{"id":150330,"date":"2023-03-21T14:23:04","date_gmt":"2023-03-21T18:23:04","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150330"},"modified":"2023-03-20T21:51:40","modified_gmt":"2023-03-21T01:51:40","slug":"cognitive-behavioral-therapy-cbt-skills-and-counseling-techniques-with-dr-dawn-elise-doc-snipes","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150330","title":{"rendered":"Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise &quot;Doc&quot; Snipes\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/EpWfDdY4-vk?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\n&nbsp;\r\n\r\nCEUs are available for this presentation at AllCEUs.com\/CBT-CEU Hi everybody and welcome to today’s\r\npresentation on cognitive behavioral therapy skills. Like the other\r\nthe presentation we did on assert not assertive community treatment acceptance\r\nand commitment therapy, which is also based on just providing information\r\nabout skills that can be used not providing an evidence-based practice\r\nwe couldn’t cover that in a full hour or just an hour so over the\r\nnext hour we’re going to define cognitive behavioral therapy and its\r\nbasic principles a lot of us are familiar with this but it’s going to be\r\na good review and it also may highlight some nuances that you didn’t know about\r\nwill identify factors impacting people’s choice of behaviors explore causes and\r\nimpact of thinking errors and identify common thinking errors and their\r\nrelationships to cognitive distortions so why do we care well as therapists we\r\nwant to help people figure out the best way to live a happy healthy meaningful\r\ngoals-driven life for some people that’s going to mean using some cognitive\r\nbehavioral interventions that can be in addition to mindfulness that can be in\r\naddition to a lot of other things but it’s important to help people understand\r\nthat the way we believe things to be the way we interpret things is going to\r\naffect our reactions so for example think about a situation you know you’ve\r\nwalked into and maybe you walked into it with a small child and it was a\r\ndifferent situation it was a new situation but you know it was no big\r\ndeal you walked in it was not a threatening situation to you because you\r\nwere like hey I got this the little kid walks in and goes oh wow there are a lot\r\nof people walking around here, this is the really scary same situation as two\r\ndifferent perceptions you probably didn’t have much of a stress reaction\r\ngoing on whereas the little child probably had this fight-or-flight thing\r\ngoing on grabbing onto your hand like please don’t let go\r\nAtlanta Airport is a perfect example if you’ve ever\r\ntaken a little kid through Atlanta Airport gives you an idea about how\r\npeople can perceive things differently and when you enact that fight-or-flight\r\nthe reaction you’re going to have all those stress hormones you’re going to have all\r\neither anxiety or anger or whatever that goes with it it may serve to\r\nexhaust the person and leave them feeling hopeless and helpless so what we\r\nwant to do is help people see that but we also want to help them see that when\r\nthey’re depressed when they’re tired when they’re sick things are going to\r\nseem a lot worse a lot of times because they don’t have the energy to perceive\r\nit differently I mean when you’re sick it’s overwhelming to think of going\r\nthrough Atlanta Airport so this is what we want to help people start\r\nunderstanding is it’s two sides of the same coin they interact if one is you\r\nknow kind of going wonky is going to affect the other one the good thing is\r\nif one’s going well the other one’s going to go well if you’re\r\nhaving positive thoughts you’re probably going to feel pretty good\r\nthere’s an activity and I think we’re going to talk about it later it’s called\r\nthe coin flip activity and I asked client clients to flip a coin in the\r\nmorning and in the morning if it turns heads then they have to be the most\r\npositive Pollyanna all day long look for the silver lining and everything smile\r\nwalk with their head up hold those nonverbals up and see how they feel at\r\nthe end of the day besides a little sore because there are muscles they’re using\r\nthey haven’t used in a while if it lands on tails they can just be their normal\r\nselves which generally if they’re seeing me means that they are depressed anxious\r\nstressed out angry about something in the negative realm then we\r\ntalk about how did things seem different on the days when you were feeling better\r\nwhen you were walking taller when you were smiling even our nonverbals it\r\ndoesn’t even have to be sickness it can be our nonverbals that can make us feel\r\nor make our body feel heavy and tired and make it seem like it’s a whole lot\r\nharder to deal with life as a person who perceives the world\r\ngenerally good and believes they can deal with challenges as\r\nthey arise that good old self-efficacy will be able to allow their stress\r\nresponse system to function normally so if they’re like you know what I can deal\r\nwith whatever life throws at me I’ve got it and maybe I need help with it maybe\r\nI’ll need to ask for support but I’ve got it it’s not going to completely\r\noverwhelm me with people who see the world as hostile unsafe and unpredictable you\r\nknow for a variety of reasons whatever happened to make their scheme as such\r\nthat they don’t believe that people or the world is trustworthy are predictable\r\nthey are always on guard they’re always kind of like a hamster in a cage that has\r\nHave you ever had hamster hamsters don’t recognize you and go hey that’s my own\r\nor human contact score hamsters go run under their little house\r\nand you just kind of open the cage and stick your hand in there and flip over\r\ntheir house and you’re like come here and give me cuddles and you’re like you\r\nknow 200 times bigger than they are so the little hamster is like freaking\r\nout this is what it’s like for people and obviously, I’m exaggerating but this\r\nis what it’s like for people who have a negative perspective a negative view or\r\na hostile view of the world so kind of keep that little hamster in your mind cognitive behavioral therapy we have\r\ncore beliefs those things that are in our hearts when I talk with my clients\r\nabout honesty step one and that’s what they’ve got to do to start recovery is\r\nget honest with themselves first and then other people we talk about head\r\nheart and gut honesty do you think it’s right does it seem like the right thing\r\nto do does it feel right in your heart you know does it make you happy it\r\ndoesn’t make you feel good and then the spidey senses is your gut saying and or\r\nis your gut fine if one of