Saturday, September 12, 2020

The ABC of thinking equation in Cognitive Behavioural Therapy (CBT)


One of the most useful tools in Cognitive Behavioral Therapy (CBT) is the “ABC of thinking” equation. It helps us to understand why we feel how we feel, react how we react, do what we do, and how we can change that. 

I often get patients to give me a list of their negative reactions to triggers, and apply those variables to the ABC of thinking equation, like in algebra.  It is often very enlightening. 

So like in algebra, if we know A (triggers) and C (reactions), we can work out B (Beliefs, thoughts, fused stories).  This will give us the opportunity to change or defuse from those beliefs, and associated thoughts/stories. 

Triggers (A-Antecedent event) + Beliefs (B-Beliefs) = Reactions (C-Consequence)

When people have a negative reaction to a trigger, the natural tendency is for us to try and change/remove that trigger, avoid the trigger, change/suppress our outward reactions to that trigger. Often this does not work long term as we don’t often have full control of our external environment, and changing those does not change the beliefs that underlie that context.  In actual fact, it often reinforces it.  This strategy represents the external locus of control. 

Alternatively. we can focus on our beliefs/thoughts/stories underlying that context. Same trigger but different beliefs lead to a different reaction.  So if we can change or defuse from our beliefs/thoughts/stories, we can change our reactions to our triggers, and how we feel about them.  This represents the internal locus of control. 

The common unhelpful beliefs, thoughts, and “fused stories” (the B in the equation) are:

I am not good enough.

You can’t trust anybody.

I can’t cope on my own.

Everyone will leave me in the end.

Nobody loves me.

I am all alone.

I am the black sheep. I am too different.  

When someone does something wrong, they need to be punished including me.

Things has to be done properly or not at all.

Why me. Why can’t I have what I want.

Something bad is going to happen to me.

If I fail, I am insignificant. 

Once we are aware of them, we can defuse/detach from them or even change them. Like when we know and understanding how a magic trick is done, the optical illusion has less grip on us. 

Naming them is one strategy and simply state, “Ah Mr Personal Trainer is here” if the feeling of inadequacies pop up for example. Then understand that the feelings of inadequacies is to propel us to take action for self improvement, and not simply to “feel bad” may help with some folks. Feelings are used for both feedback/information, and to propel/take helpful value based actions.  Feelings have both passive and active functions, and when used more mindfully and intentionally, rather than simply reactively, better outcomes may be achieved. 

Saturday, September 5, 2020

Feelings are not just for perceiving. It is also important for driving value based actions



When using feelings to drive action rather than simply to perceive, feelings are like your set of clothes in your wardrobe. You have a diverse set of clothes for different weather, seasons and events. 

Proficient users of feelings know what clothes they have, where to find it, and when to use it correctly for different situations. 

Non proficient users of feelings use it reactively or try not to use it at all. 

Counseling is like being someone’s stylist. We help people to recognize the items of clothing in their wardrobe (feelings), where to find them, and recognize which one to use in any particular context or event.

We learn to use feelings to drive value based actions more intentionally rather than reactively. 



Monday, August 31, 2020

Counseling is a balance between validation and challenge of your current thoughts, beliefs and behaviors to impact change



Counseling is a balance between validation and challenge. It’s important to have a safe, compassionate, nonjudging space for the acknowledgement and validation of our current thoughts, thinking, feelings and behaviours. Validation is safe and supportive and at the same time, over-validate and things may be a bit slow to change. 

Challenge is an important vehicle for change, but if we are unprepared and over-challenged, our unwanted defensiveness and resistance may be triggered and hinder change. It’s a bit of a dance as one of my colleagues might say.

In practice, I often ask my patients which way do they prefer?  Towards the validation, towards the challenge, or somewhere in the middle, and use that as a rough guide. When in doubt, we would use validation as a default as it’s more foundational in counseling.  

No one size fits all. 


Saturday, August 29, 2020

Shame is the granddaddy of all uncomfortable feelings


The emotion of shame (I am bad/not good enough) is the granddaddy of all uncomfortable feelings. 

I think folks with unhelpful feelings of shame is very common but nobody really presents to us with....

“Hi Doc. I have unhelpful feelings of shame.”

Often the presenting complaint is...  I am stressed out, burnt out, anxious, frustrated or I am angry all the time”. 

Folks with primary emotions of shame invariably has associated sense of disconnection leading to fear/anxiety, leading to the fight/flight/freeze responses OR distractions like emotional eating, which then creates more shame/disconnection. 

