Psychological Resilience in the Time of Coronavirus

6. True and Useful Thoughts

May 11, 2020 Ann Marie Roepke, Ph.D.
Psychological Resilience in the Time of Coronavirus
6. True and Useful Thoughts
Chapters
Psychological Resilience in the Time of Coronavirus
6. True and Useful Thoughts
May 11, 2020
Ann Marie Roepke, Ph.D.

In Episode 6 we're thinking about our thinking: noticing the ways that our thoughts and beliefs work for us -- or work against us -- when we face challenges. We explore what cognitive therapy is all about, and learn a 4-step process for examining and maybe changing our thought patterns.

Resources and references:

1. Cognitive therapy research (selected):
https://i-cbt.org.ua/wp-content/uploads/2017/11/Dobson-Depression-1989.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0272735812001602
https://link.springer.com/article/10.1007/s10608-018-9920-y
https://www.sciencedirect.com/science/article/abs/pii/S0005796718300561

2. Dr. Aaron Beck's institute:
https://beckinstitute.org/

3. List of cognitive distortions:
https://en.wikipedia.org/wiki/Cognitive_distortion

4. Mental health resources:

Directory of therapists: https://www.psychologytoday.com/us/therapists

National Suicide Prevention Life Line: 1-800-273-8255

National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI

SAMHSA Disaster Distress Helpline: 1-800-985-5990

NAMI’s guide on coronavirus: https://www.nami.org/covid-19-guide

CDC’s coronavirus information page: https://www.cdc.gov/coronavirus/2019-ncov/faq.html

Show Notes Transcript

In Episode 6 we're thinking about our thinking: noticing the ways that our thoughts and beliefs work for us -- or work against us -- when we face challenges. We explore what cognitive therapy is all about, and learn a 4-step process for examining and maybe changing our thought patterns.

Resources and references:

1. Cognitive therapy research (selected):
https://i-cbt.org.ua/wp-content/uploads/2017/11/Dobson-Depression-1989.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0272735812001602
https://link.springer.com/article/10.1007/s10608-018-9920-y
https://www.sciencedirect.com/science/article/abs/pii/S0005796718300561

2. Dr. Aaron Beck's institute:
https://beckinstitute.org/

3. List of cognitive distortions:
https://en.wikipedia.org/wiki/Cognitive_distortion

4. Mental health resources:

Directory of therapists: https://www.psychologytoday.com/us/therapists

National Suicide Prevention Life Line: 1-800-273-8255

National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI

SAMHSA Disaster Distress Helpline: 1-800-985-5990

NAMI’s guide on coronavirus: https://www.nami.org/covid-19-guide

CDC’s coronavirus information page: https://www.cdc.gov/coronavirus/2019-ncov/faq.html

