 I'd like to welcome everybody to today's presentation. Today, we're going to be talking about cognitive behavioral therapy and irrational thoughts. We're going to define thinking errors again and explore the different types of thinking errors. We're really going to focus today on evaluating how these thinking errors or what I call unhelpful thoughts in cognitive behavioral, they're called irrational thoughts. I find that a little bit pejorative, so I try to use a kinder, gentler term. But well, look at how they impact our fears of rejection, isolation, the unknown, loss of control and failure. And then we'll finish up with reviewing ways to increase awareness of thinking errors in our clients, how to help them address thinking errors and address basic fears. So remember that thinking errors play a large part in keeping people miserable. Even if everything's going well around them, if they perceive it as negative or they're constantly waiting for the other shoe to drop. They're going to keep that HPA axis, that threat axis in high alert mode, which is their stress mode, which is going to have negative impacts on their ability to sleep, their eating, their libido, in addition to their availability of serotonin as well as other neurochemicals. So we don't want people to feel stressed all the time. And we found that, you know, for the majority of people, there is a cognitive component to their anxiety, depression, anger, addiction, yada, yada. So yes, we need to help them address the physical vulnerabilities. Yes we need to help them start figuring out how to add happy to their day and feel happier. But we also need to help them address their unhelpful thoughts that undermine them and pull them backwards. Missing unhelpful thoughts helps people not make mountains out of molehills. We've all had clients who, something happens and all of a sudden it feels like the sky is falling. They, they lose their job and they go from, or maybe even not that bad. Maybe they get a bad evaluation and then they're sure they're going to get fired and then they're going to be homeless and they're going to lose their kids. And I mean, all of a sudden they've plated out to the nth degree of the extreme worst case scenario. So we're going to help figure out how to help these clients look at, yes, that is a possibility. But what is the probability that's going to happen? We'll help them focus on the things they can change. You know, if you get that bad evaluation, you know, let's look at what it said and what can you do to improve your evaluation or what can you do to respond to that evaluation if you thought it was unfair? And then we'll identify and eliminate thought patterns that are keeping our clients stuck. And that takes some time, maybe a little bit of prodding, maybe a little bit of highlighting. When my clients get upset, you know, if they typically are struggling with anger or anxiety or, you know, whatever the primary emotion is, I encourage them when they start feeling that way just to jot down the things they're thinking and not necessarily even evaluate them. Not necessarily even do any mindfulness stuff with them at that point in time. But then when we meet each week, we put all those papers out on a table so we can see them together. And we look for common themes and common thought patterns that might be keeping people stuck. Because a lot of times these thought patterns relate back to things that they learned and I use that term kind of loosely when as they were growing up that they never challenged. And those thoughts are now unhelpful. They may have been unhelpful back then and they're still unhelpful, but possibly they may have been helpful back in the past and we'll look at that in a second. Cognitive distortions, if you remember, take a thought and manipulate it to fulfill your expectations of a situation, create that self-fulfilling prophecy or conform to the negative head space. So if you're in a bad mood, you're probably going to see the negative stuff and not the bunnies and the deers and whatever else. Irrational thoughts or unhelpful thoughts are beliefs or thoughts that people may hold that are usually extreme. They involve, and we'll see, most all of them involve one or more cognitive distortions. They tend to be unrealistic, hence the fact that they're extreme. And it sets up the scenario to create feelings of failure, inadequacy and disempowerment, such as, I must be liked by everybody all the time. Yeah, you can see how nobody is going to meet that. So it sets them up for feelings of failure and inadequacy. And there is nothing we can do to make everybody like us all the time. So we're setting ourselves up to feel disempowered and hopeless and helpless. So a note about irrationality or unhelpfulness, something that is an unhelpful or irrational thought for an adult may not have been for a child. So based on the information the person had at the time and their cognitive development, their ability to look abstractly, it may not have been unreasonable. Think about an infant. You have an 18-month-old standing in the crib screaming bloody murder, or maybe even six-month-old, and screaming bloody murder because they're scared. They're standing up. They don't see mommy. They don't see daddy. And when we don't see mommy or daddy, then mommy and daddy are gone. In an infant's mind, in a very, very young child's mind, they don't have object permanence. So knowing that mommy or daddy are going to come as soon as I cry is something that they've got to learn. So for them to be afraid when they wake up and they don't see mommy or daddy there makes perfect sense. Now, as they get older and they learn, you know, that when you put something under the blanket, it's still there. When mommy or daddy can't be seen as soon as you cry, they'll