 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. So I'd like to welcome everybody to today's presentation on cognitive behavioral therapy interventions. We're going to be talking today a lot about what I call group activities, and I use that term kind of loosely. These activities I found can also be effective if you give them to a client to take home and use for as a family activity, family interactive thing. It can help disseminate the tool. It also helps your client to whom you teach the tool, solidify that tool in his or her brain, and figure out if there are any aspects of the tool that he or she is not quite comfortable with yet. So teaching, I always say you don't know what you don't know until you try to teach it, and then you really realize. So it is something that you can use with them. Group activities and group counseling obviously is a cost-effective way for people to access our services. From our perspective, you get more money per hour. So a lot of people do do groups in order to increase their revenue, which is why I've been focusing, if you will, of past couple of weeks on providing some group activity tools. Because one thing that they don't teach us a lot in graduate school is how to do group. I mean, they teach you the basics of group therapy, but as far as what kind of activities can you do? My goal is to provide you some activities, but also to help spur your creativity so you can see how you can take a worksheet that you see in a self-help book and turn it into a group activity that you can use with your people. So we're going to explore ways to teach cognitive behavioral interventions in group. That's pretty simple. So the basis of cognitive behavioral therapy is changing thoughts or your cognitions has a direct impact on the physiological response, the urges and behaviors people experience. Before they start launching into CBT groups, they need to understand what's the foundation, why are we doing this, how is this supposed to help me? Changing behaviors has a direct response on thoughts and emotional reactions. So I encourage people to think of a time where they had to do something they didn't really want to, and they went into it with a grumpy attitude, and they drug their feet and they griped about it the whole time, versus going into something they didn't want to do, and they tried to make the best of it and their actions reflected that. How did it feel? How much more stressful was it? Also thinking about how you react to things, whether you choose to give it your energy versus choosing to just let something go. At its core, Cognitive Behavioral Therapy or CBT has the principles of noticing what you're feeling and what you're thinking, understanding what you're thinking. Think about the ABCs, your automatic beliefs, you're trying to identify what those are and understand where they're coming from, and then addressing the thoughts, feelings, and behaviors. So you go through and you figure out which of these thoughts that I'm having are helpful, which are unhelpful, and what can I do about them? Another part of Cognitive Behavioral is the Functional Analysis, which is the process of identifying the antecedents or the causes and triggers of behaviors and feelings and consequences, the positives and negatives of those. Again, think of your basic ABCDE, activating event, automatic beliefs, consequences, then you dispute the automatic beliefs, and then you evaluate your reactions and your outcomes to see if it's helping you get to your ultimate goals, or if it's keeping you stuck or just wasting a lot of energy. When we do a functional analysis, we ask people generally they come in and they said, I had a really awful fight with my significant other and I am so angry about it. Okay. That's something that we can talk about. You had a fight, that was the trigger. Your response or your consequence was that you got angry. What happened during that discussion, during that argument that caused you to feel angry? What were the emotional causes of the argument? That was another antecedent that led up to the argument, but what were the emotional causes of your anger? What were the mental causes? What thoughts did you have that contribute to you being angry and still being angry? For example, maybe it felt like your significant other wasn't taking your feelings into account or you were being disrespected or you were feeling powerless. Were there any physical causes that contributed to your ultimate reaction, emotional and behavioral? Sometimes being exhausted or being hyped up on caffeine or having low blood sugar, all three of those things can be physical causes that can exacerbate your consequence or your reaction. We want to look at those. What were the social triggers that might have caused you to feel more angry in this situation? Was there an audience or did you talk to your girlfriend about it later or your best friend? And they kind of stoked the fire a little bit. And environmentally, what were the causes of your anger? Was there something going on? Maybe your significant other picked this fight in front of people which made you feel even more self-conscious and powerless and added to your anger about the whole situation. So we want to look at what is fueling this anger because we remember anger is part of the fight-or-flight response and it indicates that there's a threat. So we want to look at what was causing you to feel threatened at that point emotionally, mentally, physically, socially and environmentally. And then we look at the consequences of the behaviors. You got angry and you screamed at your significant other or you stormed off. So what were the positive consequences of storming off? Emotionally, you may have felt a little bit more powerful because you were the one who ended the conversation. You were going to take your ball and go home. Thank you very much. The mental effects of storming off. What are you thinking now? What are your, how are you thinking about your anger? How are you reacting? What are your thoughts about the threat level? Physical consequences of storming off. Well, initially you're probably revved up, but probably when you walked off and you left the situation, your blood pressure started to go down and physically there were some rewards to leaving that situation. Socially, what were the consequences? Not only with the audience, whoever it was, but with your significant other. And generally, if you're in an argument and you go storming off, that has a negative consequence. So I want to start listing