Cognitive Behavioral Therapy Skills: Counselor Toolbox

Cognitive Behavioral Therapy Skills: Counselor Toolbox

Hi everybody and welcome to today’s
presentation on cognitive behavioral therapy skills. Like the other
presentation we did on assert not assertive community treatment acceptance
and commitment therapy, this is also based on just providing information
about skills that can be used not providing a an evidence-based practice
obviously we couldn’t cover that in a full hour or in just an hour so over the
next hour we’re going to define cognitive behavioral therapy and its
basic principles a lot of us are familiar with this but it’s going to be
a good review and it also may highlight some nuances that you didn’t know about
will identify factors impacting people’s choice of behaviors explore causes and
impact of thinking errors and identify common thinking errors and their
relationships to cognitive distortions so why do we care well as therapists we
want to help people figure out the best way to live a happy healthy meaningful
goals driven life for some people that’s going to mean using some cognitive
behavioral interventions that can be in addition to mindfulness that can be in
addition to a lot of other things but it’s important to help people understand
that the way we believe things to be the way we interpret things is going to
affect our reactions so for example think about a situation you know you’ve
walked into and maybe you walked into it with a small child and it was a
different situation it was a new situation but you know it was no big
deal you walked in it was not a threatening situation to you because you
were like hey I got this the little kid walks in and goes oh wow there are a lot
of people walking around here this is really scary same situation two
different perceptions you probably didn’t have much of a stress reaction
going on whereas the little child probably had this fight-or-flight thing
going on grabbing on to your hand like please don’t let go
Atlanta Airport be a perfect example if you’ve ever
taken a little kid through Atlanta Airport it gives you an idea about how
people can perceive things differently and when you enact that fight-or-flight
reaction you’re going to have all those stress hormones you’re going to have all
the either anxiety or anger or whatever that goes with it it may serve to
exhaust the person and leave them to feel hopeless and helpless so what we
want to do is help people see that but we also want to help them see that when
they’re depressed when they’re tired when they’re sick things are going to
seem a lot worse a lot of times because they don’t have the energy to perceive
it differently I mean when you’re sick it’s overwhelming to think of going
through Atlanta Airport so this is what we really want to help people start
understanding is it’s two sides of the same coin they interact if one is you
know kind of going wonky is going to affect the other one the good thing is
if one’s going really good the other one’s going to go really good if you’re
having really positive thoughts you’re probably going to feel pretty good
there’s an activity and I think we’re going to talk about it later it’s called
the coin flip activity and I asked client clients to flip a coin in the
morning and in the morning if it turns on heads then they have to be the most
positive Pollyanna all day long look for the silver lining and everything smile
walk with their head up hold those nonverbals up and see how they feel at
the end of the day besides a little sore because there’s muscles they’re using
they haven’t used in a while if it lands on tails they can just be their normal
selves which generally if they’re seeing me means that they are depressed anxious
stressed out angry something in the negative realm then we
talk about how did things seem different on the days when you were feeling better
when you were walking taller when you were smiling even our nonverbals it
doesn’t even have to be sickness it can be our nonverbals that can make us feel
or make our body feel heavy tired and make it seem like it’s a whole lot
harder to deal with life a person who perceives the world
generally good and believes they have the ability to deal with challenges as
they arise that good old self-efficacy will be able to allow their stress
response system to function normally so if they’re like you know what I can deal
with whatever life throws at me I’ve got it and maybe I need help with it maybe
I’ll need to ask for support but I’ve got it it’s not going to completely
overwhelm me people who see the world as hostile unsafe and unpredictable you
know for a variety of reasons whatever happened to make their scheme as such
that they don’t believe that people or the world is trustworthy are predictable
they are always on guard they’re always kind of like a hamster in a cage have
you ever had a hamster hamsters don’t recognize you and go hey that’s my own
or human contact score hamsters go run under their little house
and you just kind of open the cage and stick your hand in there and flip over
their house and you’re like come here and give me cuddles and you’re like you
know 200 times bigger than they are so the little hamster is like freaking
out this is what it’s like for people and obviously I’m exaggerating but this
is what it’s like for people who have a negative perspective a negative view or
a hostile view of the world so kind of keep that little hamster in your mind cognitive behavioral therapy we have
core beliefs those things that are in our heart when I talk with my clients
about honesty step one and that’s what they’ve got to do to start recovery is
get honest with themselves first and then other people we talk about head
heart and gut honesty do you think it’s right does it seem like the right thing
to do does it feel right in your heart you know does it make you happy it
doesn’t make you feel good and then the spidey senses is your gut saying and or
is your gut fine if one of those is saying this might not be the right