come. Totally makes sense that you start changing those thoughts. But think about a child. And unfortunately I've worked with a lot of people who grew up like this. They would wake up and it was hit or miss whether mom or dad were going to be home and they could have still been running around in diapers. Because mom and dad would put them to bed and then go out to drink, use, party, do whatever. So it's important to understand that even if something developmentally seems like they should have outgrown it, we need to look at what that person went through. And it's important to understand that thoughts need to be examined. As we grow older, as things change, when we continue to hold a thought, to hold a way of thinking, despite the fact that it causes us harm and anxiety, that's when it becomes irrational or unhelpful. So we need to be able to examine that. So what are some of these irrational beliefs? If I make a mistake, it means that I am incompetent. You know, that's one of the common irrational beliefs that we hear that, you know, if you Google irrational beliefs, that's going to come up. So where does that play out? Now, as a child, remember, young children think in all or nothing terms. So if they make a mistake, then they, they messed up. So they feel they are incompetent. And as adults, it's up to us to help them make that more specific, not as global. So we can help them see that they are competent with all these other things, but they may not be competent with respect to this particular problem or issue. So that's incumbent upon the parent or as the child grows, hopefully teachers and other adults will help them see that they do have strengths in other areas. And one area of weakness does not mean they are a complete and utter failure. But if you hold this thought, that if you make a mistake, you're totally incompetent. Even if it's, if I make this mistake, I'm totally incompetent at my job. You know, there's a lot of things we do in our job. So if you make a mistake or if you're not, your strength is not in one area. My strength is not in group therapy. I do group psycho-ed wonderfully. Group therapy is not my strength. Does that mean I am completely incompetent as a therapist? No, it means that that is not my strength. But we need to look at how this plays into our basic fears. If I think that if I make a mistake, I am totally incompetent, then that sets me up to reject myself and tell myself that I'm incompetent and sets me up to expect rejection from other people. And when you're rejected from other people, you're isolated. If you're incompetent, then you may not know what you can do or how you will survive. You see how this can quickly spiral out of control. If you are incompetent in general, people equate incompetence with failure. So we've got multiple of our basic fears, those things that trigger our fight or flight reaction from this one statement. So one thing I encourage clients to do is to look at it and say, OK, now I hear that you made a mistake doing this. So are you incompetent at everything? And generally, they're going to be like, no, OK, so you made a mistake and you screwed this thing up. Does it mean you have to stay incompetent or is it something that you can change? What parts of this do you have control over? So encouraging them to look at. What they do well and what they do have control over and how they can turn this failure into a learning opportunity instead of seeing it as a devastation. When somebody disagrees with me, it's a personal attack. Now think back to those cognitive distortions and how personalization is a cognitive distortion. When we take something and assume it's all about us. When somebody disagrees with me, yeah, it may be a personal attack. It could be. However, it also may be that the other person has a different opinion and is asserting that and you are taking it as a personal attack. So it's important to encourage people to look at. What happened factually and then examine what hypothetically could have been the motivations of the other person. I must be liked by all people. Again, we talked about this on the last slide. This is not realistic. So if when our clients are holding this and I've worked with a lot of clients who wear their heart on their sleeve and if anybody doesn't like them, it's just devastating and cuts them to the core, which makes them feel rejected, makes them fear that other people are going to reject them. If this one person doesn't like me, then maybe everybody else. Is going to eventually turn against me too. They feel a loss of control because they can't make that person like them and they may feel like they failed because they're not liked by all people. So again, we look at how realistic is this? How many people do you know that are liked by everybody? Absolutely everybody. And I have yet, thankfully, knock on wood to find a client who can sit, can identify. Anybody. So we start there. We start with the evidence and say, okay. Now, how does this other person deal with it if somebody doesn't like them and start looking at that? We also look at who does like you because most people can say, yeah, I'm a generally good person. I've got a few friends. If they tend to be more introverted, they're not going to have 50 friends, but they can probably identify. Two or three people that are friends that like them. However you want to put it. So we start looking at that. And then we start looking at the value of those relationships. You know, if this person that you run into every other week when you go to the bank or wherever it is, doesn't like you. How important is that in the big scheme of things versus your best friend who you talk to every other day? You know, if this person over here doesn't like you, does it have an impact on your life? Another statement. My