Transforming Schema That Cause Anxiety & Depression with Counseling

I'd like to welcome everybody to today's presentation on how schema affect anxiety and depression. I am your host, Dr. Donnelly Snipes. We are going to define schema, explain how they're formed, discuss why they may be inaccurate or outdated, and identify strategies to address unhelpful schema. Most of us are familiar with schema, but for anybody who's not, schema are mental representations or beliefs about a particular person or event that we repeat and hopefully adjust throughout our lives. One of the easiest ones we can use to explain to people is we have schema about traffic lights. We expect that when the traffic light is red, after that it will turn green and then yellow and then red again. But if for some reason it didn't follow that pattern, that would not fit with our schema. When you drive up to a traffic light, you anticipate, you expect that it is going to follow that normal pattern and that is a result of your schema, the schema that you hold about traffic lights. We form schema about ourselves and our goodness. From the time we are knee high to a grasshopper. We have schema about going to the doctor. What happens when you go to the doctor? A lot of us have that schema that we're going to go to the doctors and we're going to sit there for 45 minutes past, past our appointment time and yada, yada. But you have certain schema based on your doctor. I had one doctor who was amazing and I have a dentist right now who's the same way, always on time, never have I been there and they've run more than five minutes late. So my schema for going to those particular providers is that they are going to be on time, so I better be a little bit early. But I had to adjust my schema when I started going to them because I was used to the other way. We have schema about job interviews, how it's going to go. If you go into a job interview and the first thing they do is instead of sitting down and talking to you, they take you and have you do a drug screen. That might be a little weird. You expect when you have a job interview, you're going to meet somebody, you're going to go sit in an office, they're going to ask you some questions. That's your schema. We have the schema about news media and this one is one that has changed over the years. My mother was a journalist and my stepfather was a journalist. And back when they started in journalism, journalism tended to be much more Devoid of opinion. It tended to be much more objective. And that seems to have changed over the last 30 or 40 years or so. We expect, and they expect the news media to be very objective. However, you know, that schema isn't holding true nearly as much anymore. And part of that is because so many stations are competing for our attention that they're having to use clickbait and they're having to present particular points of view in order to try to attract viewership. So we want to look at what the motivation is. A lot of times it's not malicious, it is capitalistic, if you will. But you may have to adjust those schema anymore. We don't want to assume that everything that we see on, on the news or in print is the God's honest truth. We need to investigate. We have schema about flu season. You know, what's going to happen, how likely we are to get it, how many people are going to get sick. We have schema about the stock market, and this is one, you know, if you've watched it over the past couple of years, don't watch it right now because it is really freaking scary. But over the past year and a half, two years, the market analysts have been telling us, oh, we're getting ready for a crash, we're getting ready for a crash, and then it doesn't happen. You know, they say we have these indicators that tell us that every time this has happened in the past, we've gone into a bear market or whatever, and those didn't come true. So there are a lot of things with our stock market schema, for example, that have had to be adjusted because we're. When we see these indicators and this thing doesn't happen, we're left going, well, I'm glad, but I don't know, you know, what to expect now. I have no idea how to predict if my prior schema didn't work. We have schema about the coronavirus based on what we're hearing, and we have schema about the safety or dangerousness of other people. We have lots of schema. That's kind of my point. And these are just some highlights that most of us can relate to. We can think, yeah, you know, when I think about a job interview or flu season or something, this is what I anticipate. And if we can anticipate, then we've got a schema. We've got something in our brain telling us this is what to expect. Schema can be thought of as a type of metacognition. It helps us Think about a situation. It's the way we think about a situation. If our schema about something is primarily negative, then we are going to expect a negative outcome. General categories of schema and this comes from schema therapy. There actually is a philosophy called schema therapy. We have schema about security and abandonment. And as I go through these, I want you to think to yourself how they correlate to a certain extent with the psychosocial crises that Erickson said we had to go through. Because a lot of them do sound very similar to the trust versus mistrust, the autonomy versus dependence and, you know, the rest of the stages that he went through. So think about Erickson and this is. It doesn't exactly parallel because we form schemas throughout our lives. And Erickson said we went through these stages in a very sequential process at certain ages. But I just found it to be interesting because a lot of our schemas