all of the positive and negative consequences of your ultimate behavior and reaction to see, did this get you where you wanted it to be? And, you know, if not, where did you want to be and how could you have maybe acted differently, addressed your thoughts in order to get to the point you wanted to be at. But it's important and I stress this frequently to really consider the biopsychosocial consequences, triggers, really look at the big picture, not just what were you thinking in the moment, but what else was going on? What was the environment like that may have been, you know, stoking the fire? What was the, did you have any physical vulnerabilities that may have added fuel to the fire? You had those thoughts, but then you were already feeling vulnerable, which triggered a more, a stronger emotional reaction. So the first thing that we look at is problem identification and solving. And we talk about just basic principles. Stop, use self-talk, distress tolerance and or relaxation techniques to restrain impulsive actions. For those of you who are new, I'll share the B philosophy. Assuming you're not like deathly allergic to bees, but if a bee lands on your arm, for most of us, whether it's a bee or a fly or anything, our automatic reaction, our urge is to brush that bee off. It's our impulsive response when we feel something on our arm. However, if you swat at the bee, you're a whole lot more likely to probably get stung. So the problem in this case is the bees on your arm. So if you stop and you use positive self-talk and you take a break and you think about what's the outcome I want here? I want the bee to get off of me and I want it to not sting me. Well, what's the best response? The best response is just to kind of wait it out and tolerate the bee being there until it gets bored or whatever bees do and fly off instead of swatting at it. So we want to help people stop that impulsive swat reaction because a lot of times that ends up causing negative cascade effects. So stop, figure out, and this is probably one of the hardest parts of the whole thing for most of our clients, helping them figure out when they get upset. They've got those adrenaline blinders on. They are feeling dizzy. They've got so much adrenaline going. How do you get them to stop for a second so they can identify the problem, develop alternative solutions, explore the short and long-term consequences and outcomes, choose a response and evaluate the outcome? When you say all that, the client's going, I ain't got time for all that, but once they practice it, it really goes a lot faster. So one of the first things I ask clients is to figure out how to practice the pause. How do they get themselves to stop? And we brainstorm this in group because it's different for each of your clients. Sometimes when they get upset, they have a rubber band that they flick on their wrist to remind them that they need to breathe. Some clients count at 10. It does take a lot of practice and dedication, and I encourage clients to be mindful of the fact that you're not going to stop and pause every time you get upset, probably for the first six months that you're trying to do this because that's not your normal reaction. Your normal reaction when you get upset is to lash out, is to run away, is to bury your head under the covers, whatever they do. So it's important to understand that that's worked for them for a while, and while they want to change it, change is not easy. So they're not going to be perfect, but what we want is to get closer. We want them to start trying to remember to practice the pause. What techniques can you use to get through the initial adrenaline rush when your clients are upset? What kinds of things do you have them do in order to help them sort of diffuse the moment? To help get that adrenaline out of their system, get their blood pressure and their heart rate back down because when they're in that fight or flight, state of mind, it's going to be harder to think quite as clearly. So one of the things I have teach my clients is combat breathing. Works for some, not for all. So that's fine. Combat breathing, you breathe in for four, hold for four, exhale for four. When your respiration slows, your heart rate naturally follows suit. So they start kind of getting out of that fight or flee mindset, if you will. So that behavior has a direct physiological effect on not only their heart rate and their breathing, but the brain is sending out the calming neurotransmitters to go, okay, the threat's gone right now. Even though nothing really has changed all that much, except for the fact that they have taken charge of the situation. I encourage clients, sometimes they can't think about how they practice the pause or what they do. Because they're so charged up during those upsetting situations. So I asked them to describe the time they get upset and they effectively managed it. Because everybody has gotten upset and effectively managed it before. I have never met anybody yet who says, well, I've never, ever managed a situation when I've gotten upset. Well, think about a time when you got upset with your boss or you got upset with a cashier or you got upset with your in-laws, someone who might not be as safe, if you will, to lash out on. Not to say that you should lash out on people, but we tend to behave differently and handle things differently and sometimes better with those who are not as close to us. So we talk about when you effectively managed a situation, how did you do it? Because your boss really ticks you off, you're not going to scream at him and show out. So how do you practice the pause and choose a different behavior? And then we talk about examples, which are typically easier to come up with, of a time the client got upset and didn't effectively manage it. And then we compare the differences. And sometimes we can put this up on the board, draw a line down the middle, effective management, ineffective management. And we start identifying things that people do when they effectively manage. But what I want them to really start looking at is the fact that they have the ability to effectively manage emotional distress and start brainstorming ways they can remember to take a deep breath, to feel empowered to handle the situation and then to start taking the next right steps. So then we move on to practicing identifying the problem, going back to one of those issues. Who was involved, thinking broadly about it, not just you had a fight with your significant other when you were at your in-laws