choice and we need to think about what’s going on so you have those core beliefs
and I put them in the heart just because that’s the middle of the head heart and
gut but you have core beliefs about yourself whether you’re good with
you’re bad whether you’re effective at certain things yada yada
you have core beliefs about other people same thing good bad effective
predictable and you have core beliefs about the future and a lot of that goes
with locus of control but also your past experiences if the world in the past is
seemed unfriendly and uncontrollable and you’ve perceived it that way then you’re
going to expect the future to be uncontrollable so what we want to do is
help people look at their schemas and their core beliefs about themselves
others in the future and figure out kind of what they want it to look like these
schemas are going to affect your behavior and your thoughts and your
feelings and you know you can pick wherever you want to start it doesn’t
matter because all three inter interface with one another so if you haven’t let’s
start with negative thoughts if you have negative thoughts then you might feel
anxious angry stressed dysphoric which will affect your behavior you’re going
to do different things than if you have positive thoughts about something you
feel excited and energized you’re going to have different behavior the best
thing example I can give you is if you’ve ever done public speaking or had
to present something some people really detest public speaking it’s just
terrifying for them to get up in front of a group of people so their thoughts
are I’m going to trip up I’m going to forget what I’m going to say I’m going
to make a fool of myself I’m going to you know it can go on forever that when
you get on a roll you can get on a negative roll and go on forever or
positive hopefully get on that roll with those thoughts you start holding onto
those thoughts remember like we talked about in a CT the other day when you
hold those thoughts and you kind of mush them around in your mind and you come to
believe them that you’re going to make a fool of yourself and it’s going to be
awful you’re going to start feeling terrified likely which is going to
likely affect your behavior if you go out on the stage and you’re terrified
you’re going to probably stutter you’re probably going to get foggy headed
you’re going to have that fight-or-flight reaction so there’s an
adrenaline rush and you start sweating and you can’t focus and you can’t
concentrate you really want to away as opposed to somebody like me who
loves public speaking and I’m just like cool I get to go out there and try to
engage however many people are in the audience it’s a game for me because when
I can actually see your faces I really enjoy trying to figure out and make eye
contact with people and figure out what it is that they’re there for what is it
that’s going to make them tick what resonates with them so my behavior as
you can kind of see right now when I go out there I’m excited and I want to
engage people and it’s a fun experience for me again just like the airport the
same experience for two different people and two very different interpretations
and reactions to it so what effects and I don’t like the term rational but when
we’re talking about CBT irrational comes up a lot I like to replace it with
helpful because every behavior in its own weird sort of way is or probably was
rational at one time that being said we’re going to get back to that stress
affects our behavioral choices if we’re under stress we can have negative
emotions negative emotions will affect our thoughts if we’re feeling sad we’re
probably going to look at the dark side if we feel sad we’re going to look at
the bottom falling out if we’re happy we’re probably going to look for that
silver lining physical factors if you’re in pain sick sleep-deprived poorly
nourished so your body can’t produce the neurotransmitters it needs to or heaven
forbid intoxicated you’re probably not going to make the same decisions as you
would if you were comfortable healthy well rested nourished and not
intoxicated any of those things can go to really impact how you perceive a
situation or how you react in a situation especially the intoxication
whereas in your non intoxicated State in your sober state you may think that you
want to do something but then you’ve got that filter that goes really not
not a good idea in an intoxicated State or even in a manic state if you’re you
know if you have somebody with bipolar that filter kind of goes away so the
behaviors that someone may normally not do because they have a rational filter
that goes you know punching this guy outs probably not the best idea right
now the filter goes away when you’re sleep-deprived you’re less generally
people are less patient generally people don’t have as much of a filter think
about watch your children if you have children or your grandchildren or even
yourself I know myself when I’m sleepy I am giddy as all get-out and things I
wouldn’t normally say because they’re you know stupid I’ll just come out and
say anyway and my kids just roll their eyes or like mom you’re overtired could
go to bed uh but that’s okay you know I’m okay with that
in that situation now if I acted that way at work it would be a worse thing
environmentally if you’re introduced to a new or unique situation and you
perceive it as stressful because the unknown we know can be stressful then
you may not make as rational of a choice or as helpful of a choice because you
may be trying to escape same thing as exposure to UNPROFOR bellowing for a
word here but UNPROFOR ball is the best I could come up with we all prefer
certain situations some people like I said would rather do just about anything
then get up in front of a lecture hall of a hundred and fifty people and talk
but if they have to do it then they’re going to be under stress which may
affect how they do things so we want people to understand that their
perception and their feelings is affected by a lot of other things not
