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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
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If you will, I don’t keep them in the house, but I will allow myself occasionally to buy a small snack-size pack of M Ms, when I’m out or I will get a regular-size pack and I’ll share it with my daughter, so I’m not restricting it.I’m not saying I can never M. Ms again, I’m just not making it available to myself when I might have some unrestricted time, try to avoid buying a bunch of comfort foods and keeping them around the house, and when you’ve got kids when you’ve got family, it’s not entirely possible, usually to not have some of that stuff around but try to avoid having the things that you particularly used for comfort, because if it’s not readily available, then you’ve got to focus on guess what dealing with the emotions.Instead of stuffing them with food, try not to go too long without eating.Like I said earlier, if you go too long, then by the time you get to the food, your blood, Sugar,’s low and you’re just shoveling it as fast as you can initially distract.If you know that you’re getting you’re eating and you’re, like I’m – really not hungry, but I want to eat, take a bath, take a walk, call a friend, heaven forbid get on Facebook.Whatever it is, you can do to distract yourself for 10 or 15 minutes if, after 10 or 15 minutes, you’re still going, I want whatever it is, then you can decide what to do about it.Then, most of the time when people stop and go, I’m not hungry.Let me distract myself.They get caught up in that distraction and before they know it, they’ve forgotten about the craving, and identify the emotions.If you know that you’re not hungry, but you want to eat, then say: okay, what’s going on what’s going on with me? It doesn’t mean that the person is never going to eat when, when they’re upset, because a lot of people do, and is it the end of the world, probably not necessary if they can start reducing the frequency of times that they eat.In response to emotional distress that’s, what we want, we want to progress, not perfect if it’s, depression, what’s causing them to feel hopeless or helpless right now, if it’s, stress, anxiety, or anger, remember our big kind of lump together stuff. What are they stressing out about? Do they feel like they’re overwhelmed? Are they afraid of failure, rejection, and loss of control of the unknown? We’ve gone through those things.We want them to identify what’s going on with them, and then they can make better choices about how to deal with it.So general coping helps them develop, alternate ways of coping with distress.Distract we’ve, already kind of gone over that one.I encourage people – and you know it’s – one of those DBT things – that a lot of therapists encourage their clients to keep a list of things.They can do to distract themselves because it’s not always practical to get up and go on a walk.If you’re at work or it’s, you know two in the morning.So what else can you do to distract yourself? Talk it out with a friend with yourself with your dog? Sometimes you just got to get it out.People who are more auditory will prefer talking it out as opposed to journaling it now.If they talk it out with themselves, they can record it if they want to, or sometimes it’s just better to have a dialogue with themself. If it worked for Freud, it can work for other people journaling.If your clients are inclined to journal, encourage them to write it down.Sometimes just getting stuff out of your head and onto paper will help the feelings dissipate a little bit.So you’re not mulling them over and obsessing over them and getting stuck in those thoughts and feelings.Additionally, while you’re distracted talking it out or journaling, this is also your break.Your stop between the urge and the behavior make a pro and con list of the de-stress, not the eating whatever it is, that’s stressing you out and how can you fix it or what are the pros of this situation and what are the downsides To this situation, encourage them to focus on the positive.You know.If something stressing you out at work, you know you’ve got a big meeting coming up or something you don’t want to do or what it is.You can get stuck on focusing on that or you can focus on the positive that you do have a job.That meeting only comes around once a month. You can it’s time you don’t have to be doing paperwork whatever the pros are for that person encourage them to focus on the positive.If you’re distressed because of some kind of a failure or perceived failure, figure out what you learned from it, whether it was a relationship failure, or maybe you learned what not to do in a relationship anymore. Maybe you learned things that you may have ignored.Maybe you learned what you should have done instead, but how can it be a learning opportunity, instead of somewhere to stay stuck and finally, if something’s making you upset if something’s causing anxiety, depression, hopelessness, helplessness, whatever the negative feeling figure out.If it’s worth your energy to get stuck here, is it worth the turmoil? Is it worth you know having to pacify yourself with food or whatever? It is a lot of times people say you know what now it’s, just it’s, not even worth my effort.It’s not worth moving me away from my goals, because my goal is to stop emotional eating.My goal is to eat for hunger, so I can go to dinner with people and feel comfortable.I can be at a party where there’s a buffet and not feel stressed out that I’m going to go and eat half the stuff on the buffet that’s my goal so is holding on to whatever this de-stress is getting me Closer to being able to do those things and generally the answer:’s no develop alternate ways of coping with the stress the ABCs, the a is the activating event.What is stressing you out and what’s causing the de-stress C is the emotional reaction.Angry depressed stressed, whatever be: are your behaviors? What behaviors or B are your beliefs? Sorry, what are the beliefs that are in there that may need to be addressed? What kind of things are you telling yourself, and, and how can you counter them? Cognitively eliminate your vulnerabilities.You knew we couldn’t get through a presentation without talking about vulnerabilities. If someone is well-rested.Well, the fed has a good social support network, not stretch timewise.Then