those is saying this might not be the right\r\nchoice and we need to think about what’s going on so we have those core beliefs\r\nand I put them in the heart just because that’s the middle of the head heart and\r\ngut but you have core beliefs about yourself whether you’re good with\r\nyou’re bad whether you’re effective at certain things ya ya\r\nyou have core beliefs about other people same thing good bad effective\r\npredictable and you have core beliefs about the future and a lot of that goes\r\nwith the locus of control but also your past experiences if the world in the past is\r\nseemed unfriendly and uncontrollable and you’ve perceived it that way then you’re\r\ngoing to expect the future to be uncontrollable so what we want to do is\r\nhelp people look at their schemas and their core beliefs about themselves\r\nothers in the future and figure out kind of what they want it to look like these\r\nschemas are going to affect your behavior and your thoughts and your\r\nfeelings and you know you can pick wherever you want to start it doesn’t\r\nmatter because all three inter interface with one another so if you haven’t let’s\r\nstart with negative thoughts if you have negative thoughts then you might feel\r\nanxious angry stressed dysphoric which will affect the behavior you’re going\r\nto do different things than if you have positive thoughts about something you\r\nfeel excited and energized you’re going to have different behavior the best\r\nthing example I can give you is if you’ve ever done public speaking or had\r\nto present something some people detest public speaking it’s just\r\nterrifying for them to get up in front of a group of people so their thoughts\r\nam I going to trip up I going to forget what I’m going to say I’m going\r\nto make a fool of myself I’m going to you know it can go on forever that when\r\nyou get on a roll you can get on a negative roll and go on forever or\r\npositive hopefully get on that roll with those thoughts you start holding onto\r\nthose thoughts remember as we talked about in a CT the other day when you\r\nhold those thoughts and you kind of mush them around in your mind and you come to\r\nbelieve them that you’re going to make a fool of yourself and it’s going to be\r\nawful you’re going to start feeling terrified likely which is going to\r\nlikely affect your behavior if you go out on the stage and you’re terrified\r\nyou’re going to probably stutter you’re probably going to get foggy-headed\r\nyou’re going to have that fight-or-flight reaction so there’s an\r\nthe adrenaline rush and you start sweating and you can’t focus and you can’t\r\nconcentrate you want to away as opposed to somebody like me who\r\nloves public speaking and I’m just like cool I get to go out there and try to\r\nengage however many people are in the audience it’s a game for me because when\r\nI can see your faces I enjoy trying to figure out and make eye\r\ncontact with people and figure out what it is that they’re there for what is it\r\nthat’s going to make them tick what resonates with them so my behavior as\r\nyou can kind of see right now when I go out there I’m excited and I want to\r\nengage people and it’s a fun experience for me again just like the airport the\r\nsame experience for two different people and two very different interpretations\r\nand reactions to it so what effects I don’t like the term rational but when\r\nwe’re talking about CBT irrationally comes up a lot I like to replace it with\r\nhelpful because every behavior in its weird sort of way is or probably was\r\nrational at one time that being said we’re going to get back to that stress\r\naffects our behavioral choices if we’re under stress we can have negative\r\nemotions negative emotions will affect our thoughts if we’re feeling sad we’re\r\nprobably going to look at the dark side if we feel sad we’re going to look at\r\nthe bottom falling out if we’re happy we’re probably going to look for that\r\nsilver lining physical factors if you’re in pain sick sleep-deprived poorly\r\nnourished so your body can’t produce the neurotransmitters it needs to or heaven\r\nforbid intoxicated you’re probably not going to make the same decisions as you\r\nwould if you were comfortable healthy well-rested nourished and not\r\nintoxicated any of those things can go impact how you perceive a\r\nsituation or how you react in a situation, especially the intoxication\r\nwhereas in your non intoxicated State in your sober state, you may think that you\r\nwant to do something but then you’ve got that filter that goes not\r\nnot a good idea in an intoxicated State or even in a manic state if you’re you\r\nknow if you have somebody with bipolar that filter kind of goes away so the\r\nbehaviors that someone may normally not do because they have a rational filter\r\nthat goes you know punching this guy outs probably not the best idea right\r\nnow the filter goes away when you’re sleep-deprived you’re less generally\r\npeople are less patient generally people don’t have as much of a filter thing\r\nabout watching your children if you have children or your grandchildren or even\r\nyourself I know myself when I’m sleepy I am giddy as all get-out and things I\r\nwouldn’t normally say because they’re you know stupid I’ll just come out and\r\nsay anyway and my kids just roll their eyes or mom you’re overtired could\r\ngo to bed, uh but that’s okay you know I’m okay with that\r\nin that situation now if I acted that way at work it would be a worse thing\r\nenvironmentally if you’re introduced to a new or unique situation and you\r\nperceive it as stressful because the unknown we know can be stressful then\r\nyou may not make as rational of a choice or as helpful of a choice because you\r\nmaybe trying to escape the same thing as exposure to UNPROFOR bellowing for a\r\nthe word here but UNPROFOR ball is the best I could come up with we all prefer\r\ncertain situations some people as I said would rather do just about anything\r\nthen get up in front of a lecture hall of a hundred and fifty people and talk\r\nbut if they have to do it then they’re going to be under stress which may\r\naffect how they do things so we want people to understand that their\r\nperception and their feelings are affected by a lot of other things not\r\njust you know an emotion here or a particular memory there’s a lot that\r\ngoes into it and social if peers your family convey\r\nirrational thoughts as necessary very standards for social acceptance\r\npeople may tend to cling more to it to those unhelpful thoughts and unhelpful\r\nbehaviors you know in CBT they say irrational because quote nobody wants to\r\nassociate with those people you know who are those people and why can’t we\r\nassociate with them there are a lot of things