerous to drive? Yes, there are probably more crashes when it is dark, foggy, and the roads are icy from a recent, you know, ice storm. That's probably not the best time to be out there driving. So, yeah, there are going to be a lot of Crashes then. But if it is sunny weather and not rush hour, and, you know, all things considered, is driving all that unsafe. So we want to help them. Look at these polarizations every time they say an extreme word. And you'll hear in your clients, there are certain ones that they like to use always. Never have to challenge them to take that word out of their vocabulary and replace it with a conditional word. Instead of sometimes, say a lot of the time, or instead of all the time, say sometimes or a lot of the time, even in session, if they just practice changing their verbiage in session, it'll go a long way. One of the things, and this isn't a cognitive distortion, but one of the things that we talked about when I was in college was having clients focus. And I can't remember who it was. It was either. I think it was either Aaron. I think it was Aaron Beck, but I can't remember. Said to eliminate the words. Can't eliminate the word can't. It's not that you can't do something. You know, 99% of the time, men can't have children. But, you know, there are very few of those that are true can'ts. It's. I choose not to. I choose not to. Helping people take their power back, I can't is like I'm hamstrung, you know. You know, I'd love to, but I'm not able to. I choose not to. Gives me the power to say I could if I wanted to, but I don't want to. Small changes in vocabulary and, you know, we don't want to give clients 15 things to change in a week. Pick one or two words that they often use that seem to cause them the most distress or have them pick one or two words. You know, talk about themes that you're hearing where they use the word all the time. Everybody does this all the time. Everybody does this all the time. So I've heard this. This is a recurring theme that it seems like you feel like everybody in your life does bad things to you all the time. So instead of saying everybody, let's focus at any time it happens on exactly who did what and how many times such and such betrayed me and told me a lie last week. That's not everybody all the time. That's such and such lying to you last week. So it helps them keep a little bit more perspective and also have them identify exceptions. So who doesn't betray you? Who in your life hasn't done awful things to you? Who in your life has done some good Stuff and some bad stuff. You know, we're not perfect. Catastrophizing, Making a mountain out of a Molehill, going from 1 to 15 on a 1 to 10 scale in 2 seconds flat. Most things are not a catastrophe. They're inconvenient, they're frustrating, they're depressing. But they are not the end of the world. A client's car breaks down. Now, this is pretty common for a lot of my clients. They go into a tizzy. It's just like, I'm not gonna get to work. I'm gonna miss counseling. I'm not gonna get in for my urine drop, and I'm gonna go to jail, and they're gonna take my kids away. And I'm like, whoa, whoa, whoa, whoa, whoa. Let's stop. You know, can we prove that your car broke down? Because in substance abuse and dual disorders counseling, if you've got legal involvement, a lot of times you have to be able to prove it. So, okay, can we prove this? If we can prove it, could you have planned better? Maybe, maybe not. But your car broke down. It happens. So what's the next step? Getting all wound up and foggy headed over it in this adrenaline haze is going to do no good. So let's stop, figure out how to decompress, and then start making plans for how to handle it. This goes a lot into some of the dialectical behavior therapy techniques that we've talked about. When they feel a feeling, if they know they're one of those people who goes from 0 to 120 in 2 seconds flat, when they feel that feeling, they start to get upset. Remind them to use whatever skills that you've worked on together to identify the feeling, but they don't have to react to it, and then talk about distraction, whatever they need to do to get through that adrenaline rush. Overgeneralization. Taking one thing and applying it to every other situation. If you have a fight with a female friend saying, well, I just. I don't get along with women. Where did that come from? Even if you have a fight with two female friends, to say that that means you don't get along with women is kind of an overgeneralization. My guess is there are females out there you would get along with. So when clients come in and they say, I can't work with a female counselor, okay, you know, there may be situations where that's true and there's nothing we can do about that. And obviously we want to try to put a client in a situation where they feel the most comfortable in Residential treatment. That's not always possible in private practice. That's not always possible. If you are the sole practitioner in your practice and you're a woman and somebody comes in and says, I can't work with women counselors, it's like, well, we got a choice here. But encouraging people to look at over generalizations. Shoulds do you no good. I should have gotten up earlier. Well, you didn't. So how can you prevent it from happening again? Because beating yourself up over the fact that you were late to work because you should have done something is no good. So whenever a client starts saying, well, I should have done this and I should have done that, I stop them and I have