Thought Records and Depression

The most effective way to practice cognitive restructuring is to complete a thought record or thought diary. The thought record is one of the foundational tools of CBT. In the thought record we write down:

  • Our automatic negative thoughts
  • The situations that triggered them
  • The moods, emotions, feelings, and physical symptoms or sensations we experience in response.

Then we identify the automatic negative thought most responsible for how we feel, and use cognitive restructuring to come up with alternative and more balanced thoughts. The thought record is the main tool we use in CBT to change the way we think. It helps us see things from a different perspective, and as a result, change the way we feel.

Modifying our thoughts can be very challenging, especially when we’re depressed. In the video below we’ll learn how to complete a thought record. Then in the next post, we’ll look at some of the challenges we can face when trying to modify our thoughts, and how we can overcome them.

The Thought Record in CBT

There are a couple of different formats of the thought record you can download below. The first is based on Mind Over Mood by Dennis Greenberger and Christine A. Padesky. The second is based on the thought diary from the Centre for Clinical Interventions. For this format there is a full two-page thought record, a condensed one-page version, and a filled out example of a completed thought record:

If you have any questions or comments, please leave them on the YouTube video page.

Mindfulness Based Cognitive Therapy (MBCT) for Depression

At the start of this course we looked at how vicious cycles contribute to depression, and we can start to revse them. BUth rather than hving to resverse these ycles, its even better if we can prevent tham from sgetting started in the first place. And that’s MBCT ca n help . MBCT is a type of therapy that integrates elements of mindfulness into cognitive behavtioural therapy. MBCT was veevloped to help [revent depression relapse. IF we’re more mindful of our thoughts and behviours, and our modds and how we’re feeling, we can often intervene in ways that prevent us freom becoming depressed in the first place. I offern an entire online course in MBCT. The bideo below uses the parable of the two arrows to teach us how we can respond to our unpleasant expereinces such as depressed moods, negative thoughts, and physical discomfort, in ways that prevent things from escalating, prevent vicious from getting started, and as resutl help prevent relatps of dperssion. Mindfulness-based cognitive therapy (MBCT) uses the parable of the two arrows to explain the difference between pain and suffering. This video takes another look at the interrelationships between thoughts, feelings and emotions, behavior, and body sensations from that perspective. And it teaches us how to respond to unpleasant and painful experiences in ways that don’t lead to suffering.

The Difference Between Pain and Suffering

To learn more about MBCT, please check out my Online MBCT Course. If you have any questions or comments, please leave them on the YouTube video page.

Our Thoughts Are Not Facts

In CBT we modify or replace negative thoughts to help improve our moods and how we feel. But aren’t our thoughts important? How can we just change them? Shouldn’t we pay attention to them and listen to what they say?

It is important to be aware of what we’re thinking. But we need to recognize that most of our thoughts are not facts. They are just our own subjective interpretations of the world, what we’re experiencing, how we’re feeling, and so on.

So when we dispute and modify or replace our thoughts in CBT, we’re not altering facts or denying reality. We’re not trying to make ourselves believe things that aren’t true. We’re simply looking at things from a different perspective, and reframing how we understand situations and subjective experiences. And this is very helpful when we’re depressed. Since our negative thoughts contribute so much to our depression, when we change or replace these thoughts to make them less negative, we start to feel better.

On the other hand, when we’re mindful of our thoughts, we don’t try to modify our thinking. Instead we acknowledge our thoughts, and then, if those thoughts aren’t related to what we’re doing at the time, we just let them go. And so if we start having negative thoughts, there’s no need to give them any special attention. Since these thoughts are not facts, there’s nothing to be gained from dwelling or ruminating on them. We can just allow them to pass into, and then out of our minds, and not let them pull us into vicious cycles or downward spirals.

Thoughts Are Not Facts

If you have any questions or comments, please leave them on the YouTube video page.

STOP and Choose Our Behavior

We go through a lot of our lives acting on automatic pilot and out of habit, which can make it difficult to change our behaviors. The STOP exercise can encourage behavioral activation, because it allows us to be more mindful of how we act. It gives us a moment to pause, and then consider what we want to do next. And this makes it more likely that we’re able to choose behaviors that can help relieve depression, instead of just falling into habitual patterns that can contribute to depression, or acting automatically based on our moods and how we feel.

STOP stands for:

  • Stop what you’re doing
  • Take a step back
  • Observe
  • Proceed

We can even add an extra “P” for Plan, to help us choose how we wish to Proceed.