just you know an emotion here or a particular memory there’s a lot that
goes into it and social if peers your family convey
irrational thoughts as necess very standards for social acceptance
people may tend to cling more to it to those unhelpful thoughts and unhelpful
behaviors you know in CBT they say irrational because quote nobody wants to
associate with those people you know who are those people and why can’t we
associate with them there are a lot of things if you think back think high
school you know high school is pretty rough if we’re going to talk about
having irrational thoughts and cognitions if you have to be part of
this particular group in order to be accepted you have to do this you have to
do that but do you do you really so those kinds of all-or-nothing statements
are cognitive distortions and while they may have served a purpose in some way
shape or form in the past we need to encourage our clients to take a look at
them now and go are they still helpful ways of thinking is it still helpful for
me to think that I am only successful if I live in a million-dollar house in a
gated community and do this that and the other or can I be can i define success a
different way or do i define success a different way and lack of supportive
peers to buffer stress so we had those peers that caused stress by talking
about the half dues and categorizing and lots of attributions but then there’s
also having not having somebody to go you know does this make any sense
because sometimes we are our own worst enemies and if we go to a friend and we
go you know this is what I’m thinking and I think I have to do this in order
to be acceptable in order to be loved or or you know whatever the case may be
most people are not going to use those exact phrases a good friend is probably
going to listen and go yeah you’re right or no no that’s way off so supportive
peers are essential to reminding us to consciously regularly check in with our
cognitions to make sure that they are hopeful and rational so a note about
irrationality and this is mine this is not from CBT the origins of most beliefs
for rational and helpful given the information the person had at the time
and their cognitive development their ability to process that information so
concepts and schemas and core beliefs that people formed when they were five
are probably going to be very egocentric you know the person is going to feel
like everybody sees it my way because this is how I see it you know just like
a five-year-old does a five-year-old doesn’t think well you know let me take
Johnny’s perspective no he assumes that Johnny sees it the same way so it’s
going to be egocentric it’s probably going to be focused on only one aspect
of the situation because small children can’t focus on multiple aspects and it’s
probably going to be dichotomous it’s all-or-nothing
mommy loves me mommy hates me and it could be personalized you know
everything a lot of kids think that everything has
to do with them so if something happens something bad happens many times
children will take it personally or be afraid it’s going to happen to them
again you know if hurricane katrina hurricane
andrew those sorts of things you know we saw a lot of trauma in children and they
developed very real fears about thunderstorms and about hurricane season
and if you’ve watched florida hasn’t had a notable hurricane in years now but
there’s a lot of stuff that goes into that but people who were really young
during some of those really bad hurricane seasons perceive those
situations differently okay so we need to help people understand that if we
especially if we use the term irrational those thoughts you formed when you are
knee-high to a grasshopper and they made perfect sense to you back then but now
that you’re an adult you’ve got more experiences and you’re
able to take different perspectives your brain is more developed
let’s take a look at it and see if you can look at different perspectives and
come up with something that’s a little more helpful maybe a different way of
perceiving this situation the irrational irrationality or unhelpful nosov Fox
comes when those beliefs are perpetuated without examination so something a
belief that you formed when you’re five you’re still holding when you’re 35 and
you’ve never questioned it you’ve never gone you know does this make sense is
this helpful to getting me toward where I want to be most of us don’t you know
we form these attitudes and beliefs when we’re you know growing up when we’re in
elementary school middle school high school from watching TV from being
around our peers from being around our family in our community and we get all
this input of the way things should be and a lot of times people don’t stop to
question and go and go well does this really make me happy is this really what
I want and they can be irrational if they continue to be held despite causing
harm to the person so the person continues to hold this belief even
though it is causing them a generally emotional cognitive harm is making them
miserable we need to look at why what’s motivating them to hold on to that
belief why is that belief so important and how can we make it so they can live
a happy values-driven life emphasis on the happy how can we make it less
harmful sometimes it’s more productive for clients to think of these thoughts
as unhelpful or helpful instead of irrational sometimes when I say
irrational to clients and you know I’m the same way if somebody says you’re
being irrational I’m like oh I’m not it elicits this instantaneous defensive
reaction it’s like when you tell them they’re being resistant they’re like I
am NOT rien resistant so helpful or unhelpful and then we talk about why it
is unhelpful towards getting them toward their goals
basic principles of cognitive behavioral therapy we teach or help clients learn
to distinguish between thoughts and feelings I can think something is scary
I’ll probably feel it but if I have an automatic you know feeling I walk into
Atlanta Airport and I see yeah I went to an airport in New York I can’t even
