Tips, Ideas & Recommendations in CBT Treatment

Negativity bias is a psychological phenomenon where negative experiences, thoughts, or emotions disproportionately influence our cognitive appraisals compared to positive ones. This bias, rooted in our evolutionary history, served an adaptive function by helping our ancestors respond quickly to threats. However, in modern life, it often skews our perceptions, leading to distorted thinking and unhelpful emotional responses.

Cognitive appraisals refer to the way we evaluate situations, events, and experiences. They are central to how we interpret and respond to the world around us. When negativity bias infiltrates these appraisals, we tend to overemphasize negative aspects while underestimating or overlooking the positive. For instance, a person might receive glowing feedback from their boss but fixate on a minor critique, allowing it to overshadow the praise.

This bias can have significant implications for mental health. It contributes to the development and maintenance of conditions like anxiety and depression, where negative thoughts dominate and create a cycle of negative appraisal. For example, someone with anxiety might perceive a minor mistake as catastrophic, leading to heightened stress and further negative thinking.

Life is full of ups and downs. Sometimes, challenges throw us into emotional turmoil, leaving us feeling overwhelmed and unsure how to cope. Here's where coping strategies come in – mental and behavioral tools we use to manage difficult emotions and navigate stressful situations. But with so many strategies available, how do you choose the right one? Let's explore the two main approaches: emotion-focused coping and solution-focused coping.
Facing the Feels: Emotion-Focused Coping
Imagine you receive a critical email from your boss. Your heart races, anger bubbles up, and you feel like lashing out. Emotion-focused coping acknowledges these intense emotions and focuses on managing them rather than directly addressing the source of stress. Here are some key features:

• Riding the Wave: Emotion-focused strategies don't try to suppress emotions. Instead, they help you acknowledge and accept your feelings without judgment. Mindfulness exercises, deep breathing techniques, and journaling can be effective tools.
• Seeking Support: Talking to a trusted friend, therapist, or family member can provide emotional validation and help you process your feelings in a healthy way.
• Self-Soothing Activities: Engaging in activities you find calming, like taking a walk in nature, listening to music, or taking a hot bath, can help reduce emotional intensity and promote relaxation.

Problem-Solving Power: Solution-Focused Coping
Now, let's say that critical email from your boss keeps nagging at you. You want to address the situation and prevent it from happening again. This is where solution-focused coping comes into play.

• Identifying the Problem: The first step is to clearly define the problem causing you stress. In this case, the issue might be unclear communication with your boss.
• Brainstorming Solutions: Once the problem is identified, actively brainstorm potential solutions. Maybe you could schedule a meeting with your boss to clarify expectations, or perhaps you could implement a system for double-checking your work before sending it.
• Taking Action: Choose the most promising solution and take concrete steps to implement it. Following through demonstrates a proactive approach to problem-solving.

Choosing Your Weapon: When to Use Each Strategy
So, which strategy should you choose? The answer depends on the situation. Here's a general guideline:

• Emotion-focused coping is ideal for:
  • Managing overwhelming emotions like anxiety, anger, or sadness.
  • Situations where the stressor is out of your control.
  • Taking a step back and gaining perspective before tackling a problem.
• Solution-focused coping is ideal for:
  • Situations where the stressor is something you can potentially change.
  • Feeling empowered to take control and prevent future problems.
  • When a clear action plan can reduce ongoing stress.

These approaches aren't mutually exclusive. You can often combine them. When faced with a challenge, acknowledge your emotions (emotion-focused), then brainstorm and implement solutions (solution-focused). By having both tools in your coping toolbox, you can navigate life's curveballs with greater resilience and emotional agility.

Effective communication is a cornerstone of healthy relationships, and Dr. David Burns, my mentor, friend, and the creator of TEAM-CBT therapy, has articulated five key secrets to mastering it. These techniques are designed to improve how we connect with others, fostering understanding and reducing conflict. Here’s a look at these five secrets:

1. The Disarming Technique: This strategy involves finding truth in what the other person is saying, even if you disagree with their overall point. By acknowledging the validity of their perspective, you can defuse tension and create an environment where both parties feel heard and respected. This doesn’t mean conceding your stance but rather showing empathy and openness.