The STOP Excercise

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Stop is a distress tolerance skill from dialectical behavior therapy and a great tool to use whenever we’re feeling overwhelmed or in distress or experiencing uncomfortably strong emotions. Stop is an acronym that stands for stop, take a step back, observe, and proceed.

When we stop we stop whatever we’re doing right away. If we’re talking or arguing with someone, we stop. We shut up. We don’t say anything more. If we’re working, either at our jobs or doing something around the house, we stop working. Not as soon as we finish whatever we’re working on. We stop right now. If we’re doing something on our phones, we stop and put them away. If we’re engaging in some impulsive or self-destructive behavior. We stop that.

Stop sounds like a really simple instruction, but sometimes it’s hard to stop, either because we’ve already gathered so much momentum it can be hard to put on the brakes, or because we want to keep going so we can just finish whatever we’re in the middle of. Or we don’t want to stop because stopping means we’re going to have to acknowledge something we’re trying to avoid, like a conflict, or some uncomfortable thoughts or feelings, and we’d rather just keep going so we don’t have to think about this problem, and can just keep ignoring it.

But the longer we wait to stop, the more dangerous things become, and the more likely it is we end up past the point of no return and find ourselves in the middle of some sort of crisis that can be really difficult to get out of. So as soon as we notice we’re starting to feel distressed, or overwhelmed, or panicky, or frustrated, or angry, or engaging in some impulsive or unwanted behaviors, or having any other sort of strong negative experience, that’s when we need to stop right away.

And then as soon as we stop we take a step back. The t in stop stands for take a step back, but i also like to think of it as t for time out. Taking a step back is like taking a time out. It gives us a chance to remove ourselves from the situation, get some perspective, and calm ourselves down.

And the t can also stand for take a breath. One of the best things we can do to help calm ourselves down is to take a few breaths, slow down our breathing, and follow our breath for a few moments, using our breath to help reconnect ourselves with the present.

And then we observe. We observe what’s going on outside ourselves, and in particular what other people are doing. We observe our own behavior, what we’re saying and doing and how we’re acting. And we observe what’s going on inside ourselves, observing our thoughts feelings and emotions and the physical sensations in our bodies.

Observing makes us more aware, gives us some perspective, and it helps us see things more clearly and gives us the information we need to take the final step, p, which stands for proceed. But i also like to think of the p as standing for plan. So before we proceed we can take a moment to reflect on what we’ve observed, figure out our goals for the situation and the most effective way we can accomplish them.

If we’re having a conflict with someone else, we can plan how to de-escalate, how we’d like to resolve the situation, and what we’d like to say. If we’re acting impulsively or out of emotional mind, we can plan to connect with our wise mind. And if we’re frustrated with something we’re working on, we can plan what we need to do to complete the task. And if we’re experiencing negative thoughts or our minds are racing, we can plan to do something to help calm our minds. And if we’re experiencing some uncomfortable emotions or physical sensations, we can plan to do some emotion regulation.

And then once we’ve come up with a plan, or even if we didn’t feel it was necessary to come up with a plan and have just stopped, taken a step back and observed, now it’s time to proceed mindfully, perhaps re-engaging with whatever prompted us to stop in the first place. And now acting with more awareness, taking into account our thoughts and our feelings, and our goals for the situation. And if other people are involved, their thoughts feelings and goals as well.

If you have any questions or comments, please leave them on the YouTube video page.

Best Ways to Cope with Panic and Stop A Panic Attack

Man Having a Panic Attack

Having a panic attack can be one of the most terrifying things in the world. In this post we’ll learn how cognitive behavioral therapy (CBT) helps us respond to panic, and calm panic before it can escalate into a full-blown panic attack. Or, if we’re already in the middle of panic attack, how we can deescalate panic.

Panic attacks are so scary because we’re reacting to our anxiety as if it were a life-threatening situation. This engages our sympathetic nervous systems, setting off the fight or flight response. And this leads to a number of intense and distressing physiological symptoms associated with panic attacks such as:

  • Chest pain or discomfort
  • Elevated heart rate and/or racing or pounding heart
  • Heart palpitations or our hearts skipping a beat
  • Breathing faster or hyperventilating
  • Feeling like we’re choking or suffocating
  • Dizziness, light-headedness or feeling weak in the knees
  • Nausea and other stomach symptoms
  • Feeling detached, or like we’re floating away or watching ourselves from outside our bodies
  • And many more …

And these physiological symptoms increase our anxiety, leading to catastrophic thoughts that are common during a panic attack, such as:

  • I’m having a heart attack
  • I can’t breathe
  • I’m going to suffocate
  • I’m having a stroke
  • I’m about to pass out
  • I’m losing control
  • I’m going crazy
  • I’m going to be sick
  • I’m going to embarrass myself
  • And so on …

In order to prevent or deescalate a panic attack, we need to come up with more accurate and less catastrophic thoughts about what’s going on in our bodies. And we need to reverse the effects of the sympathetic nervous system and the fight or flight response that’s driving our panic attack, by engaging our parasympathetic nervous systems.