remember which one it was because my plane was diverted and I got off and I
walked out there and I have never seen so many people packed in his place like
sardines before in my life I was just completely overwhelmed that was kind of
an automatic feeling now that was a feeling based on you know who knows it
was overwhelming to be surrounded by that many people so then I had to
separate the thoughts and go okay what am I thinking that’s making me feel so
overwhelmed and at that point you know I didn’t know how to get to my gate and
all that other sort of stuff with traveling I don’t travel well but
encouraging clients to stop and go okay why am I feeling this way what are my
what thoughts do am i having that are contributing to these dysphoric feelings
CBT helps people become aware of the ways in which thoughts can influence
feelings in ways that are sometimes not helpful
we have hecklers in our gallery the automatic tapes that we play thing
memories that we have whatever you want to call them that when you try something
when you are just going through daily life you hear these voices in the back
of your head and obviously not real voices but that are saying you’re never
going to make this or if you would have just blah blah blah then you’d be a
better person helping clients become aware of those thoughts and how they’re
negatively influencing their feelings and keeping them kind of stuck is a huge
part of CBT we help them learn about thoughts that seem to occur
automatically without even realizing how they may affect emotions again those
thoughts from the they’re saying you’re not good enough
you’re not smart enough and nobody’s gonna like you where did that come from
and do you believe it you know maybe it came from somebody
when you were in high school so was that a valid was that a valid source maybe it
came from somebody yesterday on Facebook was that a valid source taking in those
thoughts and then figuring out is this something I’m going to hold because it
makes me happy or is this something that I’ve got to deal with because I’m having
a negative reaction constructively evaluate whether these automatic
thoughts and assumptions are accurate or perhaps biased the other thing to
remember is a lot of our clients not all of them but a lot of them hold
themselves to a standard there’s like up here and they hold everybody else to a
standard that’s down here so they are a failure if they don’t achieve this but
everybody else is successful as long as they achieve this so encouraging them to
take a look at how accurate and biased or unbiased are the thoughts and like I
said they may be their own thoughts they may be telling themselves these things
evaluate whether the current reactions are helpful and a good use of energy or
unhelpful and a waste of energy that could be used to move toward those
people and things important not impotent important to the person road-rage you’re
in the car you’re driving somebody cuts you off okay natural reaction fight or
flight reaction you’re just like slam on the brakes do whatever you got to do
aversive maneuvers you’re good so you could let it go at that point ago got
lucky on that one and keep driving most people not all but most they found that
80% of drivers have reported at incidences of road rage which is a
really high number but most people will start getting all fired up and irritated
and grumpy and we and just rageful and so my question
would be I hear that and I hear that it made you angry
in retrospect did screaming at the person as you pass them at sixty miles
an hour in your car with the windows rolled up really do any good did it do
any good at all what else could you have done with that energy if you wouldn’t
have expended it all yesterday we had to wait for the vet to come by and my
daughter just completely wore herself out worrying about when when the vet was
going to get there what he was going to say about her donkeys and was beside
herself so by the time it got to evening and it was time for her to go to her
martial arts class she didn’t have the energy to go she’s like um wiped out I
just want to go to bed in retrospect we’re looking back and saying okay now
tell me what it was that you were so stressed out about and let’s talk about
whether that was a realistic and helpful line of thought to perseverate on all
day long and what could you have done differently because she didn’t bother to
mention any of that to me yesterday and then developed the skills to notice
interrupt and correct these biased thoughts independently causes of these
thinking errors information processing shortcuts when we form schemas and we
encounter a situation that reminds us of something in the past like when I go to
my grandmother’s house I have a schema I have a belief system I have you know
stuff that I know about my grandmother’s house so when I go to my grandmother’s
house it’s kind of a shortcut to know what to expect when I walk in how to
behave how to do different things and it helps me plan and predict if you’re
using outdated or dichotomous all-or-nothing schemas it may cause
thinking errors because you may be now incorrectly processing current events
mental noise some of us have it a lot of us have it
not everybody think about trying to focus and study for a final exam in the
middle of a really busy sports bar okay this is a cause of thinking or you’re
going to miss important things you’re not going to be able to focus you’re not
going to necessarily attend to the correct things because there’s just so
much else going on your attention is drawn in 17 different directions and or
the brain’s limited information processing capacity due to age we talked
about that before young kids think all or nothing they think dichotomously
egocentric ly middle school-aged kids and older start developing the ability
for abstract thinking by the time we get older you know as adults theoretically
we’re able to you know think pretty well think pretty clinically about different
events but if we’re in crisis when someone is in crisis and it could be
