Category: Cognitive Distortions

When people are just mean: How to overcome the hurt and anger

8/25/2017

For the past two years, I've been working in nursing homes, offering counseling to seniors dealing with adjustment issues, depression, anxiety and a host of other mental health concerns. During that time, I've learned that there are people who are polite, and people who are just flat-out mean. I recently had the pleasure of trying to interview a gentleman who could not get over the idea that I was fat, and was very obnoxious about it. Factually, he is right - I am fat. I'm not upset about that - it's the judgment and cruelty in deciding that I am less of a human being because of it that was hurtful.

We'll call him "Mr. Jones" for simplicity. When I went into Mr. Jones' room to introduce myself, he immediately said, "Well, you've put on weight, haven't you?" Not hello, not "how are you," - just an immediate comment on my body. I ignored it and introduced myself and told him I was here to talk with him. He, however, could not get past my appearance. I went to sit down, and he said, "You can't sit on the furniture. You'll break it." I let him know, gently and politely, that I had been sitting on the furniture for over two years without a problem, and that I had a job to do. He said, "you're too fat." At that point, even my patience was shot. I said, "Mr. Jones, I am here as a professional and your comments are out of line. My body is not under discussion. I'll come back again on Friday, and maybe we can try this again."

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Robin Williams, Suicide and Depression - Resources Updated

8/12/2014

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I thought for a while about whether or not I wanted to write about this, because there are so many armchair psychologists who are ready to explain and point fingers in regard to Robin Williams' suicide. Today, however, after hearing some of my clients' reactions and after hearing some of the things said in the media about it, I feel that I have something to say that might be helpful.

Mr. Williams' struggles with depression and addiction are well-known, and it's very easy to point fingers and say, "that was what did it." I've heard variations on that theme all day, most of them said with the attitude that nothing could help it. One radio host even went as far as to say, "He was beyond help. He was too far gone."

I nearly had to pull my car off the road after hearing that, because I was so angry. I work all day with people who struggle with those feelings and with the pain and hopelessness that goes along with them. To hear a DJ blithely blame the victim was nearly too much for me. NO ONE IS "BEYOND HELP;" AND NO ONE IS "TOO FAR GONE." I can't emphasize that enough.

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You Are Not Your Mood

7/14/2014

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Emotions are weird. They have a way of changing so fast we hardly know what hit us, and they can change our outlook on a situation, person or perception nearly as quickly. It helps to remember that as much as our emotions affect us, they do not define us. We are more than our emotions.

A few months ago, I struggled with this. I was feeling down - I was being impatient and it seemed like nothing was going right. Now, if you've been reading these blogs, you know as well as I do, that this is not the case. Red Flag #1 - feeling down about things does NOT mean that the feeling is reality. Ok, good enough - and I was still feeling lousy.

So, I thought...if I were the client, what would I be doing in therapy? (Yeah, I know... I'm a therapy geek.) Most likely, I'd be looking at the situation and testing out whether my emotions were really reflecting reality, or whether they were masking reality. How do you do this?

Marsha Linehan has a really cool tool that she uses in DBT called "chain analysis." You start with the event, behavior or situation that was the problem. In my case, I looked back to when I started feeling down, and the even had nothing to do with what seemed to be the situation. I was feeling lonely on the afternoon before, because I couldn't reach my family members to talk. That spiraled into feeling somewhat depressed. Specifically, I remember thinking, "I guess no one wants to talk to me. I might as well not exist." Red Flag #2: I was getting caught up in "Stinkin' Thinking."

In doing a chain analysis, you identify the event/situation that started the problem, describe the event, including what you were feeling and/or thinking at the time or what you did as a result of what you felt, and then describe how intensely you behaved, thought, or felt. In my case, the loneliness, sense of failure and depression were pretty strong. I ended up thinking, "I"m never going to be able to do this. I might as well just quit." Red Flag #3 - Stinkin' Thinking again. The idea here is that you want to describe all this in as much detail as you possibly can. Here's a good litmus test: Could someone recreate *exactly* what you went through? If so, then you've done it.