for Thanksgiving. Okay, so who was involved in this? And if it happened in the middle of Thanksgiving dinner, heaven forbid, or in the middle of a crowd of your relatives, then they're kind of all involved because there's more of an audience going on. And the person who is not a blood relative may feel more on the spot than the person who is related to everybody. They may feel less defended. So thinking broadly about who was involved in this situation, what happened? Explore it objectively. Not he made me or yada, yada. I want you to step back and pretend that you were a police officer who walked in and observed it or a fly on the wall or whatever you want, a thing you want to use to describe it. But I want you to explore it objectively. What actually went on and who said what, what actions happened? When did it take place in the chain of events? So we want to look at, what else was going on? You know, maybe you got to your in-laws and I know for, in my case, we would get to our in-laws and they lived like an hour and a half away and I would get terribly car sick. I just don't travel well in the vehicle. So if I got to my in-laws, I was already usually not in the best of moods because I was a little bit green. So when did it take place in the chain of events? Well, if something happened, as soon as we walked in the door, I would typically probably struggle to handle it more than I would if I had had 30 or 30 minutes or an hour of not moving in order to get my land legs back again, so to speak. So looking at other vulnerabilities that may have kicked in, where did it take place? Is there a significance to this place? So again, if it takes place at your in-laws' house and you have no blood relatives there, so it feels like it's them against you, then it can be very intimidating. And then exploring, why did it happen? Why did you get into this argument? Why did you choose to put your energy into this argument at this particular point in time and why did it bother you that this happened? And I mean, there's some obvious reasons to why getting in a knockdown throw... What is it? Throw down in the middle of a family reunion or a family gathering would be bothersome, obviously, but you want to look at what specific things about this situation really bothered you. So encouraging people to really look deeply into what's going on so they can start understanding what makes them tick. Once they start understanding what makes them tick, it's easier for them to draw connections later. Encourage them to identify alternatives. What was your immediate response? You know, your immediate response was to scream and storm out of the house. Well, all right, so we can look at the benefits and drawbacks of that. What are some alternatives that you could have done and what would be the benefits and drawbacks to that? So again, as a group, you can put on the board, I usually choose common themes that come up in my group and I'll use those as examples, but you can put up on the board, got into a fight at Thanksgiving, stormed out of the house. So then you can start listing what are alternate responses you could have done right away when your significant other said something that triggered you besides getting into a fight and storming out of the house. So you start brainstorming those and then looking at the benefits and drawbacks of each, how they make you feel, whether it resolves the problem, etc. And then looking at alternate responses for the future. Choose an implement a response. So looking back, whatever we're talking about in group has already happened, we're looking back in armchair quarterbacking. So choose a response and then have the person's hypothesize how it would have gone if they had chosen to not get into that argument or chosen to ask their significant other to step outside to talk about whatever the issue was. And how would that have gone differently? So encourage them to start brainstorming and looking at ways they can handle distress. Contracting. It's another cognitive behavioral thing that we can do. You can contract with yourself, which is doable. But we tend to find in the research that people are more responsive and tend to stick to their contracts more if somebody else knows about it. So contracting, if you and your best friend are both going to try to get in shape, you can do a contract and you swap it with one another. You share because they'll hold you to accountability. In contracting, you identify the problem or the target behavior. What do you want to do? Get in shape. And identify a new behavior. And this would be going to the gym. Identify rewards. What are you going to do to reward yourself for going to the gym? And you may think, well, exercise is rewarding of itself and losing weight is reward in and of itself. Exercise sometimes leaves you sore and you're not always going to lose weight. So we want to put other rewards out there. We want to make sure that this stays reinforcing for people. Then encourage them to actually write the contract down. Have it down in black and white because it's harder to misremember contingencies if they're written down and monitor the behavior. So you want to make sure in this case, you're monitoring how many times you go to the gym, what you do when you're at the gym, etc. This is good to help people learn how to monitor their own behavior. When they start feeling like they can change their behavior, they're empowered to start making other changes in the rest of their life. We'll practice in groups sometimes, identifying a new behavior that each person wants to start doing. And it could be journaling. It could be practicing mindfulness. It could be exercising, whatever it is. And each person writes a contract. And hopefully there's somebody else in the room that has a similar goal. But if not, it doesn't really matter. If somebody wants to practice mindfulness and somebody else wants to start getting in shape, they can still look at each other's contracts and hold each other accountable each week in the contracting process. So target behaviors, persistent worrying, not getting out of bed, anger outbursts, smoking, stress eating, or caving, or being overly passive. So when we're talking about setting a contract and changing behaviors, one of the first things we need to do is identifying the antecedents of each. That is what's causing the persistent worrying. If you're experiencing persistent worrying and it started when you started getting poor sleep and overdoing it on caffeine and maybe you had a bunch of stressful