First thing is to step back and see that at the primary level and create a safe and compassionate space to talk about that in order to defuse or “zoom out” from that. Not easy because shame IS a really “yukky” feeling!



Friday, August 28, 2020

The difference between punishments vs consequences


I think understanding the difference between punishments and consequences is very important not only in parenting but also in management and leadership in your work/business.

Punishments and consequences can be seen as very similar logically but have very different “flavours” and outcomes. One has anger and frustration attached to it. The other one doesn’t. 

So the key point is in the delivery. Punishment is delivered with anger or frustration.  Consequence is delivered in a more neutral or compassionate manner. 


Thursday, August 27, 2020

How to “shift gears” when we ruminate on bad thoughts and fears


Have you ever had the experience of being stuck inside your head, ruminating about the past or worrying about the future?

How can we help you to shift gears?  This is a metaphor I often use to help in this situation. 

When we are ruminating about a past or anticipating a negative future event in an unhelpful way, we are living inside our heads. This is what we would call the “inside head experience”.  Introversion is another term, if you like that term better. We are now “stuck in that gear”. 

To shift from that gear, we must first use our “clutch” to detach from that gear.  Defusing, detaching, distancing or unhooking from thoughts is just like that clutch in the car. But this is not enough. If one purely focus on defusing and unhooking from thoughts, then it’s like pressing on the clutch and releasing it again back to the original gear. 

Once the clutch is pressed, one must then go into neutral “dropping anchor”, be present in the five sense experience rather than the “inside head” experience. 

Then shift gears to value based actions. What’s the quality of life that you want to create?  Where do you want to go despite the challenges. How can you live life true to who you are and your values?

One must coordinate all the elements above in order to “shift gears” more effectively. 

The challenge is that many of us may not know how to operate the clutch and gears properly inside our heads.  

The wonderful thing is that this is a learnable skill, just like learning how to drive a car albeit a bit more difficult perhaps.  


Tuesday, August 25, 2020

Do you have a more zoomed-in or zoomed-out perspective to life?

 


What do you see in this photo?

The point is, when we are too zoomed in, it’s hard to see the bigger picture. 

In counseling/Acceptance Commitment Therapy, one of the most important thing is to educate our patients around the concept of fusion and defusion or in other words, zoomed-in (+hook onto thoughts) or zoomed-out (+unhook from thoughts) perspectives. 

It’s like when you zoom into a forest, you can see a dead tree, but when you zoom out, you may see a beautiful lushed tropical forest. Nothing has changed but your perspective has. 

Many folks we see have a very zoomed-in or “fused” perspective to life eg folks with depression, anxiety, or personality disorders. 

Some folks we see have a very zoomed-out or “detached” perspective to life and so zoomed-out, that it is out of focus. Think ASD or even Dissociative Disorders when in “extreme”. 

Of course, life is very dynamic and requires us to zoom in and zoom out all the time depending on context. The problem is when this zoom function malfunctions.  Imagine having a camera without the ability to zoom in and zoom out in order for us to focus.  It would be quite frustrating. 

Part of counseling is to help folks to zoom in and zoom out in various context through active listening, reflection, validation, and “gentle” challenge. 

Using metaphors like these can help us explain abstract concepts to our patients in more digestible ways.

The more zoomed-in folks may have to learn how to zoom out more through meditation, mindfulness etc, and the zoomed-out folks may have to zoom in more to gain more empathy, passion, and connection in life perhaps. 


Sunday, August 23, 2020

The inner harmony vs outer harmony in decision making

Have you ever experienced the inner conflict of doing something that would make others happy but at the expense of your own happiness?

If yes, then how can we process that emotion and make a decision that we can be at peace with?

Decision making can depend on whether we want outer harmony or inner harmony. 

It would be great if we can have both, but at times, we may have to choose one over the other and then be at peace with that. This will require self awareness, acceptance, emotional literacy and emotional processing. 

To achieve outer harmony, follow the values and thinking of others. 

To achieve inner harmony, follow your inner principles and values. 

Perfectionism, self criticism, and fear of failure


In counseling, it’s very common for us to see folks with these 3 traits and often together. 

1 Have “unrelenting standards” aka perfectionism

2 Self critical and self punitive

3 Fear of failure. 

This is of course a perfect “storm” for stress. We have such high standards that we cannot reach, then self criticize, and then avoid failures and hence, cannot achieve. It’s a vicious cycle. 

If we can change self critical to self reflection/self compassion along with defusing/changing our beliefs around failures, then we may NOT have to lower our standards and succeed.