Next, you describe what led up to the feeling, thoughts, or behavior. In my case, not being able to talk to someone was the situation. This "precipitating event" (also called a "prompting event") is usually what we point to when we say that "such and such" caused the problem.

From here, you do a detailed description of all the things that affected the situation - Linehan calls them "vulnerability factors." In my case, I was tired from not sleeping well, I still had an annoying cough from a cold and didn't feel well, I was stressed by all the details stemming from running a new business as well as being worried about several emotionally intense client situations. I was overwhelmed, tired and not feeling good. I was also feeling emotionally exhausted by family situations and childcare issues.

Ok, here's where chain analysis gets tedious - you describle in minute, excruciatingly clear detail the chain of events - starting with the all the way at the beginning with precipitating event(s) and going all the way to the consequences. Ok - here goes: I called my mother and got her answering machine. I then called each of my sisters in turn and had the same result. I started feeling like I didn't matter. I called my husband, who was out at the park with our kids, and he didn't pick up. I started feeling depressed, and went to work on my task list for this week concerning my business and the paperwork I had to complete. Looking at the things I had to do, I felt overwhelmed and incompetent, and felt more depressed. I remember thinking, "Why bother?" and which led to a deeper negative mood. The consequences were that I was not present when my husband did come home and wanted to talk. Right then, I just wanted to be left alone to marinate in my own misery.

At that point, I recognized what was going on, and took steps to counteract the mood. The last step in the process is to describe in detail a prevention strategy and what you are going to do to repair negative consequences that resulted from your behavior or mood. In my case, my prevention strategy was stay mindful of my moods and to write. Writing in my journal, for me, is a safe place to vent and analyze what's going on. When I write, I feel better and so that's a good strategy for me to use. I can also go for a walk, and/or do something artistic. I could take a bubble bath, or have a hot cup of tea. Those are all things that help me - developing a list of what helps you will help you have something to turn to when you get feeling low. Nurturing and caring for yourself really IS important and necessary.

Luckily, the interpersonal consequences here were small. I went upstairs and apologized to my husband, and explained what was going on. I also told him that I needed some extra time to myself to write and sort out the depressed feelings.

If you're interested in more information on doing a chain analysis, you can go to a great website called DBT Self Help (www.dbtselfhelp.com) to get an idea of what this might look like in therapy or in practice. This website has an incredible array of tools, worksheets, handouts and articles.

Hope this helps - DBT helps with a lot of things - I highly recommend looking into it. Even if you don't go for it, learning about these coping tools and other tools available to you can help you get through these tough situations.

As Always:

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

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CBT: Dealing with Stinkin' Thinkin' and The Shoulds

7/14/2014

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Ok - in the last post, we ended on kind of a "down" note (reminds me of "The Empire Strikes Back - who wanted it to end with Han Solo getting iced and Luke losing his hand? C'MON!) Anyway - back to CBT...

In this post, we're going to talk about what to DO with these shoulds, absolutes, and other negative thought patterns that get in our way. CBT is, as I've mentioned, a very flexible orientation, and there are many systems of therapy that are based in CBT concepts (like DBT, for example.) So, instead of going into a whole lot of specific techniques based in one system, I'm going to touch on some general techniques that you'll find a lot of CBT therapists using. I've mentioned a few of them in the first post, but I'll review those here again.

One thing I mentioned in the first CBT post bears repeating again: this is NOT a "quick fix" solution to problems. These techniques, and change itself require commitment to practicing the techniques and to changing the way you think and interpret things. This takes time, and does not happen overnight. CBT has been accused also of being a feel-good way of saying that if you think happy you'll be happy. While this criticism has some merit, it's just not that simple. CBT does assert that if you change the way you think, you'll likely feel somewhat better, but does not promise results (like any therapy) and is way more complex than the simple "if you think better you'll feel better" platitude.

