Thinking

Identifying Automatic thoughts

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Lots of people struggle with identifying their thinking. Some insist that they are “just anxious” and they have no worries creating this anxiety. While it may be the case that some health conditions can produce an anxiety like response, CBT suggests that the vast majority of the time there are thoughts or beliefs creating our emotions and there are some tools we can use to help identify them.

The “what am I feeling” technique

This is a fundamental technique in CBT. Our feelings are excellent clues into what we are thinking. Also, since we frequently misuse the word “feel” in English, sometimes our “feelings” are actually thoughts in disguise. For example, woman struggling with guilt about parenting insisted she couldn’t identify her thoughts when she felt guilty. When describing the situation in therapy she claimed “I just feel like a bad Mom.” This was immensely helpful because she had been confusing her feelings with her thoughts. She felt guilty and she thought “I’m a bad mom.”

Even when we are not confusing thoughts and feelings, our emotions give us hints about our thinking. As described above, when we are anxious we are usually worried about something, when we are depressed we are usually thinking negative thoughts about ourselves, the world, or our futures, and when we are angry we are usually thinking about what “should” happen or how someone “should” behave. Sadness tends to be about loss, guilt about judgments about our own behavior, and embarrassment tends to be created by assumptions about how others might judge us.

You can improve your skills of identifying your thoughts by checking-in with yourself next time you have a feeling. So next time you feel anxious ask yourself “what am I worrying about?”

The pen and paper technique

The first technique is very simple, but usually can be effective for most people. This technique involves carrying a small notebook, a piece of paper, or a cue card with you (and a pen) and writing down any automatic thoughts you have when you feel anxious, depressed, angry, etc. You can also use worksheets to help with this process. Here are some hints for writing down automatic thoughts:

  • Write your thoughts in short sentences like “I’m going to be late!” or “this person should learn to drive.” Do not write single word bullet points like “bad” or “guilty.”
  • Do not write your thoughts in the form of a question try and turn them into statements. For example, turn “Why am I such an idiot?” into “I’m such an idiot.”

The stick person technique

Although this one can seem silly, it can be one of the most effective skills for identifying thinking. Simple think of a time when you were feeling depressed, anxious, angry, etc. Then draw a stick person in that situation. Here’s an example of a stick-person getting anxious when they saw a snake when he was on a hike with his stick-girlfriend:

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Then simply guess or imagine what the stick-person might have been telling himself in this situation to create his anxiety.

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Usually, what we imagine the stick person might have been thinking is precisely what we were telling ourselves in this situation.

Meditation and free association

Other techniques to become more aware of our thinking include meditation and free association. These techniques encourage us to be mindful or our thoughts in the present moment.

Once we can identify our thoughts, we can then use cognitive-restructuring techniques to change the way we feel and/or behave.

Understanding the Origins of those Negative Predictions and Judgments

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tversky and kahneman

 

Amos Tversky (left) and Daniel Kahnement (right)

 

Daniel Kahneman won the Nobel Prize in 2002 for the work he, and fellow psychologist Amos Tversky, began in 1974 when they and published their article “Judgment under Uncertainty: Heuristics and Biases” in the esteemed academic journal Science (Vol 185. Pp. 1124-1131). Tversky and Kahneman sought to understand how humans made decisions in uncertain situations. This work suggests people use a series of mental processes to make decisions and the underlying machinery of these mental processes tends to make predictable errors. Their findings have profound implications for our understanding of mental health.

Anxiety 101 – a Review

Anxiety is the product of perceiving a threat to something we value. In the simplest terms, when we believe there is a bear (a threat) in the bush near us (something we value) our body gets ready to run/fight/or freeze (anxiety). This simple formula can take far more advanced forms because we can value other things besides our own physical health and threats can take many forms beside that of a bear. While threats and things we value can take many forms, our bodies only have a small number of responses. These responses are run, fight, or freeze and we interpret our bodies getting ready to do these things as anxiety. For example, public speaking is perceived to be a threat to our goal of being perceived as competent and confident, taking a test poses a threat to our hopes of completing a class with a particular grade, and running out of gas threatens our goal of getting where we want on time. Our bodies will get ready to deal with all of these threats in the same ways – by making us anxious.

An Available Heuristic

If we accept this formula as an explanation for why we get anxious, this leads to another reasonable question: How do we decide how much of a threat something is? Tversky and Kahneman provide us with an answer but first let’s consider some other questions:

  • When considering all of the words in the English language, which are three or more letters, are there more words with the letter K as the first letter, or more words with the letter K as the third letter?
  • What percentage of middle aged men will have a heart attack?
  • How honest are you?

To answer these questions our minds could use a number of different strategies. Our minds could list every known English word that is 3 or more letters, then compare how many begin with K and how many have K as the third letter. Even if we used this exhaustive and thorough strategy, our answers would be imperfect because we do not know every English word so we would be guessing based on the words we do know. As for the questions about heart attacks and honesty, we would never truly know the exact values because we are not omniscient and honesty is not something you can quantifiably measure. However, most people do not find it difficult to come up with answers to all of these questions. In fact, people tend to come up with answers extremely quickly.

When we are asked questions like these, our minds take the question we have been asked then quickly replace this very difficult question with a simpler question like “How easily can I remember or imagine something like this?”

If you are like most people, when asked the question about the letter K, you tried to think of words that begin with the letter K or had K as the third letter. If you could easily recall words beginning with K, but had greater difficulty thinking of words with K as the third letter, you concluded there must be more words beginning with K. Words with K tend to be easier to recall and most people assume there are more words beginning with K, even though there are more words with K as the third letter in English. Instead of being able to provide the true likelihood of heart attacks, our mind replaces this question with something like “How easily can you remember or imagine a middle aged man having a heart attack?” Then finally, you likely replaced the question about honesty with “How easily can I remember situations in which I was honest and dishonest?” It is not about how many memories we have being honest or dishonest, we form our judgments on the availability of those memories. Memories we can easily recall are said to be more available to our conscious minds than memories that are difficult to recall.

This mental “trick” is called the “availability heuristic.” As Tversky and Kahneman explain in their 1974 article, “There are situations in which people assess the frequency of a class or the probability of an event by the ease with which instances or occurrences can be brought to mind” (p. 1127). In other words, we believe something to be more likely if memories or fantasies of similar situations are “available” to our conscious mind. Most of the time the availability heuristic serves us pretty well. If something frequently happens in our life (the sun comes up every morning), one can assume it is likely for it to happen again without many costs being associated with this prediction. This allows us to avoid living in a constant state of uncertainty, predict what is likely to happen in the future, and plan accordingly. Unfortunately, the availability heuristic can be biased and sometimes this can have serious adverse consequences.