events back to back to back. Okay, so those were the antecedents. Your target behavior is to worry less. One of the things that maybe you're worrying about now is you're starting to have more panic attacks or panic episodes, maybe not full-blown panic attacks. So encouraging the person to look at what triggers those panic episodes and what can you do differently? What are some alternate behaviors? Identify the benefits and drawbacks of not only what you're planning on doing to deal with it, but the persistent worrying. What are the benefits to worrying? Well, if you're doing it, there's some sort of reward in it. What's the benefit? A lot of times worrying is almost a way of trying to hold on to control of something that hasn't happened yet. You're worried about what's going to happen and you're putting your ideas into all the things that could happen, so you're trying to plan and you're trying to figure out how you're going to handle these things that haven't even happened yet. Well, that's a way of holding on to control when you feel disempowered, when you feel out of control. So what else could you do? What would be an alternate behavior? To help you deal with the worry and feel more in control so you don't feel like you have to worry about things that haven't even happened yet. What are the benefits to not getting out of bed? Well, I can think of quite a few benefits. Some of the drawbacks, though, are that you get achy. You actually get more tired. You disrupt your sleep cycles, so you're not sleeping as well, even if you're sleeping more. And you don't get to engage in some of the other social activities that you may want to. When clients are clinically depressed, a lot of times one of the issues they have is just not having the energy or desire to get out of bed. Maybe they get to work all week, but then on the weekends, they're just done. So we want to look at, again, what's maintaining this behavior, what's making this rewarding to stay in bed, and what are some alternate things that you could do. Sometimes people, like I said, they get to work all week, and on the weekend, they have just had all the input they could take. They were already just barely hanging on, and they had so much input during the week. During the weekend, they were just like, I want to stay in bed with the coverage over my head and hide from everyone and everything. They can't take more input. All right. So what can you do besides staying in bed that doesn't involve additional input? Maybe going out hiking, maybe getting up and reading a book, or baking, or doing something that keeps your circadian rhythms in whack, if you will, but doesn't over-stimulate you. And taking frequent breaks. There's nothing wrong with taking breaks. You just don't want to sleep too much during the day, or your body doesn't know when it's supposed to sleep. Anger outbursts, and you just go through each one of these target behaviors and look at what's the benefit of this. Well, if I have an anger outburst at somebody, they're either going to leave me the heck alone, or I am going to get power over them, and I'm going to dominate the situation. So again, they have no power. One way or another, I'm getting my power back. Okay. So we want to look at what triggers your anger outbursts. Why do you feel disempowered, and what could you do differently to feel more empowered? And you can, like I said, you go through each one of these. I'm not going to do that in this presentation. These are common target behaviors for a lot of our clients. So they can be easily done in group. Again, looking at what causes each one of these things, what causes you to want to smoke, what causes or triggers your stress eating, in what situations, or what causes you to, and I use the word cave, or be overly passive, and then look at what are the benefits and drawbacks to doing this, because there are benefits. And in order to change this behavior, we've got to find an alternate way to find an alternate solution that has the same benefits. And then you start identifying the alternate ways of dealing with the behavior. So a lot of brainstorming here, the great thing about group is the fact that you've got multiple different perspectives, multiple people that have different learning histories to share what works for them, or what they think might work. The same thing in group, or if they're doing it in a family activity, identifying persistent worrying. My son's getting ready to take the ACT right now, and he's kind of freaking out about it. And he took one of his practice tests last weekend, and he didn't do so well in his mind on the first half, and he was just distraught during that 10-minute break. And I had to go in and be like, okay son, worrying about this right now is just going to impede your performance on the next half. This is a practice test. It has no consequence. So let's look at what's going on, how's it affecting you right now, and the fact that you've got to be able to handle this distress during the real test, even if you feel you didn't do well in the first half, you've got to be able to de-escalate yourself so you can take the second half of the test. And we talked about what he might do to help de-escalate himself so he could get refocused. Cognitive distortions, and this is total CBT. Cognitive distortions underlie a lot of the distress and unhappiness that comes from our automatic thoughts. So personalization, when something happens, assuming, telling yourself it's my fault, or that person did that just to hurt me, that person hates me, taking everything personally typically makes people very unhappy, because in reality, a lot of times it's not that personal. It has more to do with the other person and where they were, they may not have even seen you. They were just off in their own little world. One day I was waiting for my kids to get out of Taekwondo, and I was doing something on my mobile device, and my daughter asked me later, she's like, what did somebody in the waiting room do that got you so upset? And I'm like, I didn't have any idea what she was talking about. She's like, oh yeah, somebody started laughing, and you just got this dirty look across your face. And I'm like, oh, I don't know. I was in my own little world. I have no idea what they were talking about. It was probably something I was reading on my mobile device. So encouraging clients to look for alternative explanations for why something may have happened. Exaggeration, making a mountain out of a molehill or seeing the worst case