 Hi everybody and welcome to today's presentation on cognitive behavioral therapy skills. Like the other presentation we did on assert, not assertive community treatment, acceptance and commitment therapy, this is also based on just providing you information about skills that can be used, not providing an evidence-based practice. Obviously we couldn't cover that in a full hour or in just an hour. So over the next hour we're going to define cognitive behavioral therapy and its basic principles. A lot of us are familiar with this but it's going to be a good review and it also may highlight some nuances that you didn't know about. We'll identify factors impacting people's choice of behaviors, explore causes and impact of thinking errors, and identify common thinking errors and their relationships to cognitive distortions. So why do we care? Well as therapists we want to help people figure out the best way to live a happy, healthy, meaningful goals driven life. For some people that's going to mean using some cognitive behavioral interventions. That can be in addition to mindfulness, that can be in addition to a lot of other things but it's important to help people understand that the way we believe things to be, the way we interpret things is going to affect our reactions. So for example think about a situation you know you've walked into and maybe you walked into it with a small child and it was a different situation. It was a new situation but you know it was no big deal. You walked in it was not a threatening situation to you because you were like hey I got this. The little kid walks in and goes oh wow there are a lot of people walking around here. This is really scary. Same situation, two different perceptions. You probably didn't have much of a stress reaction going on whereas the little child probably had this fight or flight thing going on grabbing onto your hand like please don't let go. Atlanta airport, that'd be a perfect example if you've ever taken a little kid through Atlanta airport. It gives you an idea about how people can perceive things differently and when you enact that fight or flight reaction you're going to have all those stress hormones. You're going to have all the either anxiety or anger or whatever that goes with it that may serve to exhaust the person and leave them to feel hopeless and helpless. So what we want to do is help people see that but we also want to help them see that when they're depressed, when they're tired, when they're sick things are going to seem a lot worse a lot of times because they don't have the energy to perceive it differently. I mean when you're sick it's overwhelming to think of going through Atlanta airport. So this is what we really want to help people start understanding is it's two sides of the same coin. They interact. If one is you know kind of going wonky it's going to affect the other one. The good thing is if one's going really good the other one's going to go really good. If you're having really positive thoughts you're probably going to feel pretty good. There's an activity and I think we're going to talk about it later it's called the coin flip activity and I asked clients to flip a coin in the morning and in the morning if it turns on heads then they have to be the most positive Pollyanna all day long. Look for the silver lining in everything, smile, walk with their head up, hold those nonverbals up and see how they feel at the end of the day besides a little sore because there's muscles they're using they haven't used in a while. If it lands on tails they can just be their normal selves which generally if they're seeing me means that they are depressed, anxious, stressed out, angry, something in the negative realm. Then we talk about how do things seem different on the days when you were feeling better, when you were walking taller, when you were smiling. Even our nonverbals it doesn't even have to be sickness. It can be our nonverbals that can make us feel or make our body feel heavy, tired and make it seem like it's a whole lot harder to deal with life. A person who perceives the world as generally good and believes they have the ability to deal with challenges as they arise that good old self-efficacy will be able to allow their stress response system to function normally. So if they're like you know what I can deal with whatever life throws at me I've got it and maybe I need help with it maybe I'll need to ask for support but I've got it it's not going to completely overwhelm me. People who see the world as hostile unsafe and unpredictable you know for a variety of reasons whatever happened to make their scheme as such that they don't believe that people or the world is trustworthy or predictable they are always on guard. They're always kind of like a hamster in a cage. Have you ever had a hamster? Hamsters don't recognize you and go hey that's my owner human contact score. Hamsters go run under their little house and you just kind of open the cage and stick your hand in there and flip over their house and you're like come here and give me cuddles and you're like you know 200 times bigger than they are. So the little hamster's like freaking out. This is what it's like for people and obviously I'm exaggerating but this is what it's like for people who have a negative perspective a negative view or a hostile view of the world. So kind of keep that little hamster in your mind. Cognitive behavioral therapy we have core beliefs those things that are in our heart when I talk with my clients about honesty step one and that's what they've got to do to start recovery is get honest with themselves first and then other people we talk about head heart and gut honesty. Do you think it's right? Does it seem like the right thing to do? Does it feel right in your heart? You know does it make you happy? Does it make you feel good? And then the spidey senses is your gut saying yeah or is your gut fine? If one of those is saying this might not be the right choice then we need to think about what's going on. So you have those core beliefs