a whiteboard in my office because I'm a visual learner. And we write up all the shoulds and then we draw a line and we say we'll do differently. And then we make a whole list of what they're going to do differently to prevent it from happening. Shoulds identify a learning opportunity. Holding onto it does no good. They could make amends for whatever it was. If they lied to somebody and they should have told them the truth, well, in the future, they can tell them the truth. They also may need to make amends for what they did. So it's a matter of figuring out what that should means. And then this availability heuristic. There was a plane crash a few days ago. The Egypt airplane crash. People who don't like to fly, who cite the fact that flying is dangerous because planes are constantly crashing. It seems that way because the only airplanes we hear about are the ones that crash. We don't hear about the 20,000 others that landed safely today. So encouraging people to get accurate information. How often does this really happen? When clients are talking about a behavior they do or a behavior someone else does, this is a great time to get a baseline. Let's figure out exactly how often this happens. Another time this comes up, and it could work for or against your clients, is when you do staff evaluations. If a staff member has, you know, the first six months of the, of the evaluation period, they just weren't there. They weren't with it. It was problem after problem. And then the last six months, they really turned it around. The tendency may be to forget that first six months because the last six months has been so awesome. We just kind of block out or make excuses for the first six months. The same thing is true with mental health things. If somebody is feeling better, you know, over the past three months, they've started feeling a whole lot Better, and they've made a few changes. What we want to look at is, before they were feeling better, what was different, what was the same? Because it may be they're just going through a really, I don't want to say an easy period in their life, but a less stressful period in their life. We don't want to send them out there with false security saying, I've got this by the tail, and then have life come along and kick them on their butt again. I don't want to make them. I don't want to take away any of their feelings of satisfaction or empowerment. I just want to make sure that they are aware of what may trigger their depression. I haven't been depressed for the past three months. But that's where our relapse prevention plan comes in. To remember all the things that could trigger an episode. Is it triggering it right now? No. But guess what? You're addressing your vulnerabilities. You're living mindfully. You are doing all the things that are in your recovery plan. You've got a lot of support. You haven't gotten back into this mindless kind of living. And what we find is relapse really occurs mainly under, well, three conditions. One, they never really had recovery anyway. They were just kind of holding on by the skin of their teeth. Two, they become mindless in their actions. They are getting up, eating breakfast, going to work, coming home, eating dinner, going to sleep, getting up and repeating. And they start forgetting all the stuff that they need to pay attention to. They start getting back into these thinking, thinking patterns. They stop paying attention to whether they're being positive or negative. They start stop paying attention to preventing their vulnerabilities. Before you know it, they're back into that old behavior pattern, that old thinking pattern, and they're distressed. And then the distress leads to whatever their presenting problem was, and bada bing, we've got a relapse. So they didn't have it, they didn't pay attention, or life happened. You know, occasionally they may be doing everything right, and then something like Hurricane Katrina comes along, which nobody can be expected to deal with in a completely composed manner, and it just knocks them on their ass. They. That's just the way it is. And when I talk to clients, you know, I work with adults, I don't work with kids, so I don't usually censor my language because, you know, knocked you on your hiney doesn't quite convey the same feeling. We want to match our tone. We want to show people how to identify and address Cognitive distortions. We want to figure out how these thinking errors play into our fears of rejection. So when we personalize things, if somebody personalizes all good stuff, they may be a little narcissistic, but it's probably not going to cause a negative mood situation. If they're personalizing everything bad that could play into or come from fearing rejection. So they're hyper vigilant, they're looking for rejection, they're looking for signs of rejection. Mind reading is sort of the same way. If they expect to be rejected, they're going to anticipate that people are internally rejecting them or they're going to sort of project this. I'm going to set it up so you can't win situation where I'm not going to tell you what's going on in my head, you're going to have to guess. And that usually leads to arguments, problems, and then the person's going, I'll see you rejected me again. Mind reading, all or nothing. This polarized thinking, rejection, you either love me or hate me. I mean, let's talk borderline here. Isolation, the unknown. All or nothing is extremes. All or nothing thinking tells me people are kind of grasping to hold on to some semblance of control