How to Identify and Challenge Distorted Thinking

Cognitive therapy helps a person learn how to identify distorted thinking in order to change the way you think and feel. These thoughts are automatic and simply pop into our minds automatically. As a result, people tend to respond automatically to these distorted thoughts without pausing to notice whether or not the thoughts are accurate or realistic. Everyone has a flow of positive, neutral, and negative automatic thoughts throughout the day. Unfortunately, negative automatic thoughts tend to lead to irrational thoughts. From a psychological perspective, irrational thoughts:

• are not based on evidence

• mostly operate on assumptions

• are rooted in beliefs based on past experiences either positive or negative

We all have irrational thoughts. Some people will be able to recognize irrational thoughts. Other people may struggle to let go of the irrational thought and give the thought too much time and attention. Thus, irrational thoughts can cause functional impairment in behavior which can negatively impact day-to-day life.

When irrational thinking becomes a pattern, it creates a cognitive distortion. This is an error in thinking or logic that affects the way your mind processes information. Cognitive distortions refer to your mind making judgments and inferences about a situation that are not based entirely on logic or evidence. This is usually the result of past experiences. Cognitive distortions can shape your beliefs, mood, and how you view yourself, others, and the world in general.

The 10 most common cognitive distortions: (adapted from “Feeling Good: The New Mood Therapy”)

1. All-or-nothing thinking: You look at things in absolute, black-and-white categories.

2. Overgeneralization: You view a negative event as a never-ending pattern of defeat.

3. Mental filter: You dwell on the negatives.

4. Discounting the positives: You insist that your accomplishments or positive qualities don’t count.

5. Jumping to conclusions: a) Mind-reading: You assume that people are reacting negatively to you when there’s no definite evidence; b) Fortune-telling: You arbitrarily predict that things will turn out badly.

6. Magnification or minimization: You blow things way out of proportion or you shrink their importance.

7. Emotional reasoning: You reason from how you feel: “I feel like an idiot, so I really must be one.”

8. “Should statements”: You criticize yourself (or other people) with “shoulds,” “oughts,” “musts” and “have tos.”

9. Labeling: When you label yourself or others. Instead of saying “I made a mistake,” you tell yourself, “I’m a jerk,” or “a fool,” or “a loser.”

10. Personalization and blame: You blame yourself for something you weren’t entirely responsible for, or you blame other people and deny your role in the problem.

How to challenge distorted thoughts:

1. Journal. When you notice a change in mood, journal about what you’re thinking and feeling. Pay particular attention to what you're telling yourself. When you’ve calmed down, review the list of distortions and determine which one fueled your intense emotion. Be curious about what thought triggered you and make note of it. Curiosity will create an opportunity for increasing self-awareness and allow you to grow and learn about what you can do differently next time.

2. Complete a thought record. A thought record is a core tool in cognitive-behavioral therapy (CBT). This is a one-page worksheet that you use in a difficult situation to help you notice your unhelpful ways of thinking and change your perspective to something more realistic. It focuses on the interactions between thoughts, feelings, and behaviors, and how to focus on factual evidence in order to think more reasonably and rationally.

3. Practice mindfulness which is the ability to focus on the present moment. It’s incredibly helpful to practice diaphragmatic breathing which allows you to focus on each inhalation and exhalation which brings you to the present moment. Practice noticing the thoughts and letting them go. Learn to recognize that you are not your thoughts.

4. Practice self-compassion. Learn how to talk to yourself as if you were talking to your best friend. Practice being kind and patient with yourself. Acknowledge the pain you feel and learn to sit with the emotion and let it go.

5. Consider working with a psychologist who is trained in cognitive-behavioral therapy (CBT). The therapist can provide you resources and support, teach you how to challenge your distorted thoughts, reduce anxiety and depression, and improve your mood.

Distorted thinking negatively impacts how a person, thinks about oneself, others, and the world. Be patient with yourself as you increase your awareness of your unhelpful ways of thinking. Learn to make your mental health a daily priority and learn and practice CBT coping strategies that can help reduce your irrational and distorted thoughts. Consider seeking additional support by working with a therapist who is trained in CBT.

