Sunday, November 18, 2012

How to Test, Challenge, and Replace Unhealthy Thoughts

In my last post, I introduced six cognitive distortions, or irrational thought processes, that can fuel unpleasant feelings.  Today, I'm going to show you a model that you can use to test irrational thoughts and replace them with more helpful thoughts that tend to relieve emotional distress.  

The tool I'm going to introduce is one that I often use in session with my clients and that is rooted in a concept called collaborative empiricism.  It is a process by which the client and therapist work together as if investigators or scientists to examine one of the client's thoughts and determine if it is rational or irrational.  In other words, a good cognitive therapist will not simply tell you whether or not your thoughts are rational.  Instead, the therapist will help guide you through a structured process designed to test your thoughts out.  You and your therapist will then determine whether or not the thought has withstood this test of logic.

Before I describe this test, I'd like to offer two words of caution.  First, I want to remind you that reading this post and experimenting with this tool is no substitute for therapy.  I recommend visiting a cognitive behavioral therapist to learn how to use this tool and to experience the other benefits that come from working within the context of a therapeutic relationship.  This is all the more important if you are experiencing significant emotional distress. You can locate such a therapist in your area by visiting Psychology Today's Therapy Directory, entering your zip code, and then clicking on "Cognitive Behavioral Therapy" under the heading "Treatment Orientation." Second, I'd like to caution you against using this tool to judge yourself negatively.  Remember that all human beings think irrationally every single day-it's part of the human experience.  It's okay to be imperfect.

With that disclaimer, aside, let me introduce this powerful tool.  It includes three basic steps (some of which are divided below into more detailed steps):

  1. Conduct a chain analysis (also referred to as a "functional analysis") of the event.  Map out the whole event including what happened that triggered your feeling, how you felt, what you thought about the event, and what you did to respond to it.
  2. Test the thoughts that you experienced during or after the event to determine if any of them were irrational.  If you identify any irrational thoughts, then you would move on to the third step.
  3. Revise or replace the irrational thought with a healthier, helpful, and logical thought (i.e. a rational thought).

Let me focus in greater detail on each of these three basic steps:

Step One: Conduct a Chain Analysis

  1. Describe the situation that triggered your unpleasant feeling.  This may involve a specific event, such as a driver cutting you off on the road or waking up after an unpleasant dream, but sometimes the trigger is less clear.  If you can't identify an event that triggered your feeling, then consider noticing the signs of the uncomfortable feeling to be the trigger (e.g. I noticed that my heart was beating faster and that I was feeling tense).  It is important that when you describe the situation, you avoid any interpretations, beliefs, assumptions, or conclusions.  Its best to describe the situation using specific, objective, and succinct words, like as though a reporter were describing the situation or a camera were filming it (e.g. Instead of writing, "My boss was being a jerk," you would write some something like, "My boss asked me why I was late this morning, rolled his eyes at me when I answered, and then walked away").
  2. Identify the specific names of the feelings that you experienced at the time of the triggering event (e.g. angry, anxious, depressed, frustrated, guilt, ashamed, etc.).  Try to scale how intense that feeling was at the time of the event using a scale that ranges from zero to 100.  For example, if the feeling was anger, then a score of 100 would mean that think that it would be virtually impossible for you to feel any more angry.  Typically, this would mean that your anger was so intense that you lost control, perhaps throwing things, yelling, or maybe even hitting someone or damaging property.  A score of 50 would mean that you experienced a moderate, significant, and uncomfortable anger but still felt like you had control.  A score of 10 would mean that you experienced such a mild form of anger (perhaps a minor irritation, frustration, or annoyance, for example), that you barely noticed it.
  3. Identify the physical and behavioral symptoms of the feeling.  These can include sensations in your body (e.g. increased heart rate, choking feeling in your throat, increased muscle tension, rapid breathing, nausea, trembling, etc.) or things that you did when you felt the feeling (e.g. yelled, ran away, slammed a door, threw something, called someone a name, etc.).
  4. Identify the thoughts that were running through your mind when the event happened.  This is easier said than done, and people sometimes have a difficult time with this step until they have practiced it several times with the help of a therapist.  Sometimes, it might help you to ask questions like, "Why was I feeling anxious in this situation?"  The reasons you come up with may represent the thoughts that you were having at the time of the event. 

Step Two: Test the Thoughts You Experienced During/After the Event
This test includes seven questions that you can ask yourself in order to reach a conclusion about whether the thought is logical (i.e. makes sense, is supported by evidence, and is contradicted by little or no evidence) and adaptive (i.e. helps you to function, gives you good results that you are satisfied with):