The availability heuristic is disproportionately influenced by recent and emotionally salient situations. Following a traumatic experience, people are far more likely to overestimate the probability of a similar traumatic event happening which artificially inflates our perceptions of how threatening a situation is, which in-turn unnecessarily increases anxiety and distress. Following a car accident, you will likely overestimate the likelihood of being in another car accident, which increases anxiety while driving. Following 9/11, many of us felt a new anxiety we did not previously experience while getting on air planes, not because flying was anymore dangerous (flying had probably never been safer than after 9/11) but because memories and fantasies of planes being high jacked were far more available.

Mental Process Underlying Mental Health Challenges

We determine which situations are threatening not by assessing the true threat level, but by assessing how easily we can remember or imagine similar situations ending-up poorly. Panic disorder can manifest in a number of ways, everyone is different, but people with panic disorder tend to worry that bodily sensations (heart arrhythmias, increased heart rates, accelerated breathing, dizziness, sweating, etc.) are evidence of a serious catastrophe (heart attack, stoke, going insane, etc.) which escalates anxiety resulting in panic attacks. Once we’ve had a single panic attack, the memory of this experience can be particularly available because panic attacks are so emotionally distressing. If we have had a panic attack in a store, we might later wonder about the possibility of having a panic attack in another store like Walmart. This question about the probability of having a panic attack in that particular Walmart at that particular time is replaced with “How easily can I imagine having a heart attack in Walmart?” If the answer is “very easily” then, we will assume the likelihood of having a panic attack in Walmart is high and we will likely avoid Walmart to avoid having another panic attack.

In obsessive-compulsive disorder (speaking of true OCD not the “OCD” people claim to have when they have strong preferences for cleanliness or organization), people can grossly overestimate the likelihood of someone breaking into their home and murdering their family because this specific fantasy can be incredibly distressing. When a fantasy is emotionally distressing, it is more available to consciousness, and this availability inflates perceptions of likelihood. Put simply, because the obsession is so upsetting, people will think it is likely, and they will act compulsively to reduce the probability of the feared event occurring.

In addition to anxiety disorders, the availability heuristic also plays a role in the development and maintenance of other mental health challenges. People with eating disorders often worry that people will judge them negatively if they were “fat.” They sometimes have vivid fantasies of being publically ridiculed or rejected for having what most people would consider to be an average or even below average weight. The maintenance of an eating disorder is riddled with availability heuristic errors. Often people will be able to easily imagine people judging them for being “fat” because they themselves frequently judge other people as fat and they take this as evidence suggesting other people have similar thoughts. The memory of their own judgments will be available because they are so frequent and this will inflate their perception about the likelihood of other people being judgmental like themselves. There are often historical traumas in childhood in which the person with the eating disorder was indeed bullied, mocked, and/or criticized, sometimes by close loved ones. While memories of this abuse are no longer recent, they may be incredibly available because of their emotional salience. They may also judge themselves as inadequate because they can easily recall examples of “beautiful” celebrities which inflates their perception of the regularity of these “beautiful” people.

When we are depressed, we will often have negative automatic thoughts about ourselves like “I’m a failure” or “I’m a loser.” Our minds will form these judgments by seeing which memories are most available, so if we can easily recall examples of “failures” or “losing”, we will be more likely to make judgments consistent with these memories. Since we tend to feel negative emotions more intensely than positive emotions, memories involving failure and loss may be easier to recall, and so these memories bias the availability heuristic and negatively distort our judgments.

Help is Available

The availability heuristic seems to be at the heart of many mental health challenges and this has some interesting implications for the treatment of mental illness. The availability heuristic is biased by recent and emotionally evoking memories and being aware of these biases allows us to think critically about the assumptions we make. In his 2011 book “Thinking, Fast and Slow” Daniel Kahneman explains “Resisting this large collection of potential availability biases is possible, but tiresome. You must make the effort to reconsider your impressions and intuitions by asking such questions as, ‘Is our belief that thefts by teenagers are a major problem due to a few recent instances in our neighborhood?’ or ‘could it be that I feel no need to get a flu shot because none of my acquaintances got the flu last year?’ Maintaining one’s vigilance against biases is a chore – but the change to avoid a costly mistake is sometimes worth the effort” (p. 131). This method of monitoring and thinking critically about our assumptions is identical to the cognitive restructuring interventions used in Cognitive-Behavioral Therapy.

In addition to cognitive restructuring, exposure based therapies may also be used to combat the biases of the availability heuristic. It’s no surprise that people tend to avoid anxiety provoking situations. As Dr. David Burns explains in his book When Panic Attacks:

Most people who are anxious avoid the things they fear, so they never experience enlightenment or relief. If you’re afraid of heights, you’ll avoid high places because they make you feel dizzy and anxious. If you’re shy, you’ll avoid people, because you feel so insecure and inadequate. The avoidance fuels your fears, and your anxiety mushrooms. If you want to be cured, you’ll have to face the thing you fear the most. There are no exceptions to this rule. (Pp. 252-253)

Imagine a person who has a panic attack on an elevator. Following this experience, when the person’s mind attempts to calculate how dangerous a particular elevator is, it will not be calculating the true risk of taking the elevator because this is truly unknowable for every elevator in the world at any given time. It’s not like their mind will know there is a 1.2496% chance something goes wrong if they get in that elevator right now and remain in it for 28 seconds. Instead, they will replace the question, “How dangerous is this elevator?” with “how easily can I recall having an uncomfortable emotional experience in situations similar to what I imagine it is like to be in that elevator?” The memory of their last panic attack in the elevator will be very available because it is so emotionally evoking, even if it is not recent, and so the person will conclude getting on the elevator will be very dangerous. However, if the person decides to go into the elevator, even though they feel anxious, there is very little chance anything will go wrong. They will likely feel anxious and perhaps even have another panic attack, but after a few minutes this anxiety will dissipate. If they stay until their anxiety is gone, they may even feel pride and excitement about their achievement. Let’s say they repeat this exposure exercise 5 or even 10 times. The next time they wonder about how dangerous it is to get on an elevator, the memories of taking the elevator with nothing bad happening will be far more available and they will conclude the elevator is likely safe.