I put them in the heart just because that's the middle of the head heart and gut but you have core beliefs about yourself whether you're good whether you're bad whether you're effective at certain things yada yada you have core beliefs about other people same thing good bad effective predictable and you have core beliefs about the future and a lot of that goes with locus of control but also your past experiences if the world in the past has seemed unfriendly and uncontrollable and you've perceived it that way then you're going to expect the future to be uncontrollable so what we want to do is help people look at their schemas and their core beliefs about themselves others in the future and figure out kind of what they want it to look like. These schemas are going to affect your behavior and your thoughts and your feelings and you know you can pick wherever you want to start it doesn't matter because all three interface with one another. So if you haven't let's start with negative thoughts if you have negative thoughts then you might feel anxious angry stressed dysphoric which will affect your behavior you're going to do different things than if you have positive thoughts about something you feel excited and energized you're going to have different behavior. The best thing example I can give you is if you've ever done public speaking or had to present something some people really detest public speaking it's just terrifying for them to get up in front of a group of people so their thoughts are I'm going to trip up I'm going to forget what I'm going to say I'm going to make a fool of myself I'm going to you know it can go on forever that when you get on a roll you can get on a negative roll and go on forever or positive hopefully get on that roll with those thoughts you start holding on to those thoughts remember like we talked about in ACT the other day when you hold those thoughts and you kind of mush them around in your mind and you come to believe them that you're going to make a fool of yourself and it's going to be awful you're going to start feeling terrified likely which is going to likely affect your behavior if you go out on the stage and you're terrified you're going to probably stutter you're probably going to get foggy headed you're going to have that fight or flight reaction so there's an adrenaline rush and you start sweating and you can't focus and you can't concentrate and you really want to run away as opposed to somebody like me who loves public speaking and I'm just like cool I get to go out there and try to engage however many people are in the audience it's a game for me because when I can actually see your faces I really enjoy trying to figure out and make eye contact with people and figure out what it is that they're there for what is it that's going to make them tick what resonates with them so my behavior as you can kind of see right now when I go out there I'm excited and I want to engage people and it's a fun experience for me again just like the airport the same experience for two different people and two very different interpretations and reactions to it so what affects and I don't like the term rational but when we're talking about CBT rational comes up a lot I like to replace it with helpful because every behavior in its own weird sort of way is or probably was rational at one time that being said we're going to get back to that stress affects our behavioral choices if we're under stress we can have negative emotions negative emotions will affect our thoughts if we're feeling sad we're probably going to look at the dark side if we're feel sad we're going to look at the bottom falling out if we're happy we're probably going to look for that silver lining physical factors if you're in pain sick sleep deprived poorly nourished so your body can't produce the neurotransmitters it needs to or heaven forbid intoxicated you're probably not going to make the same decisions as you would if you were comfortable healthy well rested nourished and not intoxicated any of those things can go to really impact how you perceive a situation or how you react in a situation um especially the intoxication whereas in your non intoxicated state in your sober state you may think that you want to do something but then you've got that filter that goes really no that's not a good idea in an intoxicated state or even in a manic state if you're you know if you have somebody with bipolar that filter kind of goes away so the behaviors that someone may normally not do because they have a rational filter that goes you know punching this guy out is probably not the best idea right now that filter goes away uh when you're sleep deprived you're less generally people are less patient generally people don't have as much of a filter um think about what's your children if you have children or your grandchildren or um even yourself i know myself when i'm sleepy i am giddy is all get out and things i wouldn't normally say because they're you know stupid i'll just come out and say anyway and my kids just roll their eyes they're like mom you're overtired go to bed uh but that's okay you know i'm okay with that in that situation now if i acted that way at work it would be a worse thing environmentally if you're introduced to a new or unique situation and you perceive it as stressful because the unknown we know can be stressful then you may not make as rational of a choice or as helpful of a choice because you may be trying to escape same thing as exposure to unpreferable situations and i was struggling for a word here but unpreferable is the best i could come up with we all prefer certain situations some people like i said would rather do just about anything than get up in front of a lecture hall of 150 people and talk um but if they have to do it then they're going to be under stress which may affect how they do things so we want people to understand that their perception and their feelings is affected by a lot of other things not just you know an emotion here or a particular memory there's a lot that