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CBT Essentials: ABCs & Self-Talk
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0:00
i'd like to welcome everybody today's presentation of integrative behavioral health care i'm your host dr dawn elise snipes today we are talking about cognitive behavioral therapy essentials specifically cognitive processing the abcs and self-talk
0:19
the first thing i want to talk about though is how cognitive behavioral therapy helps some people think that mental illness mental disorders distress whatever you want to call it is are caused exclusively by chemical imbalances other people think it's caused exclusively by
0:39
unhelpful thoughts other people think it's caused by unhelpful behaviors well the answer is it's caused by all three and in cognitive behavioral therapy one of the things or one of the main tenets is this triad here our thoughts our feelings and our behaviors they're all interrelated our thoughts can either trigger or down regulate our hpa axis our threat response system which impacts our physiology when that hpa axis is down regulated when we're able to relax
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then we have increases in serotonin we have you know regulation or better regulation of our gonadal hormones our thyroid functions more effectively our pain levels tend to go down because our pain perception goes or our pain tolerance goes up our immune system is improved you know there are a lot of benefits to down regulating that hpa axis and the only way to do that is when we are not feeling and thinking that we are under threat
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affectively when our hpa axis is up regulated uh we tend to have feelings of anxiety and anger because it's the fight or flea reaction when our hpa axis is down regulated we tend to be able to feel more feelings of relaxation we tend to be able to feel a wider array of feelings because we don't have that tonal vision that is caused when we are in that fight-or-flee state cognitively and behaviorally when we are more relaxed when our hpa axis is down regulated when we are having
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more positive thoughts we tend to also notice more positive things and be able to be more flexible in our thinking and our choices of behaviors all of these things our physical health and our energy levels our emotions and our thoughts impact our environment and our relationships so i just want to go through a few scenarios before we get in um the into the things for today
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so let's go over here to this little triad the one i have up here is somebody has something bad happen whatever it is they experience distress and they tell themselves i cannot tolerate this and that's one of those things we call distress intolerant thoughts so they have one of those distress intolerant thoughts saying i just i can't do it i can't survive this well what does that do to their emotions if i think that i can't survive something it's gonna scare the bejesus out of me
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so i'm gonna be more terrified when i am feeling powerless and terrified guess what my behaviors are probably going to be geared towards trying to make that go away and if i feel powerless then i may not be willing to fight anymore so i may retreat and do that by either you know getting drunk or going back to bed and just trying to pull the covers over my head and pretend that life is not going on around me none of those are helpful okay so let's take it from any any place in this
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triad no matter where you start and i have some examples let's just say you choose to stay up late you know there's a good movie on tv and then after that is another good movie on tv you gotta work in the morning but you choose to stay up really late you get like no sleep how does that affect your mood the next day are you as happy are you as carefree are you as energetic and enthusiastic
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probably not um how does that affect your thoughts throughout the next day well we know that when we don't get enough good quality sleep we don't clear out the adenosine which means we're going to have sleep pressure throughout the day and it's going to imp impair our cognitive abilities now that being said we know it's going to affect us that way but it also may make us a little bit more
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cranky or pessimistic or negative in our thought processes i don't know but it's interesting for people to take note of these things and figure out how different behaviors impact them
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another example would be i agree to help somebody do something maybe to move this weekend even though i know i don't have the time so i am choosing a behavior i am choosing to do something that i know is going to add stress to my life so how is that going to affect my thoughts i'm probably um going to be a little bit more irritable a little bit more stressed because now i have this excessive time pressure i may even feel resentful towards that person
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because i really didn't have time and i really didn't want to help
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on the other side when we do things that are positive for ourself like we choose to eat a healthy diet and i know some of you are rolling your eyes going eating healthfully doesn't impact my mood i would challenge you to do it for a week and see how it helps or doesn't you know see what it does for you when i used to do this experiment with my class at the university of florida a lot of people would choose to make one behavior change and
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that would be to start drinking more water and they figured it wasn't going to do anything and i think they were trying to prove me wrong and ultimately every single one of them no joke every single one of them ended up finding that it had positive benefits for them in their mood and in their in their thinking when we have when we're hydrated and our bodily processes can happen like they're supposed to when we are you know not having difficulty with cognition
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then it can also help our mood we don't feel as frustrated and we know that even one percent dehydration can lead to difficulty in learning and cognitive processes so let's jump over here to feelings you know maybe you're going to start in the truck try add in feelings when you are angry what are your thoughts like are you thinking happy positive courageous thoughts probably not when you are angry what do you want to do do you typically want to do something proactive and
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healthy or is your knee-jerk reaction sometimes to just try to escape or avoid that feeling
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likewise when you're excited you know when you get up in the morning and it's a beautiful day outside and maybe you're looking forward to something you are excited to get started with the day and so how does that affect your thoughts you know i know when i'm excited when i'm in a good mood i tend to be more optimistic i tend to be more creative i tend to be more enthusiastic about most everything and my behaviors tend to follow suit when i'm in a good mood i tend to do the