I recommend combining both of these cognitive and behavioral (exposure) approaches. Be mindful of how and why your mind is making the predictions and judgments it is making, but also go and have positive experiences to replace the negative memories creating these predictions and judgments. As you change your assumptions, predictions, and judgments through cognitive restructuring and exposure, you’ll experience serious emotional changes.

To be thorough, lets consider an example in which a person is depressed. As mentioned above, people who are depressed frequently experience negative judgments and predictions. We can fight depression by identifying and thinking critically about these judgments and predictions. So when we tell ourselves things like “I really can’t do anything right” we notice these thoughts and write them down, or record them in some way. Writing down our thoughts is a great way of distancing ourselves from what we are thinking. Then we think critically about these thoughts by simply asking some questions like “What memories is my mind accessing when I think I can’t do anything right? Are there other examples of me doing things reasonably well that my availability heuristic is ignoring? I put my pants on today correctly, is that not an example of doing “anything” right? So if I have done somethings right, like putting on pants, what do I really mean when I think I can’t do anything right? Do I mean that I have some regrets and if so, how do I know I have more regrets than other people? Even I have done more regretful things, what can I do about it? What is the value to ruminating on these regrets?” So this is one example of a cognitive restructuring technique called Socratic Questioning.

To combine our cognitive restructuring with a behavioral technique to combat the biases of the availability heuristic, we might create a list of things we could do to have the experience of doing something right. To make this list we might ask, what are some things you would be proud to do? Things like hike a mountain, read a book, volunteer, get a job, take a class, or clean up a local park. Then the depressed person would go and do these things, even if they don’t feel motivated to do so (action comes first, motivation comes later). The person would take photos of how they did and this would serve as evidence to dispute future thoughts about not doing anything right. Combining both these cognitive and behavioral approaches will help the person to become less depressed over time by combating the availability heuristic’s biases for emotionally evoking and recent memories.

 Summary

To summarize, the availability heuristic is a mental process we use to make predictions and judgments. While it frequently helps us make complex decisions effectively, it is also biased to overemphasize recent and emotionally salient memories and fantasies. Unfortunately, these biases can create and maintain challenges like anxiety and depression. Cognitive restructuring and exposure techniques can help us challenge the underlying thinking which contributes to these problems.

 

Postscript

I’ve been studying the work of Tversky and Kahneman for several months now, beginning with the Michael Lewis book “The Undoing Project” which tells the amazing story of how they changed the world of psychology, economics, health care, finance, marketing, and so many more fields. Judgment under Uncertainty: Heuristics and Biases is a brilliant 7-page article that can be found for free – click here. Daniel Kahneman’s book Thinking, Fast and Slow is a fantastic insight into our minds and how they work.

The Life Philosophy of Rational Emotive Therapy

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All counselling theories (narrative therapy, psychoanalysis, DBT, Albert_Ellismindfulness based theories, CBT, etc.) all have underlying philosophies about how human beings “work”, what is “healthy”, and how people can remove barriers to become more “healthy.”  People might be surprised to know there are a number of different variations of cognitive-behavioral therapy (CBT). One type of CBT is called Rational-Emotive Therapy (RET) and it was created by Albert Ellis. This article describes the underlying philosophies of RET and has been adapted from Bill Borcherdt’s book “Think Straight! Feel Great! 21 guides to Emotional Self-Control.”

RET is designed to teach people:

1. Feelings are not externally caused.

  • Our emotions and moods are caused by our thinking, not what happens to us, what others say, or our environment. We interpret the things that happen to us, and our emotions are caused by these interpretations. This is important because you can learn to control what you think and when you can do this, you can control how you feel.

2. Dissatisfaction is not the same as disturbance.

  • Things will inevitably frustrate, deprive, and inconvenience you, but you disturb yourself by insisting that dissatisfactions should not exist.

3. All rejection is self-rejection and is self-inflicted.

  • People may evaluate you and choose to not associate with you, but your feelings of embarrassment, shame, anxiety, and sadness are caused by your thoughts like “because this person does not want to associate with me, this means I’m no good!”

4. Recognize preferences are not demands.

  • While it is normal to have preferences, emotional disturbances occur when we demand to have our preferences met.

5. Nothing “has to be.”

  • You do not have to survive; you choose to survive because you want to survive. When we label “wants” as “needs” this creates desperation and a sense of urgency which can lead to distress.

6. Distinguish appropriate and inappropriate feelings.

  • Intense emotions often get in the way of working towards our goals. It is normal to get frustrated, annoyed, disappointed, apprehensive, and sad but it is often unhelpful to become enraged, devastated, panicked, ashamed, and depressed.

7. Put yourself first and others in a close second without shame or guilt.

  • This promotes happiness and joy, which can make you more fun to be around.

8. Avoid evaluating humans.

  • Humans are too complex and ever-changing to judge or score. Neither yourself nor other people are simply “good” or “bad.”

9. Do the “right thing” for the “right reason.”

  • Pursue goals and accomplishments because they provide you with happiness or some practical improvement to your life, rather than inflating your ego or providing you with approval from others.

10. Avoid overemphasizing change.

  • Learn to co-exist with your problems and imperfections, rather than putting undue pressure of yourself to overcome all problems.

11. Attempt to get better, rather than merely feeling better.

  • What feels good isn’t always good for us. For example, expressing intense unwanted emotions, like anger, might feel good at the time, but it might move us away from our life goals.

12. Abandon absolute thinking.

  • Identify, challenge, and uproot these three core irrational ideas:
    1. “I must do perfectly well or I’m completely worthless,”
    2. “You must treat me perfectly, with no lapses in kindness and consideration, or you are completely worthless.”
    3. “Life must make it easy on me to reach my goals and accomplishments.”

I suspect people will see some common themes in these recommendations. Generally, RET emphasizes personal responsibility and choice, it suggests that we are responsible for our emotional reactions and we can change our emotions, by changing what and how we think. RET also recommends we unconditionally accept our “self” while judging our emotional reactions as “appropriate” or “inappropriate”, which I think is an interesting idea. While I do not choose to use this terminology with my clients, I agree that intense emotions can interfere with our attempts to achieve our goals.

Most clients are resistant to making changes in their lives, usually for a variety of different Albert_Ellis and gloriareasons. People tend to want to minimize their choices and responsibility by suggesting they have no control over what they think or feel. There are several old videos of Albert Ellis working with clients on YouTube, and he has a very direct and almost confrontational style that I believe is reflected in the uncompromising philosophy of RET (click here for a classical example of RET at work). I’m not saying the advice listed above is bad advice, just that I suspect giving this advice in a way that clients could receive it non-defensively could take some tact.