goes into it and social if peers or family convey irrational thoughts as necessary standards for social acceptance people may tend to cling more to those unhelpful thoughts and unhelpful behaviors you know in CBT they say irrational because quote nobody wants to associate with those people you know who are those people and why can't we associate with them um there are a lot of things if you think back think high school you know high school is pretty rough if we're going to talk about um having irrational thoughts and cognitions if you have to be part of this particular group in order to be accepted you have to do this you have to do that but do you do you really so those kinds of um all or nothing statements are cognitive distortions and while they may have served a purpose in some way shape or form in the past we need to encourage our clients to take a look at them now and go are they still helpful ways of thinking is it still helpful for me to think that I am only successful if I live in a million dollar house in a gated community and do this that and the other or can I be can I define success a different way or do I define success a different way and lack of supportive peers to buffer stress so we have those peers that cause stress by talking about the half dues and categorizing and lots of attributions but then there's also having not having somebody to go you know does this make any sense because sometimes we are our own worst enemies and if we go to a friend and we go you know this is what I'm thinking and I think I have to do this in order to be acceptable in order to be loved or or you know whatever the case may be most people are not going to use those exact phrases a good friend is probably going to listen and go yeah you're right or no no that's way off so supportive peers are essential to reminding us to consciously regularly check in with our cognitions to make sure that they are helpful and rational so a note about irrationality and this is mine this is not from CBT the origins of most beliefs were rational and helpful given the information the person had at the time and their cognitive development their ability to process that information so concepts and schemas and core beliefs that people formed when they were five are probably going to be very egocentric you know the kid the person is going to feel like everybody sees it my way because this is how I see it you know just like a five-year-old does a five-year-old doesn't think well you know let me take Johnny's perspective no he assumes that Johnny sees it the same way so it's going to be egocentric it's probably going to be focused on only one aspect of the situation because small children can't focus on multiple aspects and it's probably going to be dichotomous it's all or nothing mommy loves me mommy hates me and it could be personalized you know everything a lot of kids think that everything has to do with them so if something happens something bad happens many times children will take it personally or be afraid it's going to happen to them again you know if hurricane Katrina hurricane Andrew those sorts of things you know we saw a lot of trauma in children and they developed very real fears about thunderstorms and about hurricane season and if you've watched Florida hasn't had a notable hurricane in years now but there's a lot of stuff that goes into that but people who were really young during some of those really bad hurricane seasons perceive those situations differently okay so we need to help people understand that if we especially if we use the term irrational those thoughts you formed when you were knee-high to a grasshopper and they made perfect sense to you back then but now that you're an adult you've got more experiences and you're able to take different perspectives your brain is more developed let's take a look at it and see if you can look at different perspectives and come up with something that's a little more helpful maybe a different way of perceiving this situation the irrational irrationality or unhelpfulness of thoughts comes when those beliefs are perpetuated without examination so something a belief that you formed when you were five you're still holding when you're 35 and you've never questioned it you've never gone you know does this make sense is this helpful to getting me toward where I want to be most of us don't you know we form these attitudes and beliefs when we're you know growing up when we're in elementary school middle school high school from watching tv from being around our peers from being around our family and our community and we get all this input of the way things should be and a lot of times people don't stop to question it and go and go well does this really make me happy is this really what I want and they can be irrational if they continue to be held despite causing harm to the person so if the person continues to hold this belief even though it is causing them generally emotional cognitive harm it's making them miserable we need to look at why what's motivating them to hold on to that belief why is that belief so important and how can we make it so they can live a happy values driven life emphasis on the happy how can we make it less harmful sometimes it's more productive for clients to think of these thoughts as unhelpful or helpful instead of irrational sometimes when I say irrational to clients and you know I'm the same way if somebody says you're being irrational I'm like oh I'm not it elicits this instantaneous defensive reaction it's like when you tell them they're being resistant they're like I am not being resistant so helpful or unhelpful and then we talk about why it is unhelpful towards getting them toward their goals basic principles of cognitive behavioral therapy we teach or help clients learn to distinguish between thoughts and feelings I can think something is scary I'll probably feel it but if I have an automatic you know feeling I walk into Atlanta airport and I see um yeah I went to an airport in New York I can't remember which one it was um because my