Tag: cognitive behavioral therapy

Understanding Anxiety – A Psychiatrist Explains Symptoms, Medication Options and Therapy

Fear is something that everybody experiences. We all have fear, and fear is a normal response to a threat. The difference with anxiety is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators could be rational if you know that the elevator reached the maximum capacity or you know for sure that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone to be afraid of elevators, even though it’s a perfectly functioning elevator you know has been recently installed and checked and technically is flawless, and you still have anxiety about that.Anxiety disorders are a large family with several individual disorders, but it’s important to know that sometimes they happen together or you may have one and a little bit of another one. But the most common are panic disorder, social anxiety disorder, we have also generalized anxiety disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder that is mostly seen in children. In psychiatry, probably the most successful group of illnesses or disorders that we can treat successfully are anxiety disorders. The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that, we can use medications that are just as needed, for example, panic attacks.Many people use a type of medication called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone who has only sporadic attacks, but not for someone who has chronic, what is called generalized anxiety disorder, because it’s easy to become dependent on those medications. The other mainstay type of treatment in terms of medications is antidepressants, specifically the so-called serotonergic antidepressants. Some of them, for example, are sertraline or paroxetine and these medications increase the transmission of serotonin in the brain and can alleviate some of the symptoms of anxiety. When we are thinking of treatment for anxiety disorders without medication, we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases several chemicals, like cortisol and adrenaline, but also changes the heart rate, breathing, and so forth. And so there are many activities, including meditation, yoga, tai chi, and sports in general, aerobic exercise, that can down-regulate the activation of the stress response system.In addition to self-help, another type of non-medication, non-pharmacological treatment for anxiety disorders is therapy. Counseling. And several types are specific for anxiety and they’re being developed through research and they are highly effective. One of the most common and most well-known is cognitive behavioral therapy, which is a systematic training of the patient to identify certain thoughts and beliefs that can be challenged, and the challenging of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety is avoidance. Unfortunately, avoidance is the worst thing that we can do because it will perpetrate and make it chronic.The more we avoid something, the more powerful that fear becomes, or that anxiety. Therefore, one of the treatments for anxiety is to try not to avoid the triggers, is to expose ourselves as much as we can tolerate that. For example, if public speaking is a source of anxiety, some of us can get trained and go to Toastmasters, and go to a setting where we feel safer and slowly and progressively expose ourselves. Because the brain learns not to react. With more practice, we lose that fear. If you believe that you have an anxiety disorder, I would say the first thing to do could be a screening for that. That could be done by your primary care physician or yourself. One of the most common tools to screen for anxiety disorder is called General Anxiety Disorder-7.GAD-7. And that’s widely available in the public domain on the Internet. And if you have a suspicion of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist because this, can be very effective and the therapist would be prepared to tell you, “I think you need medication in addition to therapy.”.

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Understanding Anxiety – A Psychiatrist Explains Symptoms, Medication Options and Therapy

Fear is something that everybody experiences. We all have fear, and fear is a normal response to a threat. The difference with anxiety is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators could be rational if you know that the elevator reached the maximum capacity or you know for sure that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone to be afraid of elevators, even though it’s a perfectly functioning elevator you know has been recently installed and checked and technically is flawless, and you still have anxiety about that. Anxiety disorders are a large family with several individual disorders, but it’s important to know that sometimes they happen together or you may have one and a little bit of another one.But the most common are panic disorder, social anxiety disorder, we have also generalized anxiety disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder that is mostly seen in children. In psychiatry, probably the most successful group of illnesses or disorders that we can treat successfully are anxiety disorders. The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that, we can use medications that are just as needed, for example, panic attacks. Many people use a type of medication called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone who has only sporadic attacks, but not for someone who has chronic, what is called generalized anxiety disorder, because it’s easy to become dependent on those medications. The other mainstay type of treatment in terms of medications is antidepressants, specifically the so-called serotonergic antidepressants.Some of them, for example, are sertraline or paroxetine and these medications increase the transmission of serotonin in the brain and can alleviate some of the symptoms of anxiety. When we are thinking of treatment for anxiety disorders without medication, we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases several chemicals, like cortisol and adrenaline, but also changes the heart rate, breathing, and so forth. And so there are many activities, including meditation, yoga, tai chi, and sports in general, aerobic exercise, that can down-regulate the activation of the stress response system. In addition to self-help, another type of non-medication, non-pharmacological treatment for anxiety disorders is therapy. Counseling. And several types are specific for anxiety and they’re being developed through research and they are highly effective.One of the most common and most well-known is cognitive behavioral therapy, which is a systematic training of the patient to identify certain thoughts and beliefs that can be challenged, and the challenge of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety is avoidance. Unfortunately, avoidance is the worst thing that we can do because it will perpetrate and make it chronic. The more we avoid something, the more powerful that fear becomes, or that anxiety. Therefore, one of the treatments for anxiety is to try not to avoid the triggers, is to expose ourselves as much as we can tolerate that. For example, if public speaking is a source of anxiety, some of us can get trained and go to Toastmasters, and go to a setting where we feel safer and slowly and progressively expose ourselves.Because the brain learns not to react. With more practice, we lose that fear. If you believe that you have an anxiety disorder, I would say the first thing to do could be a screening for that. That could be done by your primary care physician or yourself. One of the most common tools to screen for anxiety disorder is called General Anxiety Disorder-7. GAD-7. And that’s widely available in the public domain on the Internet.And if you have a suspicion of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist because this, can be very effective and the therapist would be prepared to tell you, “I think you need medication in addition to therapy.”.
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Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes

