Learning to deal with distressing thoughtsBY: Mahboob Ali Khan MHA,CPHQ USA Harvard

DEALING WITH TROUBLING THOUGHTS

Section Contents

Understand why attempts to control our emotions fail Learn about ‘willingness to experience’ Learn about ‘thinking about thinking’ Understand the link between thoughts and symptoms Identify ways we can deal with ‘troubling thoughts’

Background - Stoic Philosophy

Epictetus, about 55 - 135 AD

‘Man is disturbed not by things, but by the views he takes of them’

Background - Constructivism

‘Constructivism’ is a perspective in philosophy that views all of our knowledge as ‘constructed’, i.e. it doesn’t necessarily reflect any external absolute realities; rather depending on convention, human perception and social experience

Experiment with the views in this section, take and use what seems right or useful for you

There is no ‘one size fits all’ solution!

Individual Differences

The way we perceive things is determined in part by the ‘map’ of the world we carry inside our heads

Our ‘map’ is drawn up in childhood - it tells us about ourselves, life, and about other people

Our ‘map’ is a rough guide to life Sometimes our maps are inaccurate!

To Deny the Map is to Follow the Map

Complete the following

Men are ...

Women are ...

Life is ...

I am ...

Thoughts are both Consequences & Causes

Our thoughts are triggered by events around us, by our behaviour and by our feelings and emotions, as well as by other thoughts

We all have thoughts of which we’re unaware (unconscious)

We have relatively little control over thoughts which enter our minds

Although our thoughts may be ‘irrational’ we often believe them

Unpleasant emotions and feelings often accompany ‘negative’ thoughts

Which Comes First - Thoughts or Feelings?

What’s important, from a purely practical point of view, is that it’s usually much easier to change our thinking (what we think) and our behaviour (what we do), than it is to change our emotions

Therefore we can make useful changes simply by assuming that thoughts come first!

Some Anxiety is Useful - Yerkes-Dodson

Our abilities improve with anxiety, up to a point

Anxiety interferes with complex tasks more than simple ones

In Summary...

Our minds are sensitive danger warning systems Some of our thoughts are inaccurate, unhelpful or ‘out of time’ Negative and inaccurate thoughts often seem as though they’re true They also ‘feel’ true, so we tend to give them a high ‘credibility

rating’ Negative thoughts can give rise to painful moods, emotions and

physical sensations Relational Frame theory (RFT) suggests that one reason for human

suffering is the development of language!

Caution!

You might want to look away if you have arachnophobia

SPIDER

Conscious Thoughts are Lexical

Lexical means ‘made of words’ If we’re afraid of spiders, the word SPIDER can evoke thoughts,

emotions and physical feelings Thoughts (words) evoke emotions - to a greater or lesser degree,

just as though a real spider were actually present There’s a picture of a spider on the next slide ...

Careful What You Say!

Why taking about horrible things at dinner time isn’t a good idea The word ‘vomit’ can have similar stimulus effects as real vomit

Transfer of Stimulus Functions

Relational Frame Theory (RFT) talks about the way that the stimulus function of an object or an event tends to get transferred to the word used to describe it

If you’re afraid of spiders, the fear, the urge to run away and the physical effects of seeing a spider can all be evoked just by the word ‘spider’

Words as ‘Noxious Stimulants’

Our use of language can underlie a great deal of suffering as a result of the transfer of stimulus functions from referents to the language used to describe them

Words can become noxious stimulants

Words as Sources of Pain

Hearing someone talk about their relationship break-up, or about a bereavement can be very painful, especially if we have suffered something similar ourselves

All we are exposed to is words, yet the words can evoke thoughts and feelings, as though a relationship break-up or bereavement were happening here and now

‘Telescoping’

When I remember past events which went badly, or when I anticipate things that make me scared, I ‘telescope’ the past and the future into the present

Without language, could we evoke a negative past or anticipate a negative future?

Why Worry?

Worry primarily involves thinking or self-talk (Borkovec & Inz, 1990)

This kind of internal verbal behaviour is one of the most highly evolved systems characterising human beings, allowing us to experiment with ideas, consider alternative choices, evaluate our motives and consider the likely consequences of each possible choice before acting on one of them, without fearing that the environment might, in some way, punish us for considering them

Chronic Worry

However, chronic worry has an avoidant function (Borkovec, 1994; Borkovec, Alcaine, & Behar, 2004). Chronic worriers often believe worrying will help them prepare for, problem-solve, or superstitiously avoid negative future events (Davey, Tallis, & Capuzzo, 1996) despite evidence to the contrary

Borkovec and Roemer (1995) found that GAD worriers reported engaging in worry to distract themselves from ‘even more emotional things.’

The next few slides show common unhelpful thoughts and beliefs

Difficulty Tolerating Doubt &Uncertainty

Problems can arise if we believe...

That uncertainty is stressful and upsetting

That uncertainty is unfair

That unexpected events are to be avoided

That uncertainty interferes with our ability to function

‘Certainty seeking’ is a problem e.g. having a heart attack – 1 in 10,000,000 chance, but so long as there’s a chance, I worry

Consider - of what can we be absolutely certain?

Cognitive Style 2 - Unhelpful Beliefs

Problems can arise if we believe...

