We recently posted a free workbook in our “self-help” section. This workbook teaches some of the fundamental principles of cognitive behavioural therapy.
You should do breathing exercises. Maybe do yoga a few times a week and you’ll feel better. Go for a walk daily. Start your day off with a 10 minute meditation.
I cannot count the number of times people have given me advice like this to me. These are probably good suggestions and they do indeed have a reasonable amount of research supporting them, but I believe they are insufficient for promoting lasting composure. I do see a lot of value in maintaining a relaxed, composed state of mind while going through my day. When we are calm our brains function differently, we have superior reasoning and problem solving abilities. I think many people can relate to the experience of reacting inappropriately when distressed. How can 10 minutes of meditation in the morning, a walk, or yoga a couple of times a week maintain my composure throughout the day? I do not believe it can. Instead, perhaps I need a tool I can easily use throughout the day to maintain my composure. For me, this tool is practicing mindfulness.
Mindfulness refers to paying attention to the present moment, without judgement. Practicing mindfulness is simple and incredibly effective for regulating my emotions throughout my day. What does practicing mindfulness look like? Take a breath, notice the air filling your lungs, notice your rib cage expanding, notice your heart beat, just notice how it feels. Focus on those things, and without judgment (“It should be deeper”, “it should be slower”, “it should be…”), just notice the way it is. Congratulations, you have just practiced mindfulness. It’s that simple.
Paying attention to your breath can be convenient because we always have our breath, even in a completely dark room, late at night but we do not have to pay attention to our breathing to practice mindfulness. We can be focused on anything in the present moment without judgement to practice mindfulness. By “judgment” I mean assigning interpretations like “good”, “bad”, “better”, “worse”, etc. For instance I often look at a tree outside my office window. I watch how the sun hits each leaf, I look at the shades of green and grey, I watch it move in the wind. Instead of thinking “that is a beautiful tree” or “that tree should be bigger” I just notice and accept how it is in the present moment.
I direct my attention to the present moment hundreds of times a day. As the people in my life can attest (with some frustration occasionally) I do very little worrying about the future. I also try and rarely think about the past, besides considering what I can learn from it and moving on. My paying attention to the present allows me to avoid much of the anxiety and depression that is associated with worrying about the future and regretting the past.
But I need to problem-solve and plan! I can’t just be sitting around looking at trees all day! I agree, that is impractical. However, I would argue that many people do far more worrying and regretting than are truly necessary. How many times have you lay in bed and lost sleep because you were trying to worry your way out of a problem? So we problem solve and plan when we must, and we stay in the present as often as we can. This way when we do have to problem we are composed, and our thinking is productive.
Okay, so what happens when I’m paying attention to the present moment and my mind just naturally thinks about the future or the past? It takes practice to stay in the present moment for any extended amount of time but while we are training our minds we want to be compassionate with ourselves. Like training a puppy, we want to be consistent, reliable, and gentle. So when our minds wander to a place they don’t need to be, we gently guide it back to the present.
I find practicing mindfulness to be most helpful in distressing situations. For example, when talking in-front of people I find it very helpful to just take a deep breath and just for a moment notice the air filling my lungs and my ribs expanding. This relaxes me immediately. Or after a stressful experience I will take a breath and just ask myself “what is going on in my mind right now?”, “what am I feeling?”, and “where are these emotions coming from?” I find this to be much more helpful for regulating my emotions than thinking “stop getting angry”, “I shouldn’t (judgement) worry about this”, or “I’m being too dramatic (judgment).”
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.
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.
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.
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.
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.
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.
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.
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!
I’ll never find anyone as good. I’ll never meet someone else, never have my own family. I can’t handle this. This isn’t fair. I’m unlovable. Everything is awful.
Most people are familiar with thoughts like these. When under intense stress, like the loss of a significant relationship, our minds often go to those dark places. Sometimes our thoughts are irrational and since these thoughts are extreme, the emotions they evoke are also irrational. I tell clients all the time that I do not want them to be an unfeeling robot. If we suffer a significant loss we should feel some grief, if we are treated unfairly it is normal to feel angry, and it is okay to be sad sometimes. However, sometimes we have emotional reactions which are disproportionate to the situation. It is these intense emotional reactions which usually lead to behavior that is inconsistent with our values and goals. Since we know emotions are caused by thinking, we can reduce the intensity of irrational emotional responses by changing the irrational thinking evoking them.
“There are no facts, only interpretations.”