2. Express Empathy: Dr. Burns emphasizes the importance of empathy in communication. This involves listening attentively and reflecting back the emotions and thoughts the other person is expressing. There are two forms of empathy: thought empathy, where you paraphrase their words, and feeling empathy, where you acknowledge their emotions. This helps the other person feel understood and valued.

3. "I Feel" Statements: Effective communication often requires vulnerability. By using "I feel" statements, you can express your emotions without blaming or criticizing the other person. This technique helps convey your feelings in a non-confrontational manner, fostering a more open and honest exchange.

4. Stroking or Affirmation: Stroking involves expressing genuine, positive feelings or admiration toward the other person, even during a disagreement. This technique softens the interaction, making it easier to navigate difficult conversations with kindness and respect.

5. Inquiry: Engaging in inquiry means asking gentle, open-ended questions to encourage the other person to share more about their thoughts and feelings. This not only shows genuine interest but also helps you gain a deeper understanding of their perspective, paving the way for more meaningful dialogue.

These techniques can help improve your communication with your spouse, coworkers, family members, customer service representatives and even strangers in line ahead of you! Here is an example of an exchange between a husband-wife duo that didn't go so well:
Wife: "You never listen to me"
Husband: "I listen to you complain all the time"
Wife: "You suck!"

Here is the same exchange using the '5 secrets' above:
Wife: "You never listen to me"
Husband: "You are right, it's hard for me to stop and just let you talk (Disarming), and it feels like I never listen to you (Thought Empathy). I imagine you are feeling upset and angry, but also hurt and lonely (Feeling Empathy). I feel sad when I see you sad and frustrated when we can't communicate well (I Feel Statement). I love you so much and you mean the world to me (Stroking); I want to be here for you. Can you tell me more about how you're feeling?"
Wife: "Well, I am feeling lonely...(and continues to share, towards a more loving and intimate exchange)"

If you want to learn how to use these techniques on your own, you can start with Dr. Burns Feeling Good Together book. And if you need more help after that, you may want to consult with a TEAM-CBT therapist. 

In Cognitive Behavioral Therapy (CBT), core beliefs are the deepest level of negative thinking patterns. These are the most fundamental assumptions we hold about ourselves, the world, and others. They are formed early in life and tend to be rigid and unquestioned.
Core beliefs are central to CBT because they influence everything from our automatic thoughts (fleeting negative ideas) to our emotions and behaviors. Here's a closer look at core beliefs in CBT:
Characteristics of Core Beliefs:

• Deeply Held: Core beliefs are ingrained and often unconscious. We might not even realize we hold them.
• Global and Overarching: They are broad generalizations applied to many situations, not specific to one event.
• Difficult to Change: They are resistant to change due to being deeply ingrained and reinforced by experiences.

Impact of Core Beliefs:

• Filter for Perception: Core beliefs act as a lens through which we interpret events. They can distort our perception of reality.
• Fuel Negative Thoughts: Core beliefs can trigger automatic negative thoughts, leading to emotional distress and unhealthy behaviors.
• Self-Fulfilling Prophecies: When we believe something strongly (even if untrue), it can influence our behavior in ways that confirm that belief.

Examples of Core Beliefs:

• I am worthless. (Leads to feelings of worthlessness, social withdrawal)
• The world is a dangerous place. (Leads to anxiety, avoidance of new experiences)
• I can't trust anyone. (Leads to isolation, difficulty forming relationships)

How CBT Addresses Core Beliefs:
While directly targeting core beliefs can be challenging, CBT helps individuals:

• Identify Core Beliefs: Through exercises and therapy sessions, individuals can uncover their core beliefs.
• Challenge Their Validity: Examining the evidence for and against the core belief can help weaken its hold.
• Develop More Balanced Beliefs: CBT helps replace negative core beliefs with more realistic and empowering ones.

Changing core beliefs takes time and consistent effort. However, by working with a therapist, individuals can loosen the grip of these negative beliefs and experience significant improvements in their mental and emotional well-being.

Cognitive Behavioral Therapy (CBT) is a widely used, evidence-based psychotherapeutic approach that helps individuals understand and alter negative thought patterns and behaviors. Among its array of techniques, one stands out for its logical appeal and practical application: the "examine the evidence" technique. This method empowers individuals to challenge their negative thoughts by scrutinizing the evidence supporting and refuting them, fostering a more balanced and realistic mindset.