plane was diverted and I got off and I walked out there and I have never seen so many people packed in a place like sardines before in my life I was just completely overwhelmed that was kind of an automatic feeling now that was a feeling based on you know who knows it was overwhelming to be surrounded by that many people so then I had to separate the thoughts and go okay what am I thinking that's making me feel so overwhelmed and at that point you know I didn't know how to get to my gate and all that other sort of stuff with traveling I don't travel well um but encouraging clients to stop and go okay why am I feeling this way what are my what thoughts am I having that are contributing to these dysphoric feelings CBT helps people become aware of the ways in which thoughts can influence feelings in ways that are sometimes not helpful we have hecklers in our gallery the automatic tapes that we play thing memories that we have whatever you want to call them that when you try something when you are just going through daily life you hear these voices in the back of your head and obviously not real voices but that are saying you're never going to make this or if you would have just blah blah blah then you'd be a better person helping clients become aware of those thoughts and how they're negatively influencing their feelings and keeping them kind of stuck is a huge part of CBT we help them learn about thoughts that seem to occur automatically without even realizing how they may affect emotions again those thoughts from the hecklers they're saying you're not good enough you're not smart enough and nobody's gonna like you where did that come from and do you believe it you know maybe it came from somebody when you were in high school so was that a valid was that a valid source maybe it came from somebody yesterday on facebook was that a valid source taking in those thoughts and then figuring out is this something i'm gonna hold because it makes me happy or is this something that i've got to deal with because i'm having a negative reaction constructively evaluate whether these automatic thoughts and assumptions are accurate or perhaps biased the other thing to remember is a lot of our clients not all of them but a lot of them hold themselves to a standard that's like up here and they hold everybody else to a standard that's down here so they are a failure if they don't achieve this but everybody else is successful as long as they achieve this so encouraging them to take a look at how accurate and biased or unbiased are the thoughts and like i said they may be their own thoughts they may be telling themselves these things evaluate whether the current reactions are helpful and a good use of energy or unhelpful and a waste of energy that could be used to move toward those people and things important not important to the person road rage you're in the car you're driving somebody cuts you off okay natural reaction fight or flight reaction you're just like slam on the brakes do whatever you got to do averse of maneuvers you're good so you could let it go at that point and go got lucky on that one and keep driving most people not all but most they found that 80% of drivers have reported at incidences of road rage which is a really high number but most people will start getting all fired up and irritated and grumpy and angry and just rageful and so my question would be i hear that and i hear that it made you angry in retrospect did screaming at the person as you passed them at 60 miles an hour in your car with the windows rolled up really do any good did it do any good at all what else could you have done with that energy if you wouldn't have expended at all yesterday we had to wait for the vet to come by and my daughter just completely wore herself out worrying about when when the vet was going to get there what he was going to say about her donkeys and was beside herself so by the time it got to evening and it was time for her to go to her martial arts class she didn't have the energy to go she's like i'm wiped out i just i want to go to bed in retrospect we're looking back and saying okay now tell me what it was that you were so stressed out about and let's talk about whether that was a realistic and helpful line of thought to perseverate on all day long and what could you have done differently because she didn't bother to mention any of that to me yesterday and then develop the skills to notice interrupt and correct these biased thoughts independently causes of these thinking errors information processing shortcuts when we form schemas and we encounter a situation that reminds us of something in the past like when i go to my grandmother's house i have a scheme a i have a belief system i have you know stuff that i know about my grandmother's house so when i go to my grandmother's house it's kind of a shortcut to know what to expect when i walk in how to behave how to do different things and it helps me plan and predict if you're using outdated or dichotomous all or nothing schemas uh it may cause thinking errors because you may be now incorrectly processing current events mental noise some of us have it a lot of us have it not everybody think about trying to focus and study for a final exam in the middle of a really busy sports bar okay this is a cause of thinking error you're going to miss important things you're not going to be able to focus you're not going to necessarily attend to the correct things because there's just so much else going on your attention is drawn in 17 different directions and or the brain's limited information processing capacity due to age we talked about that before young kids think all or nothing they think dichotomously ecocentrically um middle school aged kids and older start developing the ability for abstract thinking by the time we get older you know as as adults theoretically we're able to you know think pretty well think pretty clinically about different events but if we're in crisis when someone is in crisis and it could be like what we think of clinically as crisis