and construct. If I say sometimes this happens, then I can't predict it because I don't know all the variables. So that makes me uneasy. If I say all the time this happens, then I can predict it. And if I can predict it, then it's not unknown. Follow me there. It's kind of artificially putting things into boxes, even if they don't quite fit into that box, like the DSM IV used to call them. Diagnoses not otherwise specified doesn't quite fit into the nice little box that is not comfortable for a lot of people. Having them figure out why that's not comfortable. Why is this unknown factor causing you stress? Maybe because of loss of control. And generally when we look back into the history of our clients, we see instances where they've been rejected and isolated, had a lot of stuff that was completely out of control, especially when they were kids, they had no way to control it, they couldn't predict it. You know, foster care, law enforcement, all kinds of stuff gets involved when you're talking about people with co occurring disorders. And a lot of times in these dysfunctional households, the children are not provided a sense of accomplishment or a sense of love or a sense of safety. So they develop a sense of failure. I couldn't keep our family together. I couldn't do it right If I would have only been a better child, then daddy wouldn't have or mommy wouldn't have. Okay, we can't fix the past. But they're taking that same mindset, they're taking that same belief system and they're using it now when they do have more control and when, you know, rejection isn't great, but they can tolerate it. More rejection by a parent, you know, that's a whole therapeutic issue in and of itself. But we want to talk with the client about how is trying to get that person's acceptance Today as a 25 year old, how is that affecting you and is it worth your energy? You know, what would be different? If this person accepted you, how would that affect your life? And if this person never accepts you, how is it going to change your life? And you know, just to throw a kicker in there, what can you learn from this person about how you do or do not want to interact with other people? So irrational beliefs are a lot of times that people take thoughts and they've learned over time to that there are certain beliefs that they have to hold on to. If I'm. If I make a mistake, it means that I am incompetent. Is that true? Sometimes, yeah. You know, sometimes we make a mistake because we're incompetent. Sometimes we make a mistake because we were careless. Sometimes we make a mistake just, you know, for a lot of reasons. What does that mean about you as a person and what does that mean about your competence in everything? Are you incompetent in one particular thing, like changing a car battery? I am not competent with anything automotive. It's just scary. So I know this. I know that there are certain things. I am not the one for the job, but there are some things that I am. Encourage clients to focus on what something means and whether it means something about them as a whole person or them in this particular situation. So take that globalization, that all or nothing thinking, and kind of squish it down and you'll see cognitive distortions and irrational beliefs kind of overlap. When somebody disagrees with me, it's a personal attack. If you grew up in a household where you weren't allowed to disagree, how do you think people as adults react to confrontation or disagreement? And it may be disagreement about. Did you like that movie we saw last week? What does that mean? If someone disagrees with you, does that mean that they're saying you're stupid? Sometimes that's kind of the underlying thought that comes out. So you want to. We talked in prior classes about playing the tape all the way through, client comes in and says, you know, I was talking to my best friend, we went to the movies and we got into this huge fight because I said it was a great movie and she hated it and I just couldn't understand why. And then, so my question would be, what was the fight about? Starting to talk about why it was so important to defend your position. Why is it so important to be right? And what does it mean if you're not right? Going back to those fears, does that mean you failed? Does that mean you're rejected because you think that they think your opinion is dumb? Taking it back to these fears doesn't always fit nicely, but it gives you a way to make a table so you can identify what fears we're talking about and what thoughts we're talking about. I must be liked by all people all the time. It ain't going to happen. And when I go through irrational beliefs in group, we'll read some of the most common irrational beliefs. And I ask people, when I say this, how many of you think this is true? How many of you think that you can be liked by everybody all the time? Very few people will raise their hand, if any. Usually there's a couple. But for the rest of them, when we start talking about activating events that have led to their upset, a lot of times it comes back to this, well, so and so disagreed with me. So I felt rejected or I felt like they were saying that I was stupid or a failure. And we'll come back to this. You must be liked by all people all the time. And then we talk about how this irrational belief underlies a lot of their other cognitive distortions. My value depends on what others think of me. And classes I've taught in the past, we've really focused a lot on external validation. If people cannot self validate, if they