are formed when we are younger. Now we can adjust them, but that means we have to think about adjusting them. We don't want to just hold on to a schema we formed when we were four years old without checking to see if it's still valid. So we have schema about security and abandonment. How safe are our relationships and how lovable are we? We do people want to be around us? We have schema about trust and safety versus abuse. Are people generally trustworthy and safe to be around or is the world a dangerous place? We have schema about emotional support versus emotional deprivation and invalidation. Think about people who have borderline personality disorder or who are. Who have always tended to have a low threshold for emotional dysregulation. A lot of their environments were very invalidating and they were always told that they were wrong or they weren't provided the tools to deal with their emotions. They weren't provided the support to handle that emotional dysregulation. So they formed a schema when they were young that emotions are powerful and uncontrollable and really scary. Scary to deal with. Other people who had good emotional support and had assistance with emotional regulation when they were growing up feel much more comfortable experiencing emotions. We have schema that relate to self determination. How much of our life do we control and our vulnerability to emotional or physical harm? Can we get out there and do something or if we step outside of our comfort zone, are we going to get squished like a bug either emotionally or physically? You know, how dangerous is it out there and how vulnerable are we if we take a chance on industry versus Inferiority. To quote Erickson, positivity and optimism versus negativity and pessimism. Which one serves us best? Is the world generally optimistic? Do we view the world and talk about the world in positive, optimistic, hopeful, empowered terms? Or do we use the negative and pessimistic metacognitions where we see the danger? Pretty much everywhere we go? There are schema about acceptance and contentment versus hyper criticalness. Some people live their life and they accept their strengths, they accept their weaknesses, they are content with who they are, they have a good self image. Other people are hyper critical, critical of themselves and maybe others. They're always looking for faults, they're always looking to dig. And instead of looking at it in terms of okay, this is a place where I might be able to improve it is looking at it in terms of this is a weakness and this makes you unlovable or unworthy. We have schema related to competence or defectiveness. Are we capable of doing things? Are we functioning or are we broken? Are we intact or are we broken? Independence versus Dependence. How much do we have to rely on people? If you're raised in a environment in which your caregivers are extremely enmeshed, then you may believe that you need to be in a dependent state. If you are raised in an environment in which your caregivers are supportive and empowering, then you may believe that you have the capacity and that you're supposed to be more independent. Self concept and self esteem go along with, you know, kind of follow shortly after that with enmeshment. If somebody has a good self concept and good self esteem, they are okay with who they are versus do they need to be a chameleon and conform to the wills and wishes of everyone else in order to be lovable? The next set of schemas refers to success and empowerment. And once we get through these, we're going to talk about how they impact our anxiety and depression. Success and empowerment. Can we be successful? Do we have the power to make a difference in our lives or are we going to fail at everything we try to? We have schema about our ability to control our situation and our ability for self control. Physical, emotional, cognitive versus thinking that we have no self control, we have no impulse control and we need to be subjugating ourselves to the will of other people. And finally belongingness and connectedness versus alienation. Or we have schema about do we fit in or don't we? Are we going to be rejected? And you can look at these and obviously the things that are on the right Side of the slash are the ones that probably promote feelings of hopelessness, helplessness, or anxiety. So you can see kind of where we're going here. Schema are formed based on the interpretation and memories of experiences. We don't have a schema about something until we experience it or we see someone else experience it. Then we're like, okay, that's a pretty good thing, or, okay, that's a really bad thing. When I was in fourth grade, we had. I was going to a school and the. We didn't have walls. Everybody had pods, but there were no actual walls between the classrooms. And I remember being in fourth grade and there was this fifth grade teacher who, who when he would get angry, he would pull the pupils that he was angry with into the library, which was in the middle of the pod, and scream at them until his face turned red. My schema related to that teacher was one that he was very dangerous, he was very scary, and that he was going to scream at me. Because what I saw was him screaming at students. I didn't notice the fact that he wasn't screaming at the other 18, was not screaming at the other 18 in his class. I noticed the ones he was screaming at. So my schema with that teacher was one of fear. And guess what? When I went to fifth grade, guess who I got? And getting through the first part of fifth grade was a little bit challenging because I was terrified to go to school because of that schema. And then finally we had a parent teacher