Perfectionism: Life-satisfaction and coping with challenges

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People with anxiety and panic frequently tell themselves “I must do perfectly well” then ask themselves some version of “will I do perfectly well” and the answer is always “no.” After they have avoided the task, or tried and failed to meet their hopes, they then become depressed because they tell themselves they did not do as well as they “should” have done. These are some of the claims made by one of the most influential contributors to counselling psychology in history, Albert Ellis. (See here)

While, I’m not bold enough to claim that perfectionism is the core of mental illness, the majority of my clients report high levels of perfectionism. There does seem to be a real connection between anxiety, depression, and perfectionism. Therefore, this article delves into some modern research on perfectionism, how to know if you might practice unhelpful perfectionism, and what you can do if you are a perfectionist, to live a more satisfied life.

Perfectionism

According to research, there are two dimensions to perfectionism: perfectionistic concerns and perfectionistic strivings.

concerns-vs-striving

While these two dimensions are related, they are not the same thing and you can have one without high levels of the other. In other words, you can have high personal standards and work to meet those standards, without over-focusing on mistakes, excessively doubting your performance, or being very concerned about what other people may think. Research shows people who report high levels of perfectionistic concerns also typically report lower life satisfaction, neuroticism, low self-esteem, negative affect, anxiety, depression, and suicidal ideation. While people who report high levels of perfectionistic strivings, without high levels of perfectionistic concerns, report higher levels of conscientiousness, positive affect (they are generally happier), endurance, and academic performance (Stoeber & Otto, 2006).

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When working with clients, I often hear rationalizations like “my perfectionism motivates me to work harder” or “I have to be a perfectionist or something really bad might happen.” The research described above does suggest that there are a number of benefits to having high personal standards and working hard to achieve those standards. However, when we are overly focused on making mistakes, doubting our actions, and focusing on what others think, we lose the positive benefits of our perfectionism. For the remainder of this article, I’ll refer to being overly concerned about mistakes, doubting ourselves, and being focused on how others might evaluate our performance (perfectionistic concerns) as “unhelpful perfectionism.”

Interestingly, unhelpful perfectionism is a recipe for low life satisfaction regardless of how well we actually do. In a study from Pennsylvania State University, 273 students reported engaging in unhelpful perfectionism led to less satisfaction with grades, regardless of how well they did (Grzegorek, Slaney, Franze, & Rice, 2004). In other words, even if they met their high personal standards, they were still unsatisfied if they were overly focused on making concerns, doubting their actions, and focusing on what others think.

How to know if you might practice unhelpful perfectionism

People that practice unhelpful perfectionism might claim:

  • If I fail at work/school, I am a failure as a person
  • I should be upset if I make a mistake
  • I hate being less than the best at things
  • If I do not do as well as other people, it means I am an inferior human being
  • Even when I do something very carefully, I often feel that it is not quite right
  • I usually have doubts about the simple everyday things I do
  • I tend to get behind in my work because I repeat things over and over
  • I find it difficult to meet others’ expectations of me
  • The better I do, the better I’m expected to do
  • Anything I do that is less than excellent will be seen as poor work by those around me
  • My family expects me to be perfect

These are items from two measures of perfectionism, the Frost Multidimensional Perfectionism Scale (Frost et al., 1990) and the Multidimensional Perfectionism Scale (Hewitt & Flett, 2004) and they reflect concern about mistakes, doubts about actions, and concern about other people’s evaluations. Beliefs and behaviors like these tend to interfere with a person being satisfied in life.

 Increasing satisfaction as a perfectionist

In 2011, two researchers from the University of Kent, Joachim Stober and Dirk P. Janssen, wanted to better understand the relationship between perfectionism, how people typically coped with stresses in their lives, and the amount of satisfaction they generally felt at the end of the day. They found people reporting high levels of unhelpful perfectionism seemed to cope with stressors in their lives in similar ways, and these coping mechanisms were contributing to lower satisfaction. People who reported a lot of unhelpful perfectionism reported typically trying to cope with stresses by criticizing themselves or blaming themselves for the “bad things” that happen to them. Unsurprisingly, self-criticism was associated with diminished satisfaction.

Alternatively, people who reported high levels of unhelpful perfectionism reported more satisfaction when they used a coping mechanism “positive reframing” (aka “positive reinterpretation”). These people attempted to cope with challenges by “trying to see it in a different light, to make it seem more positive” or “looking for something good in what is happening” (Carver, 1997).

positive-reframing

Two other ways of trying to cope with perceived failures were related to high levels of satisfaction, acceptance (“accepting the reality of the fact that it has happened”) and humor (“making fun of the situation”). Although, these coping mechanisms seemed to be less effective for people reporting high levels of unhelpful perfectionism.

Positive reframing has been explored in great detail in a multitude of studies over the last 30 years. Back in 1984 Lazarus and Folkam explained that positive reframing allowed people to manage their distress when challenged so they could continue with effective problem solving. This combination of positive reframing and actively trying to deal with stressors in an effective way can be an incredibly useful way to handle challenging situations in life.

Summary

We can have high personal standards and work hard to achieve these standards without over-focusing on our mistakes, excessively doubting your performance, or being very concerned about what other people may think. Indeed having high personal standards is associated with better life satisfaction. However, when we engage in unhelpful perfectionism it leads to reduced life satisfaction, neuroticism, low self-esteem, negative affect, anxiety, depression, and suicidal ideation.

Examples of unhelpful perfectionism include claiming things like:

  • If I fail at work/school, I am a failure as a person
  • Even when I do something very carefully, I often feel that it is not quite right
  • Anything I do that is less than excellent will be seen as poor work by those around me

However, even if we engage in unhelpful perfectionism we can experience greater satisfaction in life, by attempting to cope with challenges by seeing challenges as opportunities, focusing on what we learned from challenging experiences, and looking for something good in what has happened. By thinking about problems in this proactive way, we are better able to engage in effective problem solving.

Overcoming Anxiety and Avoidance

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Although this will likely reduce the number of “likes” I get for this post, I believe it is important to begin with some honesty. Overcoming anxiety is hard work. Most people want a simple and easy answer that can make all of their suffering go away. However, for every complicated and messy problem there are many simple and easy answers that are ineffective. For example, in Canada the use of antidepressants increased over 450% between 1981 and 2000, but the demand for mental health services has never been higher. This post is not an “8 easy steps to being less anxious” kind of post, it is more of a “if you work really hard, stay determined despite set-backs, and keep an open-mind about trying new things you may be able to make some real improvements to your life” kind of post.

