Sunday 29 September 2013

How To Deal With Thoughts That Cause Guilt

This post looks specifically at how to use thought challenging (or cognitive restructuring) to manage thoughts that cause us to feel guilty. If you often feel guilty then the exercise below can help, even if you haven't heard of thought challenging before. If you are interested you can read about the basics of thought challenging in the earlier posts in this blog. In this post I will go over a quick introduction about guilt then look at a written exercise that has been shown to reduce guilt in research trials.

Guilt has many definitions but for the purpose of this exercise I will refer to it as the emotion that comes up when we feel as though we should have done things differently and/or feel as though something is mostly our fault.

Here is the thought challenging exercise for challenging thoughts about fault and responsibility:

Step 1: Write down the thought
Step 2: List all the other factors that contributed to the outcome
Step 3: Estimate how much influence that each factor had
Step 4: Look at what is left to see your own role in the outcome

For example:

Step 1: Write down the thought. One easy way to make sure it is in a format that can be challenged is to finish this sentence: It's all my fault / mostly my fault that ...

Let's say that my thought is: It's my fault that I couldn't make my relationship work with my partner (Ben).   

Step 2: List all the other factors that contributed to the outcome. This includes people, events, institutions and any other circumstances that influenced the outcome.

So for a relationship break up it might be:

  • Ben's depression
  • Influence of Ben's parents (always critical of me as no one was good enough for him in their eyes)
  • Ben's upbringing (especially his experiences at boarding school)
  • Ben's sister (she was always cruel to him and he has trouble relating to women)
  • Bad economy (and financial stress on us)
  • Work stress (due to five people in my department being let go and rest of us picked up the work)
  • My parents (if they had been better communicators I would have learned skills to manage my relationship with Ben more easily)
  • Ben's drinking
  • Ben's friends (none of them look out for him or help him when he is depressed)

Step 3: Estimate how much influence that each factor had. To do this, write down your best guess as a percentage. It can help to ask yourself: if this factor was different then how much more likely would it have been for everything to work out ok. For example: if Ben wasn't depressed then perhaps it would be 20% more likely for me to stay with him. 


  • Ben's depression (20%)
  • Influence of Ben's parents (15%)
  • Ben's upbringing, especially his experiences at boarding school (5%)
  • Ben's sister (15%)
  • Bad economy and financial stress on us (5%)
  • Work stress (5%)
  • My parents (35%)
  • Ben's drinking (25%)
  • Ben's friends (10%)

Step 4: Look at what is left to see your own role in the outcome. To do this, you subtract each percentage from 100%. 

So you start with feeling 100% responsible for the outcome and you...
- 20% (for Ben's depression)
- 15% (for Ben's parents)
- 5% (for Ben's upbringing)

... and so on. By the time I get up to my parents I am already at 100%. What does this mean? It means that there are a lot of factors that have played a role, some of them much larger than my own. By the end of doing this hopefully you can see that your role in this may be much, much less than you feel. 

Guilt is caused by many things, but perhaps the largest contributor may be that guilt is a survival mechanism that helps us avoid punishment from our parents. As children we are taught to feel guilty and to take responsibility for our actions. We are taught that if we do something that causes our parents to be upset, we should feel very bad. In the parents' minds - they are teaching an important lesson. In the child's mind - we feel guilty and think about how we might be able to avoid upsetting our parents in the future. In order to believe that we can do something to avoid the situation in the future, we must view the event as somehow under our control or that we were responsible. The other option would be to feel that the outcome was not under our control. Importantly, if we believe we have no control, there would be nothing that we could do to prevent our parents from getting mad at us again. It is a survival mechanism to feel as though we are in control, rather than feeling hopeless and as a consequence, depressed. However, this means we must also feel guilty. 

So guilt is a learned reaction where we typically take on much more responsibility for things than we need to. The payoff is feeling that we are in control bad outcomes by noticing all the things we did to create it. The cost is that the guilt can become crippling. 