  1. Do any of these thoughts look like cognitive distortions?  Review the list of cognitive distortions I described in my previous post and decide if any of them seem to match up with your thoughts about this event.
  2. What is the evidence for and against this thought?  First, pretend that you are a prosecuting attorney and that you must convince a prudent judge and a jury of 12 reasonable people that this thought, is in fact, true beyond even a shadow of reasonable doubt.  What evidence would you bring to the table?  Identify and review each piece of evidence.  When you have run out of ideas, pretend that you are a defending attorney who must poke holes at the prosecution's argument that you previously detailed.  Your paycheck and reputation as an attorney now depend on your ability to raise a shadow of reasonable doubt that the thought is true.  Identify and review all the evidence that you can think of.  (People who are not well-trained at using this tool typically need the help of a therapist with this step.  Alternatively, a trusted family member or friend whose perspective you value may be able to help you come up with some ideas.)  Decide which side seems to have presented a stronger argument.
  3. What are some other options for how to think of this situation?  When a scientist or an investigator observes something that she can't explain, she first identifies different hypotheses, or educated guesses about what may be happening.  When it comes to questioning our thoughts, we can do the same.  You would identify every possible way of interpreting or thinking about this event that can come up with, no matter how unlikely some of these explanations might seem.
  4. What is the worst that could possibly happen from this situation?  This question is optional and is best asked when a thought seems to fit into the cognitive distortion known as Catastrophizing, meaning that you are exaggerating the negative aspect of a situation.  For example, if the triggering event involved your tire going flat, and you think, "This is horrible!  I can't handle this," then you might decide that the worst that could happen is that you will have to spend a few minutes changing your tire out on the side of the road or will have to wait for roadside assistance and that you will later have to spend some money to replace the tire.  You would then ask questions like, "Would that really be so bad?  Would I be able to stand it?  Would I survive it?  In the grand scheme of things, would I eventually be okay?" You can also ask yourself what the best case scenario would be, and what the most realistic outcome would be (typically something in between the best and worst case scenarios).
  5. What is the effect of me having this thought? Here, you would think about how this thought is affecting your emotions, choices, and behaviors.  Is it feeding strong, unpleasant feelings?  Do you like the way you handled it?  Is it giving you good or bad outcomes?  Do you like where this reasoning is taking you?  Is it hurting you or helping you?  It is improving your circumstances?  Is it holding you back in some way?
  6. What could I do about this situation?  This question helps you to pull yourself out of your feelings and thoughts about the circumstance (reactive) and shift your focus to solutions that may empower you (proactive).  You may find that some ideas pop up in your head that suggest that the situation isn't as bad as you originally thought or is much more manageable than it seemed at first.
  7. If my friend or loved one was in this situation and had this thought, what would I tell him or her?  This question pulls you out of your limited perspective for a moment and puts you in the more objective, less emotionally attached position of being a third party observer who cares about the person who is struggling.  It allows you to start considering some other perspectives.
Step Three: Revise or Replace the Irrational Thought

If the seven questions you asked yourself in Step Two lead you to the conclusion that your thought was irrational, then the next step would be to tweak that thought so that it is more rational.  Below, I'll suggest some conversions for the six cognitive distortions I outlined in my previous post.

  1. All-or-None Thinking: Consider a new thought that pulls your conclusion away from an extreme stance and into a more balanced "gray area."  For example, if you concluded that a training seminar you attended for work was "a complete and total waste of my time," you might consider a thought like, "The training wasn't as helpful as I wanted it to be, but a few things were worth hearing."
  2. Jumping to Conclusions: Rewrite the thought to be less conclusive or to raise questions instead of defaulting to assumptions.  For example, if you're driving down the road, a driver cuts you off before making a sharp turn onto a side street, and you conclude that he's a jerk, you might consider a thought like, "I have no idea what's going on with this guy, but he's not driving safe.  Maybe he's not paying attention, maybe he's experiencing an emergency, but I doubt he's intentionally trying to harm me."
  3. Magnifying or Minimizing: Revise the thought to include evidence that contradicts your initial thought.  For example, if you see a TV story about a veteran who suddenly became violent and started hurting people, and you thought something like "Veterans are dangerous, unstable people who have issues," you might replace it with a thought like "Some veterans are unstable, but now that I think of it I know of stories of veterans who are doing wonderful things for their communities, and I've only seen a small handful of stories about them doing something harmful."
  4. Personalizing or Blaming: Revise the thought so that it no longer defaults to a conclusion that is either solely about you or solely about others.  For example, if you're on the phone with an angry customer, replace thoughts like "What did I do that was so wrong?  Why is this lady being so rude?" with thoughts like "She may be angry for reasons that have little or nothing to do with me, but I also may have played a part in her anger."
  5. Imperatives: Convert the absolute statement into a personal preference or possibility.  For example, replace "I should have caught that mistake" with "I wish I'd caught that mistake, but I can't catch them all."  Similarly, a thought like "Those two should not be together" could be replaced with "I don't think those two are a very compatible."
  6. Emotional Reasoning: Accept that you are having an emotional response while acknowledging that the emotion isn't a fact and doesn't have to prove anything.  For example, if you reason "I feel guilty, so I must be doing something wrong no matter what others tell me," you can think "I know I'm feeling guilty, but that doesn't necessarily mean I'm doing something wrong."
That's it, folks!  I've presented a tool that I hope you find helpful in recognizing or replacing irrational thoughts.  A few more notes on this tool: First, the aim of this tool isn't to completely erase all unpleasant feelings.  Unpleasant feelings can be healthy and functional.  In fact, they are necessary for our survival.  Instead, the tool often reduces the intensity of unpleasant emotions so that you can think more clearly and react more intentionally.  Second, this tool will probably only be helpful if you use it repeatedly, and there are a number of tools that you can use to train yourself.  In addition to attending sessions with a Cognitive Behavioral therapist until you have mastered the process, you can use paper tools such as the Dysfunctional Thought Record or the REBT Self-Help Form.  I'm also a big fan of using smart phone apps and tablet apps.  If you enter the term "CBT" into your device's app store, you can experiment with a number of helpful tools.

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