Anxiety and Avoidance

Anxiety is a normal reaction to perceived threats. However, when we have a tendency to focus on threatening situations, the problems in our lives, we are fueling excessive amount of anxiety. One way we attempt to reduce the amount of anxiety we experience is by avoiding challenging situations. However, avoidance prevents us from overcoming our fears. Furthermore, as we avoid more and more things, our lives become more and more restricted.

For example, if you had social anxiety and were terrified of 1talking to authority figures, you would likely experience anticipatory anxiety before you spoke to people of authority, then when you did have to talk to someone of authority (exposing yourself to the feared situation) your anxiety would likely spike. Then when you avoid the situation by promptly leaving, your anxiety will naturally go down. Unfortunately, when we cope with anxiety by avoiding challenging situations we cannot challenge our assumptions that the situation is dangerous, we cannot challenge our assumptions that we cannot handle the stressful situation, nor can we learn how to handle the situation more effectively. So then the next time we exposure ourselves to the stressful situation we experience a similar amount of anxiety.

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Overcoming anxiety can be accomplished a number of ways. However, research strongly suggests that one of the most effective strategies for overcoming anxiety is something called “exposure therapy.” Exposure therapy rests on the premise that if we can expose ourselves to our anxiety provoking situations in a certain way, we can learn: the situation isn’t as dangerous as we assume, we can handle the challenging situation, and we can practice skills to better handle similar situations in the future.

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Exposure therapy

  • Begin by creating a list of situations you avoid
  • Rate how much anxiety you suspect you will experience in each of these situations on a scale from 0-100
  • Select a situation that will provoke a small amount of anxiety – set yourself up for success
  • Create a plan to expose yourself to this situation –when? Where?
  • Expose yourself to the situation
  • When you are in the situation try and pay attention to what is going on around you as opposed to what is happening in your body or distracting yourself (looking at your phone, talking to a friend, reading a book, etc.)
  • Stay in the situation until your anxiety has diminished, do not just leave when you feel some anxiety
  • After your anxiety has gone down, ask yourself what you have learned about how dangerous the situation was, what you have learned about your ability to cope (did you survive?), and some skills you could practice to handle the situation more competently in the future
  • If you notice yourself going over and over the situation in your mind, distract yourself by doing something engaging
  • When you are able, expose yourself to the same situation again and again until you do not feel very much anxiety at all in that situation
  • Once you have completed the first anxiety provoking situation, move on to another situation on your list of anxiety provoking situations and repeat this process

By exposing ourselves to anxiety provoking situations appropriately, we are able to reduce the amount of anxiety experienced when we face similar situations in the future.

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Some notes about exposure therapy:

Exposure therapy can be immensely effective for anxiety created by many different situations. Personally, I have seen clients make radical changes in only a small number of sessions when they are committed to their exposure plan. However, it is important to remember than some situations are actually dangerous and we are not always exaggerating the danger in our minds. Therefore, I do not encourage people to behave recklessly, for example standing in a busy highway, going down dark alleys at night, or committing any crimes. Also, this article only describes one type of exposure therapy, something called “in vivo” exposure therapy and this type of exposure therapy cannot be used to overcome some anxiety provoking situations. Obviously, we cannot expose ourselves to our fear of our own death (at least not more than once), to fears of loved ones dying, or to fears of natural disasters. For these types of hypothetical fears, we may need to practice something called “imaginal exposure” which is not described in this article.

Some notes for therapists:

Many clients struggle with creating the motivation to engage with exposure therapy. When we are distressed we often resort to coping mechanisms that are familiar to us, even if they are not helpful. It can be useful to go slow with clients and discuss the costs and benefits of avoidance. Encourage the client to consider what their life may be like if they continue to avoid anxiety provoking situations indefinitely and/or consider the opportunities their avoidance may have already cost them. Remember, it is not our job to convince the client to do anything. Instead we are there to help them make informed decisions. If the client chooses to continue to avoid, while knowing the consequences of this decision, that is their choice and that should be respected.

Processing what the client has learned from exposing themselves is just as important as collaborating with the client to design the exposure activity. “what did you learn from exposing yourself to this situation?”, “what did you learn about your ability to cope with the situation?”, “what did you learn about your anxiety in general?” “what did you learn about your fears?” – Questions like these can be very helpful.

Reduce anxiety and improve your mood: Free workbooks

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There are two workbooks you can now access in our “self-help” section for free.
The Making Changes workbook can help you learn about Cognitive Behavioral Therapy principles and how to apply them to your life. It can help you improve your living habits, set goals, and change your thinking.
The new Anxiety workbook can teach you about anxiety, skills to manage anxiety, and steps you can take to reduce your anxiety over time. Here is an portion from that workbook:
SUMMARY

· Anxiety is a normal human response to perceived danger.

· The more we worry, the more we are thinking about potential dangers, this then triggers the anxiety response.

· We can practice skills like box breathing, 5-4-3-2-1 sensory grounding, and progress muscle relaxation to cope with extreme anxiety.

· Cognitive behavioral therapy can help use reduce our anxiety.

· Our thoughts cause our emotions and behaviors, not situations. Therefore, our anxiety is being created by the story in our head, not the situation we are in.

· When we experience excessive anxiety we are usually engaging in unhelpful thinking styles.

· CBT teaches us to recognize our unhelpful thinking and then dispute irrational thoughts, replacing them with more helpful thoughts.

· Excessive worry fuels excessive anxiety. Sometimes we believe excessive worry can be a good thing, but these beliefs maintain worry.

· When we believe (1) “problems are threatening”, (2) “I can’t handle problems effectively”, and (3) “problems will turn out badly regardless of what I do” we are preventing effective problem solving. We can solve this by recognizing problems as a normal part of life and seeing the opportunities presented by our problems.

· A problem solving model can be used to help us effectively cope with challenges we can reasonably do something about.

· Graded exposure can be used to decrease the amount of anxiety we experience in situations. Graded exposure is a process by which we practice exposing ourselves to anxiety provoking situations, practicing and developing our skills, and gradually learning situations are not as threatening as our minds make them.

· We can improve our abilities to cope with stressors by maintaining a healthy self-care plan which includes diet, exercise, sleep, relaxation, work , socializing, thinking helpful thoughts, and goal setting.
 