If you’re needing help in dealing with your unhelpful thinking patterns, consider setting up a free phone consultation and we can discuss how therapy can be helpful.

Anxiety Attacks vs Panic Attacks

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year. (Anxiety and Depression Association of America). Given the high rates of anxiety disorders, It’s common to hear people talk about anxiety attacks and panic attacks interchangeably. This is understandable given that anxiety attacks and panic attacks share common symptoms like increased heart rate and shortness of breath.

Close to 11% of Americans experience a panic attack. Approximately 2% to 3% of them go on to develop panic disorder, per the Cleveland Clinic. According to the DSM-5, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. Common symptoms during a panic attack include physical and mental symptoms.

physical symptoms: pounding heart, sweating, trembling or shaking, shortness of breath, feelings of choking, chest pain or discomfort, nausea or abdominal distress, feeling dizzy, light-headed or faint, chills or heat sensations, numbness or tingling sensations (paresthesia).

mental symptoms: feelings of unreality (derealization) or being detached from oneself (depersonalization), fear of losing control, or fear of dying.

A panic attack is the hallmark feature of a condition called Panic Disorder. Furthermore, panic attacks can occur in the context of any anxiety disorder as well as other mental disorders. Panic attacks can occur suddenly and without warning. The symptoms usually peak within 10 minutes and tend to disappear soon after.

The term ‘anxiety attack’ is not defined in the DSM-5 but is used to describe a core feature of anxiety disorders. Anxiety tends to intensify over a length of time. Anxiety is significantly correlated with a potential danger (real or perceived) or excessive worry. If the anticipation of something escalates and a significant amount of stress becomes overwhelming, it might feel like an anxiety attack. The symptoms of anxiety tend to include the following symptoms:

mental symptoms: restlessness, irritability, difficulties concentrating.

physical symptoms: dizziness, fatigue, muscle tension, increased heart rate, disturbed sleep.

While some of the symptoms of anxiety are similar to panic attacks, the symptoms are generally less intense. The symptoms of anxiety may be persistent, short-lived, or long-lasting.

Psychotherapy especially cognitive behavioral therapy (CBT) is very effective in treating panic attacks and anxiety disorders. CBT helps you understand how your thoughts, feelings, behaviors, and physical symptoms are all inter-connected. In psychotherapy, you can learn various CBT skills that can help feel in control of your anxiety rather than anxiety controlling you.

If you are needing help in dealing with your anxiety, please consider setting up a free phone consultation and we can discuss how therapy can be helpful.

Navigating Anxiety During Unprecedented Times

Current stressors in this country are increasing more worries given COVID-19, physical distancing, social and racial injustice, riots/looting, financial hardships, climate change and divisiveness.  It’s like the perfect storm. Given the extreme circumstances we currently face, it tends to trigger much uncertainty, loss, anxiety and worries. When we are anxious, we seek a need for safety, predictability, and control which is very challenging given these hectic times.

Many kids, adolescents and adults are impacted by these stressful times in various ways:

• Emotionally: worried, sad, angry, scared, impatient, exhausted, bored.

• Socially: isolated; increase in arguments and frustrations at home and at work; more time on social media.

• Physically:  problems with sleep; tension in body (neck, shoulders, jaw); sitting most of the day at work or school so experiencing limited movement; headaches; limited concentration.

• Behaviorally:  avoid things that cause anxiety; overcompensate; eat more or eat less; increase in substance and alcohol use.

Given the increase in anxiety during these unprecedented times, it’s important to understand the difference between normal anxiety and an anxiety disorder.

Normal anxiety:

• Is related to a specific situation or problem.

• Lasts only as long as the situation or problem.

• Is proportional to the situation or problem.

• Is a realistic response to a realistic problem or situation.

When someone experiences an anxiety disorder:

• Anxiety may come up unexpectedly, for seemingly no reason.

• The anxiety response to a situation or problem may be much stronger than they would expect.

• They may experience unrealistic anxiety, such as fear of a situation that likely will never happen.

• Anxiety may last for a long time, even when the situation or problem has been resolved.

• Anxiety may feel impossible to control or manage.

• They may avoid situations or things that they believe will trigger anxiety symptoms.

• Anxiety is fueled by avoidance.