if you think back think high\r\nthe school you know high school is pretty rough if we’re going to talk about\r\nhaving irrational thoughts and cognitions if you have to be part of\r\nthis particular group to be accepted you have to do this you have to\r\ndo that but do you really so those kinds of all-or-nothing statements\r\nare cognitive distortions and while they may have served a purpose in some way\r\nshape or form in the past we need to encourage our clients to take a look at\r\nthem now and go are they still helpful ways of thinking is it still helpful for\r\nme to think that I am only successful if I live in a million-dollar house in a\r\ngated community and do this that and the other or can I be can I define success a\r\ndifferent way or do I define success differently and lack supportive\r\npeers to buffer stress so we had those peers that caused stress by talking\r\nabout the half dues and categorizing and lots of attributions but then there’s\r\nalso not having somebody to go you know does this make any sense\r\nbecause sometimes we are our own worst enemies and if we go to a friend and we\r\ngo you know this is what I’m thinking and I think I have to do this in order\r\nto be acceptable to be loved or you know whatever the case may be\r\nmost people are not going to use those exact phrases a good friend is probably\r\ngoing to listen and go yeah you’re right or no no that’s way off so supportive\r\npeers are essential to reminding us to consciously regularly check in with our\r\ncognitions to make sure that they are hopeful and rational so a note about\r\nirrationality and this is mine this is not from CBT the origins of most beliefs\r\nfor rational and helpful given the information the person had at the time\r\nand their cognitive development their ability to process that information so\r\nconcepts and schemas and core beliefs that people formed when they were five\r\nare probably going to be very egocentric you know the person is going to feel\r\nlike everybody sees it my way because this is how I see it you know just like\r\na five-year-old does a five-year-old doesn’t think well you know let me take\r\nJohnny’s perspective is no he assumes that Johnny sees it the same way so it’s\r\ngoing to be egocentric it’s probably going to be focused on only one aspect\r\nof the situation because small children can’t focus on multiple aspects and it’s\r\nprobably going to be dichotomous it’s all-or-nothing\r\nmommy loves me mommy hates me and it could be personalized you know\r\neverything a lot of kids think that everything has\r\nto do with them so if something happens something bad happens many times\r\nchildren will take it personally or be afraid it’s going to happen to them\r\nagain you know if hurricane Katrina hurricane\r\nAndrew those sorts of things you know we saw a lot of trauma in children and they\r\ndeveloped very real fears about thunderstorms and hurricane season\r\nand if you’ve watched Florida hasn’t had a notable hurricane in years now but\r\nthere’s a lot of stuff that goes into that but young people\r\nduring some of those really bad hurricane seasons perceive those\r\nsituations differently okay so we need to help people understand that if we\r\nespecially if we use the term irrational those thoughts you formed when you are\r\nknee-high to a grasshopper and they made perfect sense to you back then but now\r\nthat you’re an adult you’ve got more experience and you’re\r\nable to take different perspectives your brain is more developed\r\nlet’s take a look at it and see if you can look at different perspectives and\r\ncome up with something a little more helpful maybe a different way of\r\nperceiving this situation the irrational irrationality or unhelpful Nosov Fox\r\ncomes when those beliefs are perpetuated without an examination so something a\r\nthe belief that you formed when you’re five you’re still holding when you’re 35 and\r\nyou’ve never questioned it you’ve never gone you know does this make sense is\r\nthis is helpful to get me to where I want to be most of us don’t know\r\nwe form these attitudes and beliefs when we’re you know growing up when we’re in\r\nelementary school middle school high school from watching TV to being\r\naround our peers from being around our family in our community and we get all\r\nthis input of the way things should be and a lot of times people don’t stop to\r\nquestion and go and go well does this make me happy is this really what\r\nI want and they can be irrational if they continue to be held despite causing\r\nharm to the person so the person continues to hold this belief even\r\nthough it is causing them general emotional cognitive harm is making them\r\nmiserable we need to look at why what’s motivating them to hold on to that\r\nbelief why is that belief so important and how can we make it so they can live\r\na happy values-driven life emphasis on the happy how can we make it less\r\nharmful sometimes it’s more productive for clients to think of these thoughts\r\nas unhelpful or helpful instead of irrational sometimes when I say\r\nirrational to clients and you know I’m the same way if somebody says you’re\r\nbeing irrational I’m like oh I’m not it elicits this instantaneous defensive\r\nthe reaction’s like when you tell them they’re being resistant they’re like I\r\nam NOT being resistant so helpful or unhelpful and then we talk about why it\r\nis unhelpful in getting them toward their goals\r\nbasic principles of cognitive behavioral therapy we teach or help clients learn\r\nto distinguish between thoughts and feelings I can think something is scary\r\nI’ll probably feel it but if I have an automatic you know feeling I walk into\r\nAtlanta Airport and I see yeah I went to an airport in New York I can’t even\r\nremember which one it was because my plane was diverted and I got off and I\r\nwalked out there and I have never seen so many people packed in his place like\r\nsardines before in my life I was just completely overwhelmed that was kind of\r\nan automatic feeling now that was a feeling based on you know who knows it\r\nwas overwhelming to be surrounded by that many people so then I had to\r\nseparate the thoughts and go okay what am I thinking that’s making me feel so\r\noverwhelmed and at that point you know I didn’t know how to get to my gate and\r\nall that other sort of stuff with traveling I don’t travel well but\r\nencouraging clients to stop and go okay why am I feeling this way what are my\r\nwhat thoughts am I having that are contributing to these dysphoric feelings\r\nCBT helps people become aware of how thoughts can influence\r\nfeelings in ways that are sometimes not helpful\r\nwe have hecklers in our gallery the automatic tapes that we plaything\r\nmemories that we have