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hello and welcome back to psychological resilience in the time of Corona virus. This is a podcast about the ideas, the skills and the relationships that can help us to get through the Cove in 19 Crisis. I'm your host and bury Rep key, And I'm also a psychologist, trainer and consultant based in Seattle, Washington. Now this is Episode six, and in this episode we will be thinking about our thinking, looking at the way that our thoughts and our beliefs can impact our ability to cope with anxiety, fear, sadness, discouragement and other difficult emotions in difficult situations. No, As always, this podcast is for educational and informational purposes, and it's not intended as medical advice, health care service, a doctor patient relationship or any kind of diagnosis or treatment. So feel free to take a look at the show notes for some resource is and ask a mental health provider if you have questions or concerns about your own situation. All right on with Episode six True and Useful Thoughts. So imagine this you're driving, minding your own business, your eyes on the road, maybe just a little bit distracted by your partner, telling you about a problem they're having at work. And then all of a sudden, someone accelerates around you, cuts you off, cuts over the next two lanes of traffic, and they race off the freeway at the exit. Now, from here, I'm going to give you two different endings to this story in one ending. You, Blair your horn and you yell a whole bunch of words that I can't say here because my mom listens to this podcast. Hi, Mom. And you're swearing and you're shouting, you know? Can you believe this guy? He doesn't care about anyone but himself. He's gonna kill someone. He won't even get hurt. Because look at that huge truck. You know, I bet this more words that I can't say to my mom is texting too. And as you go on and you're shouting, you maybe are taking your hands off the wheel to gesture and not noticing how uncomfortable your partner is getting. Now, here's another ending to this scenario. In this other ending, you take a breath and you say that was really dangerous. I hope he had a good reason for that. He might just be a words that I can't say to my mom. Or maybe he was trying to get someone to medical care. Or maybe he was having a panic attack and he was trying to get off the road to park. Okay, we're safe. And to keep it that way, I need to focus on my driving right now. Here's another scenario. Imagine. You reach out and you send a text message to someone that you haven't talked to in a while. You're trying to make an effort to connect and take the first step to talk to someone during this quarantine and isolation, and it's approaching the end of the day, and this person still hasn't replied to your message in the first ending to this story. You think I must have done something to offend them? You know, last time we were out, I was tired and stressed, and I was just I was not a good listener. I was bad company, and they probably decided that I'm not worth being friends with or an option. Number two, you say to yourself, I hope they're OK. You know, maybe they're busy and scattered with everything going on. I know that they have two kids at home, so they're probably busy with home schooling now, on top of everything else. If I don't hear back by tomorrow, I'll just send a follow up message just to ask if they're OK in the low pressure way. Or how about this third scenario You are on a zoom meeting for work and you suggested idea to your team. No one says anything and you see someone's photo in the gallery view and they've got their face kind of scrunched up, so it looks a little bit like they're glaring. And then your boss says that you'll need to move on to other topics, and that will just brainstorm this idea another time in one ending to this story you say, Oh, I think that that was a bad idea. They must think I'm bad at my job. I shouldn't say anything in these meetings. When my boss figures out how little I really know about things, I'll get laid off. And then how will I find a job in all of this? Or in ending number two, you say to yourself, huh? Well, maybe that wasn't the right idea, and I need to think this through some more or you know, maybe everyone's just tired and burned out on zoom. Half of them have kids running around and we were way over time and we offer agenda. And you know that coworker honestly sort of always has that face. I can do some more research on some options and then, you know, bring those up at the next meeting. So you're getting the point here the way that we think about our lives matters. It matters for how we feel and how strongly we feel those emotions, how angry we are about that other driver, how sad we are about that friend, how fearful we are about our job and our thinking also has the power to impact how effective we are. Which line of thinking ending number one or ending number two is the type of thinking that helps us to drive safely in the moment. That helps us to keep on reaching out to people and making efforts to stay connected. Which line of thinking helps us to be more effective at our job Now? Cognitive therapy is a therapeutic approach that is based on these ideas. That is based on the premise that the way that we think makes a difference for how we feel and potentially for how we act. And so if we want to change the way that we're feeling, a helpful starting point can be examining the way that we're thinking. Cognitive therapy was developed by a fellow named Aaron, back among a couple others in the sixties and seventies when he was working with people who were depressed and Dr Back noticed a couple of patterns in the folks he was working with who were experiencing depression. And in particular he noticed that they had really dark, negative thoughts about three things. Three themes or patterns. Really negative views of themselves, really negative views of the world and how it works and really negative, bleak views of the future and what it holds in store for them. And Aaron Beck found