 CEUs are available for this presentation at AllCEUs.com/CBT-CEU Hi everybody and welcome to today’s presentation on cognitive behavioral therapy skills. Like the other The presentation we did on assert not assertive community treatment acceptance and commitment therapy, which is also based on providing information about skills that can be used not providing an evidence-based practice We couldn’t cover that in a full hour or 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 as 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 onto your hand like please don’t let go Atlanta Airport is 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 either anxiety or anger or whatever that goes with it it may serve to exhaust the person and leave them feeling 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 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 well the other one’s going to go well if you’re Having 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 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 are muscles they’re using they haven’t been 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 about something in the negative realm then we Talk about how things seemed 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 and tired and make it seem like it’s a whole lot harder to deal with life as a person who perceives the world generally good and believe they can 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 with 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 that has Have you ever had a hamster hamsters doesn’t recognize you and goes 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 hearts 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 we 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 yadda 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 your thoughts and your feelings and you know you can pick wherever you want to start it doesn’t matter because all three interfaces 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 the 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 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 as 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 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 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 see your faces I 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 I don’t like the term rational but when We’re talking about CBT irrationally comes up a lot I like to replace it with helpful because every behavior in its 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 impact how you perceive a situation or how you react in a situation, especially the intoxication whereas in your intoxicated State in your sober state, you may think that you want to do something but then you’ve got that filter that does 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 out is 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 thing about watching 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 the 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 Maybe trying to escape the 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 are 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 necessary 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 to be accepted you have to do this you have to do that but do you do you do 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 as a different way or do I define success differently and lack supportive peers to buffer stress so we had those peers who caused stress by talking about the half dues and categorizing and lots of attributions but then there’s Also 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 to be loved 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 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 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 is 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 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 young people 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 form 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 experience 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 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 the 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 is helpful to getting me toward where I want to be Most of us don’t 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 to 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 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 general emotional cognitive harm is making them miserable we need to look at 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 with an emphasis on the harness and 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 resistant so helpful or unhelpful and then we talk about why it is unhelpful in 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 am I having that are contributing to these dysphoric feelings CBT helps people become aware of how thoughts can influence feelings in ways that are sometimes not helpful We have hecklers in our gallery the automatic tapes that we plaything memories that we have whatever you want to call them when you try something When you are just going through daily life you hear these voices in the back of your head and not real voices but that is 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 going to 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 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 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 and 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 found that 80% of drivers have reported incidences of road rage which is a 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 does any good Did it Did 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 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 knowing what to expect when I walk in and 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 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 thinks 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 and think pretty clinically about different events but if we’re in crisis when someone is in crisis it could be like what we think of clinically as a 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 we need 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 my guess is most of us have times in our lives when 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 and 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 is helpful It stands for feedback about the reality of what’s going on is everybody 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 makes people want to fight or flee when they get upset and we use upset as a 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 don’t I don’t even have the energy to do it anymore behaviorally some people withdraw because they Shut down We all know people get frustrated when they get overwhelmed When they start feeling hopeless or helpless they just kind of withdraw from Everything and everyone’s 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 in 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 torn up from the stress they can’t even think about holding anything down physical stress-related illnesses fibromyalgia gastrointestinal problems headaches neck aches backaches you know the whole the 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 thatch closer to kind of just kind of being overwhelmed as you do You 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 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 learn to 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 are terrified what is the evidence that you are in some sort of danger Right now you know that danger may not be the right word for your client at that a 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 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 in the past, we wanted people to 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 them They 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 onto it and going I wonder what I feel sad about I must feel sad about all these sad things now I’m going to be 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 tolerate them because feelings are there for a reason they’re there to tell you your brain thinks something’s going now thankfully we have that higher-order cognition stuff going on so We can contradict our 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 say 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 optimistic would say so asking them what’s the benefit to focusing on the negative in what ways is this helpful to 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 challenges 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 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 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 always not being not a real doctor because a Ph.D. is not an MD and I’m like really So is it somebody else’s standards or can I feel good about having a Ph.D. 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 what you interpret as not the nicest thing and this happens in text messages a lot and they get upset now an egocentric thinking error would say that purse is just grumpy today Someone who’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 another you know obvious 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 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 some alternate explanations for this event that are doesn’t involve me you know why this might have happened 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 been about you now think about the last 10 times you’ve taken something personally how many of Those 10 times has it 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 the facts ah the most obvious One that we talk about is plane crashes You know it is very dangerous to fly on a plane because you hear about all those plane crashes well yeah you hear about the airlines crashes but don’t hear about the 20,000 every day 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 a 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 look objectively at the facts magnifying high and low probability outcomes what are the chances that this is going to happen how Many clients have worked with have gone to the doctor and gotten into a physical or get 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 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 going to 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 happens and 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 to 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 a pet of mine you know labeling yourself is 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 the skills I can change skills stable I am and I always will be versus it’s something I can change it’s something I can learn internally 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’s irrational thoughts how do these thoughts impact the client’s 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 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 may be 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 to feel good about yourself how can you do that Besides 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 dramatic to say all people and for them to be content 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 challenge this one this is all you know Also very personally I would challenge people to look at and say it so your child’s value as an individual depends on what other people think of 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 to 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 the area that they have to be perfect I am in total control of 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 Do they think if they’ve got everybody on marionette strings 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 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 look at what these beliefs are saying important thoughts impact behaviors and emotional and Physical reactions emotional and physical reactions impact thoughts and interpretations of events so if you do something 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 are a lot fewer cognitive distortions or general ways of thinking about the world then there are thinking errors because There are 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 of the hecklers you know the automatic tapes that maintain our unhappiness the person can choose whether to accept those thoughts or change them.As found on YouTubeNatural Synergy $47.⁰⁰ 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Addressing Negative Thoughts | Cognitive Behavioral Therapy with Dawn Elise Snipes