Ok - on to the nuts and bolts again. When you're involved in doing CBT or going through one of the many CBT-based workbooks you can find in the self-help section, you will see that there are many commonalities. First, you are likely to be asked to either talk about what the problem is (to help the therapist understand your interpretations and perceptions as well as your thought patterns) and/or fill out some paper-pen type questionnaires (called "inventories" in the clinical field.). These inventories will ask about a variety of symptoms (to help therapist or you get a handle on what's going on.) For example, if you come in thinking or feeling depressed, you might be given something called the "BDI" (Beck Depression Inventory - guess who developed that? ) This questionnaire asks you to rate the severity of common depressive symptoms that you might be experiencing. There are other inventories and symptom checklists that are useful as well. Well and good, so when do we get to the CBT stuff?

A-ha...remember the "B" part of CBT? That stands for "behavior" - in order to work well here, your therapist (or you, if you're working in a workbook) needs to know what you're experiencing and doing, as well as what you're thinking. There really is a reason behind the stuff we do - promise! How we act often reflects the way we're thinking - we interpret things, we feel an emotion related to the interpretation, and we act based on the interpretation and the emotion. Ok...so you've filled out the inventories, done all the paper work, described the situations and what you've been feeling - now what? That's where the "behavior" part - what we do - comes in. A lot of the "homework" and activities in CBT is, quite frankly, behavioral.

Here's where the workbooks and being in therapy differ some. The workbooks will go straight into the things that we typically call "homework," where a therapist will explore the situations more in-depth, provide support, and help you see and work with the stuff that brought you in. This is why I really recommend therapy (ok - I'm biased, too - I admit it). The workbooks can be really valuable resources; I use them myself as part of the work I do with clients sometimes. I've recommended them to clients, and I use them in session, when appropriate - they make my job easier because I don't have to reinvent the wheel here in terms of homework. BUT, they don't provide you with that ongoing sense of support and empathy that you get with a well-trained therapist. It's a choice you make, though.

When you're working with a therapist, the therapist will help you identify the thought patterns that are getting in the way for you - are you thinking in absolutist terms? Are you overwhelmed by "shoulds"? What about feeling like everyone should like you - or that you should do everything to make people like you? You get the idea...the therapist will spend time talking with you and helping you identify where your thinking and/or interpreting get in the way of you feeling better. The workbooks may have you answer a lot of fill-in-the-blank questions or do a lot of sentence completions, but the goals are the same: helping you identify the types of negative thinking or interpreting that are not helping you.

Typical homework assignments include keeping a record of your thoughts and how those thoughts affected your emotions and behavior, or keeping track of how many times you catch yourself sliding into one kind of thought pattern. There are also behavioral challenges or assignments to help you practice a new way of interacting with and intepreting the world around you. I once kept track for a week of all my "shoulds" - I filled an entire 70-page mini-notebook! It's really eye-opening when you realize how often we engage in these ways of thinking, and how much they affect our moods and behavior - which is, of course, the point of the exercise!

Next, what may happen is that you may be asked to work on contradicting or "softening" these patterns. For example, if you're overly harsh with yourself, you might be asked to come up with thoughts or phrases or sentences to tell yourself that are loving, accepting and/or nonjudgmental. If you're stuck in a pattern where you're overgeneralizing things or magnifying/minimizing, you might be asked to come up more realistic interpretations. Many times, some of this work is done in the therapy room with the therapist helping you, because for many people in therapy these thought patterns have become habits. It may have happened out of ongoing abuse or neglect - these patterns are likely part of what helped you survive, or it may be something that's resulted from some situational things going on like, "I've been out of work for a year, and I'm worried I may not have enought money left to meet my or my family's basic needs" or "I can't seem to get myself to feel better even though it's been two years since my great-aunt Clara passed away".

Situations have a LOT of power - we tend to interpret our stuff in terms of the situation ("I was speeding because I needed to get home to a sick child") but we tend not to give others the same benefit of the doubt ("They were speeding...what jerks. I bet they cut everyone off and run red lights too"). As a side note: If you've taken introductory psychology, you'll probably recognize a few concepts here: self-serving bias, fundamental attribution error, actor-observer effect...

So, your therapist may use some gentle challenges, some reflecting, some humor (when appropriate), summations, "check-ins" (making sure they understand what you're telling them), etc. In therapy, you may also use some of the "workbook techniques" - they're very useful as homework.