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things that i need to do and it doesn't feel like it's as much drudgery so i do encourage you to
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investigate the triad when you're in a bad mood you know notice how it affects your behaviors and your thoughts when you're having negative thoughts notice how it affects your feelings and your behaviors and when you are doing things that are let's say good for yourself notice how when you treat your body well when you engage in behaviors that are proactive pro-social how does that affect your mood and your thinking
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i think you may be surprised at how intimately these three things are connected
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so let's talk about the abcs of cognitive behavioral therapy this is cognitive behavioral therapy 101 and you can go much deeper than this on evaluating situations but this is a really nice quick analysis of what's going on and we've talked about this before so i'm not going to spend a whole lot of time on it but a is the activating event it is what happens you get cut off in traffic for example okay most of us have gotten cut off in traffic so you can relate to that
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you get cut off in traffic and you feel something and that's the consequence you know almost instantaneously you may feel angry you may feel scared you may feel frustrated
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however you feel that is the consequence but in that micro second um between the activating event and the consequence you had a litany of automatic and often unhelpful or exaggerated or out of context beliefs and it's important to go back and recognize those and we're going to talk a lot of cognitive behavioral therapy involves evaluating your thoughts
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in the present context for their accuracy and their hopefulness and that's really what it comes down to because if your thoughts are accurate and they're helpful
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it doesn't necessarily mean that it's going to make you feel better right away if you're in the middle of you know a very distressing situation but they're also not going to keep you stuck so going back to getting cut off in traffic your beliefs may be that the person was rude i could have been killed um they were intentionally doing this well think about it have you ever accidentally cut somebody off in traffic maybe not recently maybe you're a super defensive driver now
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but think about when you were younger you were first starting to drive i know i did and you know i feel bad bad about it in retrospect i wasn't trying to be rude um i just hadn't developed the driving skills at that point in time so it's important to evaluate the beliefs to
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adjust any beliefs that are overly exaggerated and eliminate the beliefs that are just not on target for this situation you know if somebody cuts in front of you and you have to slow down a little bit is that you know could you really have almost been killed no you had to apply your brakes now if you have to swerve over into the shoulder and slam on your brakes to avoid going off into the ditch
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that's something different but it's important to use perspective so that's our a's our and our b's and our c's then you want to dispute the beliefs based on facts you know we just talked about that and evaluate the effectiveness of your reactions for helping you use your energy and time for achieving a life that's important to you and that takes us to road rage
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yes we get cut off in traffic sometimes yes it's possible that you know bad things could have happened we could have been killed i think most of us have been in a position at one time or another where we've been cut off and we actually have had to swerve into the um into the shoulder and try to avoid rolling off in the ditch and that can be extremely terrifying
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so it's important to accept you know the beliefs when they're there but does getting angry about it and staying angry about it is that an effective use of your energy the person who cuts you off may not even realize they cut you off but even if they do do you think they really care probably not and does your getting angry will that do anything to change their behavior or to change their
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perception probably not therefore is holding on to this anger you know anger's a natural emotion it tells you there might be a threat it happens you notice it you check out the situation you say is staying angry going to be a good use of my energy is it going to change anything for the positive in this situation and in this case i think 99.9 times out of 100 the answer is no
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now sometimes your reactions and what you do your your thoughts and your behaviors can be helpful you can ask yourself what is the best thing that i can do with my energy right now to improve the next moment and in the case of you know the person that cuts you off and may be driving erratically well back off you know don't get too close to them because they're clearly either not good drivers or they have a lack of consideration for others or whatever's going on but instead of
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tempting fate and getting up next to them again probably better just to give them some space
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challenging questions and this comes along with cognitive processing therapy which is exactly what it says we are processing our cognitions and the mnemonic i use for this is face palm and i like mnemonics because it makes it easier for people to remember but this is another way of saying what we just talked about but differently so f stands for facts for and against your belief so sticking with the scenario of getting cut off in traffic what are the facts that i was almost
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killed what are the facts for and against that you know look at what's actually there not my feelings did i feel terrified well yeah possible were there any facts to support it you know let me give you another scenario semis i really detest being by semis especially on the interstate but generally anywhere because i feel like i'm this little bug right next to them that they may not see and they may squish at any moment that is my emotional reasoning that i don't have any
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facts for that because i stay out of their blind spot and that sort of thing so i know that they can see me i know that they know i'm there so there are no facts supporting my fears when i am you know in not in their blind spot that they are going to not be able to see me and they're going to squish me so you know that's the difference between factual and emotional reasoning when we fear something sometimes we try to convince ourselves that it's true
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but we need to look at the facts and say is this actually true flying on an airplane is another example some people are terrified to fly on an air airplane because it's quote so dangerous and they have convinced themselves that flying on an airplane is very very dangerous when you look at the facts it's far more dangerous to drive in a car than it is to fly on an airplane but we pay more attention to when airliners go down because those those things get