like what we think of clinically as crisis or it could be they’re just
completely overwhelmed and burned out and have been burning the candle at both
ends for three months they’re not going to process information quite as well
they’re not going to take in all this stuff because they’re just like
shell-shocked have you ever seen teachers in the hallway of like an
elementary school Oh at the end of the second nine weeks they just kind of
stand there with this blank look on their face they’re not processing as
much as they were the first day of school and you know God loved them they
have a lot to deal with but it’s important for us to help our clients
understand that there are some times that they are going to have to really
stop and focus write things down so they can remember or they can make decisions
a little more clearly my guess is most of us have times in our life where we’ve
been able to think through complex problems but then there are other times
where you just can’t keep it all in your head and you’ve got to put it on a
whiteboard maybe that’s just me but we want clients
to understand that they are not broken they’re not faulty they’re doing the
best they can with the tools they have and the knowledge they have and our job
is to help them see where some of this might have gone a little awry other
causes of thinking errors emotional motivations I feel bad therefore
whatever I’m thinking must be bad if I’m scared that means whatever it’s coming
on the other end of the phone is bad news moral motivations I did it because
it was the right thing to do and that can be an excuse for doing wrong
behaviors as well it can also be you know you can argue on
the moral one social influence well everyone else is doing it so it must not
be bad set that again a lot of times and this is where the frames approaching the
motivational interviewing really is really helpful f stands for feedback
about the reality of what’s going on is everybody really doing it let’s look at
statistics you know not subjective information let’s look at objective
information so the impact of these thinking errors it makes people want to
fight or flee when they get upset and we use upset as kind of this
all-encompassing garbage term emotionally they get depressed or
anxious we don’t want to feel that way anxiety and anger are flee or fight
fight or flee it’s our body saying there’s a threat you got to do something
depression is your body going I give up I just I don’t I don’t even have the
energy to do it anymore behaviorally some people withdraw they
shut down we all know people when they get frustrated when they get overwhelmed
when they start feeling hopeless or helpless they just kind of withdraw from
everything and everyone addictions numb that out so they don’t have to feel
the dysphoria sleeping problem and changes when we start being on that
constant fight-or-flight hyper-vigilant sort of thing going on the body is
always sort of turned on which means you’re not going to sleep as well then
the circadian rhythms get messed up which starts causing exhaustion and
lethargy and then everything seems harder because you’re sleep-deprived and
then you start thinking more negatively and more hopelessly you see where this
is going it’s a downward spiral and eating changes some people eat a lot
more because they’re eating comfort foods some people eat a lot less because
their stomach is so tore up from the stress they can’t even think about
holding anything down physical stress related illnesses fibromyalgia
gastrointestinal problems headaches neck aches back aches you know the whole
gamut of it when you start feeling bad when you start hurting generally it gets
frustrating after a while and that frustration makes it kind of raises the
bar brings you up a little bit so you’re
that much closer to kind of just kind of being overwhelmed you don’t have as much
of a cushion as you would if you were happy healthy well nourished not in pain
and socially a lot of times we will get irritable or impatient with other people
or withdrawal when we’re having these negative cognitions these thinking
errors that are keeping us in a dysphoric state these effects of
thinking errors contribute to fatigue and a sense of hopelessness and
helplessness which intensifies thinking errors this is an important concept that
I want my clients to understand and I want to drive home in this presentation
so thinking errors what are they emotional reasoning feelings are not
facts and we want to help people to learn to effectively identify feelings
and separate them from facts so if somebody says I’m terrified
okay that is a feeling what are the facts supporting that feeling why are
you terrified what is the evidence that you are in some sort of danger
right now you know and danger may not be the right word for your client at that
particular point in time but what’s the evidence that there’s a threat in what
ways is this similar to other situations maybe it’s triggering something from the
past that was really really scary or you know you were too little to be able to
handle it but you can handle it now and how if you dealt with similar situations
like this in the past we want to help people just step back and get some
distance between their feelings and their thoughts and try to figure out you
know which thoughts are helpful and productive and even if a sought makes
people anxious or angry it can be helpful it may be telling them hey dude
you need to get your butt up and get out of there if it’s helpful it means it’s
moving them toward where they want to be happy healthy safe and values-driven
life so happy and helpful developed a stress tolerance skills when people use
emotional reasoning they feel emotions which then they start attributing
finding the facts to support those emotions instead of looking at all the
facts we want to help them learn to tolerate their distress so they can kind
of let that subside for a second they can accept their feeling they can name
it they can say I’m scared I’m stressed I’m angry and whatever but they don’t