With both the workbooks and in therapy, you'll also examine what triggers the thoughts, the emotions, and the behaviors - you may find that a certain style of thinking or way of interpreting things is behind the way you feel or behave. Or it may be something in your environment - a certain authority figure that reminds you of someone in your past who'd been critical, or a certain place, smell, sound that triggers memories and experiences from a a traumatic event - it's hard (or even impossible) to think clearly and well when you're re-experiencing something traumatic. (Here's where working with a therapist is really helpful - the therapist can help with the PTSD symptoms as well as the cognitive stuff.) From there, you can work to change, heal and hopefully start to feel better.

One thing I want to say about triggers: If you're dealing with PTSD or things that trigger severe emotional distress, please see a therapist. The therapist can provide a safety net where you can work on and process these triggers, and can again provide support for you while you're working on these. Any time you're dealing with severe or chronic emotional distress, it's best to see a professional who can do more than anything you'd find in a workbook or web site. A therapist can also help you go more in-depth and safely explore the event(s) or trauma behind the triggers. Workbooks and web-sites can provide tremendous support and information, and they don't take the place of a really good therapist. I don't want to diss support groupgs and websites - they are incredible and filled with fantastic people who have been through, treated or supported people through some pretty traumatic stuff. However, if you're in the throes of serious distress, adding a good therapist to that mix will only help you.

Ok - back to nuts and bolts: Another area you'll want to concentrate on, again with both the self-help stuff and in therapy, is what to do to help you maintain any changes you make and/or improve on them. Changing things in your lifestyle may help (for example, if you're dealing with depression, building in some exercise into your routine will likely help you feel better), as would continuing to use some of the tools you've used in therapy (like the mood log, or examining realistic vs unrealistic thinking). These aspects of therapy or self-help can help you manage situations in the moment and help you realistically process and think about them afterward.

The nice thing about CBT is that what you do and how you do it really is individualized. It's not about unconscious motives, Oedipus complexes, penis envy or any of that - it's about what YOU can do to help yourself think in a healthy manner, feel better and change your behaviors so that you're interacting with the world in a way that creates a better life for you. It's not a one-size-fits-all orientation either - CBT, through research, is always working to incorporate things that help and are validated by research. That said, sometimes it can seem "manualized" and "remote" - if this is the case, bring up how you're feeling about it in therapy, and process that with your therapist. If you're using a workbook, ask yourself what you're hoping to see in the workbook, and where you're missing what you wanted - then get recommendations for something new, or scale down your expectations and continue to work the program. (And expectations are a whole AREA of cognitions to work on, by the way!).

So...if you have questions about specific techniques, or want to know more about a specific area of cognitions and/or disorder where CBT may be helpful, feel free to comment or send me an email. I'm always happy to help, and answer all the comments and emails I get.

Take care and think well!

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected]

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CBT: What is "Stinkin' Thinkin'"?

7/14/2014

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Now that you've gotten a pretty good idea of what CBT is and how it might work, let's take a more in-depth look at understanding how negative thinking and interpretations of the things around you affect you. Let's start with the kinds of negative thought patterns that are related to feeling rotten (I know - great way to start, huh?) Albert Ellis and Aaron Beck are two guys in our field that are pretty much the founding fathers of CBT. They both start with types of negative thinking or information processing - Ellis calls these "irrational beliefs" and Beck calls them "errors in information processing." (Ellis, by the way is the dude who came up with the phrases "stinkin' thinking," "catastrophizing," and "don't 'should' on yourself". The man is blunt, but he does know how to turn a phrase!) The gist of these is that we get caught up in unrealistic and unhelpful ways of thinking, interpreting and perceiving ourselves and the world around us.

Ellis has 11 "irrational beliefs" that he describes:

It is essential that a person be loved or approved of by virtually everyone in the community
A person must be perfectly competent, adequate, and achieving to be considered worthwhile
Some people are bad, wicked, or villainous and therefore should be blamed and punished
It is a terrible catastrophe when things are not as a person wants them to be
Unhappiness is cause by outside circumstances, and a person has no control over it
Dangerous or fearsome things are cause for great concern, and their possibility must be continually dwelt upon
It is easier to avoid certain difficulties and self-responsibilities than to face them
A person should be dependent on others and should have someone stronger on whom to rely
Past experiences and events are the determinants of present behavior; the influence of the past cannot be eradicated
A person should be quite upset over other people's problems and disturbances
There is always a right or perfect solution to every problem, and it must be found or the results will be catastrophic.