cannot say, I am okay, and my thoughts may not always be right, but they're mine. My feelings are my feelings. And if you like them, great. If you don't, you know, I'm open to talking about opinions, but I'm not necessarily going to change mine. If people rely and put their value on what other people think of them instead of what they think of themselves, they're setting themselves up for disappointment. I turn this back around and I say, okay, you know, let's think about your kid or your little sister, or pick somebody that is younger than them that they may be mentoring. You're going to tell them that their true value depends on what all their classmates think. Of them. A lot of times that gets us thinking and talking about, you know, actually, no. You know, I want them to think that they're okay for who they are. Okay. And sometimes there's a middle ground where people believe that they do need peer approval and that kind of stuff, but it opens a dialogue, and we can start looking at, you know, those shades of gray. If I'm not in a relationship, I am completely alone. Well, that's true. But guess what? The one relationship, and for some people, there may be two, but there's one relationship everybody can have, and that's a relationship with themselves. If you don't have that relationship, then you don't have anything to give. So if you're alone, what does that mean? And there's a difference between being alone and being lonely. A lot of clients are alone, but some are not lonely at all. They don't mind being alone. They don't mind having quiet time. There are a lot of people who can be in a room full of other people and still feel lonely because there's a void inside of them. They don't have that relationship with self. So encouraging people to nurture that relationship, and I said, there might be a second one. For those who have a faith in a higher power, that relationship is also another relationship that they can nurture before or in addition to relationships with other humans that they encounter. Success and failure are black and white. There is no gray. I encourage people to really look at, okay, you failed at something. What can you learn from? Was a learning opportunity not a complete roadblock, necessarily? Failures are learning opportunities. Successes are also learning opportunities. You got the success. How? What do you want to do again? And most of the time, no matter what the success was, we can look back because hindsight's 20 20, and go, you know, next time, or if I ever did this again, I'd probably tweak these things here, here, and here. So looking at both success and failure as learning opportunities, as training sessions in life, if you will, nothing ever turns out the way you want it to. Look for exceptions. Has anything ever turned out the way you wanted it to? And I let people sit with that for a while because the first reaction is generally no. But then when they think about it, they can say, yeah, you know, I've had a few good things happen. Keeping a gratitude journal is one way to help people focus on the positive. And the things that did turn out okay. Was it the way you anticipated it? Not necessarily. You know, ask any woman who's ever gotten married. Most of the time the wedding does not turn out exactly how she had envisioned it. But did it turn out okay? And most of the time the answer is yes. Which takes us to if the outcome was not perfect, it was a complete failure. You know, this is that extreme thinking again. Well, it wasn't how you envisioned it, or the outcome wasn't perfect, but was it a complete failure? My kids are school age right now, and we talk about grade levels and, you know, what's an acceptable grade level and what I think they can do and what I know they can do, you know, and sometimes they bring home seas and sometimes they're struggling with stuff. Does it mean it's a complete failure? No, it just means there's a learning opportunity. But there are always some things that they did right. They're both in martial arts right now. So when they go to sparring, there are some good things and some bad things. So I have them identify two things they did well and one thing they can work on. So they focus on the preponderance of good things with one thing to work as one thing to work on. If something bad happens, it's my fault. Personalization it was a cloudy day today. My fault. My mother, this is one of her go by habitual, irrational beliefs. And my, her current husband teases her about that. And he's like, oh, there was a train wreck over in Siberia, must have been your fault. And is it funny? Not really. But the fact that he can point these things out to her and be like, okay, you're taking things way too personally in his own sort of jovial way. And they have this communication, it jolts her back into, okay, you know, maybe it wasn't my fault that that train crashed over there. The past always repeats itself. Well, the sun rises and the sun sets. That's true. There are some things that are going to repeat themselves. As far as our lives go, as far as our behaviors go. The past repeats itself only to the extent we let it. If we get into a dysfunctional relationship and we get out of it and then we get into a similar dysfunctional relationship, yeah, it's going to repeat itself because we haven't learned anything from the first one. Life is a learn set of learning experiences, whether it's from successes or failures. So if you don't want it to repeat itself, learn from it. If it was true, then, it must be true now. Sometimes this is