conference. And, you know, he explained what was going on, mom explained what was going on. Everybody, you know, talked, and I felt safer. So I changed my schema about him. And I understood that, okay, he only screams until he's red in the face if you make a big boo boo. So I did my best not to make a big boo boo. But, you know, that helped me alter my schema. Schema are a shortcut the brain creates to help us better anticipate future situations. We know what we're walking into. We have schema about things that we do every day. You have schema about this class. You know, you expected that you would turn on your computer, you would log in, and you would go through the process that you always do. And if it didn't happen that way, then you might have to change your schema. A little interpretation of events. You know, even if we have schema, or if we don't have one yet and we're forming a schema, interpretation is impacted by our age and prior similar experiences. Remember that children are especially under the age of like 9 tend to be very egocentric. So they think that most of what happens has to do with them. In some way they caused it or they should have prevented it, or, you know, somehow they were involved. They think dichotomously. There is no alternate thing here. If they're in a family where they've got a caregiver who has an active addiction and leaves or goes to jail or just whatever the child may think, it's my fault that my parent used drugs and it's my fault that my parent left. It's, you know, they're very personal and they think, you know, they either love me or they hate me. So my parent left. So my parent hates me now. And there's no, you know, my parent doesn't like that behavior and my parent loves me. That's one of the things that we have to work with our children when they're very young, being very articulate about what we're angry about. You know, I love you. However, I really don't like this behavior that you're doing. So they start understanding the difference and forming schema about appropriate behavior as well as forming schema about their lovability even when they make a mistake. So the person's age and prior experiences start giving you, start giving them a framework in order to form these schema. If you're thinking about something in a 5 year old's mind, how would a 5 year old understand it? Well, that's their schema now. We change things as we grow up. You know, when you were 3, 4, 5, you may have thought that there were monsters in your closet or under your bed or something. By the time you're older, you know, you've outgrown that and you've realized that doesn't exist because you've had multiple nights that you've gone to bed and multiple times that you've looked under the bed and guess what? There's never been anything there. So you have used facts in order to counter or alter those schema. And the person's cognitive development and metacognition also impact how we form our schema. If they have good cognitive development, if they are past that egocentric, dichotomous place, then they have a better ability to consider other opportunities or other alternative suggestions or solutions to, to what's going on. And metacognition, remember, is how we think about thinking. If people tend to be negative in their metacognitions, if they tend to be pessimistic, that's going to increase their anxiety, increase their Feelings of threat increase their awareness of threats in the environment and decrease their awareness of safety triggers in the environment. So people can continually form negative schema based on what they're noticing. If they are not noticing the positive, then they can't factor that into their schema. People with trauma histories may notice and remember more threats in the environment because they tend to be more hyper vigilant in their state of being and in their thinking. They're noticing those threats. They're always looking for whether they're going to be safe. If you've had a bad experience with something, then you likely expect another bad experience. I remember when, back when H1N1 the swine flu was going around, we had to drive to Tallahassee from where we lived in order to get our kids the H1N1 vaccination, because they didn't have any in central Florida. And that was a little bit of a bummer. But we went there and it was this huge line of people because people were coming in from all over the state to try to get these vaccinations. And they had nurses and paramedics and all kinds of people administering the shots. Well, lo and behold, we got a paramedic who was administering the shot. And the paramedic was not gentle like a lot of nurses are. You know, they're used to doing things quickly. And both of my kids had, you know, got this shot that was, you know, very traumatic for them. Instead of being something that, you know, was not pleasant, they remember it to this very day. Please don't tell me when we go to get this flu shot, please don't tell me a paramedics gonna be doing it. Like, no, it's gonna be a nurse. You know, you're good. We're not, you know, we don't have to go through that again. But they are terrified of paramedics now. And, you know, I haven't had a way for. Thankfully, we haven't had any other situations where we've interacted with paramedics because I'm sure there are some that are very gentle. But, you know, nurses are really good at trying to help quell people's fears because they know a lot of us really are afraid of needles. And, you know, it's important to help them adjust that. But my kids think of nurses as okay, if I have to get a shot, I want a nurse to give it to me. Please don't with the paramedics. And that's their schema and I understand where