or it could be they're just completely overwhelmed and burned out and have been burning the candle at both ends for three months they're not going to process information quite as well they're not going to take in all this stuff because they're just like shell shocked have you ever seen teachers in the hallway of like an elementary school oh at the end of the second nine weeks they just kind of stand there with this blank look on their face they're not processing as much as they were the first day of school um and you know god love them they have a lot to deal with but it's important for us to help our clients understand that there are some times that they are going to have to really stop and focus write things down so they can remember or they can make decisions a little more clearly my guess is most of us have times in our life where we've been able to think through complex problems but then there are other times where you just can't keep it all in your head and you've got to put it on a whiteboard or maybe that's just me we want clients to understand that they are not broken they're not faulty they're doing the best they can with the tools they have and the knowledge they have and our job is to help them see where some of this might have gone a little awry other causes of thinking errors emotional motivations i feel bad therefore whatever i'm thinking must be bad if i'm scared that means whatever's coming on the other end of the phone is bad news moral motivations i did it because it was the right thing to do and that can be an excuse for doing wrong behaviors as well um it can also be you know you can argue on the moral one social influence well everyone else is doing it so it must not be bad say that again a lot of times and and this is where the frames approach and motivational interviewing really is really helpful f stands for feedback about the reality of what's going on is everybody really doing it let's look at statistics you know not subjective information let's look at objective information so the impact of these thinking errors it makes people want to fight or flee when they get upset and we use upset as kind of this all-encompassing garbage term emotionally they get depressed or anxious we don't want to feel that way anxiety and anger are flee or fight fight or flee um it's our body saying there's a threat you got to do something depression is your body going i give up i just i don't i don't even have the energy to do it anymore behaviorally some people withdraw they shut down we all know people when they get frustrated when they get overwhelmed when they start feeling hopeless or helpless they just kind of withdraw from everything and everyone addictions numb that out so they don't have to feel the dysphoria sleeping problems and changes when we start being on that constant fight or flight hyper vigilant sort of thing going on the body is always sort of turned on which means you're not going to sleep as well then the circadian rhythms get messed up which starts causing exhaustion and lethargy and then everything seems harder because you're sleep deprived and then you start thinking more negatively and more hopelessly you see where this is going it's a downward spiral and eating changes some people eat a lot more because they're eating comfort foods some people eat a lot less because their stomach is so tore up from the stress they can't even think about holding anything down physical stress related illnesses fibromyalgia gastrointestinal problems headaches neckaches backaches you know the whole gamut of it when you start feeling bad when you start hurting generally it gets frustrating after a while and that frustration makes it kind of raises the bar brings you up a little bit so you're that much closer to kind of just kind of being overwhelmed you don't have as much of a cushion as you would if you were happy healthy well nourished not in pain and socially a lot of times we will get irritable or impatient with other people or withdrawal when we're having these negative cognitions these thinking errors that are keeping us in a dysphoric state these effects of thinking errors contribute to fatigue and a sense of hopelessness and helplessness which intensifies thinking errors this is an important concept that I want my clients to understand and I want to drive home in this presentation so thinking errors what are they emotional reasoning feelings are not facts and we want help people to learn to effectively identify feelings and separate them from facts so if somebody says I'm terrified okay that is a feeling what are the facts supporting that feeling why are you terrified what is the evidence that you are in some sort of danger right now you know and danger may not be the right word for your client at that particular point in time but what's the evidence that there's a threat in what ways is this similar to other situations maybe it's triggering something from the past that was really really scary or you know you were too little to be able to handle it but you can handle it now and how if you dealt with similar situations like this in the past we want to help people just step back and get some distance between their feelings and their thoughts and try to figure out you know which thoughts are helpful and productive and even if a thought makes people anxious or angry it can be helpful it may be telling them hey dude you need to get your butt up and get out of there if it's helpful it means it's moving them toward where they want to be happy healthy safe and values driven life so happy and helpful develop distressed tolerance skills when people use emotional reasoning they feel emotions which then they start attributing finding the facts to support those emotions instead of looking at all the facts we want to help them learn to tolerate their distress so they can kind of let that subside for a second they can accept their feeling they can name it they can say i'm scared i'm stressed i'm angry i'm whatever but they don't have to act on it right then they can tolerate the distress