These are pretty harsh statements, don't you think? While some may be true in part, having these roiling around in your mind as absolutes can really make it hard for you to see things as they are. Beck's list is somewhat similar (but shorter!):

Arbitrary Inference: Coming to a certain conclusion without any evidence or in the face of evidence to the contrary. (Example: "I'm an idiot.")
Selective Abstraction: Pulling out one little bit of a situation and ignoring other meaning ful pieces, followed by labeling or interpreting the whole thing based on that one little bit. (Example: I got a "C" on my exam. I'll never get into grad school. I'm going to flunk out, I just know it.")
Overgeneralization: Making a general rule out of what really should be an isolated incident - then using it over a whole range of situations. (Example: The driver of that car was an idiot - he cut me off! Ah, he's from California...the people there don't know how to drive. I'm sure he's a hippie, too.)
Magnification: blowing something out of proportion (Example: You ruined this whole trip by not sharing a room with me. This whole thing is just a mess now.) Minimization: the opposite of magnification - making things that significant seem insignificant or nonexistant. (Example: An abusive spouse, who after hitting someone says, "It was just a tap. It wasn't anything.")
Personalization: Thinking it's all about you, even when there's no reason to think so. (Example: "Oh it just figures it would rain. It's MY prom day, and of course, there's bad weather.")
Absolute and/or dichotomous thinking (Also called "black & white" and "either/or" thinking): Not seeing the "gray area" or middle ground, and categorizing people, "I'm the worst mother in the world" or "Nobody will ever like me" or "I'm a failure.")

Another type that is common here - and probably falls across a lot of these categories is the "should." Ellis had a phrase that I love: "Don't 'should' on yourself," and I have to tell you that as true as it is, it's also hard to break the habit of shoulding. And, quite frankly, not all shoulds are harmful - some of them are the glue holding our society together: we should follow the law, we should not harm other people, we should respect other people's boundaries, etc. However, there are a LOT of shoulds that can and (pardon the pun) should be examined - do they help us or not? Even becoming aware of all the shoulds is a tough process - a lot of them are so ingrained in how are and who we are that we don't even think of them as "shoulds" anymore. Things like, "I should not complain, even when ________ hits me," or "I should not air my family's dirty laundry" (even when doing so would stop abuse). "I should be over it by now" "I should be a better ________" " I should do _______ better/more often/less"...you get the idea.

Beck thinks that, with people who are depressed (and my guess is that this this true for people in a lot of situations), there is a cognitive triad that is essentially a cycle that is on a downward spiral. The first part of the triad is seeing the self as being fundamentally flawed or defective. The second piece is that the person interprets things as being negative, even when they're not or if there is evidence that they aren't. Life here is always getting in the way and is never good, so the everday aspects of living feel overwhelming and impossible. The final piece of the triad is that the future is probably going to be bad, and the person expects failure to happen.

I don't know about you all...but I see myself in a lot of this. "Stinkin' thinking" and "shoulding" are easy patterns to slip into, easy to make a habit out of. It's especially true when there are others who get let off the hook and gain from us doing this - they tend to reinforce us thinking this way. There are ways out, though - and as I said earlier, it takes commitment and practice. On that pleasant note...on to the next bit, which will be a lot more upbeat.

So, next up: Dealing with Stinkin' Thinkin & the Shoulds (sounds like the name of a band, doesn't it? "Stinkin' Thinkin' & the Shoulds")

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: [email protected].

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When people are just mean: How to overcome the hurt and anger

Robin Williams, Suicide and Depression - Resources Updated

You Are Not Your Mood

CBT: Dealing with Stinkin' Thinkin' and The Shoulds

CBT: What is "Stinkin' Thinkin'"?

Laura Burlingame-Lee:

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