have to act on it right then they can tolerate the distress for a minute
without having to try to make it go away and emotional regulation skills they can
feel a feeling without having to make it go from zero to 120
you know if they feel sad they go I feel kind of sad instead of grabbing on to it
and going I wonder what I feel sad about I must feel sad about all these sad
things now I’m really going to be really really sad and devastated so we want to
help people learn how to regulate their emotions identify them accept them
whatever word you want to use and tolerate them because feelings are
there for a reason they’re there to tell you your brain thinks something’s going
on now thankfully we have that higher-order cognition stuff going on so
we can contradict our own brain and we can go you know maybe that’s not true in
this situation cognitive bias negativity mental filter whatever you want to call
it people who focus on the negative they walk in they get up in the morning and
they look outside and it’s partly cloudy they get to work and they said instead
of saying there was it was very light traffic they said there was a fair
amount of traffic everything is always the flip side of
what somebody who’s really optimistic would say so asking them what’s the
benefit to focusing on the negative in what ways is this helpful to you you
know some people say well it keeps me from getting disappointed because I know
it’s going to end up negative anyway so we can trap challenge that know that
whatever it is they think they know and see if there have been exceptions when
it hasn’t turned out that way what are the positives to this situation
I give the example a lot of you know I wash my car or it rains and maybe I
wanted to go out on a run that day but I can perceive it I can look at the
positives you know the rain washed my car for me so I don’t have to do it now
score it watered my garden all the better it knocked down some of the
pollen out of there even better I can find and I can encourage people to find
positives in a situation yes there are negatives there are negatives to every
situation if you want to find them you’re going to find them but if you
want to find the positives you can too which takes us down to what are all the
facts there’s the positive and the negative and the neutral I told you
earlier about the coin toss activity having people toss a coin and on the
heads days they act like it is just the greatest day to be alive and see how
things are different when they do their journal because you know I have my
clients do I’m sort of a mindfulness check-in in
the morning and in the evening and preferably at lunchtime how are they
feeling what’s their emotional state what’s their energy level on the happy
days a lot of times it can be less and sometimes they need a little coaching
throughout because some of those old patterns kick in but I want them to
start challenging some of their automatic thoughts that we’re going to
talk about in a minute disqualifying or minimizing the positive most of us can
probably say we’ve had a bunch of clients that do this they are more than
happy to tell you about all the things that they mess up but then when they do
something right they minimize it encouraging people to hold themselves to
the same standard they would hold everyone else to and I know I talked
about that earlier ask them things like would it minimum would you minimize this
if it was your best friend’s experience your best friend came to you and said I
just got into such-and-such college would you say awesome or would you say
anybody can get in there how would that go ask them what is scary about
accepting these positive things that you might have actually had an
accomplishment for some people it means that it might mean other people expect
more of them for other people they just don’t know how to accept the positive
they don’t know how to accept compliments they don’t know how to be
the center of attention and they don’t like it and then we want to look at why
that is sometimes we disqualify the positive because it fails to meet
someone else’s standards so as people might that be true here you know I know
when I was growing up and going through college and going through school and
everything got my doctorate but I will for always be ever and always being not
a real doctor because a PhD is not an MD and I’m like really
so is it somebody else’s standards or can I feel good about having a PhD egocentrism my perspective is the only
perspective I’ll being egocentric but it doesn’t work
most of the time so encouraging people to take alternate perspectives
maybe you’re texting with someone and they say something that is not that you
interpret as not the nicest thing and this happens on text message a lot and
they get upset now an egocentric thinking error would say that purse is
just grumpy today someone that’s taking other perspectives would stop and go
back and read the text and go I wonder if maybe this could have been taken some
other way you know cuz obviously their reaction is not what I intended
so egocentrism if you hold on to that I don’t understand anybody else because
you know I don’t see a problem with anything personalizing and mind-reading this is when you assume that everybody’s
frowning because of something you did your boss walks down down the hallway
and looks at you and grimaces and continues to walk on oh I must have done
something wrong no maybe he just got out of his senior management meeting that
was five hours long and he’s got to go to the bathroom you know there could be
a hundred different explanations for why that happened so encourage clients to
ask themselves what are some alternate expla nations for this event that
doesn’t involve me you know why might this have happened because if they hold
on to that I must have done something wrong but as soon as their boss calls
them up and goes hey can you come to my office for a second you know where their
thoughts are going to go I’m getting fired I’m going to get laid off I don’t