whatever you want to call them that when you try something\r\nwhen you are just going through daily life you hear these voices in the back\r\nof your head and not real voices but that is saying you’re never\r\ngoing to make this or if you would have just blah blah blah then you’d be a\r\nthe better person helping clients become aware of those thoughts and how they’re\r\nnegatively influencing their feelings and keeping them kind of stuck is a huge\r\npart of CBT we help them learn about thoughts that seem to occur\r\nautomatically without even realizing how they may affect emotions again those\r\nthoughts from they’re saying you’re not good enough\r\nyou’re not smart enough and nobody’s gonna like you where did that come from\r\nand do you believe it you know maybe it came from somebody\r\nwhen you were in high school so was that a valid source maybe it\r\ncame from somebody yesterday on Facebook was that a valid source taking in those\r\nthoughts and then figuring out is this something I’m going to hold because it\r\nmakes me happy or is this something that I’ve got to deal with because I’m having\r\na negative reaction constructively evaluate whether these automatic\r\nthoughts and assumptions are accurate or perhaps biased the other thing to\r\nremember is a lot of our clients not all of them but a lot of them hold\r\nthemselves to a standard there’s like up here and they hold everybody else to a\r\nstandard that’s down here so they are a failure if they don’t achieve this but\r\neverybody else is successful as long as they achieve this so encouraging them to\r\ntake a look at how accurate and biased or unbiased are the thoughts and like I\r\nsaid they may be their thoughts they may be telling themselves these things\r\nevaluate whether the current reactions are a helpful and good use of energy or\r\nunhelpful and a waste of energy that could be used to move toward those\r\npeople and things important not impotent important to the person road-rage you’re\r\nin the car, you’re driving somebody cuts you off okay natural reaction fight or\r\nflight reaction you’re just like slam on the brakes and do whatever you got to do\r\naversive maneuvers you’re good so you could let it go at that point ago got\r\nlucky on that one and keep driving most people not all but most they found that\r\n80% of drivers have reported incidences of road rage which is a\r\nhigh number but most people will start getting all fired up and irritated\r\nand grumpy and we and just rageful and so my question\r\nwould be I hear that and I hear that it made you angry\r\nin retrospect did screaming at the person as you pass them at sixty miles\r\nan hour in your car with the windows rolled up does any good did it do\r\nany good at all what else could you have done with that energy if you wouldn’t\r\nhave expended it all yesterday we had to wait for the vet to come by and my\r\ndaughter just completely wore herself out worrying about when the vet was\r\ngoing to get there what he was going to say about her donkeys and was beside\r\nherself so by the time it got to evening and it was time for her to go to her\r\nmartial arts class she didn’t have the energy to go she’s like um wiped out I\r\njust want to go to bed in retrospect we’re looking back and saying okay now\r\ntell me what it was that you were so stressed out about and let’s talk about\r\nwhether that was a realistic and helpful line of thought to perseverate on all\r\nday long and what could you have done differently because she didn’t bother to\r\nmention any of that to me yesterday and then developed the skills to notice\r\ninterrupt and correct these biased thoughts independently causes of these\r\nthinking errors information processing shortcuts when we form schemas and we\r\nencounter a situation that reminds us of something in the past like when I go to\r\nmy grandmother’s house I have a schema I have a belief system I have you know\r\nstuff that I know about my grandmother’s house so when I go to my grandmother’s\r\nhouse it’s kind of a shortcut to knowing what to expect when I walk in and how to\r\nbehave how to do different things and it helps me plan and predict if you’re\r\nusing outdated or dichotomous all-or-nothing schemas it may cause\r\nthinking errors because you may be now incorrectly processing current events\r\nmental noise some of us have it a lot of us have it\r\nnot everybody thinks about trying to focus and study for a final exam in the\r\nmiddle of a really busy sports bar, okay this is a cause of thinking or you’re\r\ngoing to miss important things you’re not going to be able to focus you’re not\r\ngoing to necessarily attend to the correct things because there’s just so\r\nmuch else going on your attention is drawn in 17 different directions and or\r\nthe brain’s limited information processing capacity due to age we talked\r\nabout that before young kids think all or nothing they think dichotomously\r\negocentric ly middle school-aged kids and older start developing the ability\r\nfor abstract thinking by the time we get older, you know as adults theoretically\r\nwe’re able to you know think pretty well and think pretty clinically about different\r\nevents but if we’re in crisis when someone is in crisis and it could be\r\nlike what we think of clinically as a crisis or it could be they’re just\r\ncompletely overwhelmed and burned out and have been burning the candle at both\r\nends for three months they’re not going to process information quite as well\r\nthey’re not going to take in all this stuff because they’re just like\r\nshell-shocked have you ever seen teachers in the hallway of like an\r\nelementary school Oh at the end of the second nine weeks they just kind of\r\nstand there with this blank look on their face they’re not processing as\r\nmuch as they were the first day of school and you know God loved them they\r\nhave a lot to deal with but we need to help our clients\r\nunderstand that there are some times that they are going to have to really\r\nstop and focus write things down so they can remember or they can make decisions\r\na little more my guess is most of us have times in our life when we’ve\r\nbeen able to think through complex problems but then there are other times\r\nwhere you just can’t keep it all in your head and you’ve got to put it on a\r\nwhiteboard maybe that’s just me but we want clients\r\nto understand that they are not broken they’re not faulty they’re doing the\r\nbest they can with the tools they have and the knowledge they have and our job\r\nis to help them see where some of this might have gone a little awry other\r\ncauses of thinking errors and emotional motivations I feel bad therefore\r\nwhatever I’m thinking must be bad if I’m scared that means whatever it’s