Tag Archives: CBT

can I get a redo?

My experience with psychotherapy supports the findings that we can “rewire our brains.” In cognitive therapy, I learned to stop negative thoughts and suicidal ideation, rewrite those thoughts and replace them with more accurate ones. In therapy I’ve learned to reframe my life experiences as meaningful – as preparing me to be a better mother, wife, and daughter, […]

via Bipolar Disorder and Neurocounseling — Kitt O’Malley

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Aha! Moments

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

Okay, heads up: this entire post is a re-blog from PESIinc., a company that provides continuing education for a variety of professions. I kind of love them, even when they spam me four thousand times a day with courses I might like to take.

10 Ways to Help Stuck Clients Move Forward

posted Nov 24, 2015.

“I know it’s irrational, but I can’t stop the extreme anxiety I feel around people because I’m a 6’3” tall woman and fear they’ll think I’m a freak,” said Natalie, a 35-year old nurse. Though she was comfortable working with patients, was happily married, and had two very close friends, she couldn’t shake the anxiety she felt around colleagues and large groups of people.

“My last therapist taught me relaxation exercises, how to talk back to my negative thoughts, and encouraged me to get out socially with small groups,” Natalie added. “But none of that seems to work. The anxiety just hijacks my brain.”

She’s right. Sometimes, no matter how we try to outsmart it, our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think.

Orchestrating such felt experiences with your clients is easier than you think. In this post, I’ll share 10 strategies from my book, “The Therapeutic ‘Aha!’” that you can use to engage the emotional brain and help stuck clients move forward.

Strategy #1: Align, Lift, and Lead

Most of us were taught to validate our client’s feelings. However, if you spend too long merely validating your client’s pain, it can amplify negative feelings in the emotional brain. To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”

You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:

 “Natalie, I understand that you’ve had these experiences where you’ve not felt comfortable around large groups of people because you’ve not been sure how they would react to your height. Being a nurse, you’re obviously an empathic person and are probably pretty good at helping people feel at ease. I’m seeing you using these people skills in other social situations, too, realizing that a person’s reaction just tells you something about them, and you can sense how to put them at ease.”

Reframing her problem in this way helped Natalie feel more socially competent and encouraged.

Strategy #2: Visualize the Desired Response

Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.

Strategy #3: Identify Inspiring Goals

Instead of setting dry, lifeless goals like, “Client will practice relaxation skills and talk to two new people per week,” explore potential goals that have real value and meaning for your client.

When I explored inspiring goals with Natalie, she began talking about her desire to have lunch with a group of colleagues. They’d been inviting her to lunch for several weeks, and she liked the idea of connecting with fellow nurses. Targeting a small group of people she wanted to be around felt more intriguing and doable to her and less like a task.

Strategy #4: Locate the Root of an Emotional Conflict

Even though Natalie felt encouraged by this goal, she still felt a knot in her stomach at the thought of going out to lunch with these colleagues. I asked Natalie to follow the sensations in her stomach back to the first time she could remember having a similar feeling. Her eyes widened as she recalled being teased during lunchtime in middle school by a group of kids who called her names like “Amazon” and “Sasquatch.”

She had coped by avoiding the school cafeteria and doing her homework in the library during lunch. As a result, she avoided her bullying classmates and was praised by her teachers for being studious. Natalie gasped as she realized she was doing the same thing at her job­—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.

Once Natalie made this connection, she understood her emotional brain had simply continued the pattern because it had been adaptive for her in the past.

Strategy #5: Reverse Traumatic Memories

Natalie was excited to have made this connection, but just having cognitive insight into the cause of her social anxiety didn’t change it. In fact, recent neuroscience discoveries have shown us that in order for the emotional brain to change a response that was once adaptive, we have to recall the old memory while eliciting a new experience that invalidates the beliefs that got attached to the disturbing memory.

Strategy #6: Change Beliefs With Imagery and Metaphor

To change Natalie’s negative self-concept, we revisited her imagery of the redwood tree­—tall, beautiful, and majestic. I suggested she imagine the smaller trees laughing at the redwoods for being so tall and see the absurdity of it. Imagining this scene made Natalie laugh and realize every tree had its natural place in the world, and so did she.

Strategy # 7: Conjure Up Compelling Stories

Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.

The first time Natalie told her story about being bullied at school, she ended the story with an incident where a boy asked her to dance, then brought out a chair to the dance floor and stood on it so he could be as tall as she was. Everyone laughed, which made Natalie cry.