scenario. Encouraging clients to look at this and say, in the big scheme of things, how big of a deal is this and how likely is the worst case scenario to happen? Generally it's a pretty slim margin. All or nothing, viewing things in dichotomous terms, encourage them to look for a both and scenario or exceptions. She does this all the time. Well, let's look for a time when she didn't do it, or I fail every test. Well, let's look for a test that you've passed. So you want to look for exceptions. Availability heuristic comes down to data, and I like data. You may think that flying on an airplane is dangerous because you've seen all those stories about airplanes crashing. Well, yeah. But when you look at it, how many flights go up every day and how many actually crash? And you drive your car every day. You don't think much about it. How many car crashes are there every day? But you don't hear about those, so it doesn't feel as dangerous. Encourage people to look at the data. There's actually data that shows it's more dangerous to drive than to fly. For those of you who felt comfortable driving, sorry. Minimization, not giving credit where credit is due. When you do good things, a lot of times people who have a negative self-image minimize what they did. They're like, ah, anybody would have done that, or it's not a big deal. But when other people would do it, they'd be like, oh, that was so wonderful that you helped that person pick up their groceries when the bag broke. Another way they may minimize, which makes them miserable, is when other factors are involved. You know, maybe you went to work and you had to do a project and you just didn't do your A work. It was, you know, barely passable. And you look at it and you start beating yourself up for it. And you're like, that was barely passable. That's inexcusable. I am just like the worst employee ever. Well, let's back up. What other factors may have gone into you doing this stuff that was possible, but barely? Oh, wait a minute. There was a crisis down on the main unit and you spent six hours waiting for the crisis stabilization team to get there. And then you had less time to do your notes. You know, so look at other factors that may have contributed to poor performance, if you will, or contributed to emotional upset. Not just taking it personally going, well, it was all me. Well, you know, when you get into an argument or a disagreement with somebody, there's generally another person involved. So consider the factors there. Were, you know, what part were you responsible for? And I used the finger explanation. Two fingers point out to the other person. They had the two parts in it and you may have had three parts in it. You know, just because we have five fingers, it can't be even. But making sure to take into consideration the other factors and selective abstraction, seeing only what fits your mood or perspective. If you're in a bad mood and you think people are evil and awful and miserable, then when you go out, what are you going to notice? Are you going to notice the random acts of kindness? Or are you going to notice the people that cut you off and take your parking space and do ugly, nasty things? And you can actually have clients practice this. By flipping a coin and pretending one day to be in a really bad mood and see what they notice. And pretending on another day to be in a really good mood and see what they notice. And help them see that their mindset will impact what they pay attention to. So activity, go back through each distortion and have clients give examples of when they've used each one, like minimization. When did you do something really good and you just didn't take credit for it? Discuss why each distortion may develop. Why would we minimize when we do something good? Well, a lot of times people don't get credit for when they do something good. They only get feedback when they do something wrong. So they pay attention to what they generally get feedback for, what they do wrong. So they may not have ever learned to give themselves credit for the good things. Explore the benefits and drawbacks of each distortion. And you're like, what benefits and drawbacks? Personalization, what is the benefit to taking everything personally? Well, if I take everything personally and I'm already feeling bad, then I'm prepared so nobody can surprise me by hurting me. If I exaggerate, if I look for the worst case scenario, what's the benefit? Well, I get myself all riled up. That's a drawback. But again, if I already expect the worst, then anything else that happens is a bonus. Kind of backwards reasoning there. But make sure clients can identify and understand that there is a benefit to why they've used this so far. But they also need to look at the drawbacks. If you use some of these distortions, if you use personalization, it's probably going to make you more anxious and negatively impact your self-esteem. And then have them identify ways to address each distortion. So personalization, I call it less ego, more happy. Letting go of the, it's all about me and just being in the moment and accepting the fact that somebody else may be having a bad day. And obviously looking at your part in it and checking it out, going, did I do something that contributed to this? If yes, do something about it. If no, let it go. How do they address exaggeration? Looking for the likely outcome instead of the worst case scenario. Mind reading and fortune telling, I'm going to jump down to that one. I call it stop being an ass. Because a lot of times people who mind read or fortune tell, assume they know what you're going to do. Assume they know what you were thinking. And it causes a lot of conflict in relationships. So encouraging people to use effective communication skills and paraphrase and check to find out, you know, if they know what's going on before they assume. The ABCDEs, we already talked about a little bit. You're activating event. B is your automatic beliefs about that event, which leads to see the consequences, which usually is getting upset. D, dispute automatic beliefs. So you go back and you go, which of these are rational? Which of these are on point? Which of these have cognitive distortions in them? And then adjusting any distortions so they're more realistic. And E, evaluate the effectiveness of your reactions. You know, you get cut off in traffic. Your automatic belief is that person was disrespectful. They were being rude to you. They have, you know, they could have killed you. You could have been in a car