it when he helped people Teoh really dig down and examine these thoughts and examine related beliefs and assumptions that they had about themselves, the world, the future and the situations that come up in day to day life. That people got better, that people felt better, that their depression lifted. And at this point there's pretty strong evidence that cognitive therapy works, particularly for depression and aspects of cognitive therapy, are baked into all sorts of different cognitive behavioral therapies, which is sort of a broader umbrella term. And cognitive behavioral therapy works for a whole range of different difficulties. Now it's not so clear that cognitive therapy is superior to other therapies that work, and it's not so clear exactly how and why cognitive therapy works. Is it really because of that change in thoughts and beliefs? Or could it be something else about the therapy? Cognitive therapy also has some potential risks, downsides and criticisms, and it's important to me to be real about that with each of these psychological resilience skills that we talk about. So I think one concern about cognitive therapy, you said, If it's not done well, it can be kind of invalidating, kind of insulting. It can kind of suggest that the therapist is smart and knows the right way to think about things, and you're stupid and irrational for thinking or feeling the way that you dio more broadly. I think cognitive therapy can be seen as insisting that being totally rational and totally logical is the only healthy way. The only right way to be, and that might not fit within individuals, values or with the culture's values. You might value other ways of knowing. Besides fax and rationality, you might value knowledge that comes from emotions or from collective wisdom, spiritually guidance or other sources. Also, like all tools, cognitive therapy techniques are not right for all people. In every single situation. We can't think ourselves out of everything. And psychological tools cognitive there appear otherwise shouldn't be used to try to coerce people into being okay with things that just are not OK. For instance, if a nursing assistant doesn't have personal protective equipment to do their work, they need to get personal protective equipment. They deserve that, and it needs to be supplied to them. They don't need to be told to change how they think about it or to think more positively about the situation. Now, with that said, I wanna share with you a core tool that's used in cognitive therapy because I still think that these sorts of techniques can be really helpful for analysing and possibly for changing our thoughts about an upsetting situation, and I think it's particularly helpful if we think we might be having some self defeating thoughts that are making an already hard situation even harder. This brings me back to an idea that we talked about originally when discussing mindfulness, the idea that sometimes as we go through our lives, there are certain situations that at the core just have unavoidable pain and hardship, and that no amount of therapeutic tools are going to take away that painful nous that is just part of that difficult experience. But sometimes these tools can help to melt away some of the additional layers of suffering that are part of that experience that surround that core of unavoidable pain. Sometimes some of those layers of additional suffering can come from the way that we're thinking about the situation, the way that we're talking to ourselves about it in our heads, the way that we're reacting. So in those sorts of cases, you might want to check out some cognitive therapy tools. So right now I'll explain a core tool called cognitive restructuring, and there's some different ways to do this. But at the heart, it's a multi step process that helps you to analyze and then potentially change your thoughts about some situation that's upsetting you. And in the version that I like to use, there's four steps represented by the acronym A B C. D. So here we go. A in cognitive restructuring stands for activating event. What was it that happened that brought up some difficult emotions where that's got us upset, for instance, getting cut off by that driver or sending a text and not getting a reply or saying an idea in that work meeting that nobody followed up on and in this stub when were writing down the activating event? We just want to stick to the facts. We're going to get to the thoughts and the emotions later. Right here. We just want to stick to the core facts that would hold up in a court of law. So, for example, I said something in my team meeting. No one followed up on it or responded to it. And then my boss said that we will brainstorm this another time. Now, Step two have this cognitive restructuring tool is B and that stands for beliefs. This is where we get into our thoughts the way that we are framing the situation or talking to ourselves about it now. The term we use here is believes, because it conveniently fits in alphabetical order and makes this acronym work well. But the term that I like a lot better is automatic thoughts, because I think it captures the way that we experienced this in the moment when we make that suggestion in the zoo meeting and then we start feeling badly about it. It's not because we've taken a lot of time to carefully consider our true beliefs about things that happen in zoom meetings. No, we just have thes little thoughts that pop up sort of automatically without us choosing them without us often even really being that aware of, um, they just kind of pop up and they can be very slippery and sort of invisible, but still quite powerful in how they affect us. So this be step is really important. This is where we stop to think about our thinking and say to ourselves, Gosh, how was I framing that situation? What did I say to myself? Sometimes it's in words, or sometimes it might even be in a picture. And if we're having a hard time getting it, these thoughts we might just grab the 1st 1 like, Oh, they thought that was a bad idea. And then ask ourselves if that