coming\r\non the other end of the phone is bad news moral motivations I did it because\r\nit was the right thing to do and that can be an excuse for doing wrong\r\nbehaviors as well it can also be you know you can argue on\r\nthe moral one social influence well everyone else is doing it so it must not\r\nbe bad set that again a lot of times and this is where the frames approaching the\r\nmotivational interviewing is helpful f stands for feedback\r\nabout the reality of what’s going on is everybody doing it let’s look at\r\nstatistics you know not subjective information let’s look at objective\r\ninformation so the impact of these thinking errors makes people want to\r\nfight or flee when they get upset and we use upset as a kind of this\r\nall-encompassing garbage term emotionally they get depressed or\r\nanxious we don’t want to feel that way anxiety and anger are flee or fight\r\nfight or flee it’s our body saying there’s a threat you got to do something\r\ndepression is your body going I give up I just don’t I don’t even have the\r\nenergy to do it anymore behaviorally some people withdraw they\r\nshut down we all know people who get frustrated when they get overwhelmed\r\nwhen they start feeling hopeless or helpless they just kind of withdraw from\r\neverything and everyone’s addictions numb that out so they don’t have to feel\r\nthe dysphoria sleeping problem and changes when we start being on that\r\nconstant fight-or-flight hyper-vigilant sort of thing going on in the body is\r\nalways sort of turned on which means you’re not going to sleep as well then\r\nthe circadian rhythms get messed up which starts causing exhaustion and\r\nlethargy and then everything seems harder because you’re sleep-deprived and\r\nthen you start thinking more negatively and more hopelessly you see where this\r\nis going it’s a downward spiral and eating changes some people eat a lot\r\nmore because they’re eating comfort foods some people eat a lot less because\r\ntheir stomach is so torn up from the stress they can’t even think about\r\nholding anything down physical stress-related illnesses fibromyalgia\r\ngastrointestinal problems headaches neck aches backaches you know the whole\r\nthe gamut of it when you start feeling bad when you start hurting generally it gets\r\nfrustrating after a while and that frustration makes it kind of raises the\r\nthe bar brings you up a little bit so you’re\r\nthat is much closer to kind of just kind of being overwhelmed you don’t have as much\r\nof a cushion as you would if you were happy healthy well nourished not in pain\r\nand socially a lot of times we will get irritable or impatient with other people\r\nor withdrawal when we’re having these negative cognitions these thinking\r\nerrors that are keeping us in a dysphoric state these effects of\r\nthinking errors contribute to fatigue and a sense of hopelessness and\r\nhelplessness which intensifies thinking errors this is an important concept that\r\nI want my clients to understand and I want to drive home in this presentation\r\nso thinking errors what are they emotional reasoning feelings are not\r\nfacts and we want to help people to learn to effectively identify feelings\r\nand separate them from facts so if somebody says I’m terrified\r\nokay that is a feeling what are the facts supporting that feeling why are\r\nyou are terrified what is the evidence that you are in some sort of danger\r\nright now you know and danger may not be the right word for your client at that\r\na particular point in time but what’s the evidence that there’s a threat in what\r\nways are this similar to other situations maybe it’s triggering something from the\r\nscary past or you know you were too little to be able to\r\nhandle it but you can handle it now and how if you dealt with similar situations\r\nlike this, in the past, we want to help people just step back and get some\r\ndistance between their feelings and their thoughts and try to figure out you\r\nknow which thoughts are helpful and productive and even if a sought makes\r\npeople anxious or angry it can be helpful it may be telling them hey dude\r\nyou need to get your butt up and get out of there if it’s helpful it means it’s\r\nmoving them toward where they want to be happy healthy safe and values-driven\r\nlife so happy and helpful developed a stress tolerance skills when people use\r\nemotional reasoning they feel emotions which then they start attributing\r\nfinding the facts to support those emotions instead of looking at all the\r\nfacts we want to help them learn to tolerate their distress so they can kind\r\nof let that subside for a second they can accept their feeling they can name\r\nthey can say I’m scared I’m stressed I’m angry and whatever but they don’t\r\nhave to act on it right then they can tolerate the distress for a minute\r\nwithout having to try to make it go away and emotional regulation skills they can\r\nfeel a feeling without having to make it go from zero to 120\r\nyou know if they feel sad they go I feel kind of sad instead of grabbing onto it\r\nand going I wonder what I feel sad about I must feel sad about all these sad\r\nthings now I’m going to be sad and devastated so we want to\r\nhelp people learn how to regulate their emotions identify them accept them\r\nwhatever word you want to use and tolerate them because feelings are\r\nthere for a reason, they’re to tell you your brain thinks something’s going\r\nnow thankfully we have that higher-order cognition stuff going on so\r\nwe can contradict our brain and we can go you know maybe that’s not true in\r\nthis situation cognitive bias negativity mental filter whatever you want to call\r\nit people who focus on the negative they walk in they get up in the morning and\r\nthey look outside and it’s partly cloudy they get to work and they said instead\r\nof saying there was it was very light traffic they said there was a fair\r\namount of traffic everything is always the flip side of\r\nwhat somebody who’s optimistic would say so asking them what’s the\r\nbenefit to focusing on the negative in what ways is this helpful to you you\r\nknow some people say well it keeps me from getting disappointed because I know\r\nit’s going to end up negative anyway so we can trap challenges that know that\r\nwhatever it is they think they know and see if there have been exceptions when\r\nit hasn’t turned out that way what are the positives to this situation\r\nI give the example a lot of you know I wash my car or it rains and maybe I\r\nwanted to go out on a run that day but I can perceive it I can look at the\r\npositives you know the rain washed my car for me so I don’t have to do it now\r\nscore it watered my garden all the better it knocked down some of the\r\npollen out of there even