 

Improve your Relationships by Understanding and Managing Anger

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You never listen to me. I fell like you are overreacting. I can’t do anything right, I’m always the bad guy. Don’t get upset. You always do this. You’re an asshole. Why do you have to be such a bitch? This is why this shit always happens to you.

Have you ever been hanging out with friends and have the displeasure of watching another couple’s argument turn into a full-blown fight? Have you ever been shocked by the devastatingly hurtful things family members say to each other? I’ve both been the shocked observer and I reluctantly admit to having been one of the people saying the hurtful things. On the surface, these statements appear to be motivated by anger. However, anger is described as a “surface emotion” and underneath anger there is usually a more vulnerable emotion like hurt, sadness, embarrassment, grief, etc.

anger

Our angry behavior (yelling, intimidating, saying hurtful things) can be a way of communicating more vulnerable emotions. Unfortunately, communicating in this way is inherently manipulative because we are not communicating directly about what is going on for us. Instead of using the words “when you said I was lazy, I felt hurt because I really value your opinion. I also felt afraid because I was concerned you might not want to be in a relationship with someone you think is lazy”, we hope they get some form of this message through our angry behavior.

Our anger can also serve as a tool to teach another person about what we want. People learn through processes like reinforcement, punishment, and extinction. When another person does something we don’t like, we can use anger to punish them, in hopes they will not replicate this behavior in the future. For example, when Person A says something hurtful (you’re lazy), Person B may retaliate to punish the other person to reduce the probability of future hurtful comments. However, when we are in a relationship with a person and they are continuously punishing us we are likely going to develop resentment because, by definition, people don’t like being punished. So while anger can be a powerful form of punishment, it can seriously poison a relationship.

Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned. – Buddha

One of the best examples of these two concepts is when we get angry about another person getting angry. Getting angry at another person for getting angry at you is like trying to put out a camp fire with gasoline. Person A gets mad, then Person B thinks something like “I don’t deserve to be treated like this!” and gets angry to punish Person A. In addition to feeling anger, Person B is also probably feeling fear, hurt, and maybe even embarrassment.

If you have the goal of intimidating someone, expressing anger in an aggressive way may move you closer to achieving your goal. However, if you have the goal of having a good relationship with the other person, expressing anger in an aggressive way will be less helpful.

So how do we reduce the likelihood we will get extremely angry and how do we communicate better when we are angry?

Reducing the likelihood of getting extremely angry. CBT recommends we begin by identifying our “triggers” and times when we are more likely to become triggered. “Triggers” are things (people, comments, situations, etc.) that rapidly increase our emotional responses. For example, if you are triggered by criticism, you are likely to have an extreme emotional response to being criticized. Common triggers include perceived rejection, failure, abandonment, and loss. Identifying your triggers in advance is a form of exposing yourself to your triggers through the use of your imagination. This “imaginal exposure” actually can reduce how distressing these triggers will be when you are exposed to them in real life. Furthermore, identifying your triggers in advance allows you to plan how you want to respond when faced with this trigger.

We are more likely to be triggered in certain circumstances. For example, I am more likely to be triggered when I am tired, hungry, or while drinking alcohol. So I make reasonable attempts to avoid situations that may trigger me during times when I’m more likely to become triggered. For example, if I have to talk to a friend about a sensitive topic, I do so when I’m rested, fed, and sober.

These two principles of identifying triggers in advance and considering times when we are more likely to become triggered can be useful for managing all extreme emotions, not simply anger.

Regardless of whether or not we identify triggers and times we are more likely to be triggered, we may still get triggered unexpectantly. While there are a ton of relaxation skills out there, some are more effective than others. These are the ones I recommend to people managing intense anger.

Minimize risk. Stop yourself from the “knee-jerk” reaction that often accompanies anger. Then I recommend you remove yourself from the situation if it is reasonably possible, it may also be useful to say something like “I don’t mean to be rude but I have to go calm down for a moment” and go for a walk.

Relax the body. Then cool off by splashing cold water on your face, taking a cold cloth and putting it on your face or the back of your neck, or taking a cold shower. You’ll learn that it is really difficult to stay mad when your face is frozen. Take some breaths, one useful breathing exercise is the 4-7-8 breath where you breath in for 4 seconds, hold your breath for 7 seconds, and breath out slowly for 8 seconds.  Intense exercise and something called “progressive muscle relaxation” also can be very effective for calming our bodies.

According to Baranowsky, Gentry, and Schultz (2011, p. 127), when our fight/flight/freeze response is activated we are using our “sympathetic nervous system” and when we are calm we are using our “parasympathetic nervous system.” When the sympathetic nervous system parts of our brain are dominant our thinking is reactive, we have an increased threat perception, and we have diminished brain functioning. By contrast when the parasympathetic nervous system parts of our brain are dominant, we are more capable of creative problem solving, we have better decision making, and we are better at regulating our emotions. By relaxing our bodies we can shift from sympathetic nervous system dominance to parasympathetic dominance.

Calm down the mind. Once our bodies are calm, we are more capable of communicating and problem-solving. We can use cognitive-restructuring strategies to identify the thoughts causing our intense emotional reactions, challenge the validity of these thoughts, and replace them with more realistic thoughts. The automatic thoughts commonly associated with intense anger include thoughts about fairness (How dare you call me a jerk after all I do for you! I don’t deserve this!) and about how we want people to behave (You shouldn’t be acting like this! I should better at this! You should take out the trash!).

We can also use mindfulness skills to calm our mind. Put simply, when using mindfulness we are paying attention to what is going on in our mind, without judgement. We notice, accept, and let go of our anger inducing thoughts. It sounds simple but it takes practice.

Communicate. Once our bodies and our minds are calmer we may choose to communicate. Some good skills for communicating assertively include “I-messages” and the “assertive message format.”

I-messages typically include a description of how we feel, explaining the reasons for this emotional response, and clearly describing what you want. Some examples:

I felt angry when you said that I never listen to you, I’d like to talk about this.

I felt concerned when you raised your voice earlier, I’d appreciate if you could avoid doing that in the future.

I felt sad and surprised when you said my family is crazy, I’d like to understand where that comment came from.

 The assertive message format includes: a description of behavior, an interpretation, describing your emotions, consequences, and your intention/position. These components can be combined in any order.