 CEUs are available at AllCEUs.com/CBT-CEU This episode was pre-recorded as part of a live continuing education webinar. On demand CEUs are still available for this presentation through ALLCEUs. ALLCEUs.com/CBT-CEU I’d like to welcome everybody today to cognitive behavioral therapy addressing negative thoughts. Now a lot of us took courses and cognitive behavioral therapy we’ve worked with CBP for many many years so some of the this is just going to be a refresher and others you know you may pick up a few new tips or tools as we go along so we’re going to define cognitive behavioral therapy and its basic principles just get a really basic refresher on what was that original CDP about well identify factors impacting people’s choices behaviors because you know they always have a choice we’ll explore causes and the impact of thinking errors whether you call them cognitive distortions irrational thoughts or when I work with my clients I try to call them unhelpful beliefs or unhelpful thoughts because distortions and irrational seems sort of pejorative to me so I try to avoid those words as much as possible and help clients see them as not incorrect necessarily but unhelpful and then we’ll identify some common thinking errors and their relationship to cognitive distortions and some of our just very basic fears why do we care well because cognitive distortions or irrational thoughts or unhelpful thoughts whatever you want to say really impacts people on a physical level a mental level and an emotional level a person who perceives the world is hostile unsafe and unpredictable will tend to be more hyper vigilant until they exhaust the stress response system so think about you know a bottle ship and you’ve got a bunch of new people on this battleship and all the sailors every time there’s the least little thing they send off the all-hands-on-deck so a big bird flies over and I mean literally a bird and they freak out found me all hands on deck and this goes on for a week or two or six months you know let’s think about our clients they don’t usually come in right away where everything is set to OFF that startle response everything sets off that fight-or-flight response the staff starts to get exhausted all the rest of the sailors that have to drop everything and run to their battle stations after a little while they’re like really no no we just we can’t even do this and it also reminds me of the boy who cried wolf anyhow I digress sticking with the battleship metaphor so eventually the captain says you know what let’s retrain on what is worth setting off the all hands on deck because everybody here is exhausted and nobody’s even really responding anymore when they come to their battle stations they’re just kind of dragging their butts in like whatever it’s probably another false alarm the same sort of thing is true with us when we’re on on high alert for too long our brain says you know what we got to conserve some energy in case some really really big threat comes along so it turns down what I call the stress response system it turns down the sensitivity so you don’t get alerted for every little thing that would cause you stress but you also don’t get alerted for those little things that would cause you happiness either anything that would cause the excitatory neurotransmitters to be secreted you’re just not getting those anymore which a lot of people kind of refer to as depression it’s just kind of like the F whatever and only the biggest most notable things actually cause an emotional effect we don’t want people to get to that point that’s no way to live so we need to help them learn how to sort of retrain their spotters to figure out what is actually stressful a person who perceives the world is generally good and believe they have the ability to deal with challenges as they arise will be able to allow their stress response system to function normally there are going to be times you have all hands on deck whether it’s a real emergency or whether it’s just a drill but it will happen and they can go they can you know do what they’re going to do they have that adrenaline rush they have the energy and the focus to do their jobs and when it’s over they go back to their quarters they can relax refresh you know just kind of chill for a while and then there’s a low where their body rebalances before the next one and this is kind of what we want in life I mean ideally we wouldn’t have super high peaks very often but we want to make sure we give our body time to rebalance after there’s a stressor and not have to stand on on edge not be hyper vigilant constantly just waiting for the next one to come along so what is the impact of these thinking errors well whenever we have that stress response system activated the body is saying we either need to fight or we need to flee so you’re dumping all kinds of adrenaline and other neuro chemicals so there’s anxiety there can be stress when people start having this reaction you know they start having muscle tension sweating heart rate increases breathing increases people will call that anxiety some will label that as anger either way they’re both sides of the same coin they need to do something but if it lasts too long then we start moving into depression and they just they don’t have to get up and go anymore there’s just not any excitatory neurotransmitters really left they need some time to rest and rebalance behaviorally think about it if you go somewhere and you are just constantly on guard are you going to keep going there or are you going to withdraw so people who have a lot of thinking errors unhelpful thoughts tend to withdraw more they may turn to addictions to kind of numb or blunt some of the inputs sleep problems and changes when you are hyper vigilant when you have this stress response going even if it’s not a full-bore if it’s still there somewhat if you’re stressed out you’re not going to sleep as well you’re going to maintain higher levels of cortisol so you’re not going to get that restful rejuvenating sleep you may kind of goes on and off eating changes you know depending on the person some people eat the self food that some people can’t eat it all but we do see that the hormones Guerlain and lets them get all out of whack not under stress but also when sleep gets out of whack when your circadian rhythms get out of whack so we’re starting to see the Cascade effect where it’s emotional and behavioral physical you’ve got stress-related illnesses that start coming up if you’re on that lunch you’ve got muscle tension for that long it starts to hurt I mean you start to get migraines your back starts to hurt wherever you store your stress so to speak it starts to come out and most people when they’re under a lot of stress for an extended period you know a day is not a big deal for most people but for an extended period become more susceptible to illnesses they start getting sick easier headaches GI distress you know some people store their stress right in their gut socially think about the last time you were stressed were you patient and tolerant and just a pleasure to be around you may have tried to be but you’re more prone to irritability and impatience and again wanting to withdraw all of these affects contribute to fatigue and a sense of hopelessness and helplessness which often intensifies thinking errors so you’ll see this negative reciprocal interaction if somebody feels stressed out and overwhelmed and that they withdrawal then they may start feeling like they have no support and they don’t and they lose all their social buffers to the stress so they feel even more stressed so they want to withdrawal even more so we’re going to talk about how to prevent that now I like this little diagram maybe because it’s got a heart in the center I don’t know but behavior feelings and thoughts this is the outside of the circle all three of these impact diecuts each other when you do something it often impacts your feelings and your thoughts about a situation when you when you’re thinking if you think positively you’re probably going to choose more positive behaviors and more have more positive feelings you’re thinking negatively obviously you may choose more of an escape behavior Protection behavior and may have more feelings of anger anxiety depression etc so these things are going on and they’re all interacting the one really cool thing is if you break this chain somewhere or this circuit then you can stop that reciprocal negative downward spiral so cognitive behavioral helps people who are willing to show up or who are willing to address their thoughts not everybody is willing to start addressing their thoughts right away maybe they want to start addressing their sleep problems in their eating problems or something that’s more physical okay that’s fine because anywhere we interrupt this circuit is going to have positive effects assuming the intervention is positive it’s going to have positive effects on the other ones so what about the triangle well yourself so you’re feeling thoughts and behavior impact you it impacts how you feel and you’re like well yeah okay just stay with me but the way you feel think and act impacts your future and it also impacts how you interact with others so you know that kind of affects things because remember social support is a big buffer for us now core beliefs and you can do this inward to outward or outward to inward but either way it comes down to core beliefs if you have positive thoughts and positive feelings and you generally engage in positive behaviors to keep that cycle going you will probably feel pretty good about yourself have good relationships have a somewhat optimistic feeling about the future and your core beliefs may be more like people are generally good I can do this you know very self affirming and other affirming positive core beliefs about yourself in the world now if your thoughts or feelings are negative then you have this negative outer circle you don’t feel so good you start questioning the goodness and Trust ability and dependable of other people you have more of a bleak look in the future so what do you think is going to happen to the core beliefs the core beliefs may change too if someone doesn’t love me I am completely unloveable they may change to being more extreme more negative and more difficult to rectify if you want to have somebody who’s happy I mean you’re not going to have somebody who’s happy who thinks the world is an unkind unpredictable scary place going it’s just wonderful roses today so we have to help people try to adjust eventually start adjusting those core beliefs and when we get into causing that behavior remember the ABCs your automatic but well your automatic thought then your and beliefs are what happened as soon as that event occurs and those you don’t think about that’s why they’re called automatic so when you have the ABCs these core beliefs are those things that pop up that we need to address so what factors affect this and whoops you know there’s a lot of stuff right here and EBP they call them vulnerabilities you know we’re just going to talk about in general different factors that affect the choices our clients make in terms of behaviors so negative emotions if they are not if they’re feeling angry if they’re feeling anxious they’re feeling depressed they’re probably not going to be really motivated to get up and engage in a whole lot of self affirming activities they’re not probably not going to be having a lot of positive self affirming thoughts they’re going to be focused on whatever is causing that distress and maybe escaping from that physically pain and illness when you don’t feel well it’s harder to be Susie sunshine I don’t think many of us are just a barrel of monkeys when we don’t feel well so if our clients have pain this is one of those if you want to put it in behaviors behavioral areas physical areas we can address and have them go see their physician have them go see their physical therapist and get recommendations so they aren’t feeling physically painful physically and distress all the time because physical distress and emotional distress both mess with sleep unfortunately sleep is the first thing to usually go and I’m not talking about quantity I know a lot of clients who when they get depressed they’re in in bed for you know days they’ll get up they’ll maybe shower and you know go back to bed and they’re sleeping a lot but it doesn’t mean it’s quality sleep so what we need to look at is what is the quality of their sleep are they getting that rejuvenation the time for their brain and neural chemicals to rebalance so they can feel happy so they can have that nice balance of all the the neurotransmitters they need to feel happy poor nutrition well no matter how much sleep they get if they don’t have the building blocks to make the neurotransmitters and the hormones that are needed to prompt the feelings the physiological sensations that we’ve labeled happiness or excitement or you know even depression and anxiety those are all caused by different neurotransmitters being secreted in different combinations if your body doesn’t have the building blocks to make those then it doesn’t matter how much sleep you get you’re not going to get any benefit from it an intoxication and this can be uppers downers anything that is psychoactive if you are messing with that neurotransmitter balance you’re going to get it out of whack and you may either use up too much of the excitatory or cause us a lot of it or you may use up too much of the depressant either way there’s usually a rebound effect which we call withdrawal so you’re not going to be in a good space either during the intoxication sometimes but definitely when you’re sobering up there’s a period where there’s going to be negative emotions negative feelings environmentally yeah your environment can even make you grumpy introduction of a new or unique situation some people love new challenges love going to new places other people not so much depending on the person taking on going somewhere new may be really stressful for them so if they’ve already got de-stress going on because of having to go to this new situation then their thoughts may be a little bit more on the anxious side about a lot of things and they may have less patience and tolerance to deal with other stuff that comes their way because they’re already kind of on edge and exposure to unpress you know going places that you just really don’t want to go maybe and one of the places I used to work we had this meeting once a month and it was literally an eight-hour meeting and we would all sit in there for eight hours and one person at a time would get up and give their staff reports or whatever but it tended to be a relatively dreadful sort of environment or eight hours and we all knew we had to be there and that was fine but it was an unprecedented were grumbling on the way in they were getting their coffee and going well I better do this because I’m not getting out for another eight hours we need to help our clients obsess what is it in your environment if anything that is making you already feel grumpy or not as happy and likewise what can you put in your environment to make you feel happier you know I keep pictures of my kids and my animals on my phone that way if I’m having a moment or not sometimes I just like looking at them I can take a look at it it makes me smile and I’m like okay life is good you know this moment may not be so wonderful but it’s just this moment then we move on to stress of a social nature peers or family who convey irrational thoughts as necessary standards for social acceptance nobody wants to associate with those people or nobody’s going to like you when you’re like this or you read if you really want to be successful then you need to change fill in the blank it’s always a something needs to change you are not okay for who you are how you are and a lack of supportive peers to buffer stress because we all have negative people in our life it happens but if you have negative supportive peers that you can call afterwards and go yeah I had just had to meet with someone so for an hour and it was just dreadful and that person can go well I’m sorry or be there make you laugh or whatever they do it helps buffer the stress if you don’t have those positive social