better I can find and I can encourage people to find\r\npositives in a situation yes there are negatives to every\r\nsituation if you want to find them you’re going to find them but if you\r\nwant to find the positives you can too which takes us down to what are all the\r\nfacts there’s the positive and the negative and the neutral I told you\r\nearlier about the coin toss activity having people toss a coin on the\r\nheads days they act like it is just the greatest day to be alive and see how\r\nthings are different when they do their journal because you know I have my\r\nclients do I’m sort of a mindfulness check-in in\r\nthe morning and in the evening and preferably at lunchtime how are they\r\nfeeling what’s their emotional state what’s their energy level on the happy\r\ndays a lot of times it can be less and sometimes they need a little coaching\r\nthroughout because some of those old patterns kick in but I want them to\r\nstart challenging some of their automatic thoughts that we’re going to\r\ntalk about in a minute disqualifying or minimizing the positive most of us can\r\nprobably say we’ve had a bunch of clients that do this they are more than\r\nhappy to tell you about all the things that they mess up but then when they do\r\nsomething right they minimize it encouraging people to hold themselves to\r\nthe same standard they would hold everyone else to and I know I talked\r\nabout that earlier ask them things like would it minimum would you minimize this\r\nif it was your best friend’s experience your best friend came to you and said I\r\njust got into such-and-such college would you say awesome or would you say\r\nanybody can get in there how would that go ask them what is scary about\r\naccepting these positive things that you might have had an\r\naccomplishment for some people it means that it might mean other people expect\r\nmore of them for other people they just don’t know how to accept the positive\r\nthey don’t know how to accept compliments they don’t know how to be\r\nthe center of attention and they don’t like it and then we want to look at why\r\nthat is sometimes we disqualify the positive because it fails to meet\r\nsomeone else’s standards so as people might that be true here you know I know\r\nwhen I was growing up and going through college and going through school and\r\neverything got my doctorate but I will always be ever and always being not\r\na real doctor because a Ph.D. is not an MD and I’m like really\r\nso is it somebody else’s standards or can I feel good about having a Ph.D. egocentrism my perspective is the only\r\nperspective I’ll being egocentric but it doesn’t work\r\nmost of the time so encouraging people to take alternate perspectives\r\nmaybe you’re texting with someone and they say something that is not that you\r\ninterpret as not the nicest thing and this happens in a text messages a lot and\r\nthey get upset now an egocentric thinking error would say that purse is\r\njust grumpy today someone that’s taking other perspectives would stop and go\r\nback and read the text and go I wonder if maybe this could have been taken some\r\nanother way you know cuz their reaction is not what I intended\r\nso egocentrism if you hold on to that I don’t understand anybody else because\r\nyou know I don’t see a problem with anything personalizing and mind-reading this is when you assume that everybody’s\r\nfrowning because of something you did your boss walks down the hallway\r\nand looks at you and grimaces and continues to walk on oh I must have done\r\nsomething wrong no maybe he just got out of his senior management meeting that\r\nwas five hours long and he’s got to go to the bathroom you know there could be\r\na hundred different explanations for why that happened so encourage clients to\r\nask themselves what are some alternate explanations for this event that\r\ndoesn’t involve me you know why might this have happened if they hold\r\non to that, I must have done something wrong but as soon as their boss calls\r\nthem up and goes hey can you come to my office for a second you know where their\r\nthoughts are going to go I’m getting fired I’m going to get laid off I don’t\r\nknow what it was that I did wrong but he walked by me two weeks ago in the\r\nhallway and grimaced and I’m just I’m the worst person in the whole world\r\nbut where did that come from so encouraging people to not necessarily\r\nassume they know what’s going on in someone else’s mind and not\r\nautomatically attributing every person’s negative behavior to something they did\r\nhow often and then ask them how often has it been about you\r\nnow think about the last 10 times you’ve taken something personally how many of\r\nthose 10 times has it been about something you did versus something with\r\nthe other person then the availability heuristic remembering what’s most\r\nprominent in your mind so asking clients what are the facts ah the most obvious\r\none that we talk about is plane crashes you know it is way dangerous to fly on a\r\nplane because you hear about all those plane crashes well yeah you hear about\r\nA few planes crash but you don’t hear about the 20,000 every day that land\r\nsafely so you remember it and it seems more dangerous because that’s what is in\r\nyour mind that’s what is available to you that’s what you’ve based your\r\nthought processes on because maybe you didn’t know that 20,000 planes or more\r\nfly and land just perfectly every day this can also be true with people\r\nremembering what’s most prominent in your mind sometimes and this can be very\r\nvery true in domestically violent relationships if somebody falls in love\r\nwith someone and that person is just the greatest person since sliced bread for\r\nthe first four months and then the cycle starts and there’s this little tiny\r\na sliver of the honeymoon period after the battering cycle and the person’s like\r\nthat’s the person I fell in love with that’s what I remember and they try to\r\nfocus on what’s most prominent in their mind and they ignore the rest of\r\nthe stuff so we need to encourage people to look objectively at the facts magnification are you confusing high and\r\nlow probability outcomes what are the chances that this is going to happen how\r\nmany clients have we worked with that have gone to the doctor and gotten in a\r\nphysical or get a test run and then the doctor had to call them back and\r\nthis could be true for you too and the doctor had to call them back two or\r\nthree days later when the tests came back from the lab and that whole three\r\ndays they were just in a panic because they\r\nwere afraid they were going to get some terminal diagnosis so thinking about\r\nhigh and low probability outcomes another instance or example of\r\nmagnification