true. You know, if, you know, thinking about how the past repeats itself. If someone was a really bad match for you in the past, thinking about codependency or addictive relationships or whatever. In the present, it may still be true now. That person may have gone to therapy and, you know, discovered their sober selves and yada yada, and that may not be true. So we can't say from the very beginning if it was true then, it's true now. But there are certain things we can weigh odds on. There are other things. Like when I was five years old, I couldn't stand to be alone. Now I'm 45 years old and I really rather like being alone. It's quiet. But understanding that things that you couldn't handle in the past doesn't mean that you can't handle them in the present. You're a different person. You've grown, you've developed other skills. You've developed other support systems. So what was true then may not be true now. When I work with clients in recovery, one of the issues a lot of them have is guilt over being a bad parent. So we talk about what made them a bad parent. You know, what qualities are they identifying that they think made them a bad parent, and do they still have those qualities or are they a different person now that they're in recovery? So back then, these qualities made you a bad parent in your definition. I am not going to take that away from you. You know, if that's how you feel, then we can work on grieving over not being the kind of parent you wanted to be. However, now in the present, let's talk about what you can do with the new skills that you have because you're not the same person you were before you went into recovery. So, quick, help have your clients ask them what's upsetting me, why is it upsetting me? What are the facts for and against this? Am I reacting based on facts or feelings? And if they have time, what cognitive distortions am I using? And irrational thoughts if they have a worksheet. You know, again, I always talk about the smartphone and having clients have a PDF that they can look at on their smartphone when they start to get upset because they're not going to think of all these things. But if they have these on their smartphone and they have a list of like the top five cognitive distortions and irrational thoughts that, that they use, then they can go through and go, yeah, I'm using that one. Yeah, I'm using that one. Oh, yeah. And I'm blowing this all out of proportion based on how I'm feeling about the situation. It gives structure. It also gives the person time to decompress, to let that adrenaline go away so then they can make more rational decisions. And we all know the A, B, C, D, E and Fs, but we're going to talk at them real quick. The activating event is what happened. And I always teach this out of order, however, you know, because it makes sense for me to teach it out of order. The activating event is what happened, what was the action. C is the consequences. You got upset. So between the A and the C, there was this automatic be that just happened. Bada bing. What were those beliefs that made this meaningful? Because a car crash, you know, it's just an event. Why did it make you upset? What were the beliefs about it that led to your emotional reaction? Dispute any irrational thoughts. And then, you know, sometimes, you know, I said before, sometimes bad things just happen. Sometimes you can't get all of the negative thoughts to go away. Sometimes they are actually rational. So the next step is to say, is this worth my energy? Is getting upset over this going to do any good? And how can I best use my energy to deal with it or let go of it? When clients are going in for job interviews or job reviews, pardon me, sometimes it doesn't always work out the way they want. And the old way of thinking would be to dwell on the fact that it didn't go well and have a litany of irrational beliefs and cognitive distortions to support the fact that they deserve to be miserable. We want to encourage them to figure out, you know, how could you better use that energy now instead of using it to stay upset and to nurture that upsettedness, how could you better deal with that? And if you can't fix it, you know, maybe you got fired. All right, that sucks. Maybe we can't change that. So how can you let go of it so you can move on and get another job instead of feeling resentful and apprehensive and you know, whatever other feelings are coming up when something triggers a negative emotion. And this would be those cognitive distortions. And you know, because automatic beliefs, our irrational thoughts and cognitive distortions happen so quickly because between the A and the C we don't have time to really take a breath. So when you get upset, distract, don't react, feel it, name it, and figure out how to move through that feeling until you can think about it rationally or clear headedly. Sometimes is a better way to say it. Talk it through. Go back to the irrational thoughts quick. Help talk it through with yourself to figure out what's going on. Urge surf. Remind your clients that we react we have that fight or flight reaction and it's kind of primal, so we can't always make it go away. And sometimes it's there to tell us we need to do something. Sometimes it's right, sometimes it's wrong, but it's there saying you need to do something. So you need to figure out how you're feeling. Remind themselves that it increases and decreases like a wave. So if they're upset, they're going to get progressively upset for a little bit, but then it'll go out. So if they can