In the video below, we’ll learn how to do all of this and more to manage a panic attack with techniques from CBT, which is the most effective way to treat panic attacks:

The Best Way to Stop Panic Attacks

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In this video we’re going to learn how panic attacks get started, what happens during a panic attack, and how we can calm and de-escalate a panic attack once it does start to happen.

Panic attacks arise when we feel so anxious that our sympathetic nervous systems kick in and set off our fight-or-flight responses. And this brings on a wave of intense physiological reactions: we get a rush of adrenaline; our heart rates and breathing speed up; our pupils dilate and our muscles become tense; we start to produce more sweat; and so on. And these are all great ways for our bodies to react when we’re in a life-threatening situation. But during a panic attack our bodies misinterpret our anxiety as a life-threatening situation and react accordingly, setting off this fight-or-flight response as if our lives were in danger.

And if we were in a life-threatening situation our bodies would use this physiological response to help us fight off or flee from whatever the danger is. But when these physiological reactions arise in response to our anxiety, there’s nothing for us to do with them, there’s no outlet for them, because there is no life-threatening situation to fight off or escape. So we’re left with all of these intense physical symptoms and they don’t make any sense. We don’t understand why this is happening.

And so we start having catastrophic thoughts about what’s going on, and misinterpreting this physiological response as symptoms of some sort of health or medical crisis. And these thoughts cause more anxiety, that intensifies our physiological reactions, leading us to have more catastrophic thoughts, and so on, setting off a vicious cycle that can lead us into a full-blown panic attack. So let’s look at how this happens in more detail.

Sometimes our anxiety builds throughout the day and we might have moments of panic here and there that don’t escalate into a panic attack, but then at some point all of this anxiety becomes too much and it does set off a panic attack. Other times it can be an extremely anxious thought or distressing body sensation that sets off a panic attack. Or we may not even know what sets it off and it just seems to happen out of nowhere.

But regardless of the source when we have a panic attack something at some point signals to our sympathetic nervous systems that we’re in danger, which sets off the fight-or-flight response, initiating all of those physiological reactions we mentioned earlier, which again, are great to have if we’re in an actual life-threatening situation.

But if the threats are something like: we’re standing up in front of a group of people about to give a presentation; or we’re in an airplane or on a bus or in a mall or at the dentists and start feeling trapped or claustrophobic; or we’re sitting down about to write an exam; or we’re in a social situation where we’re really uncomfortable because we don’t know anyone; in these sorts of circumstances this intense physiological fight or flight response serves no purpose and can often set off a panic attack.

So at this point what’s driving our panic is a vicious cycle between what’s going on in our bodies—the physiological fight-or-flight response—and our thoughts about what’s going on in our bodies, and what all of these symptoms and sensations mean. So first let’s look at some of the most common physical and physiological symptoms associated with panic attacks.

A lot of these symptoms occur in our chests or hearts: like a feeling of tightness or tension in our chests; or an increased heart rate or a racing heart; or heart palpitations; or the feeling that our hearts are skipping a beat.

Symptoms related to our breathing are also common. We start breathing faster or even hyperventilating, and we can feel a tightness or lump or choking feeling in our throats, and it can start to seem like we can’t breathe or are suffocating.

Stomach symptoms are also common. We might feel nauseous or get cramps or have butterflies in our stomachs. Or get a sinking feeling in the pit of our stomachs. Or we might start to feel dizzy and like we’re going to pass out.

And we can start to feel warm or start to sweat or get sweaty palms. Or our hands may become cold or clammy or start to shake and our hands or feet might start to tingle or feel numb.

And then there are symptoms like feeling detached or like we’re in a dream or floating away or watching ourselves from outside our bodies.

There are any number of physical symptoms we can experience during a panic attack, and if yours didn’t get mentioned, the way we deal with all of them is similar enough that hopefully you’ll be able to find something that applies to your situation as well.