You were running behind yesterday and (behavioral description), as a result we were late to meet up with everyone (Consequence), I’m sure you didn’t mean to be late but (interpretation), and honestly, I was feeling a little annoyed and frustrated (feelings), next time, I would appreciate it if you could toss me a text if you’re running behind (intention/position).

“We can say what we need to say. We can gently, but assertively, speak our mind. We do not need to be judgmental, tactless, blaming or cruel when we speak our truths”

― Melody Beattie

Both I-messages and the assertive message format are designed to open a dialogue with the other person, while reducing the probability they will respond defensively. When using these skills it is important to avoid blaming (you are responsible for your own emotional reactions), generalizing (“You’re always late”), or name calling. I’ll revisit more communication skills in future posts.

To summarize, anger is a surface emotion, usually with more vulnerable emotions underneath. Anger can be used to communicate more vulnerable emotions as well as punish other people to behave in ways that we want. We can reduce the likelihood of becoming extremely angry by identifying our triggers and times when we are more likely to become triggered. When we do become angry, we can manage our anger by reducing the risk, calming our bodies, calming our minds, and communicating effectively in a respectful and compassionate way.

Improve your approach to dealing with problems in life (Part 1)

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The Jewish psychiatrist Viktor Frankl remembers the day he entered the camps:

Then the train shunted, obviously nearing a main station. Suddenly a cry broke from the ranks of anxious passengers, “there is a sign, Auschwitz!” Everyone’s heart missed a beat at that moment. Auschwitz – the very name stood for all that was horrible: gas chambers, crematoriums, massacres. Slowly, almost hesitatingly, the train moved on as if it wanted to spare its passengers the dreadful realization as long as possible: Aushwitz!

His book Man’s Search for Meaning tells a harrowing tale of some of the worst conditions humans have been exposed to in modern history. As I read this book for the first time, several years ago, I was mesmerized by Dr. Frankl’s seemingly endless ability to recognize the opportunities within his experiences. His beliefs about problems and suffering were infectious.

Negative Problem Orientation

Put simply, a person’s problem orientation refers to their beliefs about problems and their ability to solve problems. People with a negative problem orientation are more likely to view problems as excessively threatening, they typically doubt their ability to solve problems, and they believe negative outcomes will occur regardless of how much effort they put in to solve them. As a result of these beliefs, researchers Dugas and Robichaud suggest people with a particularly negative problem orientation are more likely to be frustrated, irritated, anxious, or depressed when they face a problem. Behaviorally, people with a negative problem orientation are more likely to procrastinate and/or avoid problem solving. As a result, they can make new problems for themselves and increase worries.

Perhaps unsurprisingly, negative problem orientation has been connected with a wide variety of mental health difficulties including generalized anxiety disorder, depression, pathological gambling, and post-traumatic stress disorder (Robichaud & Dugas, 2005).

Locus of Control

In my opinion, a person’s problem orientation plays a massive role in how they approach the world. There seems to be a large overlap between problem orientation and something, in psychology, we call “locus of control.”  Our locus of control can be described as our beliefs about how much we influence what happens in our lives. People with an “internal locus of control” typically believe they greatly influence their destiny. While people with an “external locus of control” typically believe that what happens in their lives is largely controlled by forces outside of them. Research over the last 65 years has suggested that people with an internal locus of control have greater academic success, are more motivated, are more socially mature, have less stress and depression, and live longer. They “earn more money, have more friends, stay married longer, and report greater professional success and satisfaction” (Duhigg, 2016, p. 24). So to summarize, people with an internal locus of control will usually be less threatened by problems, work harder to solve problems, and believe they can mitigate negative outcomes through effective problem solving. In other words, they have a more positive problem orientation.

locus of control

So if a negative problem orientation and an external locus of control are typically unhelpful for promoting health and wellbeing, what can we do to change?

Luckily, research suggests there are a few things we can do to improve our problem orientation and our beliefs about locus of control. Dugas and Robichaud suggest we first have to learn how to identify problems. Many clients enter therapy and believe that their emotions are the problem, they just want to be happy. However, emotions are not the problem. Emotions are data, they are just information giving you clues something is or is not working for you in life. The problem is not that you are depressed, the problem may be you are stuck in a relationship that is not good for you, it could be that your habits are not particularly healthy, it might be that you are stuck in depressive thinking habits, perhaps the problem is that you are in a concentration camp, etc. Once we can see our emotions as information, this can help you identify appropriate solutions to the real problems.

The belief that we are exceptional because we experience problems can keep us stuck. Why does this keep happening to me? Why was I the one who was dealt a bad hand in life? We can improve our problem orientations by challenging these kinds of beliefs and recognizing that experiencing problems in life is normal. Suffering is an important part of life, it is times when we suffer the most that we are motivated to adapt and grow the most.

Challenge filtering and overgeneralizing (see our cognitive distortions list). An internal locus of control and/or a negative problem orientation occurs because we are not paying enough attention to all the times your effort and practice have influenced outcomes. We conclude because we could not have possibly prevented ____________ from happening in the past, why bother trying in the future? While there is a lot in life that you cannot control, there is a massive amount that you can. By just focusing on the things we cannot control, we are underestimating the number of choices we have. When we underestimate the choices we have, we are reinforcing the belief that we are not responsible for what happens to us and this can be a very comfortable delusion to live in. However, this short term comfort comes with a price, it disempowers us and maintains a victim mentality.

Lastly, and perhaps most importantly, we can improve our problem orientation by recognizing the opportunities that are within all of the problems we experience. Every problem has opportunities associated with it. Few people illustrate this better than Viktor Frankl. While in the camps, he became very sick, and with the sickness came a far greater likelihood of being “selected” to go to the gas chambers. Despite his sickness he remembers:

We were sick and I did not have to go on parade. We could lie all day in our little corner in the hut and doze and wait for the daily distribution of bread (which, of course was reduced for the sick) and for a daily helping of soup (watered down and also decreased in quantity). But how content we were; happy in spite of everything.”

This sickness gave him the opportunity to rest. More generally, by being a prisoner within the camp, Frankl recognized he was given the opportunity to study what happens to a human under such circumstances. He was given the opportunity to understand how people find meaning and purpose even in the worst of conditions. Gordon Allport describes Frankl’s conclusions beautifully in his preface:

In the concentration camp every circumstance conspires to make the prisoner lose his hold. All the familiar goals in life are snatched away. What alone remains is “the last of human freedoms” – the ability to “choose one’s attitude in a given set of circumstances.”