that came from. And no amount of explaining is going to change that for them right now. The thunderstorms, for example, in middle Tennessee, we had, what was it last week or the week before? It all kind of runs together for me right now. We had that EF4 tornado that came through here and decimated our area. You know, we have, we now have, quote, skylights in Walmart and Lowe's and those kind of places. And normally I wouldn't think of thunderstorms as a scary thing. However, after that particular poignant incident, we're supposed to have severe weather coming through here tonight. And I can tell you, even though I know the probability of another, you know, EF anything coming through here tonight is pretty minuscule, I can tell you in the back of my mind there's a little bit of anxiety because my schema was changed to say, you know, thunderstorms may be a bigger deal than you're used to now that you're up here in tornado alley. And I don't like that feeling. But it's important for me to use my facts and use all my cognitive behavioral techniques to counter that in order to reduce anxiety. Otherwise I could get myself all worked up. You know, I feel a lot of empathy for people who are in Crossville or down in Hermitage and Donelson where they really got the brunt of it and they lost their houses because, you know, they're hearing this now and they're already getting the severe weather alerts and they're already feeling some of that anxiety resurge. I mean, it's just ripping the band aid off. Recognizing that our schema can change by a particularly poignant incident. But we also can change it back if we need to because we can use some of those cognitive tools that help us focus on fact based reasoning instead of emotion based reasoning. Remember that schema can become outdated. What was dangerous to you as a child may not be dangerous anymore. You wouldn't leave a four year old home alone. You know, that would be scary for them. But you know, when they are 14 or heaven forbid, 24, you know, they can stay home alone and they are, you know, they are safe. What is scary to a 4 year old is often not scary to a 14 year old because they change their schema. But if they haven't had the opportunity or they never, you know, put those check marks in place, then they may still be scared or feel threatened by it. When we feel anxious, when we feel threatened, when we feel powerless, we need to look at what we're telling ourselves, look at our schema and go, is this still Accurate in the present time. Is this still accurate right now? It probably was very accurate back then from our interpretation. But is it still accurate and is it still a threat now? And if not, what's different? Other things that can outdate schema. What was dangerous to you in the past, like an abusive significant other, may not apply in the present. Your current significant other may not be abusive at all. So when that person, when your new significant other starts raising their voice, they get upset about something because everybody gets upset. Old schema may kick in and you may go into that fight or flight mode. And it's important for people to recognize is this current situation the same as the old one or is there something different? Is there something qualitatively different about this situation? I also have emotional dysregulation up here because it doesn't have to be about somebody else or something else. In the past, if people have had difficulty regulating their emotions and struggled with emotional dysregulation, non suicidal self injury, you know, anything like that, then they may feel anxious, they may feel overwhelmed about the possibility of having to deal with feelings now because it's terrifying. They, they remember what it was like in the past and they remember feeling like their emotions were oppressive and uncontrollable. So we want to help them evaluate in the present. You know, now that you've been going to therapy, you have all these new tools, you are older and wiser and have all these other support systems available. Are emotions as dangerous to you? Are they really still that dangerous or are you more in control of them? Do you have more ability to manage your emotions? And the expectations that applied to something 20 years ago may not apply now. Cancer is a perfect example. Back 20, 30 years ago, if you got breast cancer, for example, that was a really big deal and there weren't a lot of treatments for it, or not a lot of good treatments. Now people can get breast cancer and they've got medications which I'm sure you've seen advertised, that can help them, even with advanced stages of breast cancer, live for many, many years even with having that cancer. Same thing is true for HIV. Back in the 80s when people got HIV and maybe even late 70s. I don't remember exactly when it really became prominent, but it was a huge big deal because we didn't understand, we didn't know how to treat it, we didn't know how to deal with it, we didn't have the medications that we've got now. Now people can have HIV and live very long, productive lives because we have Medications that are able to help them live those kinds of lives. So our schema, if somebody gets a diagnosis of one of those things right now, for example, if they are older and their schema is still back in the past of oh my gosh, this is a death sentence, we need to help them check the facts and see if in the present that is still true or if there are new treatments and new hope that's been offered. Schema can be inaccurate because of emotional valence. And we talked about this a little bit earlier. We tend to notice threats when we are in a dysphoric mood. If somebody is already