And then the other element involved in setting off a panic attack are the thoughts we have in response to these physiological symptoms and sensations in our bodies. So for example if we’re having a lot of symptoms in our hearts or chests we might think: I’m having a heart attack; I’m going to die.

For symptoms related to our breathing: i can’t breathe; I’m going to suffocate; I’m going to start choking.

For symptoms related to dizziness or feeling weak in the knees: I’m going to pass out; or I’m having a stroke.

And for symptoms related to our stomachs: I’m going to be sick; I’m going to throw up; or I’m going to have diarrhoea.

For symptoms like feeling detached or outside of our bodies we might think: I’m going crazy; or I’m losing control.

And then there are a number of common thoughts that can kick in regardless of the specific symptoms we’re experiencing: I’m so scared; i can’t stand this; this is never going to end; i don’t understand what’s happening to me. Or there’s something really wrong with me; something terrible is going to happen; I’m losing control; I’m going to need to run out of here; or I’m not going to be able to get out of here and I’m going to make a scene; I’m going to embarrass myself; what are people going to think of me?

And all of these types of thoughts increase our anxiety. And as a result our physiological and physical symptoms become more intense, leading to even more catastrophic thoughts, initiating a vicious cycle between our physiological and physical symptoms. And these catastrophic thoughts we have related to these symptoms that can lead us to start to panic.

So if we want to avoid this vicious cycle escalating into a full-blown panic attack, as soon as we start having these catastrophic thoughts about our physiological symptoms, we need to come up with alternative and more accurate explanations for what’s going on in our bodies that can help us reverse this cycle, making it less likely that we have a panic attack. So let’s look at some specific examples.

Probably the most common type of panic attack occurs when we experience something like a racing or pounding heart, maybe with some palpitations or some tightness in our chests, and we think we’re having a heart attack. And so we start panicking because we think we’re about to die. And it’s not uncommon for people to call an ambulance during a panic attack because they think they’re having a heart attack.

And if you ever do think you’re having a heart attack you should call for help. But if you’re watching this video it’s very unlikely that you’re going to have a heart attack anytime soon, because you’re probably under 55, an age at which heart attacks are very uncommon. But again if you do think you’re having a heart attack you should call your emergency services number. And if you’re worried about your heart’s health in general please consult your doctor.

And so this is a tricky thing for me to talk about because i don’t want to discourage anyone who thinks they’re having a heart attack from calling for help. But assuming we know there’s nothing wrong with our hearts and we’ve had panic attacks before, and we know what they feel like, and we know that this is just a panic attack, when we start getting these symptoms in our hearts and chests we need to remind ourselves that all of these symptoms are associated with anxiety and especially with the fight or flight response that gets activated when we start to panic. It doesn’t mean we’re having a heart attack. It doesn’t mean we’re going to die.

And by replacing a thought like, oh my god i think I’m about to die, with something like: I’m having extremely intense and uncomfortable feelings in my chest and heart because I’m panicking and my sympathetic nervous system has initiated the fight-or-flight response, we start to reverse the vicious cycle between our physical symptoms and our catastrophic thoughts about these symptoms that’s driving our panic.

And so we start to feel less panic. And as a result the intensity of our physiological symptoms begins to decrease. And because the physiological symptoms are no longer as strong, our thoughts about these symptoms continue to become less catastrophic and more calming, which further reduces our levels of panic.

And these physiological responses like a racing heart aren’t dangerous. They’re not going to cause a heart attack and they’re not going to damage our hearts. They’re just going to feel really uncomfortable, but then they’ll pass without causing any lasting harm.

And everything I’ve said about panicking or having a heart attack applies to panicking we’re having a stroke or any other sort of life-threatening medical crisis. All of our symptoms can be explained by anxiety and panic and the fight-or-flight response. And so if we’re in a heightened state of anxiety and start having these symptoms, it’s very probably just a panic attack. But if you think you’re actually in the middle of a life-threatening medical crisis then you should seek medical attention.

Now let’s look at symptoms related to our breathing. If we feel like we’re choking or can’t breathe or starting to suffocate, we need to reassure ourselves that this is nothing dangerous. It’s been set off by the fight-or-flight response, and it’s not physically possible for us to suffocate ourselves—when we need oxygen our bodies will reflexively breathe—so there’s no way we can suffocate during a panic attack.