were true, What would be the worst part about that? And kind of dig deeper and deeper until we get to those really upsetting thoughts. So in this example, the thoughts, maybe something like, You know, my coworkers think that my idea was bad and they think that I'm bad at my job and I shouldn't say anything in these meetings. And my boss is going to figure out how little I know about things, what an impostor am and then I'll get laid off. And then I won't be able to get a new job because of this cove in 19 chaos. And then my family's gonna and so on and so forth, and we can see all of the catastrophic consequences unfold in her mind. So in the B step, we're just simply trying to identify those and jot those down. Where does my mind take me? In those moments, the third step in a BCD is see for consequences, and these were consequences for how we feel and how we act when we think about the event in the way that we just described in the second step. How does that affect us? What emotions come up, what urges do we have to do or to not do certain things? So in this example, some of the consequences might be anxiety, fear, embarrassment, dread and also maybe a desire Teoh avoid my boss or to not talk in these meetings anymore. And the fourth step de is for dispute. And this is where we really take a look at those automatic thoughts that we identified before and hold them up to the light and ask ourselves two main questions about them. The first question is, Is this automatic thought? Definitely for sure. 100% true. And to answer that question, we can look at the evidence for and against that automatic thought. So, for instance, the thought that my colleagues and my boss think that I'm bad at my job. We could say, while the evidence for that thought is that no one responded to my idea or said that it was good and one person was sort of clearing. But the evidence against it is that you know, I had a good performance review four months ago, and my colleagues come to me for advice about work situations pretty often, and they liked an idea that I brought up earlier in the meeting. So, you know, maybe there's some other factors. Maybe they have zoom fatigue, and that's why no one responded. So that's the first question. Is this Automatic thought? Definitely, completely true. The second guiding question is, Is this automatic thought useful to me? Is it serving me to approach the situation in this way with this kind of framing, regardless of whether or not it's true? Is it useful to think about it this way? And I really like this question because first of all, it gets to you the impact on us in our real lives. And secondly, a whole lot of our thoughts can never really be proven to be true or false, especially when their thoughts about the future and what may or may not happen. There's a lot of uncertainty and life to begin with, and a lot of us feel like that. Uncertainty is even greater during this current crisis, and so sometimes we can never really know if a thought is true, but we can perhaps see if the way that we're thinking about it is making our lives better or worse, making other people's lives better or worse. And in examining whether an automatic thought it's useful to us, it could be helpful to say, Well, what I say this to a friend who is in this situation. What I tell my friend, Yeah, probably everyone thinks you're terrible at your job, and your boss is going to figure it out and fire you, and then you'll never be able to get a job or income ever again. Well, probably not. We'd probably say something more constructive, more supportive or empowering to a friend. Another helpful question of the stages to ask ourselves. Well, what could I do about this situation? What's under my control to improve things? You know, maybe I could do a little bit of prep before the next team meeting to come back with some well researched ideas about this project. So at the end of this four step process of a B, C. D, you might find that you have a sense of whether you're automatic. Thoughts are both true and useful to you. And if you answer no to either of those. Then you can come up with a new framing, a new thought that's either more true or more useful. Sometimes it happens that you go through this process and you realize, Yeah, my thought is totally true. And this is a useful way toe look at my situation and at my reality, and that also is perhaps a productive conclusion to come to. Then you can realize that perhaps this is a time that you need some other tools to deal with the situation or you need some support making objective changes. So if you're interested in exploring cognitive restructuring skills further, here's a couple ideas about how you could take the next step with this. One option is to do this a B C D. Practice yourself by simply writing down those four letters on a piece of paper and exploring a recent situation that had you upset. Another option to learn more about this is to do a little reading. One starting point is to check out the show notes where I've put a link to a list of common so called cognitive distortions that can get into our automatic thoughts. Another option is to not necessarily do this cognitive restructuring, but to simply notice your thought process more often in your daily life. If you notice that you are getting upset in a situation simply pausing to notice what your internal monologue is, this kind of overlaps with the mindfulness skills that we talked about last week. And another option is just to discuss this content with a friend. Maybe send them this episode of the podcast as a jumping off point and have a support of conversation about how this sort of pattern does or doesn't show up in your life lately. All right, team. That's it. For now. As always, feel free to reach out with any ideas or suggestions. Resilience. Podcast 2020 at gmail dot com. And if you're liking the podcast, it would be awesome if you subscribe or follow it or leave a reading a review, because that can help other people to find it, too. All right, take care of yourselves. Take care of each other. See you next time