true value depends on what others think of me. Okay. For me, I often start out asking them if that is something they tell me. For me, I often start out asking them if that is something they tell their children, you know, is that what you want your kids to believe that if other people don't value them that then they're not a value. And they, they usually look at me cross-eyed and say, no. Okay. So what makes you valuable? What makes you a valuable human being? And that can get into spirituality. That can get into a lot of different things. But we start talking about why is it important to have the verification or validation from other people versus themselves? And a lot of times it comes down to they can't validate themselves because they either don't know or don't like themselves very much. So their true value depends on what others think of them because they can't validate themselves, which leads back to self-esteem work. So they can say, you know what? I'm all that in a bag of chips. And if you don't like it, tough doubly winks. If I'm not in a relationship, I am completely alone. Back to those cognitive distortions. All or nothing. If I'm not in a relationship, then I am completely and totally, utterly alone. Really. So we want to look at what does alone mean and what's the difference between alone and being lonely? And I generally start there because you can be lonely in a room full of 50 people and you can be lonely by yourself. But you can only be alone by yourself. So do you have anybody that you spend time with, that you might like to spend time with? What could you do to resolve the aloneness? And when you are in a relationship, do you feel alone? And do you feel lonely? A lot of times people say, when they were in their relationship, they felt lonely anyway. So we start talking about, do you want to be in a relationship just to not be by yourself? Or are you trying to not feel lonely? And if you're trying to not feel lonely, what do we do about that? Usually loneliness comes back to lack of a relationship with self and feeling like that a need for external validation and that need to have somebody else tell you you're okay and you're worthy of breathing the air. Sometimes it can go into, again, areas of spirituality and are you actually alone? Success and failure are black and white. There's no gray. Well, that's a cognitive distortion 101, looking at all or nothing thinking. Success, you can succeed at things and it may not be 100% success. You know, I have had many occasions where I have achieved a goal and I've achieved it successfully, but it hasn't had all of the ramifications that I had hoped. You know, I've written a SAMHSA grant and we've implemented it and it didn't quite play out the way I envisioned it. Did it mean it wasn't successful? No, but it did mean that it didn't quite meet what I had hoped. So, is it 100% of a success? Probably not. Most things we do have room for some sort of improvement. Failure is the same way. I mean, sometimes you can fail at something, but you can develop a skill along the way. You can verify your confidence. You can turn it into a learning opportunity. So, it doesn't have to be a failure, a flop, and nothing good can come out of it. Encouraging people to walk the middle path and look for when there is failure, encourage them to look for what went right. This weekend we were hit by a tornado and, you know, I woke up in the morning and we had lost 300 feet of fencing and the property was a disaster and I was just like, ah. So, I could see and look at that and say, you know, that was a total loss. But, yes, the property was kind of torn to bits, but none of the animals were harmed. So, I was able to look at kind of the gray area and try to find the positives, you know, success and failure and kind of all that goes together with not looking at extremes because, you know, most of the time things don't go to 100% the way you expect it. Nothing ever turns out the way you want it to. Anytime somebody tells me you always, it never, you know, uses the all or nothing terms, the first thing I do and most of my clients stop themselves as soon as they say it and start looking for exceptions because they know that's going to be my first question. Nothing ever turns out the way you want it to. And I usually respond with, I hear this really went south on you. However, what things have turned out the way you wanted them to. So, I want to encourage them to look at the fact that there is hope and some things will turn out somewhat helpfully. If the outcome was not perfect, it was a complete failure. So, again, back to the success and failure is black and white, it either goes 100% the way you want or it's 100% failure. Nothing's ever 100%. I mean, even think about going to school when you were in school and taking tests. If you got less than 100 on an exam, maybe you got a 94. It was still an A, you got a 94. So, was that a failure because you didn't get 100%. Think of examples that you can give your clients that are relatively non-threatening but that they have experienced. I mean, everybody I know has experienced getting a test graded. So, they can, you know, kind of understand where you're coming from there. And then you can move up to something that's a little more present and personal. But encouraging them to look for, okay, it wasn't perfect. You know, if you've, anything that you've done, anything that you've planned, especially the more involved something is, if you're planning a conference or a big party or a wedding or something, it's probably not going to go 100% the way you anticipated it. But was it a complete failure? So, you want to look at what went right and if you're going to do it again, what can I learn for the next time? If you're not going to do it again, of the things