But we can start to hyperventilate during a panic attack, which can lead to low levels of carbon dioxide in our blood, which can cause many of the symptoms we can have during a panic attack. So again if we start to hyperventilate we need to replace any catastrophic thoughts like, i can’t breathe, I’m going to suffocate, with reassuring thoughts that these are all normal symptoms of a panic attack and they’re nothing dangerous. And this can help calm our panic.

And then the second thing we can do about symptoms related to our breathing is to slow down our breathing, often we’re told if we’re feeling anxious we should take some deep breaths. But if we’re having a panic attack and we try taking deep breaths we often do this without slowing down our breathing as well. And then we start panting, taking lots of quick deep breaths, which can lead to hyperventilating. So we want to make sure that we’re taking slower rather than deeper breaths.

And there are all sorts of breathing techniques we can use to slow down our breathing so if you already have one that works for you there’s nothing special or magic about my technique. I just find it’s the easiest one for people to be able to do on the spot without any practice in the midst of a panic attack.

So i think the most effective way to slow down our breathing during a panic attack is to breathe into our nostrils for a count of two; pause for a count of two; and then breathe out of our mouths for a count of four through pursed or puckered lips, which slightly restricts the airflow naturally slowing down our exhale.

And then as our breathing slows down we can increase the length of the count breathing in for a count of three; holding our breath for a count of three; and then breathing out for a count of six, and so on. And i have a couple of videos that present this as a guided breathing exercise that you can try out if you are panicking and are finding it difficult to slow down your breathing.

So when we slow down our breathing like this not only does our breathing become easier and more comfortable, we engage our parasympathetic nervous systems. The autonomic nervous system is responsible for regulating our body’s unconscious actions. It includes the sympathetic nervous system, which is responsible for the fight-or-flight response; and the parasympathetic nervous system, which is the opposite of the sympathetic nervous system. And instead of a fight-or-flight response the parasympathetic nervous system is responsible for the rest and digest response, which helps our bodies recover and get things back to normal after a stressful situation.

And so slowing down our breathing helps not just with our breathing related symptoms, but since it engages our parasympathetic nervous systems, it reverses the effects of our sympathetic nervous systems and all of the physiological reactions brought on by the fight-or-flight response, so slowing down our breathing is a great way to help reduce panic.

This brings us to feelings of dizziness and fears that we’re going to pass out. A panic attack can’t cause us to pass out unless we have one of two phobias—a fear of blood or a fear of needles—in which case if we see some blood or get injected with a needle we might pass out. But otherwise we can’t pass out during a panic attack, because the fight-or-flight response elevates our blood pressure. And we pass out when there’s a sudden drop in our blood pressure. So having a panic attack is the opposite of being about to pass out. So the dizziness we feel is a result of anxiety and it’s not going to cause us to pass out or fall over.

Let’s look at symptoms related to our stomachs. Yes anxiety can cause us to get sick. We can throw up or have diarrhoea. But these aren’t life-threatening. They’re unpleasant and potentially embarrassing. But if we’re able to reassure ourselves that these feelings in our stomachs are the result of anxiety and the fight-or-flight response, which does affect digestion. And even if we’re not hyperventilating, slowing down our breathing still helps us engage our parasympathetic nervous systems, and the rest and digest response, which helps calm our anxiety, and our stomachs will start to feel better.

And we can’t go crazy or lose control during a panic attack. Symptoms that feel really weird or can be really scary like feeling detached or in a dreamlike state, or floating away, or watching ourselves from outside our bodies can make us feel like we’re going crazy, but we can’t go crazy (whatever that means) during a panic attack. Again these are just physiological symptoms brought on by our anxiety. And they’ll pass as the panic passes.

We can also try a grounding exercise called 54321 to help us reconnect with reality and we name: five things we can see; four things we can touch; three things we can hear; two things that we can smell; and one thing we can taste. And i have a video that helps guide you through this process if you want to try it out.

And for any other types of physiological or physical symptoms the strategy is the same. We replace our catastrophic thoughts about these symptoms with more accurate thoughts and explanations. And when we’re able to change our thinking then our anxiety and panic and the related physical symptoms we’re experiencing will begin to subside.

And then for the remaining thoughts we talked about earlier, we just need to come up with alternative and more accurate ways of assessing the situation that aren’t so catastrophic and therefore will reduce our anxiety.