accident. Well, yeah, all those things are possible, but probably relatively unlikely. So the effectiveness of your reactions, screaming at them and, you know, maybe speeding up and flipping them, driving next to them and flipping them the bird. How effective is that? Does that change their behavior? Does that stop them from doing it again? Does that make you safer? Probably no on all accounts. Did you burn up a lot of excess happy chemicals and energy? Probably a yes. So what would be a more effective reaction? So again, target behaviors. Identify three things that trigger your anxiety. For me, you know, bridges. Y'all know I have an irrational fear of bridges. Authority figures, tests, relatives coming to visit with holidays coming up not too long. That's going to become a more prominent theme. Three things that may trigger clients anger, tailgating, lying, computer problems. That's me. Laziness. So I think I did four for each of those, not three, but those give you primers, if you will, to put on the board. And you want to start just kind of brainstorming. Things that trigger anxiety and things that trigger anger. And then apply the ABCDEs to them. Talk about what the beliefs are that produce the consequences of anger or anxiety. Then go back and really look, examine the automatic beliefs and evaluate the effectiveness of their reactions. You know, getting angry or anxious. And what could you do differently that would be more effective? Cognitive restructuring or the middle path, literally changing your thoughts, helps clients find meaning in the current event, challenge the interpretation and develop a both and perspective. I encourage clients to think about unhappy events or things that cause them anxiety or stress. They've already identified a bunch of them in other activities. And think about how you could change your perspective. I have some other prompts here in case they can't come up with any. Some people, they get ready to go into an interview and they are terrified. It's very threatening to have to go in and, you know, put yourself out there and risk rejection. So how can they view it as a challenge versus a threat? Same thing for public speaking. Some people are terrified of getting up there and just like drooling on themselves or something, forgetting everything. And that can be very threatening to look foolish in front of other people. How can you look at it as a challenge? And sometimes it takes some talking in order to figure out how to look at it as a challenge, which is something I can do. You know, if I'm challenged to run a mile in eight minutes, I think we'll be able to breathe at the end, but I don't see it as a threat. I see it as a, okay, you want me to do that, bring it. And that's the kind of attitude I really want my clients to have is that I can do this or at least I can give it my best shot. Failure versus a learning experience. When a relationship ends, sometimes people look at it as, you know, that relationship was a failure or I'm a failure in relationships. But, you know, instead of looking at it as a failure, maybe looking at it as what can I learn from this relationship? So my next one doesn't have the same hiccups. Hobbies are another more benign example. You know, you try to do something. When we move to Tennessee, I'm still learning because the ground is very different in Tennessee versus Florida. I go out, I plant my garden, and some crops do really well and some crops fail miserably. And this year my harvest was pretty pitiful. Now, I could get upset about it and I could view it as a failure and be like, I'm never doing that again. Or I can view it as a learning experience, which I did. And now I know, you know, what's going to work in my soil and what some of the potential problems were. So I don't make that same mistake next season. A loss versus an opportunity. Sometimes people lose jobs. They get fired, they get laid off, whatever. Okay, you lost it. Can't change that. So do you want to dwell on the loss? And sometimes they need to grieve it, don't get me wrong. But how can they view it as an opportunity to move to bigger, better things or to experience life in a different way? And powerless versus empowerment. Forgiveness is one issue that really comes up with this one. Some people view forgiveness as giving up their power. I'm telling you, it was okay that you did whatever you did. So I feel very powerless because I don't feel it was okay. And so we talk about the fact that forgiveness is really a power move. It helps people choose whether they're going to devote their energy to this. Whether they're going to let somebody else have their energy and their power. And so we talk about how can you view forgiveness as a power move. Encourage clients to identify three common triggers for anxiety or anger. Which they may have done in prior groups. Find the meaning in the current event. You know, you got laid off from your job. How can you find meaning in that? How is it going to change your life? How can you integrate it into your life narrative? How can you view this as a challenge instead of a threat? You lost your job. Now you got to figure out how to pay the bills. Okay, that's kind of threatening. But how is it a challenge? What can you do differently? Maybe you want to see if you can give up your power. How can you do it differently? Maybe you want to see if you can get the best job you can get in the next three weeks. So make it into sort of a, I don't want to say game because it's not a game, but make it into a challenge and develop a both and perspective. Yes, you lost your job. Yes, that is very unfortunate and it creates a lot of stress right now. However, it also opens up the potential for other opportunities. So one of the examples you can talk about with them is a significant other not responding to a text. What does that mean? What is the meaning in that event? How can this be seen as a challenge instead of a threat? And I don't mean a challenge in the relationship. I mean a challenge to the person to, all right, instead of seeing this as a threat that I'm going to be abandoned, how can I see this as a challenge to be confident in myself that, you know, I'm okay. And this probably doesn't mean anything and a challenge for me to use my new skills and developing a both and perspective that, you know, they didn't respond to my text. Yes, it may be disrespectful. They may be, you know, whatever. However, you know, it's something we can talk about later and it doesn't necessarily mean the end of the relationship. Not