it will be easier to deal with stress or stressors when they come your way.You’ll have more energy to deal with it, so there won’t be this overwhelming feeling of I just want to bury my head in a jar of peanut butter, be compassionate with yourself.Some days, you know you’re, just going to feel anxious.You’re going to feel depressed.You’re going to get angry.You can beat yourself up over it and you know a lot of people do.Is that the best use of your energy or can you be compassionate? Can you learn from it? Can you give yourself a break and go? You know what I’m having a bad day today and that’s okay, I’m not going to unpack and stay here, but I’m not going to fight.It either helps clients learn how to urge surf help. They understand that, just like a panic attack just like a wave just like a lot of other things in life, it will come, it will crest and it will go out again, so they can sort of identify where they are on the energy of that Urge other tools people can use close the kitchen once I have the kitchen cleaned and you know all the dishes are done and it looks pretty.I hate going in there and finding dishes in the sink again now I’ve got teenagers, so we always have dishes in the sink.But before I had children, you know at seven o’clock.I finished all the dishes and closed the kitchen, and that would be enough motivation for me to not go in there and at least not use plates and stuff to eat.So if we’re saying that we’re going to only eat using utensils plates and sitting and all that stuff that we already talked about, then once you close the kitchen, you’re not going back in, there turn off the light.That also helps so you’re not being attracted to the pretty lights, and you know all the goodies that are in the kitchen to brush your teeth.This is something my grandmother used to do and it works.There’s some research behind it.Minty flavors reduce our appetite.So if you brush your teeth, you get all the other flavors out of your mouth and it reduces your urges to eat because it again it’s clean and fresh. And do you really want to brush your teeth again, and meditate, sometimes just getting in a space where you’re, not obsessing about anything, can help people get past that urge to self-soothe by eating a CT for emotional eating.What am I feeling or thinking about what’s going on with me right now? What is important to me? So if I am thinking I want to eat, I want to you know just dive into this jar of peanut butter, and then I think about what’s important to me.Is it important to me to get control of this? Is it important to me to you know, be able to fit into my clothes in six months or not? So what is it in? What way is controlling my eating habits and eliminating emotional eating important to me, and how does that get me closer to other things that are important to me, and what other things could I do? That would get me closer to my goals.So if the goal is to have improved relationships, be able to feel more comfortable around food reduce the stress around going out to eat, and just around food in general, what else can you do when you are stressed out? Somebody also suggested that adding a blue light in the refrigerator decreases the appeal of foods, which is interesting because yellow red and orange, and browns, I think Pizza Hut – are all foods that increase people’s, hunger and desire to eat.But blue is just a completely different primary color, and adding a blue hue seems like that would be effective, so cool thanks for that.Little tidbit there holiday help, and you know we’re coming into the holidays.So I’ve got to bring that up at every single glass and choose lower-calorie foods.If you tend to get stressed out or caught up or mindlessly eat when you are at family gatherings.Okay, you know cut yourself a break, know that that’s, probably going to happen, and fill up on the lower-calorie foods.The carrot sticks the broccoli, the white meat, turkey, anything that’s available, that’s, not like sweet potato pie or brownies, keep water or low-calorie beverage. In your hand, if you’ve got your hand full, you can’t eat at the same time.So you know if you walk around with a cup in your hand, it helps talk to people.Hopefully, you don’t talk with your mouth open or talk with food in your mouth.So if you’re talking to people, you’re not going to be as inclined to go and get something to eat because you’re wanting to stay engaged in that conversation.Stay away from the buffet, especially if you know that it could get stressful, or maybe you know for me, I turn into a pumpkin at like 7 30 at night.I get up at 4 00, but I turn into a pumpkin at 7, 30 and a lot of times holiday parties and those sorts of things are at eight, nine, o’clock at night, and you know I’ve already turned into a pumpkin.So I know that if I go to those I’m going to be more likely to eat just to kind of stay away because I’m tired and it’s a bad habit.It’s not because I’m hungry.So I know I need to stay away from the buffet during those times we rehearse refusal skills.If somebody says. Oh, you, I’ve got to try it by two.This figure out how you’re going to address that ahead of time, because there’s generally probably a lot of really good foods, and you may really want to taste some, but sometimes people who emotionally eat know if they start eating.If they start eating high-fat high calorie foods, they’re going to want to eat everything.So if I start with one bite of a brownie, I’m going to want to eat every suit that’s on the table.If they know that, then they may want to choose to not even go down that road at that juncture, encourage people to stay mindful of their distress meter before they go back for another helping and ask themselves, am I hungry? Am I just wanting to taste what’s here and how do I feel about that? Or am I eating just because I don’t want to be here and I’m bored and I want to fill the time? Have people keep an index card with their coping mantra and two reasons they don’t want to emotionally eat, so I need to be here.I can do this whatever the mantra is that’s going to get them through the night, whatever they’re.Telling themselves that it’s going to help them plow through and make the right choices, but also two reasons that they don’t want to eat, or they’re going to get around it.Maybe they’ve got something at home that they can eat when they get home eating before they go to.The party may also