For thoughts like, I’m so scared, i can’t stand this, this is never going to end, i don’t understand what’s happening, there must be something really wrong, with me something terrible is going to happen; instead we need to find a perspective more along the lines of, yes this is really scary and uncomfortable, but i know it’s a panic attack and it’s going to end, and the worst case scenario is that I’m going to feel really scared and uncomfortable for maybe 20 to 30 minutes. But then it’s going to pass and everything’s going to return to normal and I’m going to be fine. Or any similar perspective that helps calm our anxiety a little bit and makes it less likely that things continue to escalate.

For thoughts like, what if i can’t get out of here, what if i can’t escape, I’m going to end up making a scene; we need to remind ourselves that this is a panic attack. It feels really scary and uncomfortable but it’s not dangerous. These feelings are all because of anxiety, and slowing down our breathing can help us engage our parasympathetic nervous systems and the rest and digest response, which will help ease our feelings of panic. And doing a grounding exercise can also help, as well as replacing any of our catastrophic thoughts with more accurate and calmer ways of thinking about the situation we’re in. And even if we do have a panic attack, using these techniques can help reduce the severity and duration of the panic attack which is sometimes the best that we can do.

And for thoughts like, I’m losing control, I’m going to embarrass myself, what are people going to think of me; we need to tell ourselves we don’t lose control during a panic attack. It can feel like we’re losing control because of all the intense things going on in our bodies. But that doesn’t translate into acting out of control. And it’s unlikely that we embarrass ourselves during a panic attack, because most of the time nobody even notices. But even if people do notice, the fear “what will people think of me?” Is generally unfounded, because most people will have empathy and sympathy. So we may feel embarrassed, and that’s a natural reaction, but having a panic attack is not something the people around us will think we have any reason to feel embarrassed about.

But sometimes none of these things work and our panic escalates and we find ourselves in the middle of a full-blown panic attack. And so if this happens the best thing we can do is to just accept that we’re having a panic attack. Not because we don’t mind having a panic attack, but because at this stage there’s nothing we can do to prevent it from happening, because it’s already here.

And because trying to fight the panic attack is a battle we can’t win. And is only going to increase the fight-or-flight response, prolonging the panic attack and making it more intense. But the paradox is, if we’re able to just accept that we’re having a panic attack, and we just allow the panic attack to happen, it loses some of its power. Because since we’re accepting it rather than fighting it or trying to escape, there’s no need for the fight-or-flight response anymore—there’s nothing to fight and there’s nothing we’re trying to flee from—and so our physiological symptoms brought on by the fight-or-flight response begin to subside. And as a result our panic stops escalating and can begin to subside as well.

The Panic Attack Worksheet will help you plan how to respond to your physiological symptoms and catastrophic thoughts when you start to panic, in order to prevent or deescalate a panic attack. You can download the Panic Attack Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Physical Symptoms and Depression

Physical symptoms and body sensations are the last of the four aspects of our experiences that we talked about in The ABCs of CBT. Our physical symptoms and body sensations affect our thoughts and behavior, and they’re closely related to our emotions—we often feel our emotions in our bodies. Because of this connection between body sensations and emotions, the way we respond to our body sensations can influence our emotions and how we feel.

Emotion Regulation and Body Sensations

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Think about what it feels like to be sad or anxious or angry. How do you know that you’re experiencing a certain emotion? What is it that signals to you that you’re sad rather than happy or content? Or that you’re anxious or angry rather than calm or relaxed?

We generally experience our emotions through our bodies. And we often use the words emotions and feelings interchangeably. And talk about feeling sad feeling angry and so on. And that’s because we really do feel our emotions. There are actual physical feelings in our bodies that we associate with them. In my last video we learned how to regulate our emotions by naming validating and accepting them. In this video we’ll learn to regulate emotions through how we relate to the physical sensations in our bodies associated with our emotions.

There’s often a general physical feeling that accompanies an emotion. Our bodies feel heavy when we’re sad, jittery or tense when we’re nervous or anxious. We might feel hot if we’re angry or warm all over when we’re happy, and so on.

There’s also usually a sensation in a specific and localized part of our bodies that goes along with our emotions. We might feel a lump in our throats or broken-hearted if we’re sad. Or a tightness in our throats or chests, or heart palpitations or butterflies in our stomachs if we’re anxious. Or our heads might feel like they’re going to explode if we’re angry.

So because of this close relationship between our emotions and physical feelings in our bodies, if we’re able to calm the physical manifestations of our emotions and they start to subside, our emotions tend to calm down and feel less intense as well.

So in terms of a general feeling throughout your body associated with an emotion, if you’re feeling some sort of physiological arousal like with stress or anxiety or anger and your heart rate or blood pressure are elevated, or you have a lot of pent up energy and have trouble sitting still, in order to regulate your emotion you need to calm this physiological response.