• Intolerance of uncertainty and distress.

The following are various coping strategies to practice in navigating and tolerating anxiety:

• Pay attention to the content of  thoughts (can help or hurt).

• Challenge negative distorted thoughts.

• Practice rational thinking. 

• Talk back to fears with rational thinking.

• Focus on personal expectations:  are they realistic or unrealistic?

• Practice flexibility in thinking.

• Practice mindful moments.

• Practice deep breathing exercises (inhale for 5 exhale for 5; inhale for 4, hold for 4, exhale for 8.

• Rather than avoid learn how to break tasks up into smaller tasks.

• Practice tolerating emotions.

• Practice identifying your feelings and rating them 1 - 10.

• Create time for daily movement and exercise.

• Eat healthy and colorful food.

• Write by expressing your thoughts and feelings via journaling or poetry.

• Practice creativity:  baking, music, theater…

• Practice random acts of kindness.

• Practice daily gratitude: Before going to bed focus on 3 things you are grateful for during the day.

If you are needing help in dealing with your anxiety, please consider setting up a free phone consultation and we can discuss how therapy can be helpful.

5 Ways to Stop Thinking You're Not Good Enough

We live in a culture of comparison and competition which can be fierce. Social media floods us with the belief of not being enough: not pretty enough, not good looking enough, not smart enough and so on.  Our teens’ lives are super focused on competition like getting the best grades, being involved with endless extra curriculars, taking as many AP classes in order to get into the best colleges.  No wonder our society has the highest rates of anxiety and depression for kids and adolescents.  

As the saying goes, we are our worst enemies.  This culture of comparison and competition only fuels anxiety, anger, depression and shame.  It magnifies self defeating thoughts and behaviors.  We need to decide enough is enough.  It’s time for a paradigm shift.  Let us make self care a priority so we can practice taking better care of ourselves and our kids.  

Let’s take a look at 5 strategies that can help us stop thinking “I’m not enough” and learn to acknowledge and focus on our personal strengths.

1.  Practice daily self care.  Make time everyday to get enough sleep, eat healthy balanced meals and get exercise.  Learn to make time for joy, laughter and play.  Begin a gratitude journal first thing in the morning or right before you go to bed. Start small and list 3 things you are grateful for during that day.  Research shows that gratitude is good for our minds, bodies and relationships.

2. Practice challenging your negative, self defeating thoughts. Recognize that you have control over your thoughts.  Cognitive distortions are irrational thoughts that are false, inaccurate and can cause psychological damage.  Common cognitive distortions are all or none thinking, emotional reasoning, personalization, jumping to conclusions and should statements.  With daily practice, you can learn to pay attention to your thoughts, challenge your distorted thinking and learn to think more rationally and balanced.  

3. Learn to talk back to your inner critic.  The inner critic usually is the voice that judges you, belittles you, doubts you and tells you you are not enough.  Usually the inner critic thinks it’s protecting you but it actually robs you of emotional well being and peace of mind.  Start an inner critic log and notice the content of the self criticism.  Learn how to talk back to your inner critic with acceptance and compassion.  An example might be  “I hear you loud and clear, but I'm also going to consider other ways of thinking about this situation."   

4. Learn to focus on your needs and wants.  Someone who feels “not good enough” is usually focused on who they think they’re supposed to be.  If you don’t feel good enough, you may not value yourself enough to see your wants as important.  Give yourself permission to focus on what you need and want for the day.  With practice, you can learn how to ask for what you want and need in your relationships. 

5. Practice being in the present moment.  We tend to focus on the past which fuels guilt and shame or focus on the future which fuels anxiety.  Learn to be present in the here and now.  Practice deep diaphragmatic breaths which help calm the mind and body.  Being in the present moment reminds us that we are ok right here and now.  It helps us to be responsive, not reactive.  Being present allows us to be better engaged in our relationships.  

If you’re looking for mental health support, please contact me to schedule a free 15-minute phone consultation.

8 Suggestions for Navigating Anxiety

Anxiety is very prevalent in today’s society given the endless responsibilities, expectations and divisiness in our country.  According to the Depression and Anxiety Association of America, nearly 18% of the population has an anxiety disorder. Common triggers of anxiety might be unrealistic expectations of ourselves, negative thinking, stress, public speaking and conflict in a relationship .  

