All or Nothing Thinking

All or nothing thinking is a type of cognitive distortion in which we see things in black or white terms, with no shades of grey in between. Things are either all good, or all bad. We’re perfect or we’re a failure. If we don’t accomplish all that we’ve set out to do, we’ve done nothing. If someone doesn’t do everything we ask of them, then it’s like they’ve done nothing.

All or nothing thinking leads to stress and anxiety, because we put so much pressure on ourselves to achieve or accomplish all, rather than be left with nothing. And all or nothing thinking can damage our self esteem and lead to depression. If we’re often feeling like we’ve done or achieved nothing, it hurts our self worth and can leave us feeling depressed.

All or Nothing Thinking

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Problem Solving and Action Plans in CBT

In CBT we focus on changing our thoughts and behaviour in order to change the way we feel. But sometimes we experience a difficult or unpleasant emotion and our thoughts about our situation are accurate, and we’re behaving in a reasonable manner. When that’s the case, changing our thoughts or behaviour may not have much of an effect on our emotions. Or maybe we’re just finding it too difficult to modify our thoughts or behavior.

But there’s another option. Instead of changing how we’re thinking or acting, we can try to change the actual problem situation or event that’s responsible for how we’re feeling. And we do this by problem solving and coming up with an action plan to implement our solution.

Problem Solving and Action Plans in CBT

You can download the Problem Solving and Action Plan Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

The Difference Between Pain and Suffering: The Two Arrows

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, behaviors, 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.

Physical Symptoms and Body Sensations in CBT

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.

Acceptance in CBT

Acceptance isn’t emphasized in CBT, but it’s often the best way to respond to unpleasant experiences that we can’t change or control. Acceptance can be a difficult concept to grasp. The videos below, from my Online MBCT Course, help explain acceptance. But if you have trouble understanding the difference between acceptance and resignation, you’re not alone—it’s probably the most asked question on my YouTube channel.

Acceptance

I’m not sure how to try to clarify the difference between acceptance and resignation beyond what’s in these videos. I think part of the confusion is that there are various ways to define acceptance, and in some senses acceptance is very similar to resignation. But unlike resignation, in psychotherapy, acceptance is an acknowledgement and recognition of the current state of affairs, but without giving up.

Perhaps the most well-known use of this type of acceptance is the Serenity Prayer from Alcoholics Anonymous:

Grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
and Wisdom to know the difference.

The video below elaborates on the nature of acceptance.

Allowing and Letting Be

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Emotion Regulation

In CBT we focus on managing our moods and emotions by changing our thoughts and behavior. But there are some emotion regulation strategies from Dialectical Behavior Therapy (DBT) that are also helpful in addressing our emotions. We can’t control our emotions, but we can influence our emotions and how we feel. In this video we’ll learn some DBT emotion regulation skills that can help us influence our emotions.

Emotion Regulation

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Opposite Action: Behavior and Emotions

Opposite action is a behavioral therapy concept from Dialectical Behavior Therapy (DBT). Opposite action teaches us to change the way we feel by acting opposite to the way our emotions are telling us to act. Although it’s not technically CBT, opposite action is a great way to improve our moods, emotions, and how we’re feeling by modifying our behavior.

Behavior and Emotions: Opposite Action

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

Just like when we’re feeling a certain way we tend to have thoughts that are congruent with the way that we’re feeling, and then those thoughts feed back into how we’re feeling, making those feelings even stronger, the same sort of relationship exists between how we’re feeling and our behavior and how we act.

For example if we’re feeling sad or depressed we tend not to want to do much of anything. We can find it hard to get out of bed, or drag ourselves to work, or make plans with our friends, and we can want to withdraw from the world and just avoid doing things. Maybe just lie in bed all day, or on the couch, or sit in front of the TV doing nothing. And although when we’re feeling sad this can be exactly what we want to do or feel like we need to do, acting in this way he doesn’t do anything to help our mood, or make us feel any less sad, and tends to actually intensify the way that we’re already feeling, creating one of those vicious cycles that we’ve talked about so much.

One way we can combat this tendency is called opposite action: the idea that when we feel a certain way we tend to act in ways that are congruent with how we’re feeling, and this has the effect of intensifying those feelings. But if instead we take opposite action, and act opposite to how our feelings are telling us to act, this helps moderate our emotions, slows down any vicious cycles, and allows our feelings to subside.

And so by changing the way we act we can change the way we feel, just like how changing the way we think can change the way we feel. And so that was an example of using opposite action to help manage sadness or depression.

Now we’re gonna look at how you can use opposite action to help with anxiety, stress and anger. When we’re feeling anxious our tendency is to want to act in ways that allow us to avoid whatever it is we’re anxious about. But this doesn’t work because the more we avoid something, the more anxiety it tends to cause us. So instead we need to take opposite action, act opposite to the way our feelings are telling us to act in this situation. And rather than avoid what’s making us anxious, find a way to face our fears and expose ourselves, at least gradually, to whatever it is that’s causing our anxiety. And when we do this we start to feel more comfortable with whatever was making us anxious and as a result our anxiety starts to decrease.

And if we’re feeling stressed, what we tend to want to do is to work harder, rush around, multitask, and keep going and going until we get everything done so we can finally relax. But acting in this way only makes us more stressed. But if instead of acting based on what our stress is telling us to do we take opposite action, slow down a bit, be more mindful, take some breaks and give ourselves some time to relax and unwind, not only will our level of stress decrease; but we’ll be more productive in the long run and get things done quicker and be more efficient.