Understanding the 'Examine the Evidence' Technique

At the core of CBT lies the concept that our thoughts significantly influence our emotions and behaviors. Negative or distorted thinking can lead to emotional distress and maladaptive behaviors. The 'examine the evidence' technique is designed to address this by encouraging a methodical analysis of our thoughts.

When using this technique, individuals are prompted to take a thought—often a negative or distressing one—and treat it as a hypothesis rather than a fact. They then gather and evaluate the evidence for and against this thought, much like a scientist conducting an experiment. This process helps in identifying cognitive distortions and developing a more balanced perspective.

Steps to "Examine the Evidence"

1. Identify the Negative Thought: The first step is to pinpoint a specific negative thought that is causing distress. For example, "I am a failure because I didn't get the job I wanted."

2. Record the Thought* Write down the thought to give it a tangible form. This can help in viewing it objectively.

3. Gather Supporting Evidence: List all the evidence that supports the thought. In our example, this might include, "I was not selected for the job," or "I struggled with some questions during the interview."

4. Gather Contradictory Evidence: Next, list evidence that contradicts the thought. This could include, "I have been successful in other interviews," "I have good qualifications and experience," or "I received positive feedback from other applications."

5. Evaluate the Evidence: Weigh the evidence for and against the thought. Often, individuals will find that the evidence against their negative thought is stronger and more plentiful, which can diminish the thought's power and credibility.

6. Formulate a Balanced Thought: Based on the evidence, create a more balanced, realistic thought. For instance, "I didn't get this job, but I have been successful in other areas, and I can learn from this experience to improve my chances next time."

Benefits of the 'Examine the Evidence' Technique

1. Reduces Cognitive Distortions: By analyzing thoughts critically, individuals can identify and correct cognitive distortions such as all-or-nothing thinking, overgeneralization, and catastrophizing.

2. Enhances Emotional Regulation: A more balanced perspective can lead to reduced emotional distress and improved mood.

3. Promotes Problem-Solving Skills: This technique encourages a proactive approach to problem-solving, as individuals learn to confront and address their negative thoughts systematically.

4. Builds Resilience: Over time, examining the evidence can help individuals build resilience by fostering a habit of thinking more rationally and less emotionally.

Practical Tips for Applying the Technique

- Consistency is Key: Regularly practicing this technique can help reinforce balanced thinking habits.
- Seek Feedback: Sometimes, discussing thoughts and evidence with a therapist or a trusted friend can provide additional insights.
- Use a Thought Record: Keeping a journal of thoughts and evidence can be a useful tool for tracking progress and identifying patterns.
- Be Patient: Changing thought patterns takes time and effort, so it's important to be patient and persistent.

In short, the 'examine the evidence' technique is a powerful tool in the CBT arsenal, enabling individuals to challenge and reframe their negative thoughts through a structured and logical approach. By fostering critical thinking and promoting a balanced perspective, this technique not only alleviates distress but also builds a foundation for long-term emotional well-being. As with any skill, practice and perseverance are essential, but the rewards—a clearer mind and a more positive outlook—are well worth the effort.

Life throws its fair share of curveballs. Difficult emotions, stressful situations, and intrusive thoughts can leave us feeling overwhelmed and lost at sea. Acceptance and Commitment Therapy (ACT) offers a powerful technique called ACE (Acknowledge, Connect with your Body, Engage), also known as "dropping anchor," to help us navigate these stormy waters and find our inner calm.

Why We Struggle:
Our natural tendency is to avoid or fight unpleasant emotions. We might try to distract ourselves, numb out with unhealthy habits, or ruminate on negative thoughts. However, these strategies often backfire, leading to increased anxiety and a feeling of being stuck.

The Power of ACE:
ACE provides an alternative approach, helping us develop psychological flexibility. Here's how it works:

• Acknowledge (A): The first step is acknowledging your thoughts and feelings without judgment. Simply observe them – "I'm feeling anxious" or "That was a critical thought." This creates space for them to exist without fueling them further.
• Connect with your Body (C): When emotions run high, we often disconnect from our physical sensations. Focus on your breath, how your feet feel on the ground, or any physical tension. This grounding technique brings you back to the present moment.
• Engage (E): Instead of getting caught up in your thoughts and feelings, shift your focus to what truly matters. Engage in the present activity, be it a conversation, a task at hand, or simply observing your surroundings.
  