Helpful strategies in navigating anxiety:

1. Pay attention to your self talk.  Usually the thoughts are negative and distorted which fuel anxiety.  In cognitive behavioral therapy (CBT), these thoughts are called cognitive distortions. Usually these distortions fall within the categories of exaggerating, catastrophizing, overgeneralizing and ignoring the positives.

2. Learn and practice how to challenge your distorted thoughts with more rational and balanced thinking (“Although I feel overwhelmed, I am working hard and I am completing my school/work responsibilities to the best of my ability.” )   

3. Use a thought stopping technique to lessen your automatic catastrophic thinking. Try and visualize a stop sign and say STOP to yourself.  Replace the anxiety thoughts with realistic and self soothing statements. (“I can get through this, I’ve done this before.”)

4. Practice diaphragmatic breathing such as inhaling through your nose for a count of 5 and exhaling for a count of 5.  With daily practice, you can learn how to calm your nervous system.

5. Distract yourself with visual distractions.  Some suggestions include counting the leaves on a plant or tiles on the ceiling.

6. Auditory distractions can be another form of distraction.  Some ideas include talking with someone on the phone or singing your favorite song.  

7. Movement is another excellent way to lessen your anxiety.  Try going for a walk outside, doing jumping jacks or playing with your pet.   Commit to yourself to exercising at least 20 minutes a day to help lessen your anxiety. 

8. Try practicing mediation with an app or a YouTube video of your choice.  Research shows that meditation can be very effective in reducing your anxiety.

Occasional anxiety is common but chronic feelings of fear, worry and perfectionism are not common.  If you are looking for help with your anxiety, please contact me to schedule a free initial consultation.

Counseling For Anxiety: Cognitive Behavioral Therapy (CBT)

What is Anxiety?

Anxiety is the anticipation of a future threat and one of the most distressing emotions that people feel. According to the National Institute of Mental Health, anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18% of the population.  Anxiety disorders affect 1 in 8 children. Anxiety disorders are treatable and Cognitive Behavioral Therapy is highly effective in treating various anxiety disorders.

What is Cognitive Behavioral Therapy (CBT)?

CBT is a theoretical orientation that focuses on how our thoughts, feelings and behaviors are influenced by one another.  CBT highlights that each person has a choice as to how to think and behave which directly increases his/her coping skills in dealing with daily life challenges.

A Cognitive Behavioral Profile of Anxiety:

Common Physical Reactions:  sweaty palms, muscle tension, racing heart, flushed cheeks, light headedness.

Anxious Thoughts/Cognitions:  overestimation of danger, underestimation of your ability to cope, worries and catastrophic thoughts, underestimation of help available.

Typical Anxiety Behaviors:  avoiding situations where anxiety might occur, leaving situations when anxiety begins to occur, trying to do things perfectly or trying to control events to prevent danger, shutting down, restlessness, fidgeting.

Anxious Moods/Feelings:  anxious, panicky, nervous, , worried, overwhelmed.

Coping Strategies for Anxiety Using a Cognitive Behavioral Approach:

Coping Strategies for Emotions/Feelings:

Some helpful anxiety coping strategies include the following:  identify the feelings, rate the feelings, learn to let go, daily journaling, and talking with a friend, family member or therapist.

Physical Coping Strategies:

Some of the most helpful physical anxiety coping strategies include diaphragmatic breathing, progressive muscle relaxation, guided imagery/visualizations that focus on your senses, physical exercise, yoga and walking in nature.

Coping Strategies for Cognitions/Thoughts:

The following list includes helpful coping strategies for challenging our distorted anxious thoughts:  healthy distractions (counting, crossword puzzles), scheduled worry time, various cognitive exercises (thought records, cognitive restructuring, worst/best/realistic case scenario) and mindfulness.

Behavioral Coping Strategies:

Behavioral coping strategies to lessen anxiety include: exercise, yoga, meditation, acupuncture, massage, making time to socialize (friends, hobbies, sports), a healthy diet and a healthy sleep hygiene routine.

If you are looking for help with your anxiety, please contact me to schedule a free initial consultation.