That worry helps us find solutions to problems

That worry increases our motivation

That worrying in advance helps us feel better if bad things happen

That worrying prevents bad things happening (thought-action fusion)

That worrying shows we are responsible and caring people

Cognitive Style 3 – Problem Avoidance

Solving problems gives us a sense of mastery and pleasure

Problem solving = problem orientation + problem solving skills

Problem orientation = (perceptions of problems) + (perception of self as effective) + (realistic expectations)

Problem solving skills = (defining the problem) + (identifying goals) + (identifying alternative solutions) + (choosing a solution) + (implementing a solution)

Cognitive Style 4 – Ineffective Self-Soothing

Worry is lexical – there’s often little imagery involved, worry dampens our autonomic arousal and emotional processing – without ‘emotional richness’ we can’t identify our needs

GAD worry reduces hyperventilation and tachycardia – a form of self-soothing which is painful and only partially effective

Worry reduces the likelihood of ‘full network activation’ i.e. behavioural, cognitive, emotional and physiological arousal (which is required for panic response)

Common Characteristics

Early role-reversed or caretaking relationships Insecure attachments Predominance of overly-nurturing personality style Conscientiousness Positive social evaluation preoccupation – ‘people pleasing’ style

Avoiding Problems

Although acting directly on painful things in the outside world can work well (it helps us feel effective), focussing on negative thoughts and feelings doesn’t help in the same way

Avoiding things which make us afraid means we continue to fear fear itself

Our ‘willingness to experience’ reduces the likelihood of panic

An example...

A person with a fear of heights wants to take her family up the Eiffel tower, and she’s not willing to experience anxiety

She thinks: “I hope I don’t have a panic attack” “I’m not even going to think about having a panic attack”

The anxiety spiral

The very phrase “I’m not even going to think about having a panic attack”, whether spoken aloud or thought, can be a noxious stimulus for feelings of anxiety

The thoughts “I must not feel X” contain the very words likely to evoke feelings associated with “X”

Try this - shut all thoughts of Uri Geller out of your mind...

How Do You Get Out of a Chinese Finger Trap?

‘Getting Rid’ of Feelings Doesn’t Work

When we struggle to ‘get rid of’ a thought, emotion or feeling, we end up with the original pain, plus more caused by our failing attempts to ‘get rid of’ the experience (more suffering)

We sometimes call this the anxiety spiral – fear and anxiety breed even more fear, which can, in turn, lead to panic

In a sense, we get (intensify) what we notice So – we need to notice what we want to get!

What can happen if we feed one stray cat?

Thinking positively, negatively

When we think a negative thought and try to get rid of it, we are thinking positively, negatively

Thinking is like breathing: It goes on night and day and you can’t stop it. But you can change it. You can breathe slowly and deeply or shallowly and quickly. You can breathe any way you want. But you can’t stop.

‘Getting rid of’ fails because we are intensifying the experience by attending to it

What’s the Best Thing to do in Quicksand?

Emotions Come in Waves

Recognise that an emotion begins, peaks, then ebbs Think about how long horrible feelings and emotions usually last Don’t become preoccupied by the time though... Think about how confident swimmers deal with waves Don’t ‘splash about’!

Intrusive Thoughts

Intrusive thoughts - thoughts which just seems to ‘pop’ into our mind without warning and which are upsetting or which stop us from getting on with things.

Thought suppression studies, (Wegner, Schneider, Carter & White, 1987) show that the very act of trying to suppress a thought only results in more unwanted thoughts. This has been termed the ‘rebound effect’. The more you try to suppress a thought, the more the thought keeps popping up (‘rebounding’)

Dealing with Intrusive Thoughts

If you are troubled by thoughts which intrude, try the following techniques:

Thought stopping

Creative fantasies – ‘boxing’ your worries

Making worry time

Surreal Visualisation

Distraction

Guilt and regret – a special case?

Thought Stopping

Thought Replacement Yelling ‘Stop’ Thought disputation

Creative Fantasies - ‘Boxing’

Paradox - ‘Worry Time’

Put aside time each day to worry incessantly Paradoxically, it can be very difficult to consciously ‘hold’ a worry

Surreal Visualisation Re-voicing our worries to disempower them ... Give your worries a different voice Click the speaker icon above

Distraction

Thoughts have ‘charm’ – that which draws our attention to them The challenge is to find something more ‘charming’ than our

worries What can you think of that is more attractive or interesting than

worry?

Guilt and Regret – a Special Case?

Consider your values and personal philosophy, would most people with your philosophical outlook feel guilt or regret in your circumstances?

Is it possible for you to forgive yourself, even if others won’t? ‘When the whole picture is taken into account, people always do

the best they can’ – do you believe this? To what extent is personal pride or anger preventing you from

moving on? (guilt is sometimes based on anger) What reparations or amends might you be prepared to make? These may be to heal the past, or to improve the future

Summary

Understand why attempts to control our emotions fail Learn about ‘willingness to experience’ Learn about ‘thinking about thinking’ Understand the link between thoughts and symptoms Identify ways we can deal with ‘troubling thoughts’

References•B

orkovec, T.D. (1994). The nature, functions, and origins of worry. In G.C.L. Davey & F. Tallis (Eds), Worrying:

Perspectives on theory, assessment, and treatment (pp. 5-34). New York: Wiley.

•Borkovec, T.D., Alcaine, O.M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R.G. Heimberg, C.L. Turk, & D.S. Mennin (Eds). Generalized anxiety disorders: Advances in research and practice (pp. 77 – 108). New York: Guilford.

•Davey, G. C. L., Tallis, F., & Capuzzo, N. (1996). Beliefs about the consequences of worrying. Cognitive Therapy and

Research, 20, 499-520.

•Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 25-30.

•Borkovec, T. D. & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour Research & Therapy, 28, 153 - 158.

•Wegner, Schneider, Carter & White, 1987