This exercise can be done repeatedly for different thoughts about responsibility and guilt in order to see that we don't need to feel guilty all the time and that it is ok to forgive ourselves. 





Saturday 13 July 2013

How To Deal With Thoughts That Cause Anxiety and Worry

This post looks at how to challenge unhelpful thoughts that cause anxiety and worry. This post is part of a series about thought challenging so please check the previous posts if this one isn’t making sense. I’ll start by looking at how to identify the thinking that causes anxiety and then look at how to challenge those thoughts.

The thinking that typically drives anxiety is some type of prediction about the future. Anxiety is actually caused by dozens of factors, but for the sake of understanding, this post just looks at how to deal with anxiety caused by worrying predictions about the future.

Step 1 is to write down your worrying thoughts and use the downward arrow technique to identify your core fear. Instructions for using the downward arrow technique are listed in a previous post here. This exercise takes about 1-5 minutes.

Step 2 is to take the core fear and write down everything that would have to occur in order for the core fear to actually happen. You can use the steps from the downward arrow technique and then add others that are logical.

For example: Let’s say that someone’s initial worries are that their relationship with their husband is going badly. So they do the downward arrow technique and they recognise that the core fear is of being alone for the rest of their lives. In order for that to occur the following things would need to happen.

John and I can’t work through our issues together by talking.
John refuses to attend couples therapy to address the issues.
John stops talking to his friends/family and has no feedback from any other person about how to address the issues.
John becomes 100% unwilling to change.
We get a divorce.
I am unable to recover from the impact of the divorce.
No men show any interest in me for the rest of my life.
I refuse to go out or put myself in situations where I might be attracted/interested in another person.
I completely deny any feelings of interest in other men for the rest of my life and refuse to interact with men who are interested in me.
I will be alone for the rest of my life.

Step 3 is to write down the chance that each one would occur. Write this down as 1 chance in 2,3,4,5….10,000 etc so it looks like this:

John and I can’t work through our issues together by talking. (1 in 5)
John refuses to attend couples therapy to address the issues. (1 in 2)
John stops talking to his friends/family and has no feedback from any other person about how to address the issues. (1 in 20)
John becomes 100% unwilling to change. (1 in 20)
We get a divorce. (1 in 1)
I am unable to recover from the impact of the divorce. (1 in 1000)
No men show any interest in me for the rest of my life. (1 in 50)
I refuse to go out or put myself in situations where I might be attracted/interested in another person. (1 in 1000)
I completely deny any feelings of interest in other men for the rest of my life and refuse to interact with men who are interested in me. (1 in 100)
I will be alone for the rest of my life. (1 in 1)

Step 4 is to multiply all of these estimates together. This allows you to estimate how likely the core fear actually is.  1 in 2 becomes 1/2; 1 in 3 becomes 1/3 and so on.

From the above example: 1/5 x ½ x 1/20 x 1/20 x 1/1 x 1/1000 x 1/50 x 1/1000 x 1/100 x 1/1. A quick math refresher from school: multiply the numbers on the bottom on a calculator. Then the final probability of the core fear is 1 chance in that number.

1/20,000,000,000,000 or 1 chance in 20 trillion.

Step 5 is to understand how likely that is to occur by going to a page that explains the odds here. You can see from that page that this person has a higher chance of dying from spontaneous ignition of her nightwear than she does of remaining alone for the rest of her life.

Hopefully she feels a bit better now.

Our brains are built to detect threat. Evolutionary theory predicts that if we didn’t have a brain that detected threats quickly then our genes would be unlikely to survive. However, surviving in a modern world where the threats are not usually fatal means understanding that your brain will overestimate how likely a threat is. If you are an anxious person you come from a good stock of ancestors who may have been the first to detect threats and run or fight. Their anxiety saved them. In order to not feel anxious yourself you can use self-talk to remind yourself that the actual risk of something happening is nowhere near as imminent as your brain is telling you.  