  

Benefits of Dropping Anchor:

• Reduced emotional intensity: By acknowledging emotions without judgment, we lessen their power over us.
• Increased mindfulness: Focusing on the body brings us back to the present, where we can make conscious choices.
• Greater clarity: Stepping away from unhelpful thoughts allows for more rational decision-making.
  
  

When to Drop Anchor:

• Anxiety or panic attacks: Use ACE to acknowledge your anxious thoughts and feelings, ground yourself in your body, and focus on your breath or calming techniques.
• Rumination: When caught in a cycle of negative thoughts, use ACE to acknowledge them, refocus on your body and surroundings, and engage in a different activity.
• Stressful situations: Practice ACE to manage overwhelming emotions, stay present, and navigate the situation effectively.
  
  

Dropping anchor is a skill that takes practice, but it can be a powerful tool for managing difficult emotions and living a more mindful life. The next time life throws you a curveball, remember to ACE your way through the storm and find your inner peace. Here is your map!

We all have that inner critic, the voice that whispers (or shouts!) negativity after a mistake or setback. But what if you treated yourself with the same kindness and understanding you'd offer a friend in the same situation? That's the core idea behind the Double Standard Technique, a powerful tool used in Cognitive Behavioral Therapy (CBT).

The Problem with Our Inner Critic
CBT focuses on the connection between thoughts, feelings, and behaviors. Often, negative thoughts lead to negative emotions and unhealthy behaviors. A common culprit behind these negative thoughts is harsh self-criticism. We hold ourselves to unrealistic standards, leading to feelings of guilt, shame, and inadequacy.

The Double Standard Technique: Treat Yourself Like a Friend
​The Double Standard Technique flips that script. Here's how it works:

1. Identify the Negative Thought: When you catch yourself feeling down on yourself, pinpoint the critical thought driving that emotion. For example, "I messed up that presentation. I'm such a failure."
2. Imagine a Friend: Picture a close friend going through the same situation. How would you comfort them?
3. Challenge the Inner Critic: Ask yourself, "Would I ever say such harsh things to my friend?" Most likely not!
4. Reframe Your Thought: Use the compassion you'd offer your friend to reframe your negative thought. "Everyone makes mistakes. I can learn from this and do better next time."

Why This Technique Works
The Double Standard Technique works because it exposes the unfair double standard we often hold ourselves to. We'd never be so cruel to a friend, so why be that way to ourselves? By practicing this technique, you can:

• Develop Self-Compassion: Treating yourself with kindness fosters a sense of self-worth and emotional resilience.
• Challenge Negative Thinking: You learn to question the validity of your harsh self-criticism.
• Develop More Supportive Self-Talk: You replace negativity with a more realistic and encouraging inner voice.
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Putting the Double Standard Technique into Practice
The Double Standard Technique takes practice. Here are some tips:

• Start small: Begin with minor situations and gradually work your way up.
• Journal: Write down your negative thoughts and reframe them using the Double Standard Technique.
• Seek support: Talk to a therapist or counselor who can guide you through the process.

By learning to treat yourself with the same kindness and understanding you'd offer a friend, you can break free from the cycle of self-criticism and build a more positive, self-compassionate self-image. Remember, you deserve the same level of kindness and support you readily give to others.

Dialectical behavior therapy (DBT) offers a toolbox of skills to manage overwhelming emotions. One powerful technique is "opposite action," which involves deliberately choosing a behavior contrary to your emotional urges. You may benefit from learning a bit more about it.

At our core, emotions are wired with action tendencies. For example, fear compels us to flee, anger pushes us to fight, and sadness leads to withdrawal. While these urges might be helpful in immediate danger, they can be detrimental in everyday situations. Opposite action disrupts this automatic cycle. By consciously choosing an action opposite to our emotional urge, we break the emotional hijacking and regain control.

For example, if social anxiety makes you want to cancel plans, opposite action would be to force yourself to attend. This might feel uncomfortable initially, but it can lessen the anxiety over time. Similarly, when feeling overwhelmed and tempted to isolate, opposite action could be reaching out to a friend. Overcoming the initial discomfort allows for connection and support.
The effectiveness of opposite action lies in its ability to:

• Reduce emotional intensity: By taking action against the urge, we prevent the emotion from spiraling.
• Promote long-term goals: Opposite action helps us prioritize our values over fleeting emotions.
• Challenge negative thoughts: Acting opposite to an emotion can demonstrate that the associated thoughts might be distorted.
  