Dr. Aaron Beck is widely considered the father of Cognitive Therapy. He was trained in the classical forms of therapy pioneered by Sigmund Freud (Psychodynamic Therapy). Psychodynamic Theory suggests that our thoughts are the product of unconscious or subconscious forces within our psyche. In other words, this theory suggests that our thoughts mean something about us. While at a dinner party, Dr. Beck met a woman and this interaction would change psychotherapy forever. The story is that this woman explained she was depressed and she believed that no one loved her/she was unlovable. Instead of going down the usual therapeutic road, Dr. Beck decided to try something different. He asked her to evaluate the evidence for her beliefs. To her surprise, the woman was able to recognize that there were several people in her life that loved her and when she focused on this, her sadness dissipated (listen to this great podcast for more information). While working with severely depressed patients in his clinic, he noticed several common thinking errors within the thoughts of his patients. Today these thinking errors are called “cognitive distortions.” By identifying and challenging cognitive distortions, our thinking can become more rational and as a result our emotions will also become more rational.
In the following table I demonstrate how the “three column technique” can be used to challenge cognitively distorted thoughts. In this exercise you identify your distressing thoughts, identify cognitive distortions taking place, and try and come up with more rational thoughts.
While a full description of all of the common cognitive distortions is beyond the scope of a single blog post, I will post a worksheet I use with clients on the self-help resources page that goes over them in greater detail.
When I work with clients, I typically go over a list of some common cognitive distortions. The vast majority of clients are able to recognize that they have many thoughts consistent with these unhelpful thinking styles. Clients struggling with depression usually filter out all of the good things in life, those struggling with anxiety are often plagued with catastrophizing, and people overwhelmed with anger desperately want the world to work the way they want (should/musts and the fallacy of fairness). We all think cognitively distorted thoughts sometimes, it is normal. The refreshing thing about thinking habits is that they can be changed. The first step to changing our thinking is building our awareness of our thoughts. Simply reading this post and the list of common cognitive distortions on the self-help page can help you with becoming more aware of your unhelpful thinking patterns.
Personally, learning about cognitive distortions has changed my life. Challenging my unhelpful thoughts insulates me from distress that comes with being a human being. When I am irrationally frustrated about something (like a hockey game) I pull out my journal and practice these skills. When I go through a more significant challenge (bereavement, financial concerns, trauma, etc.) I use the same skills. Before learning these theories and techniques, I would stay up for hours on end, just laying in bed ruminating about things. Now I am able to process what is going on for me and let it go. Hopefully with some practice, you will be able to do the same.
A fundamental component of Cognitive-Behavioral Therapy is the idea that our thoughts, emotions, and behaviors all influence one another. This is important because it suggests that we can change how we feel by changing how we think and what we do. The connection between thoughts and emotions was somewhat explored in my last post, so today I wanted to focus on the connection between what we do and how we feel.
Runners experience a “high” when pushed to their limits, we often feel better after a “good cry”, and we feel pride and satisfaction when we improve at an important task. Conversely, we feel guilty after erupting in anger, we feel sad when we isolate, and we feel anxious when we drink 9 coffees. Therapists typically have an assortment of “relaxation skills” that they teach to their clients to use when they are upset.
When you enter therapy, most therapists will usually assess your sleeping patterns, your diet, your exercise routine, your daily habits, and your hobbies. This is because what you do, greatly impacts how you feel and what you think. Improving self-care can greatly impact a person’s physical and mental health.
The question of “how do we lead a healthy life” has been explored by humans for a very long time. Researchers at SFU have been attempting to modernize the very old idea of the “Wellness Wheel.” This model breaks down the concept of wellness into seven primary dimensions Simply put, we can improve our wellness by attempting to maintain balance among these dimensions. I suspect most people can anticipate how their well-being would suffer if they were to over focus on one dimension at the cost of the others.(http://www.sfu.ca/students/health/resources/wellness/wheel.html).
In my opinion, few examples illustrate the connection between emotions and behavior better than the behavior habits of depressed people. When you ask a person with depression about their daily routines, it is not unusual in my experience for them to describe a daily routine dominated by social withdrawal, minimal exercise, low goal-oriented behavior, unhealthy eating habits, and irregular sleeping patterns. Paradoxically, depression often reduces self-care which in turn feeds depression. I’ve often believed that if we were to take a mentally “healthy” person and force them to behave the same way as a depressed person, it would only be a matter of time before the despair, sadness, and loneliness set in. Regardless of what came first, research suggests we can reduce feelings of depression by improving self-care.