supports then you’re left walking out of it you’re kind of feeling shell-shocked and then you also at the same time have to figure out for yourself all right what do I do next now it doesn’t mean you can’t do it you know people do it all the time but it is good it is awesome to have supportive peers to buffer your stress so when cognitive therapy clients learn to distinguish between thoughts and feelings realizing that thoughts will trigger feelings but they don’t have to cause continual feelings and behaviors and feelings can cause certain thoughts but they don’t have to you can unhook from them and you can just say this is how I’m feeling right now now where am I going to go from here and we talked about that on Tuesday with unhooking from unhooking from your thoughts and stepping back and going what is the next logical action to get me to where I want to go become aware of the ways in which the thoughts can influence feelings in ways that are sometimes not helpful being critical being jealous envious maybe you just don’t like somebody and you know there’s a whole lot of reasons for that but you don’t like everybody most people don’t like everyone and so it’s you know that’s okay but recognize how that affects your interactions with that person and your thoughts about that person learn how thoughts that seem to occur automatically affect emotions so recognize start getting down to what are these core beliefs that happen every time it’s a negative incident that make me feel angry or anxious constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased 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 to the person so again back kind of to that ACP sort of thing is this a good use of your energy to help you achieve your goals and be the person you want to be and develop the skills to notice interrupt and correct these biased thoughts independently like I said you don’t always have to call somebody you can do it on your own but sometimes it’s nice to have that buffer in that middle moment so what causes these thinking errors how can we even start helping people address their thoughts and until we start thinking about well what caused them information processing shortcuts as we grow up we learn things you know when you were knee-high to a grasshopper you didn’t have a lot of experience so you learned things but things you learned when you were a kid unfortunately because you were cognitively a child are either our dichotomies they’re all or nothing it’s either this way or no way at all so things that you have things that you learn back when you were a child may not have been challenged if you heard something from your parent maybe your parents said you’re a bad girl or you’re a bad boy it’s all or nothing well I am a bad girl so I guess that means I’m not okay and if I’m not okay right now I’m never okay that can stick with a person so these outdated amis schemas can really trip somebody up once the person gets into you know middle schoolish the thoughts aren’t nearly as dichotomous there’s a lot more formal operational thought if you will but up until then I mean you’ve got a child who’s experiencing a lot of stuff and taking in like a sponge everything they hear and it gets sorted into a yes or a No pile there’s there’s no kind of middle pile that there’s no yes and so what we want to do is help people look at those thoughts now and say okay if they’re all or nothing is there a way to find both and so for example we’ll take that exam scenario I gave you earlier if a child hears you’re a bad girl when they’re young they take that to mean always everything about me is bad I’m unlovable so what is the both and compromise as an adult we can look back and go you know I’m a good person I may not make may make poor choices sometimes I may make bad choices but I’m a good person so there’s that both and you know I’m not perfect but I’m good so that it’s not all or nothing and I encourage my clients to really always look for that middle ground how can it be both or does it have to even be that negative one but most of the time there’s a little bit of something on both sides the brain’s limited information processing capacity and limited responses when children are young you know they hear something you know mom comes in and says you’re a bad girl and child hears I’m totally unlovable and it just crushes the child they don’t have experiences to go moms having a bad day she kind of tends to say things she doesn’t mean when she’s having a bad day it’s just it’s devastating to that child when you’re older if somebody says something that’s not necessarily tactful you know you can look at it and go yeah that really wasn’t nice but that person probably did not intend to be hurtful they may have something else going on children have fewer experiences so what was devastating or overwhelming as a child may not still have have to feel that way when you’re a child if your best friend moved away oh that was devastating it was the end of the world now as an adult you can go visit them you can call them and with the internet and everything you can email them you can still stay in touch so there are ways to do it yeah you can’t go out and swing swing on swings together all the time but it doesn’t have to mean the end of the end of time things will change and there’s a little process of grieving that has to go along with that but to an adult a friend moving away is less devastating than say to a six-year-old your parent being angry with you if you grew up in an alcoholic or addicted household you learn don’t talk don’t trust don’t feel when the parent came in if the parent was angry with you you could have been in a lot of hurt you know there could have been some actual danger to your physical or emotional person so it was scary as a 26 year old or however old your client is is it that threatening you know if your parent gets angry with you you don’t depend on them for food and shelter anymore you don’t have to be an inner household if they were violent towards you so is it as terrifying when your parent gets angry yes there’s lots of issues with wanting acceptance from your parents that’s over here there’s a whole nother issue but when your parent is angry do you have to have that person’s approval when we’re in crisis we don’t process much when you’re in crisis your body is worried about surviving if you’ve been in a car wreck if somebody has gone to the hospital whatever the case is you’re not processing all of the data in order to make it in for decision you’re processing what’s right in front of you because when we’re in crisis we generally have tunnel vision and really crappy memory so if something happened when someone was in crisis that hurt their feelings made them angry you know fill in the blank some sort of dysphoric emotion we want to say well let’s look back at that and see if there’s a pose and let’s look back at that and see if there was something that you missed that might help you understand why this person reacted that way but understanding that in crisis we just generally don’t make the most informed decisions so emotional reasoning helping clients understand that feeling or not facts and helping them learn to identify feelings and separate them from facts so if they say I’m terrified all right so you’re terrified got that about what are you terrified you know tell me what are these things that make you feel like the world is such a scary place and let’s list them on the whiteboard or a flip chart what is the evidence that those are present dangers right now that they’re actually impending threats so tell me about what the evidence is in what ways is this similar to other situations where you felt terrified and how did you deal with those situations I have a friend who actually went this morning on an airplane flight and she hates flying totally terrified of it so what is the evidence that this plane is going to crash you know what is the evidence that it is likely that this plane will crash and there really she’s flying on an american-based commercial airliner there really isn’t any when you look at the proportions so okay there’s there have been a couple of crashes over the past 20 years and in a couple of those there were some fatalities no doubt but looking at the proportions and running the numbers what’s the likelihood in what ways this is similar to other situations that you have felt terrified you know maybe there haven’t been any other situations where she’s flown and gotten through it and been like score I did that but what other situations have you had to get through that you were terrified and how did you deal with those help people develop distress tolerance skills one of the things I told her was when you’re sitting on the airplane and you know the airplane starts up don’t wait til you start getting really stressed necessarily but when we were little on the car when we’re in the car we used to find things on the drive find something that starts with a and everybody would find something that started with a and then find something that starts with B and you know so on and if you couldn’t find something that started with that letter you were out so I mean she’s going on this trip with her kids and I’m like why don’t you try doing that because there are some letters that you’re going to have to work really hard and it’s kind of like the game apples to apples you end up finding something really inane in order to get that letter and you laugh and you’re so busy focusing on that you’re not focusing on all of the things that could possibly maybe go wrong other distress tolerance skills you know you can go through the whole DBT curriculum and learn some of those the biggest thing is if you have to face the terror if you have to go through it figure out a way to not have to focus on it and fight it and go I shouldn’t be afraid I shouldn’t be because that doesn’t work if it worked we wouldn’t be talking about it and develop emotional regulation skills so prevent those vulnerabilities set yourself up so you are as prepared as you can to not feel stressed to not feel anxious she has her spouse with her who can help diffuse some of it she’s got her kids with her she downloaded some movies she’s prepared to endure the distress she’s you know trying to go into it with a positive mindset as much as possible and focusing on the destination which you know is ultimately the reason she’s getting on the plane social causes of stress and thinking errors everybody’s doing it well that’s not true there’s very real that everybody does so correcting misinformation how the client gather objective information about you know if they say well everybody else that I know has succeeded okay well let’s gather objective information about that who do you know and tell me if they’ve succeeded if I want to be liked I must do it this need for approval or low self-esteem can cause a lot of problems in thinking errors and fears of rejection so we say okay let’s look at developing some self-esteem so you don’t need to worry about if somebody likes you what would it be like if you woke up in the morning and you didn’t care if so-and-so liked you I mean we all want to have friends don’t get me wrong I’m not saying you want to be her moving out in the woods but if we’re talking about a particular so-and-so what would it be like in the morning to get up and go you know what if that person messages me today or call us me today that’s great and if not I’m okay with that how liberating would that be to get your power back and how people develop social supports that share their same values and goals at least mostly or at least can respect yours so for example when you know I work with people with co-occurring disorders and they don’t drink and they don’t use drugs so they may be around people family friends who drink if you’re going to be in that situation do you have to drink and can you be around do you have social supports that can be supportive of your choice to not drink doesn’t necessarily mean they’re it’s not going to not going to not drink in front of you but at least they’re not trying to get you to drink so the social causes of irrational thoughts if I want to be liked I must do this why can’t you be like for who you are cognitive bias negativity mental filter focus on the negatives and worry about the future most of us know some people like that most of us have had a moment where we felt like this we’ve just gotten ourselves in a tizzy and spun out of control but you can bring it back so you want to ask yourself or have your clients ask themselves what’s the benefit to focusing on the negative if you know that this is going to go south really fast what’s the benefit to just focusing on that could you focus on alternatives or Plan B’s what are the positives to the situation most people who have mood issues who present to us in counseling don’t focus on both sides yes every side you know has a little bit of negative to it if you really want to look hard enough but every side also has a silver lining if you really want to look hard enough so we need to balance the the positives and the negatives so encourage people to look for the positives in the situation yeah this really sucked but and what are all the facts what are all the things going into it sometimes people will go to work and not know or wonder if they’re going to get laid off because you know you’re not necessarily always guaranteed a job anywhere there can be layoffs but if somebody is going to work every day worried about this focusing on the negative up yep I’m definitely going to be the one that’s going to get the pink slip and they go to their mailbox each time looking for that pink slip expecting it to be there how is that going to affect their mood as opposed to alright there may be layoffs coming what can I do to make myself really valuable or and what are my options if I do get laid off let’s make a plan B and C so I don’t just feel like the rug was pulled out from under me coin toss activity if somebody tends to be stuck in negativity have them flip a coin every morning if it lands on heads they can just see their normal selves to their heart’s content if it lands on tails they need to act as if they are a happy positive optimistic maybe even a noxious ly optimistic person for the entire day you know we want them to be farting rainbows and when I say that they usually look at me and laugh and but that’s okay I’m like every time you start having a negative thought I want you to see a unicorn farting rainbows and take it from there and then have them process how they felt at the end of the day if they weren’t constantly focused on negativity and worrying and only seeing the bad stuff disqualifying or minimizing the positive if something happens when somebody says well I just got that promotion because they didn’t have anybody else to give it to okay if your best friend just got a promotion would you say that to them what is scary about accepting the positive about accepting the fact that maybe you got the promotion because you’re awesome sometimes we disqualify the positive because it fails to meet someone else’s standards so might that be true here you know maybe you got this promotion and you’re actually down deep down inside kind of proud of it but you know that your mother had always wanted you to be this over here and you’re never going to meet that expectation so you minimize it that way nobody else could say well you know better than nothing and take away your thunder egocentrism my perspective is the only perspective take different perspectives I always say three if something happens and you know maybe somebody was rude to you anyone they were rude to me okay they were rude to you what are three reasons what are some alternate perspectives why that person might have been rude maybe what you did something that triggers them maybe they were having a bad day and it’s got nothing at all to do with you you know there are options that we can look at personalization and mind-reading what are some alternate explanations for the event that didn’t involve you if you think well that person that person just really doesn’t like me and you know I’ve got to work with them every day and they hate me my question to my client would be what what’s the evidence for that and what are some