depressed, anxious, angry, grieving, they are probably going to notice the icky things then as opposed to noticing the positive things. I know after, you know, my mom died, I was in that state of intense grief right after it happened. I wasn't noticing what I normally would notice at her house. Normally I would notice the eastern Towhees that came to her bird feeder all the time. I love the sounds of the eastern towhees. I love the sounds of a couple of the other birds that used to visit outside at her bird feeding station. I don't even remember any birds being around at that point in time because I wasn't noticing the positive things. I was noticing stuff that was in alignment with how I was feeling. When people are depressed or anxious, we need to help them force themselves not to ignore the negative, but to also notice the positive. Because negative things, threatening things, have more emotional valence. They are more powerful in our minds than some of the positive things. It's just a survival mechanism. That's the way we've evolved. People can also have inaccurate schema because of what I call fear mongering headlines. There's a lot of clickbait out there. They want you to come to their website and they may put out a headline that you read it and you're like, oh my gosh, it's a catastrophe. And if you don't read the story in its entirety, or if the story only presents half of the picture, then people may only have half of the knowledge, which may make their schema inaccurate. And conflicting or inaccurate information also goes along with lack of knowledge that can make our schema inaccurate. If we're told the wrong stuff, then we're going to expect the wrong thing. How do we form healthy schema? Well, I have the acronym. I should have made it bold craves down here. And we've talked about this before in attachment. Well, schema is the same way. People need consistency and predictability in their world as caregivers, when children are growing up, we need to help them see the consistency and the predictability of, but also be able to understand when things don't go quite as planned and integrate that into their schema. For example, most of the time they get sick. They're down for a couple of days, they take some medicine or maybe not. They get better. Voila. That's their schema about getting sick. But what happens if grandma gets sick? And maybe it's something worse than your average cold, but in a little kid's mind, sick is sick. There are no different diagnoses. Grandma gets sick, goes to the hospital, and never comes home. How's that child's schema going to change next time they get sick? You know, we need to make sure they understand that there are big differences between having a common cold and having whatever grandma had. Or, you know, you are younger, you are stronger. Grandma had copd. Grandma's grandma was sick before she got the flu, and then, you know, she got the flu and died. Helping them understand the difference so they can alter their schema in a meaningful way is going to be really important. We need to be responsive to people when they are having, you know, emotional responses. We need to be there to help them manage their emotions as well as manage their thoughts. Thoughts. A lot of times when people get stressed out or anxious or angry, you know, their thoughts are flying through their mind and they can't focus. A responsive caregiver or supportive other is able to help somebody take a breath, take a break, stop for a second, and go, okay, let's look at the facts here. Let's look at what's going on, or, you know, let's try both. Doing some belly breathing. So, you know, we can. So I can help you tone down that HPA axis. So I can help you get a clearer head so you can think a little more slowly. Depending on the age of the person, you know, you're going to use different interventions, but we need to be emotionally as well as cognitively and even physically responsive. If someone is freaking out, you know, what is it that they need in order to help them stay safe? In order to help them regulate their own thoughts, emotions, and behaviors, we need to provide acceptance and attention. Recognizing people for who they are as lovable, not for what they do. You know, that can be awesome, too. You know, we want to give them kudos and praise for things they do well, but also helping them recognize that they are accepted and lovable and for who they are. You know, you are a Wonderful person. I may not like this behavior or you are a wonderful person, and I am so glad that. Or so proud of you for getting straight A's on your report card. But making sure you acknowledge both the person and the behavior separately. Validation is important. You know, sometimes we feel like we're going crazy. Sometimes we feel like, you know, we just can't take another step. And that empathy and validation is really important for people to go, you know, if I were in your shoes, I can't imagine what it would be like. Or, you know, I can only imagine how overwhelming that must be. And people can feel like, okay, somebody gets it. That's like, I think I've shared this story with you before, or whatever word I'm looking for. One of my teachers in college said the difference between sympathy and empathy. Sympathy is finding somebody that is stuck in a well and it's cold and it's dark, and looking down the well from the. From the top, looking down, going, wow, it really must suck to be down there because it looks dark and cold. You know, hate to be you, I'm here, but good luck. Which, you know, at least you're there. They know you're there. Empathy is putting on that rappelling gear and going down into the well with them. You can still get back up because