When I prompted her to consider a new ending to this story, she said, “Well I’ve been happily married for 15 years, and my husband said he was attracted to me because I was tall. He thought I looked like a graceful dancer.” She smiled and realized that ending her story this way suddenly caused the experiences she had with the boys in her youth to seem trivial.

Strategy #8: Prime With Play and Humor

Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,

“Who invited you to lunch with us, Amazon lady?”

I answered by simply saying, “Linda invited me.”

“Well I hope you don’t think I can be seen walking next to you, Sasquatch,” Natalie continued. And you should really consider doing something different with your hair.”

I smiled and replied, “Oh, what a shame. I fixed my hair this way just for you.”

Natalie laughed and we continued the role-play for a few more minutes. Letting Natalie play the character she feared reduced her anxiety because she realized how insecure a person would have to be to make such insensitive comments.

Strategy #9: Rouse With Rhythm and Music

Music can influence mood and neurochemistry, and it can entrain the brain to calmer states. One activity many clients enjoy is creating a playlist of tunes that evoke desired responses. Natalie started her playlist with “Creep” by Radiohead, which reflected her fears of being a social reject. Then we added “Everyday People,” by Sly and the Family Stone, which was more upbeat and affirmed that humans come in different colors, shapes, and sizes. Natalie ended her playlist with “Can’t Keep a Good Woman Down,” by Mary J. Blige, which helped her feel empowered.

Strategy #10: Integrate Mindful Movement

Movement can also engender desired states of mind. Dancing to her playlist helped Natalie shake off anticipatory anxiety, but I also suggested she could place her hand on her abdomen to calm her stomach and invoke a sense of self-compassion. She practiced this gesture while she slowed her breathing and imagined the beautiful redwood trees. Over the next several weeks, Natalie reported that her anxiety completely dissipated and she was able to comfortably enjoy lunch with her co-workers and other social situations.

Closing Thoughts

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

I hope this post has given you ideas for new techniques you can use, and that it leads to many “Aha!” moments for you and your clients.

Courtney Armstrong, LPC, MHSP, is a licensed professional counselor in Chattanooga, Tenn., and the author of “The Therapeutic ‘Aha!’: 10 Strategies for Getting Your Clients Unstuck.” She also offers training and free resources for therapists at her website: www.courtneyarmstrong.net.

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The Physiology of Mindfulness

The business world is abuzz with mindfulness. But perhaps you haven’t heard that the hype is backed by hard science. Recent research provides strong evidence that practicing non-judgmental, present-moment awareness (a.k.a. mindfulness) changes the brain, and it does so in ways that anyone working in today’s complex business environment, and certainly every leader, should know about.

Not sure how I missed this article in January, but I guess it’s never too late. Read more about mindfulness and its positive effects on the brain in the Harvard Business Review.

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just breathe.

It’s amazing how sometimes we need kids to teach us how to be adults.

By Wavecrest Films, as seen on Amy’s Smart Girls (.com) and Upworthy.

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happiness.

When you reach the point that you can appreciate the wonder in every one of your feelings, you will start realizing that there is more to life than just “happiness.” Every part of it has its wonders. What’s better than “happiness” is fascination, and interest, and commitment to maintaining light and love within yourself. Every situation is dimensional, and when you start realizing the possibility in any given situation, you will start understanding what it means to be alive.

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Back to Borderline.

“The urge was addictive, and I couldn’t think of anything else but ending my life. The ability to see how my death would hurt others was lost to me, and I still don’t quite know why I went back home after two hours. I stopped being angry, I think.

I have never considered suicide when depressed; even thinking about it would be too much effort in that situation. However, anger and panic are what drive me to think such thoughts, to harm myself, to chain-smoke and take more pills than I should. Any type of fear sends me into a blind panic; I just don’t know how to deal with the emotions. Or any emotion, really.”

From Halfway Between the Gutter.

While my therapist/psychiatrist and I established that I do not, clinically, have Borderline Personality Disorder (a constant nagging fear of which haunts me with surprising regularity), I definitely DO exhibit some serious BPD traits.  The above quote from HBG was like a lightbulb for me: it’s not depression that makes me think life is worthless, it’s anger and fear!  I’ve discussed my inability to name my emotions before, and with this new insight I feel like I have one more glimpse into the dysregulated organ that is my brain. Now to determine if I’m actually angry in these situations, or if it’s all a manifestation of fear. Specifically, the fear of being betrayed. Well, of being betrayed and not knowing about it. But still.

New goal: let’s separate the three emotions and figure out a better way to respond.  Like, now.  Actually like, two weeks ago would be nice. But you can’t undo the past, right? Dang it. #dbt.