  

Opposite action is not about suppressing emotions, but rather about choosing a more mindful response. It requires self-awareness and the willingness to step outside one's comfort zone. However, by practicing this technique, we can better manage their emotions and navigate challenging situations more effectively.

Here is a handout from Psychotherapy Academy on how to put this technique to good use in your life.

Those of us who are lucky enough to be able-bodied and perfectly capable of putting one foot in front of the other should be walking at least 30 minutes a day, 5 days a week. Why? Because walking brings enormous benefits for our health, both physically and mentally.

​This article from Fresh Daily Health details several ways in which walking can help us lead healthier lives. Benefits of regular walks include:

• Prevents muscle atrophy
• Improves blood circulation
• Builds muscle
• Builds stronger bones
• Lowers risk of several diseases such as heart conditions, cancer and diabetes
• Leads to weight loss
• Prevents dementia
• Boosts Vitamin D levels
• Increases energy levels
• Extends life span
• Boosts mental health

On this last point, it is worth highlighting that walking can help reduce stress, ease anxiety, and combat that nagging desire to do nothing that comes with a clinically significant depression. So, if you can find a few breaks on your calendar daily, even if it is just 10 to 15 minutes two or three times a day, get out there and start putting one foot in front of the other! Your body will thank you.

Often times, it is hard to find the right therapist, at the right location, available on the right days, and at the right price. If you are having trouble finding someone with whom you can connect, keep looking. Ask your friends and medical providers for recommendation. Search online directories for psychologists near you, such as those from Psychology Today. Look through membership listings at national or regional psychology associations such as the American Psychological Association. Or, if you know you want an evidence-based provider using cutting-edge technology, search for certified TEAM-CBT therapists on the Feeling Good Institute website.   

While you go through your research, you want to pay attention to your mood and well-being. Here are some tips for taking care of yourself while you wait for your psychotherapy to start:

Self-Care “While You Wait”

While you are waiting for individual counseling, you may want to implement these tips to try to alleviate some of your distress. (This is for informational purposes only, and is not intended to treat any conditions. These tips are not meant to be substitutes for mental or physical health counseling.) 

Find activities that sooth and relax you. Relaxation improves the mind and helps the body recover from stress. Even 10 minutes a day would be helpful! Use deep breathing techniques--take a deep breath slowly and all the way down to your stomach, hold your breath for a few seconds, and slowly breath out by emptying your stomach of your breath. Tell yourself to “let go of any tension” as you breath out. Do this for at least 5 or 6 times in each sitting. Practice yoga, listen to some relaxation tapes, etc. 

Do some kind of physical activity, even if you only have 10 minutes. Find a routine that creates a sweat and that fits your style (e.g., walk, swim, tennis). This will help with your stress, anxiety, and depression symptoms. 

Keep a journal. Write down your thoughts and feelings in various situations. Note any patterns or questions you’d like to discuss in therapy. 

Pay attention to your mind and body. Nourish your body with nutritious food. Skipping meals robs you of the energy to cope. Nurture your spirit. Pray, meditate, practice whatever that fits your spirituality. Sleep and rest when you are tired. 

Laugh, especially at yourself and Take time to play. Spend time with those who make you laugh. Watch a comedy or read a funny book. There is evidence that smiling changes your emotions to pleasant and your thoughts to optimism. 

Nurture a positive view of self. Catch yourself when you start to think negatively or are putting yourself down. Actively replace these negative thoughts with a positive view. Create a list of affirmations for yourself (e.g., I grow and change; I am open-minded, etc.). Even if you aren’t convinced, fake it until you make it! 

Make connections. This will take time to develop. Create and maintain contact with a small group of people you can call on for emotional support. Take turns talking and listening. Isolating yourself can make things worse. 
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In addition, here is a brief list of resources where you can obtain guidance and assistance in a crisis situation: 

• National Suicide Prevention Hotline – 1-800-273-8255 
• Starvista crisis hotline (in San Mateo County) – 1-650-579-0350 
• Text hotline - Text “START” to 741741. 
• 911 or your nearest emergency room 

Adapted from SJSU CAPS