Wednesday 8 May 2013

Thought Challenging 2

This is the second post in a series that I am writing on a skill called thought challenging. This post looks at the foundational skills for challenging negative thoughts. The two approaches for this are to challenge the accuracy and unhelpfulness of a thought. Remember, it is essential to write down your challenges otherwise this skill won’t work well.

Recognising thoughts
The first step is to identify the thought that is causing your negative mood. Many people are not aware of their thinking but instead tend to notice their symptoms, like anxiety, shame or behaviours like shutting down or feeling paralyzed. In these cases try to guess what you might be thinking. It might help to look at the post on Common Thinking Traps (which is two below this one) in order to understand what kinds of thoughts to look for.

Challenging Negative Thoughts
Once you have identified your negative thought (or thoughts) the next step is to challenge that thought by writing down the reasons why the thought is not accurate and why it is unhelpful.

Why is this thought inaccurate?
Write down all the reasons why the thought is not 100% true. No thought is ever 100% true although it is very common for it to feel that way. Look for the reasons why the thought isn’t true in all situations, all the time, with everyone.

For example, let’s say you were challenging the thought: “I am a failure because my kids hate me”. Here is a list of reasons why the thought isn’t 100% true in all situations, all the time, with everyone. 
  1. Sometimes my son can be quite caring towards me, but only when others aren’t around.
  2. Just because they don’t like me a lot of the time, doesn’t mean that I am a failure. Most parents are hated by their children when they go through adolescence – it doesn’t mean that they are all failures.
  3. There are a few areas in my life where I am not a failure. I do ok at my job, my husband is happy and I still have relationships with some friends that are quite good.
  4. My kids don’t actually hate me all the time. Last week they seemed quite happy with me for taking them out for the day.


The idea is to keep this list handy and to keep adding to it regularly. Part of the reason why negative thoughts feel so true is that there is so much evidence for the thought. If we have a thought like the one above then we are more likely to look for evidence that confirms our belief.

Think of this like a courtroom. The negative belief has a star legal team and mountains of evidence and you are on the other side with just a few reasons why the thought isn’t true. In order to feel better you will need to collect the facts in order to build evidence against the negative belief. The more evidence you have the more likely you are to win the case against your negative belief.

Why is this thought unhelpful?
It’s usually easier to start by writing out the reasons why the thought is unhelpful. Sometimes it’s just too difficult to see how the thought is inaccurate. In these cases write out your answers to the following: 
  1. How do you feel when you believe this thought?
  2. How do you behave when you believe this thought?
  3. How do you treat yourself unkindly when you believe this thought either in your head or physically?
  4. How do you treat others unkindly when you believe this thought?
  5. When you believe this thought, does it cause avoidance that will lead to long-term problems?


Troubleshooting
I can’t stress how important it is to WRITE DOWN YOUR THOUGHT CHALLENGING. This is the number one reason why I see people get stuck and unable to progress in treatment. Part of the reason why I think they get stuck is that they try to challenge the thought but their negative thinking has 10,000 reasons why the belief is true. The thought challenging may not work because each time they try to think of one reason why they thought isn’t true, their mind comes up with 20 reasons why it is true.

Writing down your challenging will slow the process down. It will help you to see that there are several valid reasons on a page that dispute the belief. It also let’s you come back to the page and add to it so that you have a solid argument against the thought instead of just a few pieces of one-off evidence.

So after reading this post write down these two questions somewhere:

Why is this thought inaccurate?
Why is this thought unhelpful?

When your mood becomes more negative try to recognize the thought by guessing what you may have believed about yourself or your situation at the time. Write down the thought then write out your challenges to it. Write on paper, in your phone, a diary, on your computer – anywhere that’s convenient. That’s the process.

Next post I will write about some more advanced techniques for challenging negative thinking.