alternative explanations for why that person may be behaving that way I had a staff member that a lot of my other staff members had difficulty getting along with and ultimately you know we had to sit down and look when I had some different staff meetings with people and say you know what gives you the idea that she doesn’t like you what gives you the idea that it’s about you and you know they cited all kinds of behaviors and I had to come back to well what are some alternate reasons why somebody anybody not just her might be expressing those behaviors could it be something besides you and of course they came back – yeah availability heuristic remembering what’s prominent in your mind if somebody was if you’re a supervisor for example and you’re doing evaluation for the year what are you really remembering when you’re doing that evaluation the whole year or the last three months and that’s the event fail ability heuristic so when you’re talking to somebody about their relationship with their best friend or their spouse or their kids and if somebody says well that that child has always been a problem okay let’s look at that you know the child is 18 and you’ve had a lot of problems with him lately but what about three years ago so was he always a problem or is this something that’s relatively new that something might have changed magnification people getting stuck on fearing the absolute worst so you want to ask them is this a high probability or low probability outcome if they’re magnifying something that happened like oh my gosh that is the worst thing in the world is this going to matter six months from now maybe you totaled your car and yeah that is a huge bummer and you’re safe in six months is this really going to matter that much you know there are going to be some bills and everything but the big scheme of things is at the end of the world what have you done in the past to tolerate events like these when something really really unpleasant has happened and then if they’re looking at dichotomous ways of thinking which a lot of our clients still do they’re like someone so it always does this or never does this have them look at the differences between love versus hate perfection versus failure and all good intentions versus all bad intentions because a lot of our dichotomies fall in one of these three categories this person always does this or Never or does it intentionally or you know just doesn’t care belief in a just world the fallacy of fairness encourage people to look for for good people they know that have had bad things happen attributional bearers are labeling yourself not a behavior such as saying I am stupid instead of I don’t have good math skills I am is difficult to get rid of I can’t get rid of stupidity if it’s part of me but if it’s a thought or a skill I can either get rid of it or improve it stable I am means I am right now and I probably always will be stupid verses I can change this thought or skill I can learn math and internal attributions mean it’s about me as a person versus about a skill or skill deficit or something completely unrelated so when somebody makes a global internal negative statement we want to help them challenge that global internal positive statements I’m all about but the negative ones I want to say let’s take a look at that is that true that this is about you all of the time and it means that there’s something wrong with you so we want to ask them how are these thoughts how are these ways of thinking impacting your emotions health relationships and perceptions of the world we want to increase motivation to start looking at these spanking errors because it’s a lot of work to start changing the way you automatically think because you’ve got to stop you’ve got to become mindful and then you’ve got to decide well what are the alternative thoughts because this is what I thought for so long how may have this thought has been helpful in the past most of the time thoughts we have came from somewhere and whether it was a thought we had when we were a child something we learned when we were a child that is dichotomous and not quite applicable anymore it may have been helpful in the past to help you navigate situations doesn’t mean it was wrong it means it’s not helpful in the present asking them to always ask themselves is this thought or feeling bringing you the client closer to those people and things that are important to you it’s hanging on to this negativity bringing you closer and and I like the energy philosophy if you will when you are unhappy you are letting this person have your power you are letting this person make you angry when you decide you are not going to give them your power then you may start feeling happier and I don’t always use that with clients but sometimes the power metaphor help when we talk about thinking Ayers asked them are there examples of this not being true and and or how can a statement be made less global stable and internal is it about you or is it about what you do at work is it about you or is it about your relationship with this particular person so the last couple of slides focusing on some of the irrational thoughts or unhelpful beliefs our basic fears are rejection and isolation failure loss of control the unknown and death generally the things that cause people to have this fight-or-flight reaction fall into one of those categories so some of the unhelpful beliefs that we hear a lot coming up when we do the ABCs is that mistakes are never acceptable so if I make one I am incompetent so we’ve got dichotomous thinking and we’ve got a lot of internal global labeling here rejection and isolation when somebody disagrees with me it’s a personal attack against me well sometimes it is what does that mean it’s about you we’re helping them address the rejection and isolation fears we want to ask them you know if they disagree with you were they attacking you and saying you were stupid or were they attack attacking you want to use that word or were they attacking the thought and saying they disagreed with the thought there’s a little bit of a difference it’s somewhat semantics but it’s a difference because they may have a lot of respect for you but they may disagree with what you just said if someone criticizes or rejects me there must be something wrong with me again that’s one of those internal global negative statements to feel good about myself others must approve of me we want to make sure our clients can self validate and they don’t rely on external validation because they’re setting themselves up for a world of hurt if they are not their own best friend to be content in life I must be liked by all people and thanks for a second are you liked by everybody I know I’m not liked by everybody so does that mean that I should not be content in life and what does it say to give people that power to say if you don’t like me that I can’t be content because I’ve got to be liked by everybody sometimes with clients I’ll help them look at what may be going on with the other person why that person might like them because a lot of times other people’s reactions towards you are more about their stuff than about you and helping them see how that might be true my true value as an individual depends on what others think of me so these other unhelpful beliefs pertain to those thoughts of failure and loss of control none of us likes to fail don’t get me wrong it’s not pleasant but it happens and there is a saying out there that says if you haven’t failed you haven’t tried which means we need to get beyond our safety envelope we need to push ourselves behind beyond our boundaries and when we do sometimes we’re going to stumble and fall and we pick ourselves up and we learn from it but to expect to never fail at anything is not realistic so nothing ever turns out the way you want it to how many times have you heard that from your clients I won’t try anything new unless I know I’ll be good at it I’m in total control and anything bad that happens is my fault so let’s look at this locus let’s control thing here you’re in total control so you can make it rain you know it was unpleasant today because I had to come to work and it was raining outside so that was bad it happened was it your fault pointing out and depending on your relationship for your client you’re probably going to be more or less snarky when you present some of these but a lot of times I have a semi joking relationship if you will with my clients and they’re like yeah I see your point that kind of didn’t make a lot of since other times you know if they’re more serious I’ll ask them to identify things that happened that were bad that they had nothing to do with if I feel happy about life something will go wrong or I’m always waiting for the other shoe to drop helping people stay focused in the moment with mindfulness and something’s going to go wrong down the road somewhere sometimes yeah it’s true this will happen let’s enjoy what we’ve got for right now the past always repeats itself it was if it was true then it’s true now so what was true when you were ten is true now that you’re forty always is that true it’s not my fault my life didn’t go the way I wanted everybody conspired against me and there’s no gray area so for people who feel the need to hold on to control its dichotomous it is or it isn’t it’s got to be that way there’s no gray area and it can make life be seem very uncomfortable because they’ve got to put things in one of two buckets and sometimes things don’t fit nicely in buckets what happens if we add a third bucket that both an bucket so a quick note about irrationality the origins of most beliefs were rational and helpful given the information the person had at the time and their ability to process that information because of their cognitive development so things that we identify as unhelpful or automatic beliefs now came from somewhere and they made perfect sense whenever they were formed they may not be healthy or helpful now which is why we want to look at them and either adjust them or just throw them out the door but when they were formed they were on point irrationality or unhelpful nasaw thoughts comes when those beliefs are perpetuated without examination so again we need to look at them continually look at what you’re telling yourself and go is this still accurate and continue to be held despite causing harm to the person sometimes you’re going to look at a thought an automatic thought and you’re going to go yeah that is still spot-on now is holding on to this helping me achieve my goals you know yet the world right now is kind of a scary place is holding on to this fear and terror helping me and be a happy productive yada-yada whatever kind of person you want to be or is it causing me to feel anxious and angry and scared sometimes it’s more productive for clients to think of thoughts as unhelpful instead of irrational because like I said I feel like irrationality and distortions seem very pejorative to a lot of clients so questions clients can ask themselves when they are faced with a situation what are the facts for and against this belief is this belief based on facts or feelings just because you feel scared is it a scary situation does the belief focus on just one aspect or the whole situation does the belief seem to use any of those thinking errors we talked about and if so you know what do I need to do about it what are some alternate explanations for this belief what else could have caused this to happen besides whatever I’m afraid of what would you tell your child or your best friend if they had this belief what would you took what would you want someone to tell you about this belief you could have somebody tell you something that would make you feel okay what would you want them to tell you and how is this belief moving you toward what and who is important to you remembering that beliefs are a combination of thought and fact and personal interpretation of those thoughts and facts I tend to when I talk you know you see me I kind of I’m all over the place with my arms I am a animated talker now if you are seeing me from a hundred feet away and you are seeing me talk might think I was angry because I make a lot of really big gestures because if you had grown up in a situation where there was domestic violence or something but if you had grown up in a household like I did where you had a first generation Italian first generations of ten Italian Americans talk big they talk real big with lots of gestures and sometimes loud and that doesn’t necessarily mean any anger a lot of times it’s just pure excitement so understanding that there’s thoughts in facts you know you see this going on but your personal interpretation can really affect what you get out of it or what you perceive that situation to be so we need to look at how is your personal interpretation maybe adding a negative bias and what what do we do about that it may be 100 percent accurate what do we do about it so it doesn’t keep you miserable thoughts impact behaviors and emotional and physical reactions emotional physical reactions impact thoughts and your interpretation of events irrational or unhelpful thinking patterns are often caused by cognitive distortions my two favorite words in that same sentence cognitive distortions are schemas or shortcut ideas or memories if you will which were formed based on faulty inaccurate or immature knowledge or understanding of the event you know little kids may not have quite understood what was going on they just understood that mommy and daddy were screaming identifying the thoughts the hecklers I call them those negative voices inside your head that are maintaining unhappiness helps people choose whether to accept the thoughts and say yeah you know that’s right I really am not good at that or whatever the negative thought is and change it or let the thought go are there any questions you you thank you miss Benson well thank you all if you come up with any questions you know you’re mulling it over later and you think you know that yet I’ve worked with a client and with something similar and I did this or you know you have a question about something I said feel free to email me the easiest one to remember is support at all CEUs com there’s only two others in the office so either my husband gets it err I do so it’ll get to me and I guess that’s it so I will see you all on Tuesday if you have any types of courses that you want to see added to the list please let me know I’m always interested in doing what you want to learn about not necessarily just where I pull out on my rabbit hat yes you can print the slides in the golly golly golly when you go into the class there’s a link that has a PDF of the slides that you can print if you want to print go ahead and print those out the video version of this will be up on YouTube by tomorrow morning maybe later this afternoon you okay everybody have an absolutely amazing rest of your day and weekend if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with dr. Schneider by subscribing at all CEUs calm / counselor toolbox this episode has been brought to you in part by all CEUs calm providing 24/7 multimedia continuing education and pre certification training to counselors therapists and nurses since 2006 use coupon code consular toolbox to get a 20% discount off your order this month.As found on YouTubeSeanCooper🗯 The Shyness & Social Guy ⇝ The 3 WORST Mistakes You Must AVOID If You Want To Overcome Shyness (PLUS: 1 weird trick that targets the root biological cause of shyness so you can stop being nervous, awkward, and quiet around people…) By Sean Cooper, The Shyness & Social Anxiety Guy. The fact that you’re reading this article tells me you may have already reached a point where you feel your shyness is NOT going away on its own… 732d01adf780998f105af3460737a431 or you fear it’s getting worse and worse. And I don’t want you to waste one more day living a life where you feel left out, bored, or depressed because you don’t have the relationships which would make you happy. That’s why I’ve put together this page to help you avoid the worst mistakes that keep many people stuck with shyness for years… often giving up hope of ever improving as you watch other people have interesting “normal” lives without you. Yet this doesn’t have to happen.

Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes

 CEUs are available for this presentation at AllCEUs.com/CBT-CEU Hi everybody and welcome to today’s presentation on cognitive behavioral therapy skills. Like the other the presentation we did on assert not assertive community treatment acceptance and commitment therapy, which is also based on just providing information about skills that can be used not providing an evidence-based practice we couldn’t cover that in a full hour or 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 the really scary same situation as 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 onto your hand like please don’t let go Atlanta Airport is 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 either anxiety or anger or whatever that goes with it it may serve to exhaust the person and leave them feeling 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 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 good if you’re having 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 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 are muscles they’re using they haven’t been 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 about 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 and tired and make it seem like it’s a whole lot harder to deal with life as a person who perceives the world generally good and believes they can 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 with 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 that has 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 hearts 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 we 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 the 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 the 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 detest public speaking it’s just terrifying for them to get up in front of a group of people so their thoughts am I going to trip up I 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 as 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 the adrenaline rush and you start sweating and you can’t focus and you can’t concentrate you 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 see your faces I 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 I don’t like the term rational but when we’re talking about CBT irrationally comes up a lot I like to replace it with helpful because every behavior in its 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 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 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 thing about watching 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 the 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 maybe trying to escape the same thing as exposure to UNPROFOR bellowing for a the word here but UNPROFOR ball is the best I could come up with we all prefer certain situations some people as 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 are 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 necessary 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 to be accepted you have to do this you have to do that but do you do 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 differently and lack 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 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 to be loved 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 is 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 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 young people 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 experience 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 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 is helpful to get me to where I want to be most of us don’t 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 to 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 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 general 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 in 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 am I having that are contributing to these dysphoric feelings CBT helps people become aware of how thoughts can influence feelings in ways that are sometimes not helpful we have hecklers in our gallery the automatic tapes that we plaything 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 not real voices but that is saying you’re never going to make this or if you would have just blah blah blah then you’d be a the 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 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 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 thoughts they may be telling themselves these things evaluate whether the current reactions are a helpful and 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 and 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 incidences of road rage which is a 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 does 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 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 knowing what to expect when I walk in and 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 thinks 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 and 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 a 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 we need 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 my guess is most of us have times in our life when 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 and 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 is helpful f stands for feedback about the reality of what’s going on is everybody 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 makes people want to fight or flee when they get upset and we use upset as a 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 don’t I don’t even have the energy to do it anymore behaviorally some people withdraw because they shut down we all know people who get frustrated when they get overwhelmed when they start feeling hopeless or helpless they just kind of withdraw from everything and everyone’s 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 in 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 torn up from the stress they can’t even think about holding anything down physical stress-related illnesses fibromyalgia gastrointestinal problems headaches neck aches backache you know the whole the 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 the bar brings you up a little bit so you’re that is 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 are 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 a 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 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 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 onto it and going I wonder what I feel sad about I must feel sad about all these sad things now I’m going to be 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 now thankfully we have that higher-order cognition stuff going on so we can contradict our 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 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 challenges 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 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 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 always be ever and always being not a real doctor because a Ph.D. is not an MD and I’m like really so is it somebody else’s standards or can I feel good about having a Ph.D. 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 in text messages 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 another way you know cuz 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 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 explanations for this event that doesn’t involve me you know why might this have happened 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 been about you now think about the last 10 times you’ve taken something personally how many of those 10 times has it 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 A few planes crash but you don’t hear about the 20,000 every day 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 a 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 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 gotten in a physical or get 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 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.