One way to do this is by slowing down your breathing, and a good way to do this is to breathe in through your nostrils and then breathe out through pursed lips because the pressure of your lips forces your exhalation to be slower. And once you slow your breathing down for a couple of minutes your level of physiological arousal will naturally start to decrease.

And doing something a little active like going for a walk can also help, but a slow relaxing mindful walk not a frantic pacing back and forth. And perhaps tying your walking in with your slowed down breathing, so walking relatively slowly and then taking three or four steps per breath. So in, step, two, step, three, step. And out, step, two, step, three, step. And walking like this is a great way to decrease physiological arousal and calm yourself down.

Or in the case of feeling lethargic or a lack of energy that often accompanies sadness or depression, doing something a little more active can help lift the feeling of heaviness in your body. And i talk about this in more detail in my video on behavioral activation that you’ll find in the playlist that accompanies this video, in the description and pinned comment.

And now let’s look at the more localized physical sensations like a tightness in our throats or chests or, butterflies in our stomachs that often accompany our emotions. But first we’re going to do a quick exercise.

So in a moment I’m going to ask you to take a deep breath and hold it for as long as you can. And I’ll keep a timer on the screen, but try not to look at the timer until you’re done. And then make a note of how long you held your breath for. And I’ll keep talking about emotions while you’re holding your breath so you don’t get bored and go watch something else instead.

So I’ll count down from three and then take a deep breath and hold it for as long as you can. Three, two, one, go.

Now these localized physical sensations that we feel in our bodies that are related to our emotions can be very distressing. Sometimes they can be acute and come and go throughout the day and when we do become aware of them they can feel extremely intense. Other times they can be more chronic and we notice that feeling in our chests or throats or stomachs from the moment we wake up until the moment we go to bed and fall asleep. And if we wake up during the night it’s still right there.

And these sensations can be so distressing, not just because they’re so uncomfortable, but because they’re so persistent. We’re sure there’s a physical medical issue that’s causing them. And it’s not uncommon for people to make multiple trips to multiple doctors to try to figure out what’s wrong with them. And when the doctors can’t find any underlying medical issue it can be hard to believe that all of this physical discomfort can be caused by emotions and psychological distress.

So what can we do to try to calm these physical sensations, and as a result help calm our emotions as well. Like with all of our unpleasant internal experiences the first step is to accept them. Not because we like them, but because anything other than acceptance is only going to make things more unpleasant. And if you don’t know what we mean by acceptance in this context check out the videos i link to in the pinned comment and description.

Okay it’s been a while now so you’re probably not holding your breath anymore, so just make a note of how long you held it for and we’ll talk about why you just did this in a few minutes.

Unfortunately we can’t just make these body sensations go away because we don’t like them. And when we fight with our internal experiences like thoughts emotions and body sensations and try to ignore them shut them out, or force them to go away they only gain more strength.

Our bodies tense up as we strain to fight these feelings, which exacerbates the feelings of tension in our throats chests or stomachs. And any negative reactions we have to them like, damn it’s still there, why do i always feel this way, when is it going to end, it’s just going to make them more difficult to tolerate, because our subjective experience of them will be worse, because now we’re faced with not just the unpleasant physical sensation but with our negative thoughts about them as well.

And our negative thoughts have a negative effect on our mood and will tend to increase the intensity of our emotions, which in turn will make the physical sensations more intense as we get stuck in this vicious cycle. And that’s something i talk about more in my video on distress tolerance and the difference between pain and suffering. So once again we’re left with the problem of how do we accept these things that we find so unpleasant.

Well first we can try to adopt an attitude of acceptance through calming thoughts and statements that we say to ourselves such, as whatever’s here right now is okay. This is my experience right now. Whatever it is, is already here. There’s nothing i can do to keep it out. There’s no need to fight it or struggle with it or try to make it go away. And just allowing myself to be open to it.

And the more you stop resisting your unpleasant body sensations the less they have to fight to be acknowledged. And as a result the more likely they are to lessen a bit in intensity. Now this doesn’t mean they suddenly go away. Our emotions and corresponding body sensations are like waves. They may seem like a constant and monolithic force but when we start to pay attention to them we can start to notice their ebbs and flows.