for a minute without having to try to make it go away and emotional regulation skills they can feel a feeling without having to make it go from zero to 120 you know if they feel sad they can go oh i feel kind of sad instead of grabbing onto it and going i wonder what i feel sad about i must feel sad about all these sad things now i'm really going to be really really sad and devastated so we want to help people learn how to regulate their emotions identify them accept them whatever word you want to use and tolerate them because feelings are there for a reason they're there to tell you your brain thinks something's going on now thankfully we have that higher order cognition stuff going on so we can contradict our own brain and we can go you know maybe that's not true in this situation cognitive bias negativity mental filter whatever you want to call it people who focus on the negative they walk in they get up in the morning and they look outside and it's partly cloudy they get to work and they said instead of saying there was it was very light traffic they said uh there was a fair amount of traffic everything is always the flip side of what somebody who's really optimistic would say so asking them what's the benefit to focusing on the negative in what ways is this helpful to you you know some people say well it keeps me from getting disappointed because i know it's going to end up negative anyway so we can trap challenge that know that whatever it is they think they know and see if there have been exceptions when it hasn't turned out that way um what are the positives to this situation i give the example a lot of you know i wash my car um or it rains and maybe i wanted to go out on a run that day but i can perceive it i can look at the positives you know the rain washed my car for me so i don't have to do it now score um it watered my garden all the better uh it knocked down some of the pollen out of the air even better i can find and i can encourage people to find positives in a situation yes there are negatives there are negatives to every situation if you want to find them you're going to find them but if you want to find the positives you can too which takes us down to what are all the facts there's the positive and the negative and the neutral i told you earlier about the coin toss activity having people toss a coin and on the heads days they act like it is just the greatest day to be alive um and see how things are different when they do their journal because you know i have my clients do some sort of a mindfulness check-in in the morning and in the evening and preferably at lunch time how are they feeling what's their emotional state what's their energy level on the happy days a lot of times it can be less and sometimes they need a little coaching throughout because some of those old thought patterns kick in but i want them to start challenging some of their automatic thoughts that we're going to talk about in a minute disqualifying or minimizing the positive most of us can probably say we've had a bunch of clients that do this they are more than happy to tell you about all the things that they mess up but then when they do something right they minimize it um encouraging people to hold themselves to the same standard they would hold everyone else to and i know i talked about that earlier ask them things like would it minimize would you minimize this if it was your best friend's experience your best friend came to you and said i just got into such and such college would you say awesome or would you say anybody can get in there how would that go ask them what is scary about accepting these positive things that you might have actually had an accomplishment for some people it means that it might mean other people expect more of them for other people they just don't know how to accept the positive they don't know how to accept compliments they don't know how to be the center of attention and they don't like it um and then we want to look at why that is sometimes we disqualify the positive because it fails to meet someone else's standards so ask people might that be true here you know i know when i was growing up and going through college and growing through school and everything i got my doctorate but i will for always be ever and always be not a real doctor because a phd is not an md and i'm like really so is it somebody else's standards or can i feel good about having a phd egocentrism my perspective is the only perspective i love being egocentric but it doesn't work most of the time so encouraging people to take alternate perspectives maybe you're texting with someone and they say something that is not that you interpret as not the nicest thing and this happens on text message a lot um and they get upset now an egocentric thinking error would say well that person's just grumpy today someone that's taking other perspectives would stop and go back and read the text and go i wonder if maybe this could have been taken some other way you know because obviously their reaction is not what i intended so egocentrism if you hold on to that i don't understand anybody else because you know i don't see a problem with anything personalizing and mind reading this is when you assume that everybody's frowning because of something you did your boss walks down down the hallway and looks at you and grimaces and continues to walk on oh i must have done something wrong no maybe he just got out of a senior management meeting that was five hours long and he's got to go to the bathroom you know there could be a hundred different explanations for why that happened so encourage clients to ask themselves what are some alternate explanations for for this event that doesn't involve me you know why might this have happened because if they hold on to that i must have done something wrong then as soon as their boss calls them up and goes hey can you come to my office for a second you know where their thoughts are going to go i'm getting fired i'm going to get laid off i don't know what it was that i did wrong but