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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 having they do something that they’re proud of that wasn’t perfect or when again when has somebody else do something that they were proud of that wasn’t perfect remembering that with availability heuristic remembering how often something happens and 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 to identify for good people you know who’ve had bad things happen and in reality we all have bad things happen good people do bad people do in between people do attributional errors and this is a pet of mine you know labeling yourself is 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 the skills I can change skills stable I am and I always will be versus it’s something I can change it’s something I can learn internally 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 is salient for that client’s irrational thoughts about how to do these thoughts impact the client’s 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 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 may be 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 to feel good about yourself how can you do that besides 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 dramatic to say all people and 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 challenge this one this is all you know also, very personally internally I would challenge people to look at and say it so your child’s value as an individual depends on what other people think of he or 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 to 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 the area that they have to be perfect I am in total control of 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 are they think if they’ve got everybody on marionette strings 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 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 look at what these beliefs are saying important thoughts impact behaviors and emotional and physical reactions emotional and physical reactions impact thoughts and interpretations of events so if you do something 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 are a lot fewer cognitive distortions or general ways of thinking about the world then there are thinking errors because there are 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 of the hecklers you know the automatic tapes that are maintaining our unhappiness the person can choose whether to accept those thoughts or change them As found on YouTubeThe Destroy Depression ꆛ System-Cure Depression Naturally YOUR DEPRESSION HAS BEEN IN CONTROL LONG ENOUGH. 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Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes

 CEUs are available for this presentation at AllCEUs.com/CBT-CEU Hi everybody and welcome to today’s presentation on cognitive behavioral therapy skills. Like the other the presentation we did on assert not assertive community treatment acceptance and commitment therapy, which is also based on just providing information about skills that can be used not providing an evidence-based practice we couldn’t cover that in a full hour or 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 the really scary same situation as 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 onto your hand like please don’t let go Atlanta Airport is a perfect example if you’ve ever taken a little kid through Atlanta Airport gives you an idea about how people can perceive things differently and when you enact that fight-or-flight the reaction you’re going to have all those stress hormones you’re going to have all either anxiety or anger or whatever that goes with it it may serve to exhaust the person and leave them feeling 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 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 well the other one’s going to go well if you’re having 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 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 are 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 about 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 and tired and make it seem like it’s a whole lot harder to deal with life as a person who perceives the world generally good and believes they can 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 with 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 that has Have you ever had 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 hearts 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 we 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 ya ya 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 the 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 the 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 detest public speaking it’s just terrifying for them to get up in front of a group of people so their thoughts am I going to trip up I 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 as 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 the adrenaline rush and you start sweating and you can’t focus and you can’t concentrate you 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 see your faces I 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 I don’t like the term rational but when we’re talking about CBT irrationally comes up a lot I like to replace it with helpful because every behavior in its 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 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 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 thing about watching 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 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 maybe trying to escape the same thing as exposure to UNPROFOR bellowing for a the word here but UNPROFOR ball is the best I could come up with we all prefer certain situations some people as 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 are 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 necessary 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 the 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 to be accepted you have to do this you have to do that but 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 differently and lack 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 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 to be loved 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 is 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 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 young people 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 experience 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 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 an examination so something a the 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 is helpful to get me to where I want to be most of us don’t 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 to 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 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 general 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 the reaction’s like when you tell them they’re being resistant they’re like I am NOT being resistant so helpful or unhelpful and then we talk about why it is unhelpful in 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 am I having that are contributing to these dysphoric feelings CBT helps people become aware of how thoughts can influence feelings in ways that are sometimes not helpful we have hecklers in our gallery the automatic tapes that we plaything 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 not real voices but that is saying you’re never going to make this or if you would have just blah blah blah then you’d be a the 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 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 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 thoughts they may be telling themselves these things evaluate whether the current reactions are a helpful and 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 and 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 incidences of road rage which is a 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 does 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 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 knowing what to expect when I walk in and 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 thinks 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 and 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 a 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 we need 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 my guess is most of us have times in our life when 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 and 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 is helpful f stands for feedback about the reality of what’s going on is everybody 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 makes people want to fight or flee when they get upset and we use upset as a 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 don’t I don’t even have the energy to do it anymore behaviorally some people withdraw they shut down we all know people who get frustrated when they get overwhelmed when they start feeling hopeless or helpless they just kind of withdraw from everything and everyone’s 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 in 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 torn up from the stress they can’t even think about holding anything down physical stress-related illnesses fibromyalgia gastrointestinal problems headaches neck aches backaches you know the whole the 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 the bar brings you up a little bit so you’re that is 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 are 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 a particular point in time but what’s the evidence that there’s a threat in what ways are this similar to other situations maybe it’s triggering something from the scary past 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 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 onto it and going I wonder what I feel sad about I must feel sad about all these sad things now I’m going to be 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 to tell you your brain thinks something’s going now thankfully we have that higher-order cognition stuff going on so we can contradict our 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 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 challenges 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 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 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 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 always be ever and always being not a real doctor because a Ph.D. is not an MD and I’m like really so is it somebody else’s standards or can I feel good about having a Ph.D. 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 in a text messages 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 another way you know cuz 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 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 explanations for this event that doesn’t involve me you know why might this have happened 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 been about you now think about the last 10 times you’ve taken something personally how many of those 10 times has it 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 A few planes crash but you don’t hear about the 20,000 every day 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 a 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 what’s most prominent in their mind and they ignore the rest of the stuff so we need to encourage people to 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 gotten in a physical or get 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 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 having they do 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 and 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 to identify for good people you know who’ve had bad things happen and in reality we all have bad things happen good people do bad people do in between people do attributional errors and this is a pet of mine you know labeling yourself is 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 the skills I can change skills stable I am and I always will be versus it’s something I can change it’s something I can learn internally 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 do 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 is salient for that client’s irrational thoughts about how to do these thoughts impact the client’s 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 this thought has 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 may be 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 to feel good about yourself how can you do that besides necessarily requiring other people to approve of you to be content in the 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 dramatic to say all people and 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 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 depends on what other people think of he or 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 the 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 to 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 the area that they have to be perfect I am in total control of 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 are they think if they’ve got everybody on marionette strings 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 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 look at what these beliefs are saying 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 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 are a lot fewer cognitive distortions or general ways of thinking about the world then there are thinking errors because there are 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 of the hecklers you know the automatic tapes that are maintaining our unhappiness the person can choose whether to accept those thoughts or change them As found on YouTubeThis solution reverses kidney disease! Guaranteed to be effective or your money back: Beat kidney disease. Just by following a simple treatment plan, you can reverse kidney disease. No matter how old you are! Just listen to what people who have tried this solution have to say. “Thank God I came across your solution by accident! Dad’s kidney function decreased from 36% to 73% in just two months. He’s 90 years old! His doctor said people his age shouldn’t have kidneys that efficient!” Graeme Asham, QLD, Australia, And this… “No more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I’ve been taken off my blood pressure medication. Your solution works! ” Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! => This solution reverses kidney disease! ← https://www.facebook.com/100000332115031/videos/590895892954739/ яαℓρн ℓєαмαи