figure out how to ride that wave out, they're going to be a lot better off than if they start stirring up the currents and notice changes themselves as the urge goes out. So if they're upset and they can go outside, go on a walk and they can notice, you know, their heart rates up, their breathing's up, their, their hands are shaking and as they calm down, if they can notice that their breathing's going down, their heart rate's going down, and they don't look like they're about to have a little bodily earthquake. They're focusing on themselves, they're focusing on the feelings, you know, physical or emotional, which is keeping them from focusing on whatever the issue was until they can let that adrenaline surge go out. Change and challenge thoughts we talked earlier about can and can't versus I will or I choose not to. If someone is having apprehensions, if they're afraid, if they're anxious, have them remind themselves that they can do it. That positive self talk reminding themselves of all the things they've done up until now that have prepared them for this challenge. Thoughts on the other hand, are dealing with especially relapse and the desire to engage in self destructive behaviors. We don't want to romanticize that how good it made you feel. We want to remember, play the tape through, made you feel really good for a minute. But then after that, what happened? Constructive self talk. Pinpoint what they tell themselves about an urge that makes it harder to cope with the urge. I can't do this or I have to have this right now. How extreme is that? Why do you have to have it? Would you like to have it? Yes, I would like to have it right now. Okay. Having to have something and liking to have something are two different things. I have to have oxygen, I don't have to have a candy bar. Differentiating wants from needs Help clients learn how to use self talk constructively to challenge these statements that make it harder to cope with their urges. If I go to the bar, I Will only have one drink. That's not constructive. This urge that saying, well, I would really like to have a drink right now. And I know if I go, I can tell the bartender that I can only have one drink and he'll only serve me one drink. That kind of minimization and rationalization going to come back and bite our clients in the behind. So helping them figure out how to use the self talk constructively to play that tape through and go, yeah, I know good and well that I will talk him out of that and I'll have three, four, five dozen drinks. An effective challenge will make you feel better, less tense, anxious or panicking. So ask the have the clients learned how to ask themselves, what's the evidence? We'll stay with the drug analogy. Right now I have to have a hit right now. What's the evidence that you have to have it? You know, unless somebody is in acute withdrawal, in which case, you know, it's possible that they may be going into a physical crisis, but that's rare unless we're talking about alcohol and benzos. So it's generally more of a want than a have to. So what's the evidence that you have to have it? What's the evidence that you're going to die if you don't have it? What is so awful about not getting it? What happens if you don't get it? You know, in reality, if you remember that we're urge surfing, this feeling, this craving, this urge, this stress will dissipate over time unless you nurture it, unless you feed it. You're a regular human being and you have a right to make mistakes. So if someone is saying, you know, I screwed up, I can't go face anybody, I need to just, I need to go clear my head and get high. You have to. You need to. Or you want to, you want to escape from it instead of facing the fact that you made a mistake, going back to that all or nothing thinking and that fear of failure, fear of rejection. When people make mistakes, a lot of times they want to crawl into a hole and that hole is their addiction or their depression where they kind of pull the covers over their head and they don't want to come out. Encourage them to look at what's making them feel like they want to do that and challenging those beliefs. So distressing thoughts worksheet. I'm just going to go through this one really quick. What's the evidence? Am I assuming causation where none exists? Am I confusing thought or feeling with fact? Am I close enough to really know what's going on. You know, if you're speculating about something that's happening with your second cousin's ex husband, you probably aren't close enough to the situation to know what's going on. If your boss comes in from a meeting and he's in a really bad mood, you know, especially if it was like a senior management meeting or something, or, you know, maybe he just comes in. You're probably not close enough to know what's going on. You know, maybe he got into a fight with his. His spouse, or maybe the management meeting he was in didn't go so well. It doesn't mean he's coming in to lay people off or that you're in trouble. Am I thinking in all or none terms? Am I using extreme words like always or never? Is the source of the information credible? And if all of this information is coming from your own head, generally that's a no. A lot of times we color this information by what we are expecting to see. Am I confusing low probability with high probability? You know, somebody comes, your spouse comes home, they're supposed to be in recovery, and they come home and they sort of trip over the cat when they walk in the door, and you automatically assume they're drunk. Is