Thursday 28 February 2013

Thought Challenging


This is the first in a series of posts that will be about an important skill called thought challenging. I have been looking at a lot of research recently about this skill. Many of the most recent trials have been consistently showing that thought challenging (even by itself without any other skills being taught) can result in large improvements in symptoms of anxiety and depression. It’s an important skill and so I thought I would go over it in detail starting from the basics in this post, then moving on to more advanced techniques in the next posts. This might be revision for some of you that know this skill well but hopefully it will be a good reminder to notice your thinking more and start challenging the ones that cause stress, frustration and pain. 


Here is what you need to know:
  • If you can figure out what you are thinking then you have a chance to understand what is causing your mood to change.
  • If you can challenge your unhelpful thoughts you can change your mood.
  • The easy way to challenge thoughts is to recognize that the thought is unhelpful. The harder (but more effective) way is to challenge whether the thought is actually true.
  • Doing written thought challenging exercises is essential. Doing it in your head will only help a little.


ABOUT UNHELPFUL THOUGHTS
Thoughts are the things we say to ourselves in our heads and the beliefs we have. They may come in the form of thoughts, images or memories. Thoughts play a powerful role in determining how we feel and behave. Thoughts happen all the time. Some thoughts are deliberate but some thoughts occur more automatically. Even though we may not always be aware of our thoughts, they’re always there – even when we sleep! Research tells us that difficult life events like trauma causes people to have lots of unrealistic and unhelpful thoughts.

While the thoughts we can have are limitless, almost all thoughts fall within 3 main categories: Positive thoughts, Neutral Thoughts and Negative Thoughts.

Positive thoughts: It’s ok if I make mistakes. It’s not a big deal because lots of people have trouble with this. I don’t have to be so harsh on myself.
Neutral thoughts: I wonder what I should do this afternoon?
Negative thoughts: I’m not normal. I have serious issues that will never change. I am definitely getting worse. I can’t seem to do even basic things that other people can.

CHALLENGING UNHELPFUL THOUGHTS
While it is near impossible to change the way you feel by telling yourself not to feel something, research tells us that it is possible to change the way we feel by challenging unrealistic and unhelpful thoughts.

The steps to Thought Challenging are:
1.            Recognise the Thought
2.            Question the Thought

Most thoughts that lead to strong negative emotions are both unrealistic and unhelpful:
1.            Negative thoughts are often unrealistic since they do not accurately reflect how probable a feared outcome actually is. The thought “Everyone at work thinks that I am incompetent” can easily overestimate how likely it is that other people think this way. You can challenge this by looking at how probable the negative prediction is.
2.            Negative thoughts are often unhelpful since they have a high cost if you think them. Sometimes thoughts might be realistic but their effects have negative consequences that keep us stuck. The thought “My husband could have been in an accident” is possible (but highly unlikely); however, the impact of this thought has a very high cost. Thinking this way might cause you to text or call your husband constantly. Over the long term, this type of thinking doesn’t even keep your or others safe but it will make you feel more and more miserable. You can challenge the unhelpfulness of a thought by looking at the cost of thinking that way.

Clients often tell say that it is helpful to:
1.            Check your thinking when you notice a drop in your mood or an increase in your anxiety – many people find this is a signal that they might be having negative or unrealistic thoughts.
2.            Start thinking about a previous situation where you felt depressed or anxious and try to think about what you were thinking – this can help to dig up common negative thoughts.
3.            Guess what you might be thinking – Many people find that their guesses are pretty accurate and that challenging the thoughts that come up is a helpful start.

And, most of all, remember to WRITE YOUR THOUGHTS DOWN and challenge them in a written format. It is very important to write out your thoughts when you think of them and challenge them on paper to start with. It’s ok to do it in your head as well but to get full benefit, it is best to challenge your thoughts on paper.

The techniques for challenging thoughts will be covered in the next post. If you are keen to learn the skills now, do a youtube search for: cognitive behavioral therapy OR cognitive restructuring.