And when we’re feeling angry usually what we want to do is attack and fight back. But that only escalates situations and tends to leave us even more angry. Or we withdraw into ourselves and avoid talking about things, which just leaves us ruminating and stewing in our heads and getting angrier by the minute, often until we can’t take it anymore and explode.

But if instead of acting based on what our anger is telling us to do, and instead of attacking we take opposite action, take a step back and remove ourselves from the situation, we can we’re usually able to calm ourselves and our anger starts to dissipate. Or if instead of staying silent and stewing about something, we take opposite action and find a way to express what’s bothering us assertively rather than angrily, we’re often able to resolve situations and let go of our anger.

And so if instead of acting based on what our emotions are telling us to do, which tends to feed back into how we’re feeling and making those feelings even stronger, we take opposite action, act opposite to the urge so that we’re having at the time, and take a moment to plan what we’re going to do, we can start to reverse any vicious cycles or downward spirals, calm our emotions, and our mood will start to improve. And in the next video we’ll learn an effective way to use opposite action to help manage depression called behavioral activation.

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

Behavioral Activation and Depression in CBT

Behavioral activation is one of the most effective things we can do when we’re feeling depressed and unmotivated. It’s often the first step in treating depression with CBT. With behavioral activation, we gradually increase our levels of activity. And as we do this, our moods start to lift, we have more energy and motivation, and we start to resume doing the things we used to be able to do before becoming depressed.

Behavioral Activation For Depression

You can download a Behavioral Activation Diary in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Anxiety and Exposure Therapy in CBT

In CBT, we often treat anxiety with exposure therapy. When something makes us anxious, we generally try avoiding it. In the short term, if we can avoid something, we may be able to avoid feeling anxious about it. But in the long term, avoidance increases anxiety. With exposure therapy, we learn to gradually expose ourselves to the sources of our anxiety. And when we do this, our anxiety starts to decrease.

Anxiety and Exposure Therapy

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Systematic Desensitization and Graded Exposure

Systematic desensitization, also known as graded exposure or graduated exposure, is a very structured type of exposure therapy. In systematic desensitization we gradually expose ourselves to the things we’re anxious about. Rather than jumping right in to whatever’s making us anxious, we break things down into small steps, and then we tackle each step one by one. Systematic desensitization is particularly helpful in treating phobias, including social phobia.

Systematic Desensitization and Graded Exposure

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

In the last video we learned how exposure decreases anxiety. But rather than plunging ourselves right into the middle of what’s making us anxious, we want to expose ourselves gradually through a process called graded exposure or systematic desensitization. Now we’re going to look at systematic desensitization in more detail.

The key to graded exposure or systematic desensitization is to break your exposure down into a series of small steps that will gradually lead you to your goal. So you start with a list of about 8 to 12 steps, and then you rate each of these steps on a scale from 1 to 10 in terms of how much anxiety they cause you. And so they form a sort of ladder with the least anxiety provoking on the bottom and the one that causes you the most anxiety at the top.

And then you work your way up through these steps, starting by exposing yourself to the ones that cause you the least amount of anxiety, and then going step by step until you make your way up to the top of the ladder. And so if you have a fear of spiders your ladder might look something like this. And notice at the bottom of the ladder we’ve started with just imagining a spider because perhaps anything involving an actual real life spider would be too anxiety provoking for you to be able to even start. And so you need to make sure that the first rungs on your ladder are manageable.

Or if you have social anxiety your ladder might look something like this.

And then once you’ve come up with your exposure ladder you start by exposing yourself to whatever’s on the bottom step of the ladder. And when you’re exposing yourself you want to feel a little bit of anxiety, up to about a three, but anything higher than that can be too much to start with now when you first expose yourself to something.

Your anxiety might spike a bit, so you want to be prepared for this initial surge of anxiety, and then if you do experience an increase in anxiety try some anxiety reduction techniques and then see if your anxiety starts to come back down to a 3 out of 10 or less.

But if your anxiety stays at a level of four or above then you don’t want to continue with the exposure because it’s causing you too much anxiety right now and it’s going to be a negative experience is going to increase the amount of anxiety that you associate with this step, rather than be a habituating experience that makes you more comfortable with this step.

So if your anxiety stays elevated then it’s time to do the three r’s: retreat, recover and repeat.

So first you retreat. And what this means is simply that you stop doing the exposure for now.

And then you recover and give yourself a chance to calm down until you’re not feeling anxious anymore.

And then you repeat and you start the exposure again.

And you continue with these steps of retreat, recovery and repeat as often as you need until your anxiety no longer rises above a three. And continue with your exposure to this step until you become habituated to it and your level of anxiety drops to below a three and then you’re ready to move on to the next step, which may have been a four out of ten before. But now as you’ve started to climb that ladder it’s now only a three out of ten which is low enough for you to expose yourself to that.

And you keep working your way up the ladder until you’ve habituated to each of these steps.

And eventually you become comfortable even with that step at the top of the ladder which may have caused you a 10 out of 10 on the anxiety scale before and now it’s down to a much more manageable level of about a three.

And so by gradually exposing ourselves to what’s making us anxious we can conquer even our biggest fears without ever getting too far out of our comfort zone.

In the next couple of posts, we’ll look at how we can manage and regulate our emotions. If you have any questions or comments about this post, please leave them on the YouTube video page.