you got the rappelling gear on. But empathy is going down into that well and experiencing a little sliver of what it's like to be in their shoes at that point in time and validating, wow, this is overwhelming, or this is powerful, or, you know, whatever it is, empathy and encouragement is really important as well. So they understand that you're at least trying to walk a few steps in their shoes, that they understand you're really trying to experience what it's like to be in the dark place that they may be in and encouraging them, you know, noticing instead of going, oh, it can't be that bad, saying, wow, this is really tough right now. You know, I know that you can get through this. And making sure that we provide that encouragement to, you know, think of people who are experiencing depression and anxiety as being stuck in that well. What kind of encouragement would you give them? You'd want to validate how hard it is for them. And what else do they need to know? That there is hope and finally safety and support in solution generation. There are lots of S's there. People need to know that they're safe, that they can trust other people, maybe not everybody else, but that they can trust and they can trust themselves, and that Generally they're safe when they're home, when they're in their normal places. And assistance with support in solution generation. Some people just need help brainstorming. They get stuck in that, you know, proverbial box and they can't see any other solutions. So sometimes getting a second or third or fourth point of view can help people alter their schema a little bit. They're seeing this is the way it's supposed to be and you can say, okay, normally it's this way, but what if, or what if this. So solution generation is a way to help people identify alternatives. So they might be able to adjust their schema to be a little bit more flexible. So what do we do to adjust these schema? Identify and evaluate current schema that are causing distress. This is one of those cognitive behavioral things. What are you thinking that is contributing to your sense of fear, anxiety, hopelessness, helplessness, anger? What types of thoughts? Why is it that you are having these feelings right now? Why are you perceiving a threat? Help me understand. Describe for me your environment, your cognitive environment, what's going on in your head so I can understand and we can walk through this together. Then start looking at those schema and evaluating the facts. You know, with coronavirus right now, that's a huge thing. And some people are just totally panicked and other people, like my in laws are still going out to eat and going to ball games and kids, birthday parties and. Or like you're in your 70s, you're kind of in that highest risk group right now, what are you doing? But that's what they are doing. And you know, so evaluating the facts and helping people examine it and make decisions for themselves. The decisions we make might not be the same as the ones that they make, but we can help them look at the schema to figure out, you know, if they feel, oh, this is no big deal, all right, let's look at the facts. Is that true for you? You know, for a lot of people, 10, I think it's 10 to 39 years old, that has the lowest mortality rate and the lowest risk of anybody from what the World Health Organization is saying. So if you're in that group, you're probably going, you know, I'm still feeling pretty confident. If you have underlying physical conditions, you may be going, yeah, thinking I might want to curtail some of my activities for a little while. Helping people evaluate facts, address cognitive distortions, especially overgeneralization and personalization. You know, if they think that every time I get a shot, it's going to Hurt. You know, let's evaluate that, let's look for exceptions. And you know, I've got lots of videos on handling cognitive distortions and unhelpful thoughts, but it's important to really figure out ways to combat those. Personalization. What are three other explanations why this happened that have nothing to do with me? You know, that's something that older people, you know, teenagers and older do better at. A 5 year old is probably going to really struggle with that because that's cognitively above where they are right now. But we can walk them through it and at least if they talk through it, then they might be able to develop a little bit more psychological flexibility. We can also explore schema related to old situations with fresh eyes. For example, if you're working with somebody whose parent or caregiver abandoned them, they may feel that it was their fault and they're completely unlovable. All right, so let's look at that, you know, now that you are 30, let's look back at that situation. Why did your parent leave? You know, did it have anything to do with you when you were six months old? And you know, the facts of the situation probably point more toward the caregiver was struggling with something and chose to leave for some reason that had little or nothing to do with that child. Or maybe they left because they thought it was in the best interest of the child because they loved them so much. But encouraging people to look back over these old schema that they're holding that are telling them that they are unsafe, unlovable, broken in some way, Schema restructuring and you know, there's a lot that we can do when people feel a sense of abandonment. We need to help them look for exceptions. You know, let's talk about some relationships where you've had a sense of security. What would it take in a relationship? What would that relationship need to look like in order for you to feel secure? Educate