Behavioral Activation (BA) is a strategy for combatting depression that has over 40 years of research supporting it. Eight common techniques used in BA are (1) Activity monitoring, (2) value and goal assessment, (3) activity scheduling, (4) skills training, (5) relaxation skills, (6) contingency management, (7) procedures targeting verbal behavior, and (8) procedures targeting avoidance. BA techniques can help challenge the belief that we are victims to our moods, that we can’t do what is good for us until we feel better. These techniques can demonstrate that sometimes we can “fake it to we make it.” Please see the “Self-Help Resources” page for more information about BA.
This idea that there is a connection between our mood and our behavior can benefit anyone, not just those with clinical depression. The cliché’ and famous Einstein quote is “the definition of insanity is doing the same thing over and over and expecting different results.” By that logic, can we really expect our mood to change when we are unwilling to change what we are doing (or thinking)?
Please feel free to e-mail me with any questions or comments.
Our thoughts, beliefs, assumptions, and interpretations cause emotions. At least that’s what cognitive therapists think. Some people have a very difficult time accepting this, but stick with me here. Many people believe that situations or other people cause their emotions. These people talk to their friends and say things like “he just makes me so mad!”, “how can I be happy when ____________ is wrong with my life?”, or “I’d never have any road rage if people could just learn to drive.” While it is true that situations influence our feelings, it is what we think about those situations that cause our emotional reactions to those situations. Take for example, two people who have recently gone through a divorce. Assume for the purposes of this example, their situations are exactly the same. The first divorce’ feels overwhelmed with depression, guilt, and shame because they think: this is the worst thing that could happen. I’ll be alone forever. No one will ever love me. I’m too old to start a relationship. This is going to ruin life for my kids. The second divorce’ has a radically different emotional reaction because they think: In all honesty I was generally unhappy in that relationship, this is an opportunity for me to invest my time and energy into something more satisfying. This is difficult and it is unfortunate that this did not work out but just because it wasn’t a good fit with my last partner does not mean it won’t work out with other people in the future.
“But what about brain chemicals??? Aren’t our emotions a reflection of the levels of neurochemicals in our brains?” First, it is true that the levels of certain neurotransmitters are associated with the likelihood of experiencing particular emotions. This is why medications like selective serotonin reuptake inhibitors (SSRIs) can help reduce depression for some people. However, your neurochemistry is greatly influenced by what you do and how you think. Therefore, you can change your neurotransmitter levels by changing what you do and how you think.
It is still okay if you are still unconvinced that your emotions are created by your thoughts, beliefs, assumptions, and interpretations. If your are still skeptical let me ask you this – even if 99% of your suffering is caused by your brain chemistry, other people, or situations, isn’t it more productive to focus on that 1% you can control? What is helpful for you? Is it helpful to believe that you are a powerless victim without any choices?
Alright so if we accept that our emotions are caused by our thinking, how does this help us? It means that we can change how we feel by changing how we think. Many types of therapy rely on thought replacement to do this.
The first step of thought replacement is building awareness about the thoughts causing your emotional reactions. These automatic thoughts (or “hot thoughts”) can be in the form of language (“I’m an idiot”) or in the form of images/fantasies, and they automatically pop into our minds when we are in moments of crisis. Unfortunately, we usually just accept our automatic thoughts to be true. This is unfortunate because often our thoughts are just dramatic nonsense.
Once we are aware of our automatic thoughts we try and assess the degree to which these thoughts are realistic or factual. Dr. Beck (the founder of cognitive therapy) recommends three questions to do this: (1) what’s the evidence that this thought is true or false? (2) What might be another way of looking at the situation? And (3) so what if this thought is true? Challenging our automatic thoughts can be very difficult at first (this is one of the reasons I have a job) because we usually have a lot of practice just accepting our opinions, interpretations, and assumptions as facts.
If we come to find that our thoughts are not realistic or factual we move into the third step of thought replacement – focusing on a more rational alternative. It is usually not enough to simply deny the validity of a thought, we usually have to focus on another thought to take its place. Our focus is like a laser pointer, we can point it at one thing at a time. Sometimes it feels like several things because we are frantically moving the laser pointer from one thing to the next. With practice we can choose to focus our attention on the more rational alternative and let the negative automatic thought go. However, we do not stop there. How do we know that the new alternative thought is more realistic or factual? We test out the new thought in the real world. In science terms – we test our new hypothesis and try and see if it is supported by evidence.