that went wrong, is there anything I need to hold on to, to address or do I just need to let it go and focus on the positive? If something bad happens, it's my fault. And this is something to think about with a lot of our clients who tend to take everything very, very personally. If someone gets mad, it's their fault. If the sky turns gray, it's their fault. My mother tends to be like this and my stepfather makes fun of her in good fun. He's not ugly about it. But she will take everything. If somebody has a bad day, she's not doing well. If she can't fix it, then it's her fault that they're in a bad situation. Taking responsibility for things that are out of your control. So, one of the things I encourage clients to do is to look at what is and is not in your control. Whether you use the serenity prayer or not, you can just ask them, what parts of this do you have any control over? If you're driving along on the highway with a flat tire, that sucks. No doubt. And it's bad. Is it your fault? You know, even if you checked the tires before you left to make sure they were all inflated correctly and there were no nails in them and whatever, you could have run over a nail. Should you have expected yourself to see a nail on the interstate at 70 plus miles an hour? No, it's not realistic. Sometimes bad things just happen. Now, what you do have control over is how you react to it. So, if you get a nail in your tire and you get a flat on the interstate, you can let it throw you into a tizzy where you can't think and you can't get help and you can't change a tire, or you stop, you take a breath and get into your wise mind and figure out, okay, what's the next step? The past always repeats itself. Well, I mean, that's true. A lot of times the past repeats itself, but I'm wondering why. And this is a philosophical question. You can kind of debate with clients or have with clients, if you will. When the past repeats itself, why does that happen? If somebody did something poorly before and they try to do it again and they still do it poorly, why does that happen? Well, generally, it's because they didn't learn from their mistakes. Think about when you taught your kids to tie their shoes. The first time you tried to teach them, they probably didn't pick it up. Maybe not the second time. Maybe not even the third time, but hopefully they're getting a little bit better and if they're not, and you keep trying to teach them the same way, then the past is going to keep repeating themselves, if you keep trying to teach them how to tie his shoe with the whole bunny rabbit and through the hole and stuff, that's not cutting it, then you may need to step back and figure out a different way to present the information so the child can learn better. Same thing is true for us. One of the questions comes in, what if the clients externalize or throw blame on everybody? For example, blaming someone else for something that goes wrong is out of their control. Which happens a lot. If you wouldn't have, then this wouldn't have happened. That's true, possibly. However, in addiction recovery, and I always take it into mental health too because I do both, when you point one finger out or actually two fingers out because the thumb is kind of sticking there, and the finger's pointing back at you. And my first supervisor drove this home for me when I first became a supervisor and something happened and we had a grievance filed on our unit and I got called into his office and I walked in and the first thing he said to me was, what did your staff do to bring this on? I stepped back and I said, excuse me? What did my staff do? And he said yes. The clients are not going to file a grievance unless they became unhappy. So about what did they become unhappy and why? And then we can evaluate everybody's part in it. So we needed to step back and look at what everybody's part and perception was in the situation. Because sometimes well, a lot of time, people in the same situation, in the same argument have totally different perceptions about what's going on. So encouraging people to say alright, I hear you saying that such and so did this and it contributed to the problem. That's true. We can't necessarily control someone else's behavior. What is it that you can do in this situation in order to help yourself get through it? And sometimes there are situations in which the other person does choose something that is they make a choice to be vicious or vindictive. And we can't take that away and go well, you brought it on yourself. Because this interaction is a two-way street. We can address if this person acted this way, how can you react in a way that is self-preservatory. Helpful to yourself. And the example I'm thinking of is if you're working with a couple and one spouse cheats. You know, you can't well, you can, but you wouldn't likely go well, what did you do to make him go do that? Not a real good step in the right direction there. Or if a spouse goes out and starts using cocaine, relapses. And you look at the non-using spouse and you go well what did you do that made him go use? That person has to take responsibility for their behavior, whatever it was that they did. But the other person needs to figure out is this a healthy situation for me to be in? If this situation keeps happening is there something I'm doing that's putting myself in the middle of it. Sometimes people are not bringing it on themselves in that they're bringing on harm and doing things that are ugly to other people. But some people are attracted, for example, to others who desperately need rescuing and desperately need help. So we might look at it and say maybe it's the type of person that you're attracted to. And we'll look at why they might be attracted to that type of person and how they might be getting into