he walked by me two weeks ago in the hallway and grimaced and i'm just i'm the worst person in the whole world but where did that come from so encouraging people to not necessarily assume they know what's going on in someone else's mind and not automatically attributing every person's negative behavior to something they did but how often and then ask them how often it is has it really been about you you know think about the last 10 times you've taken something personally how many how many of those 10 times has it really been about something you did versus something with the other person then the availability heuristic remembering what's prominent in your mind so asking clients what are the facts the most obvious one that we talk about is plane crashes you know it is way dangerous to fly on a plane because you hear about all those plane crashes well yeah you hear about the few plane crashes but you don't hear about the 20 000 every day that lands safely so you remember it and it seems more dangerous because that's what is in your mind that's what is available to you that's what you've based your thought processes on because maybe you didn't know that 20 000 planes or more fly and land just perfectly every day this can also be true with people remembering what's most prominent in your mind sometimes um and this can be very very true in domestically violent relationships if somebody falls in love with someone and that person is just the greatest person since sliced bread for the first four months and then the cycle starts and there's this little tiny sliver of the honeymoon period after the battering cycle and the person's like that's the person I fell in love with that's what I remember and they try to focus on that that's most prominent in their mind and they ignore the rest of the stuff so we need to encourage people to really look objectively at the facts magnification are you confusing high and low probability outcomes what are the chances that this is going to happen how many clients have we worked with that have gone to the doctor and gotten a physical or gotten a test run and then the doctor had to call them back and this could be true for for you too uh and the doctor had to call them back two or three days later when the test came back from the lab and that whole three days they were just in a panic because they were afraid that they were going to get some terminal diagnosis so thinking about high and low probability outcomes another instance or example of magnification is somebody that thinks this is the end of the world whatever it was um I think I've told you before my little story about um uh tripping when I was walking down the hall at work and falling and yeah it was embarrassing my folders went everywhere and yeah but in the big scheme of things will it matter that much from now you know are people going to think oh she is such a clutch she must be a dits too no I mean they may have thought that at that time I don't know but you know in six months nobody's going to remember and then ask them in the past when something like this has happened when you've had to get a test done and you've had to wait on results or if you've done something that was embarrassing and you didn't think you thought everybody was going to remember it forever how did you tolerate it how did you learn to deal with it building on those strengths that they already have all or nothing thinking errors these are things like love versus hate I love them or I hate them it's all or nothing she does this all the time or she never does it if I'm going to do it I'm going to do it perfectly or I'm not going to do it at all thank you um all good intentions or all bad intentions you know sometimes we do things with good intentions that have some bad repercussions so did we do it with all bad intentions or all good intentions and the answer is neither most of the time life is kind of in that middle ground gray area encouraging clients to look and find examples where something hasn't been one of the polls when have they done something that they're proud of that wasn't perfect or when again when has somebody else done something that they were proud of that wasn't perfect um remembering that with the availability heuristic remembering how often something really happens how long it's been since you've seen that behavior and remember that sometimes good times are amazing but how frequent are they compared with the bad times another thinking error is a belief in a just world or a fallacy of fairness I just ask clients identify four good people you know who've had bad things happen and in in reality we all have bad things happen good people do bad people do in between people do attributional errors and this is a pet of mine you know um labeling yourself not a behavior so global versus specific and I am stupid versus I'm stupid at math I don't have good math skills it's not about me it's about my skills I can change skills stable I am and I always will be will be versus it's something I can change it's something I can learn internal it's about me as a person versus it's about a skill deficit or something I could learn or change um and there's you know lots of information on um attributions out there on the internet if if you need a refresher on it but we find that a lot of people who have dysphoria have negative global stable internal attributions so questions for clients remember that beliefs equal thoughts and facts plus personal interpretation another way of saying it is reality is 10 percent or perception is 10 percent reality and 90 percent interpretation so what are the facts for and against my belief is the belief based on facts or feelings does the belief focus on one aspect or the whole situation does the belief seem to use any thinking errors what are alternate explanations what would you tell your child or best friend if they had this belief how would you want someone to tell what would you want someone to tell you about this belief so if you're telling somebody about this what are you hoping they're going to say