So to go back to my example of the first divorce’ who feels overwhelmed with depression, guilt, and shame. First we (1) identify a negative automatic thought that is contributing to their suffering – “I’ll be alone forever.” Then we (2) assess the degree to which this thought is realistic or factual by asking those three questions posed by Dr. Beck. What’s the evidence? Many people who go through divorce end up in even better relationships. What’s another way of look at the situation? This is an opportunity for me to invest my time and energy into something more satisfying. This is difficult and it is unfortunate that this did not work out but just because it wasn’t a good fit with my last partner does not mean it won’t work out with other people in the future. So what if this thought is true? The world would not end. My happiness is not dependent on my being in a relationship. While it is unlikely I’ll be alone forever, there is still a lot of joy to have in the world. Finally, we then (3) focus on a more rational alternative – I would have preferred to have been in a perfect marriage on my first try but I am not entitled to have everything I want. It is easy to be a kind, respectful, and loving person when everything is going my way, this is an opportunity for me to display the depth of my character when challenged to my children. Just because one relationship did not work out does not mean that I am unlovable or that I will be alone forever. What can I focus on improving about myself so I can increase the chances of meeting my goals in the future?
I am very aware that these principles are easier said than done. I do not mean to suggest any of this is easy. Thousands of journal articles and books have been written on these topics and this is only a very brief overview. I’ve had to use these skills many, many times in my life and they have been an immense help for me. My only hope with this post is that perhaps it may be helpful for you as well.
The influence of behaviour on emotions will be explored in more depth in future posts.
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Here is a portion from my Master’s Thesis on health and wellbeing:
Health and wellbeing are multidimensional and overlapping constructs. Health is a multicomponent concept: “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (WHO, 2006). The World Health Organization has not changed this definition of health from 1948 when the WHO Constitution entered into force, and retains this definition on its website today. The WHO definition of health aligns closely with the definition of wellness endorsed by the National Wellness Institute (n.d.): “Wellness is holistic and multidimensional, encompassing physical, mental, social, and spiritual wellbeing.” Wellness, according to the National Wellness Institute (n.d.), is a positive and affirming state of being and functioning. Seligman (2011) has developed a model of wellness, defining and characterizing wellness as comprising—and requiring—the cultivation of five, what I might call, ways of relating to life and living, namely: the cultivation of (a) positive emotion; (b) engagement; (c) relationship, (d) meaning; and (e) achievement. Wong (2015) said that wellness is an effortful and intentional process “involving personal responsibility and commitment” (p.1).
Self-perceived or subjective wellbeing is an evaluation of life as a whole in terms of overall happiness and the pleasantness of life (Diener, Emmons, Larsen, & Griffin 1985); the hedonic balance between positive and negative affective appraisals and (more cognitively driven) life-satisfaction (Chen et al., 2012; Corrigan, 2000). Indeed, life-satisfaction is used in empirical studies as an indicator of subjective wellbeing (Mcdowell, 2006, p. 206). Subjective wellbeing has a bidirectional relationship with health in general, possibly even contributing to its maintenance (Steptoe, Deaton, & Stone, 2015). The literature has hotly debated the distinction between subjective and psychological wellbeing (e.g., Chen et al., 2012). Psychological wellbeing is defined as the capacity to feel, think, and act in ways that enhance our inherent abilities to realize our self-potential (Chen et al., 2012), to enjoy life, and to deal with the inevitable and unavoidable adversities and challenges of life (Wong, 2015). Experientially, psychological wellbeing is a sense of composure or (for some) spiritual wellbeing, and is the antithesis of feelings, and behavioural and physiological symptoms, of distress (parentheses are mine; Wong, 2015). Interestingly, in their 2015 review paper of the associations between subjective wellbeing, health, and age Steptoe and colleagues (2015) collapsed across the hedonic and eudemonic distinctions, defining subjective wellbeing as comprising evaluative wellbeing (or life satisfaction), hedonic wellbeing (feelings of happiness, sadness, anger, stress, and pain), and eudemonic wellbeing (sense of purpose and meaning in life). In collapsing across hedonic and eudemonic distinctions, I think Steptoe et al. have more fully captured the human condition within the human (subjective) experience of wellbeing.
Psychological distress is a common-sense index of general health and wellbeing. Psychological distress is mental and social suffering in response to unmet needs, demanding life circumstances (Ridner, 2004), traumatic life events, or existential concerns. Psychological distress is a sense of discomfort and distress accompanied subjectively by one or more of demoralization and pessimism towards the future, anguish and stress, self-depreciation, social withdrawal and isolation, somatization, and withdrawal into oneself (Masseé, 2000). A defining and signal characteristic of psychological distress is that it does harm, either temporary or permanent, to the person (Ridner, 2004).