getting a promotion and first dates are also other examples that you can use to have people try to figure out what this event means in their life. How they can view it as a challenge, like not getting a promotion. Well, I didn't get it this time. So let me learn from it. So the next time when promotional time comes up, I get the promotion. Systematic desensitization helps clients learn to effectively use coping skills to reduce distress through gradual exposure. We all remember the spider example they gave us in counseling 101. We don't always have multiple levels, like they do with the spiders. So I usually have three that we talk about, imagine and describe the distressing event, and then rate your distress on a level on a scale from one to five. So when you're describing it to me, now tell me how you feel. Use your skills of choice. And we talk with the clients about in this situation, what skills would you use and how can you use them to help reduce your distress. Practice until you can think about the event without getting distressed. And then level to expose yourself at a safe distance to the to the distressing event. So let's go back to fear of flying. You know, initially someone might imagine flying level to they would go to the airport and watch planes take off and land. And maybe if they can even get on an airplane, not one that's moving, just get on an airplane and sit down and imagine what it would be like. Level three would actually be taking a flight. But each time they need to practice doing it and get to the point where they can be at that level without getting freaked out. Other distressing events people experience public speaking. Again, first dates, second, usually on a big deal, airplane rides and any other personal example they can think of, and have clients really talk about or explain how they would work through each of the three levels. And I generally start with the spider example or the airplane example because so many people have that fear. I say, okay, I've got a fear of flying. And I'm thinking about flying and I am at a five I am like totally wigged out how can I calm down. What would you, what would you suggest for me to do to help me start calming down and I encourage them to help me figure out how to calm down and and we work through that. Cognitive processing therapy helps clients use analytical questions to help identify cognitive errors and make more effective choices. It helps address over generalization and emotional reasoning. Now we've talked about the CPT challenging questions worksheet in many other classes. So this is not new to you. The questions you want clients to answer. What is the evidence for and against this. So if they are, their heart is racing and they're like, oh my gosh, I'm having a heart attack. I'm going to die. What's the evidence for and against this. Well, their heart's racing. So that's evidence for. But what's the evidence against maybe they have a history of panic attacks. Maybe they've already had a pot and a half of coffee. Maybe they just were driving and they got cut off in traffic. So they had an adrenaline surge. So they want to look at the evidence. Is this based on facts or feelings? If the person is saying I am going to die, I am terrified, you know, my heart's racing. I am terrified I'm going to die. So therefore I must be getting ready to have a heart attack. That's based on feelings more than facts probably are all aspects of the situation being considered what's led to your heart starting to beat so fast. You know, like I said, did you just get cut off in traffic or maybe you opened a letter and you got somebody sent you a check for $100,000 or something. You know, you may not be ready to die. Are you using all or nothing terms. If this if this keeps going, I am going to die. That's kind of all or nothing. You're either going to live or you're going to die. Are you confusing high and low probability events. Now, again, I don't want to minimize this for somebody who hasn't doesn't have a history of panic attacks or minimize heart attack symptoms. But for a lot of people, when they start to get upset and their heart starts to race, they can get freaked out. What is the probability that you're going to have a heart attack and die? And what is the most logical course of action right now? You know, in this particular case, maybe sitting down, slowing your breathing, getting into a place where there are other people. If there are other symptoms, maybe calling 911, but encouraging them to go through those questions. It's what six questions. They're easy to keep on an index card or on a little notepad sheet on their mobile device. So they can remember to check in when they start getting freaked out. By the time they go through these, the adrenaline rush has gone down and they're more into their wise mind anyway. So have them identify three things they're worried about right now, such as not being good enough, being a failure, or maybe that they're going to be alone forever. Again, common themes that I've heard from y'all and that I've seen in my practice and encourage them to one at a time, just put it up on the board. What is the evidence for and against the fact that you believe you're not good enough? Is this based on facts or feelings? You feel you're not good enough, but is there evidence to the contrary? Is there actual facts? Are all aspects of the situation being considered? Are you using all or nothing terms? Yada yada. So encourage them to go through each question and really look at it. This isn't something they're probably going to do all the time, but for most clients they'll find one or two questions that stick with them. For me, the first one, is this based on what is the evidence for and against what I'm experiencing right now? And I'm pretty logical. So if there's evidence on both sides and I can generally balance out the likelihood and then I go down to is it high or low probability? Acceptance and commitment is accepting reality as it is committing to choosing thoughts and behaviors which will help you move toward a rich and meaningful life. Commitment is a confusing word for some people and I define it as determination to improve the next moment and realization that there are multiple aspects to commit to in a rich and meaningful life. This kind of goes back to Hardiness Theory proposed by Kobasa. But helping people see that even if one thing doesn't pan out, go their way, maybe their relationships are going south or maybe their career right now has taken a little bit