in return and finally how is this belief moving you toward what and who is important to you or moving you away from what or who is important to you now they can do a worksheet and have all of these or you can pick one or two of these questions that are most salient for your clients that they can have kind of at their fingertips so as they're going through the day and something happens they can ask themselves okay what's an alternate explanation or you know whatever it is that's salient for that client irrational thoughts how do these thoughts impact the client's emotions health relationships and perceptions of the world you know this is what we want to ask them how how is this thought impacting you globally how may have this thought have been helpful in the past where did it come from how does it make sense from when you formed it in the past when you're dealing with it ask the person if the thought is bringing you closer to those that are important are there any examples of this thought or belief not being true and how can the statement be made less global less all-encompassing so it's about a specific incident a specific situation less stable which means you can change it and less internal which means it's not about who you are as a person but maybe something that you do or a skill that you have so we're going to go through some of these thoughts real quickly here mistakes are never acceptable and if I make one it means that I'm incompetent well never is kind of stable and I am incompetent is kind of global that's also that extreme all or nothing thinking so you can see where these cognitive distortions end up leading to unhelpful beliefs when somebody disagrees with me it's a personal attack well there's personalization if I ever heard it before maybe it's not about you maybe they're having a bad day and you just happen to be the unlucky target or maybe they're disagreeing with you because they have a different point of view and it's not a personal attack it's just their point of view if someone criticizes or rejects me there must be something wrong with me personalization all or nothing thinking global stable and internal something wrong with me as a person to feel good about myself others must approve of me now this is one we've talked about external validation before and we can't control other people so to feel good about yourself how can you do that besides having necessarily requiring other people to approve of you to be content in life I must be liked by all people wow I've never met anybody who's liked by all people I've never even met anybody who's been hated by all people but it's important to help clients see how this is really dramatic to say all people and in order for them to be content then everybody has to like them I mean I like to be liked but if everybody doesn't like me you know that's pretty understandable my true value as an individual depends on what others think of me I would really challenge this one this is all you know also very personal internal I would challenge people to look at it and say it so your child's value as an individual depends on what other people think of him or her most people would say no um but it's a perspective thing nothing ever turns out the way you want it to okay all or nothing thinking and probably availability heuristic if something bad just happened then they may be focusing on that which causes them to focus on all the other bad things in the past that have happened not focus on that is okay you know bad thing happened but look at all these good things I won't try anything new unless I will be good at it this fear of failure fear of rejection just really paralyzes a lot of people um when they get stuck with that thinking area that they have to be perfect I am in total control anything bad that happens is my fault well that's egocentric and personal if they think they're in total control that's their perception of how the world is they think if they've got everybody on marionette strings and that anything bad in the world that happens is their fault how powerful are they I feel happy about if I feel happy about life something will go wrong it happens sometimes but let's look at times when you've been happy that something hasn't gone wrong you know let's get rid of that all or nothing thinking it's not my fault my life didn't go the way I wanted could be true but it seems like that's making you unhappy so what do we do about that if I'm not in an intimate relationship I'm totally alone you know again that's pretty extreme I'm either in an intimate relationship or I am alone and a loner and you know it's just me and my 17 cats which follows with there's no great area so encouraging people to really look at what these beliefs are saying is important thoughts impacts behaviors and emotional and a physical reactions emotional and physical reactions impact thoughts and interpretations of events so if you do something and you and it's pleasurable and you have a great physical reaction you know let's take bungee jumping or skydiving if you go out there and it's scary but you do it and you're just like whoa what a rush your interpretation of that is probably going to be good which means you'll probably do it again if you go out there and it's just the the most horrible experience you've ever had you're probably not going to do it again and your interpretation of it is going to be not good which is going to make it hard to understand why other people would do it irrational thinking patterns are often caused by cognitive distortions so let's just look back at some of those because there's a lot fewer cognitive distortions or general ways of thinking about the world than there are thinking errors because there's lots and lots of thinking errors cognitive distortions are often schemas which were formed based on faulty inaccurate or immature knowledge or understanding and by identifying the thoughts the hecklers you know the automatic tapes that are maintaining our unhappiness the person can choose whether to accept those thoughts or change them