is somebody that thinks this is the end of the world whatever it\r\nI think I’ve told you before my little story about um tripping when I\r\nwas walking down the hall at work and falling and yeah it was embarrassing my\r\nfolders went everywhere and yeah but in that big scheme of things will it matter\r\nthat much from now you know are people gonna think oh she is such a clutch she\r\nmust be a ditz too no I mean they may have thought that at that time I don’t\r\nknow but you know in six months nobody’s going to remember and then ask them in\r\nthe past when something like this has happened when you’ve had to get a test\r\ndone and you’ve had to wait on results or if you’ve done something that was\r\nembarrassing and you didn’t think you thought everybody was going to remember\r\nit forever how did you tolerate it how did you learn to deal with it building\r\non those strengths that they already have all-or-nothing thinking errors\r\nthese are things like love versus hate I love them or I hate them it’s all or\r\nnothing she does this all the time or she never does it if I’m going to do it\r\nI’m going to do it perfectly or I’m not going to do it at all thank you all good\r\nintentions or all bad intentions you know sometimes we do things with good\r\nintentions that have some bad repercussions so did we do it with all\r\nbad intentions are all good intentions and the answer is neither most of the\r\ntime life is kind of in that middle-ground gray area encouraging clients to\r\nlook and find examples where something hasn’t been one of the polls when having\r\nthey do something that they’re proud of that wasn’t perfect or when again\r\nwhen has somebody else done something that they were proud of that wasn’t\r\nperfect remembering that with availability\r\nheuristic remembering how often something really happens and how long it’s\r\nbeen since you’ve seen that behavior and remember that sometimes good times are\r\namazing but how frequent are they compared with the bad times another thinking error is a belief in a\r\njust world or a fallacy of fairness I just asked clients to identify for good\r\npeople you know who’ve had bad things happen and in reality we all have bad\r\nthings happen good people do bad people do in between people do attributional\r\nerrors and this is a pet of mine you know labeling yourself is not a behavior so\r\nglobal versus specific and I am stupid versus I’m stupid at math I don’t have\r\ngood math skills it’s not about me it’s about the skills I can change skills\r\nstable I am and I always will be versus it’s something I can change it’s\r\nsomething I can learn internally it’s about me as a person versus it’s about a\r\nskill deficit or something I could learn or change and there’s you know lots of\r\ninformation on attributions out there on the internet if you need a refresher on\r\nit but we find that a lot of people who have dysphoria have negative global\r\nstable internal attributions so questions for clients remember the\r\nbeliefs equal thoughts and facts plus personal interpretation another way of\r\nsaying it is reality is 10% perception is 10% reality and 90% interpretation so\r\nwhat are the facts for and against my belief is the belief based on facts or\r\nfeelings do the belief focus on one aspect or the whole situation does the\r\nbelief seem to use any thinking errors what are alternate explanations what\r\nwould you tell your child or best friend if they had this belief how would you\r\nwant someone to tell what would you want someone to tell you about this belief so\r\nif you’re telling somebody about this what are you hoping they’re going to say\r\nin return and finally, how is this belief moving you toward what and who is\r\nimportant to you or moving you away from what or who is important to you now they\r\ncan do a worksheet and have all of these or you can pick one or two of these\r\nquestions that are most salient for your clients but they can have kind of at\r\ntheir fingertips so as they’re going through the day and something happens\r\nthey can ask themselves ok what’s an alternate explanation or you know\r\nwhatever it is this is salient for that client’s irrational thoughts about how to do these\r\nthoughts impact the client’s emotions health relationships and perceptions of\r\nthe world you know this is what we want to ask them how is this thought\r\nimpacting you globally how may this thought has been helpful in the past\r\nwhere did it come from how does it make sense from when you formed it in the\r\npast when you’re dealing with it ask the person if the thought is bringing you\r\ncloser to those that are important are there any examples of this thought or\r\nbelief not being true and how can the statement be made less global less\r\nall-encompassing so it’s about a specific incident a specific situation\r\nless stable which means you can change it and less internal which means it’s\r\nnot about who you are as a person but maybe something that you do or a skill\r\nthat you have so we’re going to go through some of these thoughts real\r\nquickly here mistakes are never acceptable and if I make one it means\r\nthat I’m incompetent well never is kind of stable and I am incompetent is kind\r\nof global that’s also that extreme all-or-nothing thinking so you can see\r\nwhere these cognitive distortions end up leading to unhelpful beliefs\r\nwhen somebody disagrees with me it’s a personal attack well there’s\r\npersonalization if I ever heard it before maybe it’s not about you may be\r\nthey’re having a bad day and you just happen to be the unlucky target or maybe\r\nthey’re disagreeing with you because they have a different point of view and\r\nit’s not a personal attack it’s just their point of view if someone\r\ncriticizes or rejects me there must be something wrong with me\r\npersonalization all-or-nothing thinking global stable and internal something\r\nwrong with me as a person to feel good about myself others must approve of me\r\nnow this is one we’ve talked about external validation before and we can’t\r\ncontrol other people to feel good about yourself how can you do that\r\nbesides necessarily requiring other people to approve of you to be\r\ncontent in the life I must be liked by all people Wow I’ve never met anybody who’s\r\nliked by all people I’ve never even met anybody who’s been hated by all people\r\nbut it’s important to help clients see how this is dramatic to say all\r\npeople and for them to be content then everybody has to like them\r\nI mean I like to be liked but if everybody doesn’t like me you know\r\nthat’s pretty understandable my true value as an individual depends on what\r\nothers think of me I would challenge this one this is all you know\r\nalso, very personal internal I