8 Signs You Might Have Social Anxiety

 Hey, Psych2Goers! And welcome back to another Psych2Go video. Do you find it hard to socialize with other people? Do you feel overwhelmed at the thought of going to a social event? It can be very easy to confuse social anxiety and shyness.. ..since they share many of the same characteristics. While shyness is a personality trait.. ..social anxiety is a mental illness. Before we begin we’d like to mention that this video is created for educational purposes only.. ..and is not intended to substitute a professional diagnosis. With that being said, here are eight signs you might have social anxiety. #1 You’re always self-conscious. One aspect of social anxiety is the extreme fear of being judged. According to Kocovski and Endler if you have social anxiety; You’ll constantly worry about the way you look or act and what others think of you. Your greatest fear is of embarrassing yourself in front of others. A shy person, on the other hand, will only worry about being judged in certain situations.. ..like in public speaking or when meeting someone new. #2 Your anxiety feels out of hand. There are times when it’s normal to feel shy or nervous around other people. ..for example when you move to a new school or have to perform in front of an audience. But social anxiety is irrational and unwarranted. You may feel distressed about things as simple as making eye contact with someone,.. ..using public transportation, or eating in front of other people. The fear is always there. The fear is always there. #3 It interferes with your performance. Have you ever called in sick to work when your anxiety became too overwhelming? ..or have you kept quiet when you were having trouble in class? Social anxiety can impact your performance in many ways.. ..with the constant fear of people’s judgment You may even be afraid to do well to avoid drawing attention. You don’t pitch ideas at meetings.. ..raise your hand in class… or join clubs because of how much anxiety it creates. #4 It affects your relationships. While it’s hard to make friends when you’re shy.. ..it can feel almost impossible when you have social anxiety. For a shy person, it’s usually about breaking the ice.. ..and going through the initial awkwardness of meeting each other. But having social anxiety can complicate your relationships. You feel tense and uneasy around people...no matter how close you are or how long you’ve known them. #5 It doesn’t go away with familiarity. It’s normal to feel shy at the beginning of a new relationship. But as you get to know each other the tension will start to subside. This isn’t the case if you have social anxiety. Instead, you always experience fear distress, and embarrassment whenever you’re around other people. Doesn’t matter if it’s your parent’s siblings or best friend.. ..you always feel uneasy and stressed unless you’re alone. #6 You overanalyze everything. Have you ever said things to yourself like; “I took too long to reply and now she doesn’t like me ..” or “He didn’t say hello this morning because he’s upset with me ..” Social anxiety can make you obsess over your social interactions. You may spend a lot of time and energy.. ..analyzing other people’s facial expressions.. ..body language and tone of voice.. ..to see if they mean what they’re saying or not. #7 You avoid social situations. Are you often absent or very late to social gatherings? It’s a serious matter if your social anxiety leads you to avoid social situations altogether. You decline invitations, refuse to speak in front of people, ..and would rather sit in the corner.. ..to avoid being noticed and mingle with anyone else. It doesn’t matter if it’s a normal day at work or school.. ..your birthday party, or even your wedding day. And #8 You have physical symptoms. Do you feel nausea? dizziness or chest palpitations when you’re in social situations? Just like most anxiety disorders.. ..social anxiety is often accompanied by physical symptoms. Some common ones are sweaty palms, shortness of breath.. lightheadedness, and trembling. While these are also the same signs of someone having a panic attack. You’ll be able to tell the difference if you only show these symptoms.. ..when anticipating or being out in a social setting. Do you relate to any of these symptoms above? Let us know in the comments below. If you do, you’re not alone…nor are you bad for feeling this way. The references and studies used in this video are added in the description below. If you find this video helpful, be sure to like, subscribe…and share this video with those who might benefit from it as well! Thanks for watching and we’ll see you in the next video!As found on YouTubeShow me the simple steps to overcome shyness & cure social anxiety ➫ The Shyness and Social Anxiety System was created by Sean Cooper, a former social anxiety sufferer. Learn how to overcome your quietness, erase your insecurities and be confident around people using proven psychology.

8 Signs You Might Have Social Anxiety

 Hey Psych2Goers And welcome back to another Psych2Go video: Do you find it hard to socialize with other people? Do you feel overwhelmed at the thought of going to a social event? It can be very easy to confuse social anxiety and shyness since they share many of the same characteristics While shyness is a personality. Trait social anxiety is a mental illness. Before we begin, we’d like to mention that this video is created for educational purposes. Only and is not intended to substitute a professional diagnosis With that being said, here are eight signs. You might have social anxiety. 1, You’re, always self-conscious. One aspect of social anxiety is the extreme fear of being judged According to Kocovski and Endler. If you have social anxiety, You’ll constantly worry about the way you look or act and what others think of you. Your greatest fear is of embarrassing yourself in front of others. A shy person, on the other hand, will only worry about being judged in certain situations like in public speaking or when meeting someone new 2. Your anxiety feels out of hand. There are times when it’s normal, to feel shy or nervous around other people. For example, when you move to a new school or have to perform in front of an audience, But social anxiety is irrational and unwarranted. You may feel distressed about things as simple as making eye contact with someone using public transportation or eating in front of other people. The fear is always there. The fear is always there 3. It interferes with your performance. Have you ever called in sick to work when your anxiety became too overwhelming, or have you kept quiet when you were having trouble in class Social anxiety can impact your performance in many ways with the constant fear of people’s judgment, You may even be afraid To do well to avoid drawing attention You don’t pitch ideas at meetings, raise your hand in class or join clubs because of how much anxiety it creates 4? It affects your relationships While it’s hard to make friends. When you’re shy, it can feel almost impossible when you have social anxiety For a shy person. It’s usually about breaking the ice and going through the initial awkwardness of meeting each other. But having social anxiety can complicate your relationships, You feel tense and uneasy around people, no matter how close you are or how long you’ve known them.  5. It doesn’t go away with familiarity. It’s normal to feel shy at the beginning of a new relationship, But, as you get to know each other, the tension will start to subside This isn’t the case. If you have social anxiety Instead, you always experience fear, distress, and embarrassment. Whenever you’re around other people, Doesn’t matter, if it’s your parents, siblings, or best friend, you always feel uneasy and stressed unless you’re alone, 6, You overanalyze everything. Have you ever said things to yourself like I took too long to reply and now she doesn’t like me, or He didn’t, say hello this morning, because he’s upset with me? Social anxiety can make you obsess over your social interactions. You may spend a lot of time and energy analyzing other people,’s, facial expressions, body, language, and tone of voice to see if they mean what they’re saying or not. 7. You avoid social situations. Are you often absent or very late to social gatherings? It’s a serious matter if your social anxiety leads you to avoid social situations altogether, You decline, invitations refuse to speak in front of people, and would rather sit in the corner to avoid being noticed and mingle with anyone else. It doesn’t matter if it’s a normal day at work or school, your birthday party, or even your wedding day And 8. You have physical symptoms. Do you feel nausea, dizziness, or chest palpitations when you’re in social situations, Just like most anxiety disorders, social anxiety is often accompanied by physical symptoms. Some common ones are sweaty palms shortness of breath, lightheadedness, and trembling. While these are also the same signs of someone having a panic attack, You’ll be able to tell the difference if you only show these symptoms when anticipating or being out in a social setting, Do you relate to any of these symptoms? Above, Let us know in the comments below, If you do, you, ‘re, definitely not alone. Nor are you bad for feeling this way, The references and studies used in this video are added in the description below. If you find this video helpful be sure to like subscribe and share this video with those who might benefit from it as well, Thanks for watching and we’ll see you in the next video Continue reading 8 Signs You Might Have Social Anxiety

What causes panic attacks, and how can you prevent them? – Cindy J. Aaronson

Dig into the science of what triggers panic attacks, how to recognize them, and the available treatments for panic disorder.—Countless poets and writers have tried to put words to the experience of a panic attack— a sensation so overwhelming, many people mistake it for a heart attack, stroke, or other life-threatening crisis. Studies suggest that almost a third of us will experience at least one panic attack in our lives. So what exactly is a panic attack, and can we prevent them? Cindy J. Aaronson investigates.Lesson by Cindy J. Aaronson, directed by Aim Creative Studios.Animator’s website: http://aimcreativestudios.com/ Sign up for our newsletter: http://bit.ly/TEDEdNewsletter Support us on Patreon: http://bit.ly/TEDEdPatreon Follow us on Facebook: http://bit.ly/TEDEdFacebook Find us on Twitter: http://bit.ly/TEDEdTwitter Peep us on Instagram: http://bit.ly/TEDEdInstagram View full lesson: https://ed.ted.com/lessons/what-causes-panic-attacks-and-how-can-you-prevent-them-cindy-j-aaronsonThank you so much to our patrons for your support! Without you this video would not be possible! Ivan Todorović, Alex Schenkman, Brittiny Elman, Ryohky Araya, Paul Coupe, David Douglass, Ricardo Paredes, Bill Feaver, Eduardo Briceño, Arturo De Leon, Christophe Dessalles, Janie Jackson, Dr Luca Carpinelli, Heather Slater, Yuh Saito, Quentin Le Menez, Mattia Veltri, Fabian Amels, Sandra Tersluisen, PnDAA, Hugo Legorreta, Zhexi Shan, Gustavo Mendoza, Bárbara Nazaré, Josh Engel, Natalia Rico, Andrea Feliz, Eysteinn Guðnason, Bernardo Paulo, Victor E Karhel, Sydney Evans, Latora Slydell, Oyuntsengel Tseyen-Oidov, Noel Situ, Elliot Poulin, emily lam, Juan, Jordan Tang, Kent Logan, Alexandra Panzer, Laura Cameron Keith, Jen, Ellen Spertus, Cailin Ramsey, Markus Goldhacker, Leora Allen, Andras Radnothy, Chris, Arpita Singh and Vijayalakshmi.

The 9 Most Common Specific Phobias (Mental Health Guru)

Phobias are characterized by intense avoidance of things. Take a quick look at the most common aversions! http://mental.healthguru.com/