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all kinds of of of media attention when jim bob's driving down the road in rural arkansas and has a one car collision with a tree and kills himself that usually doesn't get any press so we don't recognize we don't realize how many more accidents how how much more likely it is unfortunately
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to be in danger when we're driving in our vehicle than in a car
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so looking at the facts and we can go through this you know all day long you want to talk about spiders you want to talk about snakes you want to talk about whatever these are fears that a lot of people have that are based on emotional reasoning and not grounded in fact so the first thing in face palm is to look at the facts and see if your belief has any factual basis to it
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then you want to look at additional factors a lot of times people are when they're feeling stressed they have that tunnel vision they have those blinders on because the adrenaline is coursing through their veins so they have a hard time considering additional factors that may be important to consider in the situation that may be contributing to this situation
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a snake slithers across the path the hiking trail that you're on and stops in the middle of the hiking trail now you get scared because oh my gosh it's a snake snakes are dangerous it's going to kill me and it came out so it can attack me okay well that is a line of thinking now let's look at additional factors it's a cold day that spot on the trail is sunny the snake probably didn't even really realize you were there but we don't know that that's not a fact that's an assumption
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and the snake does not have the notable head shape of a poisonous snake so that those are additional factors that we want to add to the facts i use this um process a lot when i work with people in couples counseling as well because it does consider it makes you look brought more broadly than sometimes the abcs do if people are in a relationship and let's say one partner cheats on the other partner or they need
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they start getting a divorce or whatever it is there's discord what are the facts for and against your belief so if one cheats on the other this person um you know it's all their fault okay what are the facts for and against that belief what are additional factors that contributed to this ultimate behavior what else fed into that um and it's really important to consider especially when you're dealing with people that the fact that a lot of times
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that everybody has an effect on everybody else and vice versa so what was your part what was their part what was the environment's part in what was going on which takes us to context
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when you are evaluating the facts and the additional factors what is true and
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may be happening in one context may be very dangerous but in another context not so much you know when you were if this happened when you were six or if you're a six-year-old and you're experiencing this it may be very threatening because six-year-olds can't survive on their own six-year-olds need the support of their caregivers if you're 26 theoretically you have a lot more tools and resources at your disposal so in that context as a grown-up it may not be as big of
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a deal so we do want to consider context and asking yourself in this context at this time given the facts at hand am i safe which takes us to then we want to look and see if we're using extreme language like this always happens to me or i can never be safe all right so if your belief is that you can never be safe what are the facts for and against that what additional factors might contribute to your safety or your unsafeness in this context that you're in right now
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are you is that statement still true is it true that you are never safe um so you want to look at those different words and you can say sometimes you may not be safe if you feel that way but it's important to examine extreme language because very few things happen all the time or never
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then we want to go over to p which is probability or likelihood given the facts of the situation in this context once you adjust your language to be more reasonable to be more on point what is the probability or likelihood that the worst case scenario that your worst fears are going to come true a stands for what are some alternative explanations and that can overlap some with additional factors for example that that snake what is an alternative
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explanation for why it's literally slithered across your path and stopped well could be sunbathing what are some alternative explanations for why the person may have cut you off in traffic you know maybe you were in their blind spot maybe and that's also an additional factor
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maybe they were on the phone maybe they were changing their radio who knows but what are some alternative explanations besides that they were being intentionally rude and they were trying to hurt you l stands for learn learn from the situation once you process this you're changing your mental schema your mental shortcuts if you will so learn from this and remind yourself the next time it happens so the next time you're out hiking and that a snake slithers
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in front of you you can refer back to this you've learned from it because you've already done all the processing and you can say okay i've been through a situation like this before in which it actually wasn't threatening so let me you know not automatically go into fight or flee mode and recognize the facts the additional factors the context etc in this situation because every time we go through a situation we learn from it it modifies our schema just a little bit so we
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can anticipate how to react we can anticipate the outcome when we encounter it in the future
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which brings us to move forward once you have experienced it once you've processed it once you've learned from it then use that information so the next time you encounter that situation you can make a you can adjust your thoughts accordingly more quickly and avoid over
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over act over triggering your hpa axis and leading to
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leading to hpa axis dysregulation
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and when you are going through these a lot of times