know what it was that I did wrong but he walked by me two weeks ago in the
hallway and grimaced and I’m just I’m the worst person in the whole world
but where did that come from so encouraging people to not necessarily
assume they know what’s going on in someone else’s mind and not
automatically attributing every person’s negative behavior to something they did
how often and then ask them how often has it really been about you
now think about the last 10 times you’ve taken something personally how many of
those 10 times has it really been about something you did versus something with
the other person then the availability heuristic remembering what’s most
prominent in your mind so asking clients what are the facts ah the most obvious
one that we talk about is plane crashes you know it is way dangerous to fly on a
plane because you hear about all those plane crashes well yeah you hear about
the few plane crashes but you don’t hear about the 20,000 everyday that land
safely so you remember it and it seems more dangerous because that’s what is in
your mind that’s what is available to you that’s what you’ve based your
thought processes on because maybe you didn’t know that 20,000 planes or more
fly and land just perfectly every day this can also be true with people
remembering what’s most prominent in your mind sometimes and this can be very
very true in domestically violent relationships if somebody falls in love
with someone and that person is just the greatest person since sliced bread for
the first four months and then the cycle starts and there’s this little tiny
sliver of the honeymoon period after the battering cycle and the person’s like
that’s the person I fell in love with that’s what I remember and they try to
focus on that that’s most prominent in their mind and they ignore the rest of
the stuff so we need to encourage people to really look objectively at the facts magnification are you confusing high and
low probability outcomes what are the chances that this is going to happen how
many clients have we worked with that have gone to the doctor and got in a
physical or gotten a test run and then the doctor had to call them back and
this could be true for you too and the doctor had to call them back two or
three days later when the tests came back from the lab and that whole three
days they were just in a panic because they
were afraid they were going to get some terminal diagnosis so thinking about
high and low probability outcomes another instance or example of
magnification is somebody that thinks this is the end of the world whatever it
was I think I’ve told you before my little story about um tripping when I
was walking down the hall at work and falling and yeah it was embarrassing my
folders went everywhere and yeah but in that big scheme of things will it matter
that much from now you know are people gonna think oh she is such a clutch she
must be a ditz too no I mean they may have thought that at that time I don’t
know but you know in six months nobody’s going to remember and then ask them in
the past when something like this has happened when you’ve had to get a test
done and you’ve had to wait on results or if you’ve done something that was
embarrassing and you didn’t think you thought everybody was going to remember
it forever how did you tolerate it how did you learn to deal with it building
on those strengths that they already have all or nothing thinking errors
these are things like love versus hate I love them or I hate them it’s all or
nothing she does this all the time or she never does it if I’m going to do it
I’m going to do it perfectly or I’m not going to do it at all thank you all good
intentions or all bad intentions you know sometimes we do things with good
intentions that have some bad repercussions so did we do it with all
bad intentions are all good intentions and the answer is neither most of the
time life is kind of in that middle ground gray area encouraging clients to
look and find examples where something hasn’t been one of the polls when have
they done something that they’re proud of that wasn’t perfect or when again
when has somebody else done something that they were proud of that wasn’t
perfect remembering that with availability
heuristic remembering how often something really happens how long it’s
been since you’ve seen that behavior and remember that sometimes good times are
amazing but how frequent are they compared with the bad times another thinking error is a belief in a
just world or a fallacy of fairness I just asked clients identify for good
people you know who’ve had bad things happen and in in reality we all have bad
things happen good people do bad people do in between people do attributional
errors and this is the pet of mine you know labeling yourself not a behavior so
global versus specific and I am stupid versus I’m stupid at math I don’t have
good math skills it’s not about me it’s about my skills I can change skills
stable I am and I always will be will be versus it’s something I can change it’s
something I can learn internal it’s about me as a person versus it’s about a
skill deficit or something I could learn or change and there’s you know lots of
information on attributions out there on the internet if you need a refresher on
it but we find that a lot of people who have dysphoria have negative global
stable internal attributions so questions for clients remember the
beliefs equal thoughts and facts plus personal interpretation another way of
saying it is reality is 10% perception is 10% reality and 90% interpretation so
what are the facts for and against my belief is the belief based on facts or
feelings does the belief focus on one aspect or the whole situation does the
belief seem to use any thinking errors what are alternate explanations what
would you tell your child or best friend if they had this belief how would you
want someone to tell what would you want someone to tell you about this belief so
if you’re telling somebody about this what are you hoping they’re going to say
in return and finally how is this belief moving you toward what and who is