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Mood tracking

One of the steps in learning mindfulness is to “check in” with your moods (and your reactions to them and the thoughts that surround them) throughout the day.  Homework in various counseling approaches include mood diaries, feelings charts, etc. because so many of us don’t take the time (or don’t know how) to name our feelings and identify how they affect our behaviors – which in turn affect our thoughts about ourselves and then our feelings.  It’s a complicated cycle at first (because sometimes it’s the automatic thought that triggers the feelings that trigger the behavior, and sometimes it’s an external trigger that brings up a feeling in our body that makes us act a certain way that makes us think a certain way that makes us feel a certain way…..et cetera).  But over time the cycle gets broken up into smaller parts that are much easier to deal with, and the best part is that when you adjust one part it causes the rest of the pattern to be interrupted and you can choose how to adjust them, too.  Because it’s a cycle.  You get it right?

So here is a great way to track your mood on your iPhone or other smartphone.  My professor recommended it and I already love it:

http://t2health.org/apps/t2-mood-tracker

On your phone you can just search for “t 2 mood tracker,” and it’s FREE.  It doesn’t just ask how you feel, it asks you to rate different levels of anxiety, stress, tiredness, loneliness, etc.  It charts these over time and you can add notes whenever you want, such as “I just got run over by a bicycle, not feeling so great” so that you can account for sudden or dramatic shifts in mood.

The best part?  It reminds you to do it! In the settings you can ask it to check-in with you and at the allotted hour(s) it pops up on your screen with a “how are you feeling right now?” reminder.

So easy, so not intrusive, and so helpful.

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I’m sad today.

I know that it’s okay to be sad, to have times where you just don’t feel good.  As I’ve mentioned before, though, I don’t trust happiness in the slightest, and I’m much more prone to believing the personalized critic that follows me around during times of discontent.  What I’m saying is that when I get sad…I’m afraid I’m going to stay sad.  And that I’m a sad person. And what is wrong with me.

Everyone has bad days.  And all of us, not just the ones with an Axis I diagnosis, experience emotional dysregulation in our daily lives.  When we’re a little too angry at the person that cut us off, a little too teary eyed at an adorable dog food commercial, or a little too excited about the many uses of WD-40.  (Look it up.  It’s exciting, okay?)

So what I’m learning as I study CBT and DBT is that I have choices and agency over my thoughts/feelings/behaviors.  And the three of those things, while interconnected, are not the same thing.  If I can distinguish between them and name my feelings and change my thoughts — well then, I can start reacting in different ways and avoid [some of] this unexplained sadness!

:/

Much harder than it sounds, I guess.  But it’s totally working.  Already I’ve started a tape in my head about “goal-directed behavior” versus “mood-directed behavior.”  Essentially, many times we make our next moves in a day, in life, based on how we feel.  I want to exercise, but I don’t feel like it so I don’t.  I want to be more spiritual, but I don’t feel like going to church today so I don’t.  Sometimes it’s okay to “not feel like it,” but if you’re like me it’s easy for every behavior to become mood-directed.  With bipolar I have to learn to define my goals and perform tasks because they are in the best interest of my goals, dreams, life-vision, even if I don’t feel like it.  It’s a basic concept some people inherently understand: I want to be thinner so I exercise, I want to rest this weekend so I write my papers today.  For me it seems so much more difficult than that! My moods change so drastically, even while I am medicated, that I can get exhausted from an emotional standpoint before I’ve even done anything.

But this “goal-directed” thing has stuck with me.  I wanted to nap so badly yesterday and today, but I realize that, even though it’s the only thing I felt like doing, that I really wanted to end my day at an earlier time, get a full night’s rest, and feel productive.  I wanted to complete my to-do list for the day.  I want to stop needing a nap in the afternoons every day so that I will feel more social and creative in the evenings.

So I didn’t.  Nap, that is.  I walked around, I didn’t sit down when I got home, and I headed out to run errands rather than sleep.  I made something. I started a project.  And now I’m blogging.  All because I’m telling myself to not let my [stupid] moods dictate my behavior.  Because I’m constantly saying it to myself, catching myself, reminding myself.

It’s CBT and DBT in action: mindfulness, identifying automatic thoughts, using behavior to change your feelings, feelings to change your thoughts, etc.  It’s difficult, and it’s a tiny step.  But that’s the only way we change – in the small steps.

And look.  I’m already feeling better.  Now that I think about it…I’m not even sad anymore.

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