this kind of a situation that is so hurtful and so harmful. Our reactions do matter because communication is a two-way street not necessarily about who is right or the most objective is what you say. And that's true. I mean everybody has their own perspective of what's right. The person who was unfaithful is going to say, well that person did this, this and this which just led me to not be able to take it anymore. And the person who was cheated on is going to say, well that person did this, this and this, which everybody has their own perspective of why they were right. So we want to look at the middle path and kind of put the stuff all out there and figure out how the person can best maintain their sense of self and their safety and their boundaries and work with the situation. If they keep going back into the same bad situation you know we need to look at what's the motivation for doing that. Instead of saying, well you keep doing this so you get what you deserve we look at it and go what's the motivation to keep going back into this heart-breaking situation. What are you looking for? What is so why is this unfortunate situation more rewarding than being alone for example. We want to help people figure out why they do something and if there's a better way to meet that need, how to do that. A lot of times we can look back to their family of origin look back over their history and see similar issues and they may be trying to replay and master something from the past but they didn't master in the past. Whether it's abandonment or surviving, being victimized or whatever it is we know that sometimes people will set up a situation where they in some way or another try to replay it until they come out victorious. But I generally start by not assuming I know what's going on but I do look at what if they say if something bad happens it's my fault I stop and go okay what parts of this did you have a part in. So I'm going to give you credit where credit is due if you want to take credit for it. If they say if something bad happens it's always somebody else's fault. Alright well let's take a look at that. If this person always brings this kind of tragedy and misery onto your family why do you keep going back into the relationship? And we see this in substance abuse recovery a lot. This is frequent where somebody says I'm in recovery they're in recovery for a while they relapse they come back they steal everything they hawk it then the family's homeless and the non-using partner comes back and says something bad happened and it's his fault and you may look at it and go yeah you're right it is that person's fault they relapsed. However how can we help you stop putting yourself in a position where you are going to be part of the fallout. So quick help for people having them keep a little card in their wallet of specific questions that they find helpful to kind of jar them out of their emotional mind. What's upsetting me you know I had a client come in last week who said you know I came home and I was just angry I don't really know what I was angry about I was just kind of angry and as we talked we figured out some of the things that were coming up but have them sit down and just start jotting down what they're thinking what's upsetting them. I'm angry because if they have nowhere to start let them start out with that leading in their statement I'm angry because ask themselves why is this upsetting me why is this bothering me so much and they may or may not have the answer but if they ask themselves then they might find an answer. Look at the facts not the emotions but the actual cold hard facts for and against this belief you know if you believe that somebody was completely unfair to you when you got your evaluation or your best friend you think she was talking behind your back what are the facts for and against how do you know this happened do you just have rumor mill stuff do you just have an inkling because somebody else said something snarky to you so you think your friend was talking behind your back are you just where are the concrete facts that we have and my reacting based on facts or feelings so if you don't have facts then obviously reacting on feelings if you do have facts sometimes we look at the facts and they say one thing but our feelings tell us that we should be angry we should be appalled we should be incensed about something and so that's how we're feeling right now and when we step back and really look at the facts like you know what I was a little off base that was more like an irritation earth shattering event what cognitive distortions am I using when you go through your cognitive distortions group when you go through your irrational thoughts group have people write down or give them worksheets that have the common cognitive distortions you can even google them and there are cognitive distortions handouts and have them just kind of review those when they're having a anxiety moment or an anger moment and figure out if their thoughts are extreme if their thoughts are overly negative or overly personal so they can at least identify that that's what's going on when they start doing these activities which are very cognitive it gets them out of there or gives them time to get out of their emotional mind and into their wise mind so if they can start doing something even if it's you know you can do just stress tolerance activities or whatever or if they start doing one of these worksheets where they're focusing on something that's more objective more factual more from that logical rational mind it helps the adrenaline bleed off so they can get into their wise mind and then make better decisions just like with cognitive distortions we have the ABCDFs the activating event what happened so if you're you and your friend have a