important to you or moving you away from what or who is important to you now they
can do a worksheet and have all of these or you can pick one or two of these
questions that are most salient for your clients but they can have kind of at
their fingertips so as they’re going through the day and something happens
they can ask themselves ok what’s an alternate explanation or you know
whatever it is this salient for that client irrational thoughts how do these
thoughts impact the clients emotions health relationships and perceptions of
the world you know this is what we want to ask them how is this thought
impacting you globally how may have this thought have been helpful in the past
where did it come from how does it make sense from when you formed it in the
past when you’re dealing with it ask the person if the thought is bringing you
closer to those that are important are there any examples of this thought or
belief not being true and how can the statement be made less global less
all-encompassing so it’s about a specific incident a specific situation
less stable which means you can change it and less internal which means it’s
not about who you are as a person but maybe something that you do or a skill
that you have so we’re going to go through some of these thoughts real
quickly here mistakes are never acceptable and if I make one it means
that I’m incompetent well never is kind of stable and I am incompetent is kind
of global that’s also that extreme all-or-nothing thinking so you can see
where these cognitive distortions end up leading to unhelpful beliefs
when somebody disagrees with me it’s a personal attack well there’s
personalization if I ever heard it before maybe it’s not about you maybe
they’re having a bad day and you just happen to be the unlucky target or maybe
they’re disagreeing with you because they have a different point of view and
it’s not a personal attack it’s just their point of view if someone
criticizes or rejects me there must be something wrong with me
personalization all-or-nothing thinking global stable and internal something
wrong with me as a person to feel good about myself others must approve of me
now this is one we’ve talked about external validation before and we can’t
control other people so to feel good about yourself how can you do that
besides having necessarily requiring other people to approve of you to be
content in life I must be liked by all people Wow I’ve never met anybody who’s
liked by all people I’ve never even met anybody who’s been hated by all people
but it’s important to help clients see how this is really dramatic to say all
people and in order for them to be content then everybody has to like them
I mean I like to be liked but if everybody doesn’t like me you know
that’s pretty understandable my true value as an individual depends on what
others think of me I would really challenge this one this is all you know
also very personal internal I would challenge people to look at and say it
so your child’s value as an individual it depends on what other people think of
him or her most people would say no but the perspective thing nothing ever turns
out the way you want it to okay all-or-nothing thinking and probably
availability heuristic if something bad just happened then they may be focusing
on that which causes them to focus on all the other bad things in the past
that have happened not focus on that is okay you know bad thing
happen but look at all these good things I won’t try anything new unless I will
be good at it this fear of failure fear of rejection
it just really paralyzes a lot of people when they get stuck with that thinking
area that they have to be perfect I am in total control anything bad that
happens is my fault well that’s egocentric and personal if
they think they’re in total control that’s their perception of how the world
is they think if they’ve got everybody on marionette strings and that anything
bad in the world that happens is their fault how powerful are they
I feel happy about uh if I feel happy about life something will go wrong
it happens sometimes but let’s look at times when you’ve been happy that
something hasn’t gone wrong you know let’s get rid of that all-or-nothing
thinking it’s not my fault my life didn’t go the way I wanted could be true
but it seems like that’s making you unhappy so what do we do about that if
I’m not in an intimate relationship I’m totally alone
no again that’s pretty extreme I’m either in an intimate relationship or I
am alone and a loner and you know it’s just me and my 17 cats which follows
with there’s no gray area so encouraging people to really look at what these
beliefs are saying is important thoughts impacts behaviors and emotional and
physical reactions emotional and physical reactions impact thoughts and
interpretations of events so if you do something and you and it’s pleasurable
and you have a great physical reaction you know let’s take bungee jumping or
skydiving if you go out there and it’s scary but you do it and you’re just like
whoa what a rush your interpretation of that is probably going to be good which
means you’ll probably do it again if you go out there and it’s just the most
horrible experience you’ve ever had you’re probably not going to do it again
and your interpretation of it is going to be not good which is going to make it
hard to understand why other people would do it irrational
thinking patterns are often caused by cognitive distortions so let’s just look
back at some of those because there’s a lot fewer cognitive distortions or
general ways of thinking about the world than there are thinking errors because
there’s lots and lots of thinking errors cognitive distortions are often schemas
which were formed based on faulty inaccurate or immature knowledge or
understanding and by identifying the thoughts the hecklers you know the
automatic tapes that are maintaining our unhappiness the person can choose
whether to accept those thoughts or change them

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