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the facts for and against your belief you identify your belief by asking yourself what am i telling myself right now and a lot of times it's not overt you're not sitting there telling yourself that this is terribly dangerous or what have you you're often starting with a feeling you're terrified to go on an airplane okay well let's look at why you're terrified to go on an airplane or you see a snake and all of a sudden you're terrified which takes us back to these abcs
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there's that activating event and then they're the emotional reaction the physical reaction the thought reactions but in that millisecond in between the activating event and the consequences there is a litany of those automatic subconscious and often unhelpful exaggerated or out of context beliefs and those beliefs are the ones that you've got to run through what i call your fact filter
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to distill it down you know if you don't want to remember face palm all the time although i think going through each one of these can really help you drill down when you start feeling distressed about something ask yourself what are the facts for and against my whatever thoughts i'm having that are contributing to my distress
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in this context at this point in time am i safe and what can i do to improve the next moment
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and if i take action if i do those things that i have the ability to do in this context to improve the next moment what is the probability or likelihood that my fear will come true
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so facts what things do i have control over in this context to improve the next moment and if i do those things what's the probability so i i abbreviated fcp and that's i just can't make a mnemonic for that finally loving-kindness meditation because our thoughts impact our hpa axis and impact our emotional reactions they imp they actually do impact the neurotransmitter balance in our brains it can be helpful to practice a loving kindness meditation now the
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loving kindness meditation in its entirety starts out with focusing on ourselves then focusing on somebody we love then focusing on some stranger then focusing on somebody that we have a beef with and then maybe focusing on the universe but just a shortcut you know in order to help get you in a into a positive mental space each day i encourage you to start out the day by meditating briefly a
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minute you know when i say briefly i mean briefly meditate for a minute on loving kindness and ask yourself or say to yourself in this moment or for this day may i experience the joy of being alive
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just sit with that for five or ten seconds may i feel that safe and secure sit with that for five or ten seconds and imagine what it feels like to feel safe and secure and notice the things in your life you know kind of do a mental checklist of the things in your life that keep you safe and secure
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may i be filled with love another 10 seconds feel yourself being filled with love from those who love you and from yourself it's it is okay to love yourself that's actually really important may i feel calm and connected take that 10 seconds feel the stress feel the irritability you know draining and notice what it would feel like to feel calm and connected
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and may i accept myself just as i am now if you go through each one of those and spend 10 seconds meditating on each one that's one minute you can do one minute you know a lot of people say well i don't have time to meditate okay maybe you're not willing to take 20 minutes a day out all right that's that's your choice but i think everybody can find one minute
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now throughout the day you may find yourself getting irritable getting frustrated getting what i call dysphoric having unpleasant feelings and obviously you want to check and make sure you're safe you know kind of run through the uh the abcs making sure that you're safe and doing you know whatever you can but sometimes you know you just you're in a funk and it's you can repeat to yourself throughout the day may i feel safe loved grateful and content just as i am
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and if you're having an issue with another person add on to that may you feel safe loved grateful and content just as you are so send positive vibes to that other person and you can even do this maybe before you go into a meeting with somebody uh in order to try to set up that positive mind space for yourself this is another one of those things i would encourage you to try and in cognitive behavioral one of the tricks or tools or activities whatever you want to call it
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we have is called the coin toss and you get up in the morning and you toss a coin if it lands on heads you practice the tool throughout the day and you notice how it impacts your life if at all and you know hopefully it does if it lands on tails just go about doing your normal stuff at the end of the week compare the days the days that you practice the tool versus the days that you weren't very mindful and identify which days seem to go better which days were filled
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with less anxiety with uh more physical comfort with more energy practice it try it for yourself not every tool works for every person which is why you know it's important to try these things and if it works for you great if it doesn't work for you okay let's find something else
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ultimately it is important to recognize the impact of our thoughts of our cognitions on our attitudes and our feelings and our behaviors the impact of our behaviors on our feelings and our thoughts and the impact of our feelings on our thoughts and our behaviors
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are there questions about cognitive behavioral therapy now on the youtube channel i have started a series that i'm calling cognitive behavioral therapy nuggets and each one of those videos is about six minutes long and it teaches a single cognitive behavioral therapy tool so if you're interested in cbt and you want to explore different tools that might be able to be helpful to you i would encourage you to check out some of those videos they don't take long
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and it's something you can look at in the morning and then maybe try to practice throughout the day congratulations on your new job jamaican barbie i'm glad to hear that uh you've got that
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it is definitely important to recognize that distress may happen and and i don't want you to get into a situation of what we call toxic positivity where you're telling yourself you should feel better and you're ignoring your distress but it is important and i see lots of you are doing that and i think that's such a blessing to recognize that some things in your life can be really crappy right now however there may be other things in your life that you are actually
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very grateful for um and it's important to embrace the dialectics and find the and notice the good and the bad alrighty everybody have a fabulous day and i will see you tomorrow same time same station
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