fight and the consequences are you're devastated okay so what are your beliefs that are leading you to be devastated that you have to be liked by everybody all the time that you're never going to have another friend like that again that you are unlovable just have them start listing all those thoughts and then dispute them by looking at them by evaluating them for cognitive distortions and evaluating them for reality is it even realistic to expect everybody to expect yourself to get along with somebody all the time and never ever have a fight is that a realistic thought and have them think about other important relationships in their life like with their kids or with their parents or somebody who they are close with because generally you'll find they've had disagreements evaluate the most productive outcome once you've gotten through all the beliefs what do you want to do about it so if you've had a fight with your best friend you're devastated about it you go back through the beliefs and realize you know what it's not uncommon to have a disagreement and it probably doesn't mean this person hates me forever and always is this worth my energy well this is my best friend so yeah probably how can I best use my energy to deal with it what do I need to do now to address whatever this argument was about initially the person was upset because of the fight but once we've gotten through it and recognize that alright basically everybody's going to occasionally disagree so is this relationship important enough to work through this the person answers yes we say okay so what's the first thing you need to do to try to work through this disagreement you self talk constructively to challenge statements effective challenge statements make the person feel better so if they think oh my gosh this is the worst thing ever what's the evidence what is the evidence this is the worst thing that's ever happened most of the time that's not true I mean it could be scary as all get out but is it the worst thing ever what is so awful about it and you know sometimes there are going to be some awful things so encourage them again to walk the middle path and look for what are some not so awful things you know did anything good happened in anything not so awful happened you're a regular human being and have the right to make mistakes so encourage people to accept their fallibility as being human you can also encourage people to unhook constructive health self back constructive self talk can help people step back instead of saying I am a complete and utter failure they can say I am having the feeling right now I am a complete and utter failure now we can do something with feelings feelings are like somebody handing you a grocery bag you can do something with a grocery bag you can figure out where to put it you can put it all away you can hand it off to somebody else if I say I am a complete and utter failure then that's me that's internal that's completely global and stable so encourage people to unhook from their feelings and this comes from acceptance treatment therapy and insert the phrase I am having the thought that or I am having the feeling that I am a failure or I am unlovable and then what are you going to do about that thought or feeling because that empowers people most people once they say that they're like oh I can do something with a thought I don't have to think that again I can do something with a feeling I can choose not to feel that my thoughts work sheet so ask them what is the evidence ask them if they're assuming causation when none exists sometimes we assume that because we did X Y happened and there could be a whole bunch of different reasons maybe I was late to work and the boss was walking down the hall at 11 o'clock and saw me and didn't even look in my direction was he acting that way because I was late this morning? Or was he acting that way because he just got out of a meeting at senior management that didn't go well? Or he had something else on his mind? So assuming that personalization, assuming that causation happens when none exists, there was a television show, one of the Marvel comics that we were watching and one of the heroes is a billionaire who was lost and he comes back as a superhero and he's supposed to save the world. Well, his show flopped. I mean, it really did not do well. And I can tell you from watching it, I can see why. But his explanation to the media was because he was a billionaire that was put in charge with saving the world at a time when Trump is leading the free world and too many people made the correlation between him and Trump, which is why his show failed. And I'm like, have you watched any of these? But so looking at how people arrive at their conclusions and helping them evaluate whether they're drawing correlations, there is a similarity or causation. This happened, so this must happen. Am I confusing thought or feeling with fact? Sometimes I can have a thought that this is the worst day ever. Is that the facts? It can't be a thought, but when I look at the evidence is do I have facts to support it? Am I close enough to really know what's going on? A lot of times we can get upset about things that we have no clue really what's going on kind of behind the scenes or how bad it is or how good it is or what the motivations are. So do I have all the information I need to make an educated decision? Am I thinking in all or none terms? Am I using extreme words like always or never? We've already talked about how to address those. Is the source of information credible? What you think you remember from a conversation you had when you were drunk last night, probably not as credible as, you know, a conversation you had when you were not under the influence. Information from your best friend may be more credible than