help prevent some grazing holidays, bringing out a lot of emotions in people.Some people struggle with depression, anxiety, jealousy, grief, and anger. You know the whole gamut during this time and during this time there’s food everywhere I mean starting at Halloween when your kids bring home the Halloween candy, which usually lasts about a week in our house baby.Oh, Halloween candy followed by getting ready for Thanksgiving, followed by doing all the baking or whatever you do, and the holiday parties coming up on the December holiday season.There’s just food everywhere, so it’s really easy to cope.If you will, with stress being overwhelmed with being tired by not eating enough healthy food by binging on unhealthy and soothing food if you will so it’s, encouraged it’s important to encourage people to stay.Mindful of why they’re eating what they’re eating, when constantly bombarded with high-fat high carbohydrate foods, people are tempted to eat to feel calm yeah.I challenge anybody to say that they’ve never eaten and go okay.You know I’m.Just focused on this right now I’m not thinking about everything out here and it feels good um.I’m good now, good, probably not the word I should use, but it does help people distract themselves sometimes when they eat, especially those high-intensity foods.You feel happier serotonins are released. Dopamine is released.You’re, like oh, that’s good.I want to do that again or you just feel numb.You can get into a zone where you’re just eating and not caring about it’s.Not that you’re feeling calm, you’re just not feeling anything, and a lot of times when people get into that zone.They’re not tasting the food either.They’re just kind of on autopilot for emotional eating, like most other escape behaviors.Never addresses the underlying emotions and their causes, so we need to look at them.Are you feeling anxious? Are you feeling jittery? Are you feeling depressed because your blood Sugar’s low, because you’re nutritionally deficient because you’re not getting enough sleep or because there’s something cognitive going on, or all of the above emotional eating, often results in physical issues like weight gain Poor sleep and reduced energy weight gain, are you know in and of itself a few pounds here and they’re not a big deal, but some people can start emotionally eating to feel better.They gained a lot of weight. Then they start feeling less energetic.It starts being harder to move around.They get to the point where they are clinically obese.Then they’re going.I’m never going to take all this weight off.They feel hopeless and helpless.You see where this is going, so they eat some more.Can cause poor sleep apnea, it’s hard to get it’s also hard to get comfortable.Sometimes, if you’ve eaten a whole bunch of food right before you go to bed, you know your bellies are all full, and little you wake up.The next morning and your belly are still awful, which means you probably didn’t, sleep very well the night before and emotional eating often results in reduced energy because the foods we binge on the foods we eat for self-soothing often end up causing a sugar Crash some people try to undo emotional eating by restricting other calories which can lead to nutritional deficits and more cravings. I had a girlfriend when I was in high school and you know think back to I don’t know if they still do it, but when we were in high school there was always some kind of candy sale going on and she would always forgo all Other food, so she could have two chocolate bars each day and you know we’re not going to get into the all the other issues surrounding only eating two chocolate bars.But the point I’m making it right now is the fact she wasn’t getting protein.She wasn’t getting it.You know most of her vitamins and minerals and stuff that her body needed to make the neurotransmitter.So she could feel happy and she was contributing to a sugar crash, but I also know that it’s common around the holidays for people to do this.They’ll let go all day without eating because they know they’re going to a party tonight and there’s going to be a lot of really good food doing that once in a while.Not a big deal doing that 10 or 15 times in a month could start to have problems.Emotional eaters need to first find a way to stop before they eat, so, whether it’s writing in a journal or adding.There are a lot of apps on your phone that you can put your food in, even if you’re, not writing about your emotions and your cravings and all that kind of stuff.Sometimes it’s enough to make people stop before they reach. For the food – or you know, kind of an extreme way to go is to not keep pre-processed or prepackaged foods in the house.So anything that you’re going to eat you’ve got to make second identify the underlying reason for your eating figure out.Do I generally eat in response to and then address the thoughts and emotions leading to the urges?So if you figure out the underlying emotions for your eating or your depression, then what thoughts are maintaining that depression? And how can you address it once you address the underlying issues, some of the emotional eating will go away, but some of its habits?We’re going to have to break that habit and, throughout you know, the past couple of decades of working with people.My experience has been the majority of the time people don’t want to hear.Well, once you deal with your emotional issues, the emotional eating will go away now.They’re there because they want to stop that behavior right now.So, yes, we need to work on all the underlying issues but give them a tip or a trick or a tool whatever you want to call it to use before they walk out of your office after every single session.That way, they have something else they can put in their toolbox and feel more empowered to have control over what’s going on with them. And what’s coming their way, having the knowledge of what and why is 80 of helping them get to the recovery point now, if there’s co-occurring or if the eating issues are more than just emotional eating, if there’s, the person meets The criteria for binge eating disorder, bulimia or anorexia.There are a lot of other underlying issues they’re going to have to be dealt with.So I don’t want to trivialize that, but I do want people to feel like they’ve got some hope over what’s going on.Are there any questions? 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