of a nosedive. All right, that part of your life may suck and I'm not going to take that away from you, obviously, because they're your feelings. However, is that the only part of your life? Do you have other parts of your life that are going okay right now? And what can you commit your energy to? What parts of it make life, what other things make life worth living besides this one? And how can you improve the next moment so those other aspects of your life don't go to hell on a handbasket too, basically. So encourage them to define what is a rich and meaningful life. I ask my clients what are your top five values or what characteristics that do you want to be known for? And you can Google values or values worksheet and there are tons of them online, you know, top 50 values. Have clients go through and identify what they want to be known for. The short version is when you die, what do you want to have written on your epitaph? What do you want to have people say at your eulogy? She was a kind and generous person, yadda yadda yadda. Which people are important in your life? And, you know, while we're on the topic, which people are unimportant in your life, but you'll let them have your energy anyway. Like the people who troll on LinkedIn or Facebook or Instagram and just get on there to say nasty things. Do you give them your energy? And what things, hobbies and activities are important in your life? Because this is where you want to devote your energy. So when something comes up, like somebody's trolling you on social media, is it going to help you move towards those things that are meaningful to you? By engaging with that person? Or is it better just to let that one go? Yes, it was rude and it was an affront to you and you don't have any control over them, which can make you feel angry. However, is acting on that anger to try to get even or whatever going to be productive and move you towards what's important in your life? So we talk about people, things, experiences and values that are important. That's where you're going. And what can you do and how can you best trust the situation to move you towards those things? And what thoughts can you have that keep you moving towards those things? We also talk about what other response options do you have because you have a lot that will waste energy and prevent you from moving forward. Like getting into a posting war with somebody or, I don't know. And what thoughts can you have which will keep you unhappy or prevent you from moving forward? For example, dwelling on what that person said and how it made you look and this, that and the other. So there are a variety of ways to help people explore and address the thoughts which may be keeping them stuck. Some techniques are going to work better in certain situations than others. So it's important to encourage clients to try each one of these. See which ones work. Try them on for size. Since cognition is based on prior experiences, teaching CBT in a group can help clients explore alternate interpretations and information in similar situations. So when Sally experienced this, this is how she felt and this is what she thought. When John experienced this, this is how he felt and what he thought. They've got different stuff that they're bringing to their interpretations. So we get to get a probably a more in depth picture. By developing a broader understanding of situations, people can explore the effectiveness of their thinking in terms of how it impacts their ability to live a rich and meaningful life. Okay, so one of one of you says, one of my clients brilliantly analyzes his outbursts after the fact. But regardless of best resolutions, preparatory rituals and self awareness just can't seem to help himself. I'm trying meditative techniques with him now, but he's so wired that this is very difficult for him. He did the contract thing with the person who's the usual victim of the outbursts. One of the things I would look at with him are his expectations. You know, if he expects a situation to produce an argument, how he's interpreting what's going on is she may be unintentionally pushing his buttons, if you will, because she may remind him of somebody from his past, so I might look at that interaction. Another thing I would encourage him to look at is his vulnerabilities. You know, is he drinking a lot of coffee? Do these typically happen in the evening after he's had a long day at work where he's already exhausted his self control abilities or whatever. So start looking at some of those things to see if there are other things that lead up to it, other things that contribute, which are keeping him from practicing the pause. And like I said at the beginning, that pause part is the hardest part. Analyzing and choosing alternate responses tends to be a lot easier for clients than actually in the moment when they've got that adrenaline taking a break and going. Okay, I don't want to do this particular behavior again. So that might be where where I would start. I'm not sure that a psychiatrist would have a lot of other options. You know, obviously, there are certain medications like Boosperone that allegedly reportedly help clients not go from zero to 250 in 2.3 seconds. But medications don't work for everybody. And matter of fact, they work for a minority instead of a majority. But it would be up to him. You know, if he feels that might help him, then that might be a way to go with him too, in addition to continuing to figure out how do I practice the pause. And it also may be, you know, just kind of thinking before he gets into an argument before he even gets into a situation where there might be an argument that he de-escalates himself instead of expecting it to go poorly. And, you know, it takes two to tango. So I would also wonder what's going on with his victim, as you put it, that might be maintaining or bringing on this particular, particular behavior, because if that person tends to be the target more often than not, then there's something unique about that person that I would want to examine, whether it's a transference reaction, a crown or transference reaction, or that person's actually like button pushing. You know, I would be where I would start looking. Anybody else want to offer their ideas, suggestions, questions? Friday, everybody, I will see you on Tuesday. Have a wonderful weekend and stay safe. If you enjoy this podcast, please like and subscribe, either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. 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