people about attachment and you know, characteristics like craves that can help them figure out how to develop healthy relationships and, and start looking at relationships in terms of how many characteristics of a secure, healthy relationship does this have instead of how many characteristics of a relationship does this have that shows that I'm going to be abandoned? Have them start looking for the positive trust and safety versus abuse. What does that look like for you? What would need to happen terms of relationships and your environment for you to feel like you are safe? What could you do and what exists right now in your environment that is, does indicate that you are safe? Encouraging people again to Notice for emotional support. A lot of times, especially if we grew up in emotionally rejecting environments, we may not know how to ask for emotional support. Encouraging people to learn how to ask for emotional support. Learning what they need for emotional support. Developing skills. Maybe they do still have difficulty with emotion dysregulation. That's fine. Okay, so let's create a new schema in which you are able to modulate your emotions more effectively. You know, so come into therapy right now. Lots of emotional dysregulation. One of the goals of therapy would be to develop the tools to modulate those emotions and develop the schema that says, I can do this. Self determination is, again, working towards that empowerment. What is it that you want to do and how can you do it in a way that helps you feel safe, secure, and loved? Encouraging people each day to spend 20 minutes focusing on what went right that day. Most of us can find 20 minutes that we can set aside, you know, the critical monsters and just focus on. All right, let me think about what went right today. There's been a fair amount of research that has shown that people, especially adolescents, who journal for 20 minutes a day on what went right and what they did well that day have significant improvements in their depression and anxiety symptoms. We want to have people notice if they tend to be hypercritical of themselves, if they tend to be tell themselves they're stupid, or if they tell themselves that they're not worthy. We want to have them notice those things and alter, you know, what would it take to develop a schema of acceptance and contentment? One of the things that, you know, we've talked about before is asking them, would you say this? Would you be critical of someone else who did the exact same thing? And most of the time people would say, of course not. Well, so why are you accepting other people and content with them, perfections and imperfections and all, and you're not accepting and content with yourself? We want to help them identify areas in which they're competent. None of us is competent in everything. So helping them identify those areas of competence and then those areas of, for lack of a better word, defectiveness, evaluate whether they're worth putting the energy and effort into altering. And if they are, okay, how do we do it? You know, if they don't like something about themselves and it's really important to them to change, how can they do that? We want to help them. Look at, and some of this is cultural independence versus dependence. How much independence do they want? How much independence do they feel like they need? And how much dependence do they have? You can go all the way to the other end of the spectrum to dependent personality disorder. You know, that's too far on the dependent side. We want to help people figure out what they have the capability of doing and evaluate their identity as an individual for self control versus lack of self control and subconscious subjugation. We do want them to evaluate how much of what you do is because you want to do it is you living authentically versus you being a chameleon to try to get someone else's approval. And if they believe that they have to be a chameleon to be loved, then that is another area that we can address in counseling. Helping them see maybe how they hold other people to different standards than they hold themselves. Helping them identify the qualities about them that are lovable. Schema are lenses through which we predict and interpret situations. They are only as good as the knowledge and understanding of the situation that the person has at the time. You know, 10 years down the road they may go back and look at that schema that they formed and go, oh, that really wasn't very accurate. Because now Looking back hindsight's 20 20, we know this. Looking back, seeing a bigger picture, they may have much different revelations about what happened. Schema often need to be altered as we gain new information. So being willing to allow those schema to evolve as new information is provided is also really important. And being aware of some of the things that can cause inaccurate schema, such as that emotional valence so people can make a conscious effort to, for example, notice the positive and the negative in situations so they have a more balanced view of what's going on when they're forming that schema. Are there any questions? Alrighty everybody. I want you to have a great weekend. Now remember next week we have the Monday, Tuesday class. That's the last time we're going to be altering the days for quite a while because I have one more Chicago trip. But then after that we will be sticking to that. Our normal Tuesday, Thursday for quite a while. Okay everybody, have a great weekend. I'll see you later. Between writing notes, filing insurance claims and scheduling with clients, it can be hard to stay organized. 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