information from a complete stranger. I don't know, but you have to evaluate, you know, based on past history and experiences, how credible is this source of information? Am I confusing low with high probability scenarios? And, you know, I'm gonna stop here and say that your clients, my clients don't have the temperament, don't have the patience to go through each one of these. What we need to do as clinicians is identify the three or four maybe distressing thoughts, questions that seem to apply to our clients or have them go through this a few times and identify the three or four that seem to apply most often and put those on the note card. Cause if you ask them to go through 15 questions every time they get upset, they ain't gonna do it. Make it small, make it simple. But sometimes we do have people that when something happens, they focus on the worst possible scenario outcome instead of the most probable outcome. Am I focusing on irrelevant factors? You know, sometimes instead of focusing on the task at hand, we focus on, you know, all these other superfluous things. Is thinking this way getting me closer to what I want? You know, sometimes things are accurate and sometimes you've gotta decide whether holding onto those thoughts is getting you closer to your goals or keeping you stuck. Sometimes it's worth letting something go. What are the advantages or disadvantages of thinking this way? That saying that everybody leaves always. Well, the advantages, you don't ever expect anybody to stay around. The disadvantages, you always feel somewhat isolated. And there are more advantages and disadvantages, but if somebody has a consistent way of thinking that tends to be somewhat negative or dooms saying, you know, when something good happens, I always wait for the other shoe to drop. Look at the advantages and disadvantages of thinking that way versus thinking the opposite. And encourage people to ask themselves, what difference will this make? Whatever this issue was that got me upset, what difference will this make in a month or in a year? So if somebody doesn't return your phone call, or if you don't get a job, or if you, you know, have a fight with your best friend, or if you break up with somebody, yes, it hurts right now. In the big scheme of your life, what difference will this make for good and or bad in a month and in a year? So encourage them to figure out how impactful, it may hurt a lot right now, or it may seem terrifying right now. Most of the time, people will say, you know, in a month, it's still gonna be pretty depressing or pretty scary, but in a year, I think I'll have my balance back. So group activity, have less thinking errors that we've discussed, you know, each one, like I have to be liked by everybody all the time on a sheet and have your group go around and for each thinking error, have them identify competing responses. For example, I need to be liked by myself most of the time cause 90% of people, I'm spitballing here, the majority of people don't like themselves all the time. Sometimes we look at ourselves and we're like, really, that was an awful thing to do. I would love it if our clients loved themselves 100% of the time, but I'm trying to be realistic here. So encourage them to find rebuttal statements for each of the irrational thoughts. And hopefully if you've got a reasonable sized group, if you've got 12 people, you can have at least four rebuttal statements for each irrational or unhelpful thought. Help them identify, you know, they can also go around for each of the thinking errors and identify where they learned those. Who told you that you have to be liked by everybody all the time or that if something happens, it's always your fault. And some people may have been taught this when they were growing up. So they need to evaluate, is this still true? If it is, how do I deal with it? And if it's not, how do I let go of it? Any thinking errors your clients want to hold on to? And some people will hold on to this because that's the way they believe. And, you know, I have one client who has that belief that everybody always leaves and it's just safer to think that way. And he is unwilling to let go of that. He can see how it causes him distress, but the pain that believing that somebody's gonna be there and then them leaving or possibly leaving is too painful to even think about facing. So we start talking about, okay, well, how can we, if you're gonna hold on to this belief, how does that impact your relationship with your kids? And how can you minimize its negative impact on your life? Hopefully eventually he'll decide that some people are going to stay around forever. But, you know, that's not for me to tell him. That's at a certain point, he's got to figure out where he stands with it and what he's willing to believe. So CBT is a technique that helps people understand how thoughts create feelings and vice versa. So if you have a negative thought, it's probably going to trigger a stressful mood. And if you're in a bad mood, it's probably going to lend you to interpret things through a negative mindset and notice the negative instead of the positive. It also helps people identify and address negative self-talk. I mean, you can have them identify and address positive self-talk too, but most people don't care about that. So we wanna have them address negative self-talk. I guess with positive self-talk, you could encourage them to start adding positive mantras and positive self-statements each day. In order to buffer against the negatives. Issues and events from the past don't need to continue to negatively impact a person, but a lot of times we'll find that their irrational or unhelpful thoughts were formed around events in the past and it helped them survive that experience. So we need to help them