Being in the camp presented many, very real and horrifying, problems. However, Frankl was also given the opportunity to choose how he was going to cope with these problems. He was given the opportunity to search for answers to some very fundamental human questions – what prevents some men from committing suicide in such horrible conditions? Why choose to live when one can simple run to the electric fences at any time? What motivates a man to treat prisoners a particular way? Etc.

When your partner says something you don’t agree with, you are being given the opportunity to practice your non-defensive communication skills. When you lose a relationship you have the opportunity to be a kind, loving, and respectful person even when things do not go your way. When you get lost, you have the opportunity to become familiar with somewhere new. When you are in a concentration camp, you have the opportunity to study how humans adapt to such horrible conditions and find meaning and purpose despite great suffering.

If you have children, it is likely they will experience their own challenges in life (divorce, trauma, accidents, health problems, etc.) and every time you experience these things, you are being given the opportunity to teach your kids how to effectively face these problems in their own lives. By recognizing the opportunities within the problems we face, we are going to be more likely to accept when problems occur and we will be more motivated to engage with our problems in a helpful way.

Duhigg, C. (2016). Smarter, faster, better: The secrets of being productive in life and business. Doubleday Canada.

Frankl, V. E. (1959). Man’s search for meaning: An introduction to logotherapy. Washington Square Press, New York.

Robichaud, M., Dugas, M. (2005). Negative problem orientation (part I): Psychometric properties of a new measure. Behavior Research and Therapy (43)3, 391-401.

Worry – The illusion of action

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What if I lose my job? If I lose my job then, I won’t be able to pay rent or afford food. Then I’ll have to move back in with my parents, or worse!- I’ll be homeless. I can’t get fired, oh please god, I need this job or I’m in real trouble. What if I do lose it though? I won’t be able to pay off my debt either, then I’ll get even more interest or I’ll damage my credit, and I’ll be in a financial hole for the rest of my life.

 

These thoughts may seem a little excessive to some people, but many of us have had worries like this countless times – usually when our guard is down, when we are tired, lying in bed with nothing to distract us. What is it about worry that can be so difficult to control? Researchers Rodebaugh and Heimberg suggest that worry “acts as a trick the person is playing on himself or herself to provide the illusion of action, when useful action seems impossible.” In other words, in our minds, worry resembles problem solving or planning. We convince ourselves that if we just worry enough, we will be better able to prevent “something bad” from happening or we will be better able to cope if this “something bad” does happen.

However, worry is not problem solving or planning. Worry is simply thinking about a problem or fear, it is not a productive attempt to create solutions. Worry typically leads to anxiety, which is a physical reaction priming your body to deal with threats, it is preparing you to run away and/or fight. Now in some situations this is helpful, but in the vast majority of situations in modern society, we do not need to run away or fight. Therefore, this is an inappropriate and unnecessary reaction. Sometimes the first step in overcoming worry is actually accepting that worrying is not helping us. Moreover, in many situations worrying, and the associated anxiety, is actually reducing our ability to cope with challenges. Many clients enter therapy and want to get rid of the suffering cause by anxiety without having to stop worrying, but this is an unrealistic expectation. So long as we keep our pattern of worrying, we will keep our pattern of feeling anxious.

Cognitive model of GAD

There are several different types of anxiety. One such type is called “generalized anxiety.” People that struggle with generalized anxiety worry more than most people about everyday things, and have trouble controlling it. Generalized anxiety can keep you awake at night or make you feel sick. Sometimes people with generalized anxiety refer to themselves as “worriers.” The Cognitive Model of Generalized Anxiety Disorder, created by Dugas and Robichaud, illustrates the connection between situations, wondering “what if something bad happens?”, worry, anxiety, and demoralization/exhaustion.

So if we accept that worry is not particularly helpful for us, and we want to change this pattern of worrying, what can we do?

According to many CBT therapists, the first step in overcoming anxiety is understanding our worries. We can do this by writing down what we are worried about several times throughout the day. Then you take this list of worries and divide them into actual current problems and hypothetical “what if…?” worries.

 

worries

Now you might look at this list and think “but I could get sick!” or “but my partner might leave me!” Yes, but in neither of these situations will worrying help problem solve. You might also look at these lists and think “but my worrying helps motivate me! If I quit worrying, won’t I lose my motivation??” Let me answer this question with a question – many, many, many very motivated and successful people do not worry very much, so why do you have to play by different rules? Also, we can problem solve, set goals, and plan all without worrying, don’t get sucked into the tricks worrying is trying to play on you. One huge difference between the things in the “actual problem” category is that the things on that list are current and actionable. You can choose to make something for dinner, choose to write a paper, choose to schedule a time to exercise, and choose to create a resume. The things on the “what if…?” list are uncertain because they are in the future and greatly influenced by forces beyond your control. It would be a beautiful world if we could just choose to not get sick or choose to have everyone like you.

God grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

And the wisdom to know the difference.

The Serenity Prayer.

In the sections above, I suggested that worrying is not problem solving, this begs the question “what is problem solving?” In problem solving we first (a) identify the problem, (b) identify possible solutions to a problem, (c) evaluate the pros and cons of each solution, (d) select a reasonably good solution, (e) try it out, (f) evaluate how the solution worked to solve the problem, and (g) repeat this process as necessary. I strongly recommend you write these steps down for your more serious concerns, or chances are when you worry about the problem at 2 in the morning you won’t remember the plan to created yesterday to solve the problem.

problem solving example.PNG

The exercise of identifying which worries are actual problems that we can do something about, from those worries that are beyond our control can be a powerful tool for challenging unhelpful thinking patterns. As we become more aware of these unhelpful patterns, we can replace unhelpful thoughts with more helpful ones. When we think “I might lose my job” we can challenge this worry by thinking “yes, it is possible, however I cannot control this. Instead I’m going to focus on things I can do to decrease the probability of this happening – such as improving my performance.”

Unfortunately, there are times where there is nothing we can do to prevent a catastrophe from occurring. In those situations, we are faced with a choice – continue to worry (and suffer) or accept the uncertainty. This can be extremely difficult for some people. One way we can increase our tolerance of the uncertainty is to review the evidence that the catastrophe will take place. What is the evidence the catastrophe has taken place? What are the actual probabilities of the catastrophe occurring? Will your worrying change the probability?

As is usually the case for the topics I choose to write about, this is a huge topic that has been explored in many studies, articles, and books. However, I hope this article helps expand your understanding and will be of some help.

If anyone has any questions or comments, please e-mail!