this low probability or high probability? Well, they've been clean for two years. What's more likely, they went out and got drunk, or the cat was in the way because it was always sitting at the front desk, front door? Am I focusing on irrelevant factors? You know, sometimes you can focus on the color of somebody's shoes or, you know, whatever instead of what really matters. Is this thinking getting me closer to what I want, or is it taking all my energy away from where I want to go? What are the advantages and disadvantages of thinking this way? Finally, the big question. A year from now or a month from now, is this gonna make any difference at all if you make a mistake or you get fired or you don't get the promotion you wanted, what are the differences this will make? You know, you're fired, you may have to get another job. But does it mean you're gonna be destitute, living out of your car and lose your kids? Probably not. So we need to really look rationally at the exact effects this is going to have. Other CBT interventions reminding clients just to recognize how thoughts can cause feelings and feelings can cause thoughts. If I'm depressed, I'm going to have a harder time thinking cheerfully and seeing the sunny side. If I'm happy, I may tend to give people a wider birth. I may minimize and make excuses a little bit more. I may try to look at the optimistic side or the silver lining if people practice acting a certain way. And that's why I love the heads and tails activity. Sometimes I even say if it's heads, act grumpy and depressed and if it's tails, act happy and cheerful. Tell me how much difference it makes in your day. And a lot of times I'll do this when I teach at universities and it makes a big difference for the staff or for the students. Schedule in activities to increase positive emotions and mastery. Schedule in recreation. Hello. All work and no play Exposure with response prevention if there's something that really stresses your client out or makes them anxious. If you have the training, working with them on exposing them to the situation and preventing them from running away, acting out, hurting themselves, whatever the case may be. I am terribly afraid of enclosed spaces. You know, even thinking about going in an MRI machine makes my heart start to race. So I would start with me. I would start just thinking about going into an MRI machine and get to the point where that doesn't stress me out and then laying down on the MRI machine but not going into the tube and etc. Etc. And sometimes you got to pretend or make certain situations up that mimic whatever it is. Because you probably can't lay in an MRI machine. Just randomly recognize negative thoughts and improve problem solving skills. If you can't fix it, how are you going to let it go? In group activities, list thinking errors and discuss how those patterns of thinking protected you until now. For example, they protected you from being disappointed if you expected to fail or expected people to leave. If you just expect that, then you're not going to be disappointed. So I'll list all of the thinking errors or, you know, 10 of them up on the board and we'll talk about how they protected the person until now. But then we move on and say, how can you eliminate those thinking errors? And why don't you need them anymore? So what's your countering mantra? So instead of saying I need to be loved by everybody all the time, saying I need to love myself all the time, and not everybody's capable of loving. It's about them, not me or whatever your group comes up with, I like this activity because not only do we talk about the irrational thoughts and cognitive distortions, but we also the clients have to manipulate the material in order to come up with their countering mantra. So they really ingrain it. Identify thinking errors that you still hold onto and why and then develop a plan to start addressing them. Decisional Balance and we've talked about this before. What's the benefit to these old ways of thinking and what are the drawbacks? What's the benefit to the new ways of thinking and what are the drawbacks? We have to make it more beneficial to change our behavior. Over the past week or two, we've all probably experienced for ourselves and worked with clients who've had cognitive distortions or irrational thought patterns. I encourage you just for a baseline because I like baselines. Pay attention to your own thinking over the next week and identify some of these thinking errors that you have and ways that you might address them. Because we do. I mean, most of us have at least one or two fallback thinking errors that we may catch ourselves on, but they still come up now and again. And then think about how you can start integrating this knowledge of thinking errors and cognitive distortions into your counseling technique. How can you integrate this into your work with clients? CBT is a technique that helps people understand how thoughts create feelings and vice versa. It helps us address and identify negative self talk issues and events from the past do not need to continue to negatively impact the person. The awesome thing is thinking errors were learned and they can be unlearned. It just takes time. Negative thought patterns form and maintain a negative or vulnerable disempowered self image. So helping people address these empowers them and creates a stronger self esteem. Thank you for attending and let me know if there are any topics you'd like me to cover in future webinars by sending me an email@supportlce.com.