look at the now and say, all right, that happened back then. This helped you survive till now. Is it still helping you? These thinking errors are learned and they can be unlearned. The thought patterns help to form and maintain a negative or vulnerable self-image. So if somebody has a lot of unhelpful thoughts, they're bombarding themselves with this negativity all the time and this guilt and the shame and all this other stuff. So if they're continuing to do that, they're gonna have a hard time feeling happy and worthy and all those things we want them to feel. So helping them identify their negative thoughts and then start being willing to take a look at them and take a look at their veracity. And it's a process. People don't just come into your office and go, oh yeah, you're right. I am thinking all these things and they make no sense at all. No, it takes a while for us to help gather evidence to help them see that there might be some alternate explanations. But also helping healthy thought patterns will help people feel more empowered and worthy of love and acceptance and they'll be able to provide their own self-validation so they'll feel less lonely and they'll always feel like somebody loves them because they love themselves. All right, are there any questions? I will look on the, I will sign in as a participant or a viewer in a few minutes and see what y'all see. There should be a dropdown on your chat box where you can send a message to all panelists or to everyone. So you should be able to interact with everybody as always. Would I say CBT can work for individuals diagnosed with schizophrenia or some memory loss? CBT is not gonna work with schizophrenia in terms of addressing hallucinations and delusions. What the person with schizophrenia believes is their reality. However, there are people with schizophrenia who also have negative self-statements about themselves, about their power, about what they can do. So to the extent that you're using it to address mood issues as opposed to psychosis, I think cognitive behavioral can be very helpful. With people with schizophrenia, depending on where they are with their medication and their lucidity, you may need to write more down. I've worked with some people with schizophrenia who are just brilliant. So not saying that people with schizophrenia are not smart, but sometimes on their medication or in the middle of a psychotic state, they have a hard time processing all the information. So if you write it down and they can go back and review it, it tends to be helpful. As for memory loss, if it's, maybe they have some amnesia versus like dementia, if you're working on stuff in the present, they may not remember what the issue was that triggered the negative thoughts. They may have blank areas in their mind, blank time spans in their memory from their childhood. And that's okay. What I tell them and I believe, obviously it hasn't been proven, but what I believe is that our brain will block out and only allow us access to what we can handle at that particular time. So eventually that stuff may become open, but it may have been too traumatic where it may not have solidified. And there's a whole lot of biochemical stuff where you can speculate why that might happen. But I try to not focus on, let's look in the past and figure out why you think this way, especially with those clients, I say let's look at why you think this way and how is it helping you achieve your goals? What can we do when something like this happens to help you deal with it in a way that helps you move forward toward your goal of being happy, whatever that looks like for you? So I think with memory loss in terms of something that's happened, CBT can also be helpful, especially for helping them deal with their cognitions in the present. If they've got ongoing memory loss, such as with dementia and Alzheimer's, that's probably gonna be more problematic. I don't have a whole lot of experience working with those clients. I had one client that had alcohol-related dementia and it just kind of depended on the day and we just met him where he was at cognitively and emotionally. I do not presently have more activities for groups on this, but I will certainly put something together and make them available in the additional resources section of this class and I'll find a better place to put them on the all CEUs website. I'll create a tab, that's what I'll do. I'll create a tab on the all CEUs website that's called resources and anything you guys ask for like this, I'll put there so you can access it even after your class access expires. So let me write that down right now, resources. So I'll do that this afternoon. Alrighty, if there are no other questions, have a wonderful day. Oh, oh, oh, I did wanna tell you before you leave. Thursday's class is on HIPAA and high-tech, Confidentiality and Ethics. It is a mind-blowingly stimulating class. Let me tell you what, sarcasm inserted. It was a little too long, so I've broken it into two parts. The first part is gonna be the regular one-hour class. You can take your quiz, get your certificate and be done. If you wanna stay for the second part, that's included in your, what you've paid. So you can stay for the second part if you have time and get an extra live interactive hour for that. So just let you know, you will get your one hour. It will be, we will have a little like mini two-minute break and then I'll go into part two. So you can get two hours on Thursday for ethics if you need live interactive ethics. And then next Tuesday is risk management and next Thursday is disaster planning. All of them ethics oriented, because I know some of y'all have to have a live interactive ethics. So that's all for today. Have a wonderful, amazing day and tomorrow and I will see y'all on Thursday.