They often come into our awareness when they’re at their peak, either because that’s why they’ve drawn our attention, or because when we check to see if they’re still there they tend to perk up like they know we’re talking about them and they start to swell a bit. But if we’re able to just allow them to be there, after the initial swell they tend to crest and then start to dissipate and trough. And then they’ll swell up again and then contract and continue like this to ebb and flow and wax and wane.

And so when you have an uncomfortable feeling in your body rather than fighting it, just allowing it to be there and noticing what’s going on in your body as you hold it in awareness. And tuning into any feelings of tension or tightness or discomfort, and then breathing into these sensations using your breath to bring your awareness to them on the in-breath, and then breathing out of these sensations and seeing if they soften or relax on the out breath. And just letting your experience of these sensations be whatever and however they are from moment to moment. And if you’d like to try a short guided meditation that incorporates some of what we’ve just talked about in the last section of the three-minute breathing space we practice breathing in and breathing out a physical sensations in our bodies.

So let’s go back to the holding your breath exercise. We’re going to do it again now but this time with some guided instructions. While you’re holding your breath, and again there’ll be a counter on the screen but try not to look at the time until you’re done and then make a note of how long you held your breath for, so counting down from three, two, one, start holding your breath.

And now while you’re holding your breath, whenever you notice you’re having the urge to breathe, try to notice exactly where you’re feeling this urge in your body and whatever the body sensations associated with this urge to breathe are.

And then seeing if you can just allow these uncomfortable feelings to be here without taking a breath yet. And seeing what happens to this urge to breathe as you just open yourself up to it, allow it to be there, and allow yourself to experience it however it feels, without fighting it. And seeing if you can continue to hold your breath despite the uncomfortable feeling you’re having. And then when the urge to breathe starts to become overwhelming, take a breath and record how long you held your breath for. And I’ll just leave the timer up for a little bit longer in case you’re not done yet.

Now take a moment to think about any differences you noticed between the two times you held your breath both with respect to how long you were able to hold your breath for and what your experience was like while holding your breath.

Most people find that they hold their breath longer the second time, when they’re simply accepting of their experience for what it is allowing in that discomfort and urge to breathe and just watching it and letting it be there without resisting fighting or trying to change it or make it go away.

And so this exercise can help illustrate that the way we respond to discomfort and unpleasant feelings can change how we experience them. And that if we simply let them in and allow them to be there instead of engaging in our tendency to try to fight them or shut them out, they can become more tolerable and manageable.

And this is borne out by research into pain management that shows that responding to chronic physical pain with mindfulness and acceptance can reduce subjective pain intensity ratings by an average of forty percent. Now that’s a lot less than a hundred percent, so acceptance isn’t a magic cure that automatically makes discomfort go away, but a forty percent reduction is significantly better than nothing.

So when we don’t have the option to make our uncomfortable or unpleasant body sensations related to our emotions just disappear, why not try accepting them and make them significantly more tolerable and manageable? And the more we’re able to just accept these uncomfortable physical sensations, the more likely they are to lessen in intensity. And as a result we begin to experience a corresponding reduction in the intensity of the emotions associated with these sensations. So by learning to accept these uncomfortable physical sensations we learn to regulate our emotions as well and in the next video we’re going to look at the difference between emotion regulation and distress tolerance.

If you have any questions or comments, please leave them on the YouTube video page.

6 Tips to Treat and Manage Depression

These six tips to manage depression provide a brief overview of the main strategies we’ll be looking at in more detail throughout this course.

6 Tips To Treat and Manage Depression

If you have any questions or comments, please leave them on the YouTube video page.

Depression and Letting Go of Guilt and Regret

When we’re depressed we can experience a lot of guilt and regret.

Automatic Negative Thoughts

The first step towards reducing both the frequency of our automatic negative thoughts, and how detrimental they are, is to learn to recognize and record these automatic negative thoughts when they arise. This is part of what we do in the CBT Interrelationships worksheet from an earlier post. In addition to completing this worksheet, it’s good practice when learning CBT to just pay attention for and write down automatic negative thoughts whenever they come up.

The next step is to assess the accuracy of these ANTs. Then we can reframe our thoughts to look at things from different perspectives that don’t have such a negative impact on our moods. And as a result, we start feeling better. We’ll look at how we can do this in the next few posts. If you have any questions or comments, please leave them on the YouTube video page.

Thought Record Tips

The thought record can be challenging to complete at first. The video below looks at some of the typical difficulties we face when doing thought records and how we can deal with them, as well as some tips to make the thought record more effective.

Thought Record Tips and Troubleshooting

If you have any questions or comments, please leave them on the YouTube video page.