would challenge people to look at and say it\r\nso your child’s value as an individual depends on what other people think of\r\nhe or most people would say no but the perspective thing nothing ever turns\r\nout the way, you want it to okay all-or-nothing thinking and probably\r\nthe availability heuristic if something bad just happened then they may be focusing\r\non that which causes them to focus on all the other bad things in the past\r\nthat have happened not to focus on that is okay you know bad thing\r\nhappen but look at all these good things I won’t try anything new unless I will\r\nbe good at it this fear of failure fear of rejection\r\nit just really paralyzes a lot of people when they get stuck with that thinking\r\nthe area that they have to be perfect I am in total control of anything bad that\r\nhappens is my fault well that’s egocentric and personal if\r\nthey think they’re in total control that’s their perception of how the world\r\nare they think if they’ve got everybody on marionette strings anything\r\nbad in the world that happens is their fault how powerful are they\r\nI feel happy about uh if I feel happy about life something will go wrong\r\nit happens sometimes but let’s look at times when you’ve been happy that\r\nsomething hasn’t gone wrong you know let’s get rid of that all-or-nothing\r\nthinking it’s not my fault my life didn’t go the way I wanted could be true\r\nbut it seems like that’s making you unhappy so what do we do about that if\r\nI’m not in an intimate relationship I’m alone\r\nno, again that’s pretty extreme I’m either in an intimate relationship, or I\r\nam alone and a loner and you know it’s just me and my 17 cats which follows\r\nwith there’s no gray area so encouraging people to look at what these\r\nbeliefs are saying important thoughts impacts behaviors and emotional and\r\nphysical reactions emotional and physical reactions impact thoughts and\r\ninterpretations of events so if you do something and it’s pleasurable\r\nand you have a great physical reaction you know let’s take bungee jumping or\r\nskydiving if you go out there and it’s scary but you do it and you’re just like\r\nwhoa what a rush your interpretation of that is probably going to be good which\r\nmeans you’ll probably do it again if you go out there and it’s just the most\r\nhorrible experience you’ve ever had you’re probably not going to do it again\r\nand your interpretation of it is going to be not good which is going to make it\r\nhard to understand why other people would do it irrational\r\nthinking patterns are often caused by cognitive distortions so let’s just look\r\nback at some of those because there are a lot fewer cognitive distortions or\r\ngeneral ways of thinking about the world then there are thinking errors because\r\nthere are lots and lots of thinking errors cognitive distortions are often schemas\r\nwhich were formed based on faulty inaccurate or immature knowledge or\r\nunderstanding and by identifying the thoughts of the hecklers you know the\r\nautomatic tapes that are maintaining our unhappiness the person can choose\r\nwhether to accept those thoughts or change them\r\n\r\n&nbsp;\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/313690\/pexels-photo-313690.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=EpWfDdY4-vk\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\nThis solution reverses kidney disease! Guaranteed to be effective or your money back: <a href=\"https:\/\/hop.clickbank.net\/?affiliate=flywait&amp;vendor=empoweredh\" target=\"_blank\" rel=\"noopener\">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.<\/a> \u201cThank God I came across your solution by accident! Dad\u2019s kidney function decreased from 36% to 73% in just two months. He\u2019s 90 years old! His doctor said people his age shouldn\u2019t have kidneys that efficient!\u201d Graeme Asham, QLD, Australia, And this\u2026 \u201cNo more dizzy spells! My creatinine has gone down from a staggering 1800 to 1100. My blood count has greatly improved and I\u2019ve been taken off my blood pressure medication. Your solution works! \u201d Joe Taliana, 55, Malta Simply follow the scientifically backed solution and restore your kidneys, fast! =&gt; <a href=\"https:\/\/hop.clickbank.net\/?affiliate=flywait&amp;vendor=empoweredh\" target=\"_blank\" rel=\"noopener\">This solution reverses kidney disease!<\/a> \u2190 <a href=\"https:\/\/www.facebook.com\/100000332115031\/videos\/590895892954739\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.facebook.com\/100000332115031\/videos\/590895892954739\/<\/a> \u044f\u03b1\u2113\u03c1\u043d \u2113\u0454\u03b1\u043c\u03b1\u0438","protected":false},"excerpt":{"rendered":"<p>&nbsp; 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 &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150330\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Cognitive Behavioral Therapy (CBT) Skills and Counseling Techniques with Dr. Dawn-Elise “Doc” Snipes<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150327,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1,138],"tags":[37889,37888,37890,37897,37895,35259,59993,37884,37896,37898,37891,37879,37902,38039,39729,37878,59843,59867,37901,59809,59802,37908,37893,37894,37881,37877,37876,37880,37883,37882,37907,37892,37903],"class_list":["post-150330","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anxiety","category-community","tag-addiction-ceus","tag-addiction-counselor","tag-addiction-training","tag-cadc","tag-cap","tag-cbt","tag-cbt-skills","tag-ccapp-ceus","tag-ccdp","tag-ccjp","tag-certification-training","tag-ceus","tag-cheap-ceus","tag-cognitive-behavioral","tag-cognitive-behavioral-therapy","tag-counseling","tag-counseling-skills","tag-counseling-techniques","tag-counselor-education","tag-donnelly-snipes","tag-dr-dawn-elise-snipes","tag-homestudy-ceus","tag-ladc","tag-lcdc","tag-live-webinars","tag-lmhc-ceus","tag-lpc-ceus","tag-mental-health-ceus","tag-naadac-ceus","tag-nbcc-ceus","tag-online-ceus","tag-online-education","tag-unlimited-ceus"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2023\/03\/htmlF_IMG_6418c8ac3bc08.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150330"}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150330"}],"version-history":[{"count":4,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150330\/revisions"}],"predecessor-version":[{"id":150390,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150330\/revisions\/150390"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150327"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150330"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150330"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150330"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}