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

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

If you find yourself feeling stressed or anxious a lot of the time, or are struggling with low self-esteem or depression, one of the reasons could be all or nothing thinking. In this video we’re going to learn all about all or nothing thinking: what it is, why it can be such a problem, and what we can do to reduce our all or nothing thinking so that it doesn’t have such a negative impact on our lives.

All or nothing thinking is a type of cognitive distortion. Cognitive distortions are exaggerated and negatively biased patterns of thinking that distort reality and lead us to perceive or evaluate situations and experiences inaccurately. I have a video that describes a number of different types of cognitive distortions that I’ll link to in the description. But i wanted to make a video just about all or nothing thinking because it’s one of the most common cognitive distortions and it can negatively affect us in a lot of different ways.

So when we engage in all or nothing thinking, we see things as black or white with no shades of gray in between. Things are either all good or all bad. If we don’t do something perfectly, we failed. If we don’t accomplish everything we’ve set out to do, we’ve done nothing. Someone makes a mistake or disappoints us and they’ve let us down completely. All or nothing thinking arises in all sorts of contexts so let’s look at some examples.

All or nothing thinking often involves how well we do at something. Either we completely succeed—we ace the test, we come in first place, we get a promotion at work—or we’ve completely failed. We get a b plus when the class average is a c, but because we didn’t get an a plus, as far as we’re concerned we might as well have gotten an f. Or we come in second place with a personal best, but because we didn’t come in first who cares that means nothing. We get a raise, but someone else gets the promotion we wanted, so our careers are going nowhere and we’re terrible at our jobs.

All or nothing thinking can also involve how much we accomplish. If we don’t complete everything we’ve set out to do today, then we’ve achieved nothing. We had 10 things on our to-do list but since we only knocked off eight, what a waste of a day, we got nothing done. Or we were going to clean the kitchen tonight, but after we did the dishes and put them away and wiped the counters and cleaned the sink, we were too tired and had to be up early the next day. So we went to bed before we got around to sweeping and mopping the floor, so we’re just so lazy. Or we cleaned the whole kitchen but it’s not spotless so we might as well not bothered cleaning it at all.

And all or nothing thinking doesn’t allow for any understanding or compassion or mistakes. We get impatient with our children and we’re terrible parents, even if it’s just one lapse over a stressful day in which we handled everything else really well. And we can apply our all or nothing thinking to other people. Someone does us a favor but they forget one thing and so it’s like they’ve done nothing. Someone makes one small mistake on a project at work and they’re completely useless.

So what’s the impact of all or nothing thinking? Well when we apply all or nothing thinking to ourselves, we put so much pressure on ourselves to hit that all level, that we can push ourselves too hard, which can leave us feeling really stressed out or give us a lot of anxiety. And when we don’t accomplish or achieve all, we come away feeling like we’re left with nothing, which can damage our self-worth and self-esteem and can leave us feeling depressed. And when we apply our all or nothing thinking to other people, it can damage personal and professional relationships.

And all or nothing thinking can lead to procrastination, because we know it’s going to be so much work to try to hit that all, all of the time, that we can’t even bring ourselves to get started.

And all or nothing thinking can make it harder for us to achieve our goals, because we give up halfway through when we realize all is no longer a possibility. And so since we’re ending up with nothing, we might as well save ourselves the effort and just give up now. I wasn’t going to drink on weeknights anymore, but i had a glass of wine with dinner so i’ve ruined today and i might as well just finish the rest of the bottle.

So what can we do about our all or nothing, black and white thinking? Well the simple answer is to learn to recognize some shades of gray in between, and to see things along a spectrum rather than on a binary scale. So how do we get ourselves to do this?

Sometimes a helpful first step can be to find a good enough compromise in between all or nothing. We can strive to get ten things done, but seven is going to be good enough. We don’t have to do the next three if we don’t feel like it. We can aspire to achieve the equivalent of an a or a plus on whatever we’re working on, but once we reach a b or b plus level that’s good enough, and we don’t need to worry about getting that extra bit of improvement if it’s going to take too much effort, be too stressful, and cause us a lot of anxiety trying to get there. And it also makes it less likely that we fail in ways that damage our self-esteem and can lead to depression.

But that’s only half the story, because it’s still not really seeing shades of gray. It’s just a single shade of gray in between black or white, which means that if we don’t hit that compromise not quite all but good enough level, we still can end up feeling like it’s nothing.

But achieving c level work instead of b or a plus, getting five of our ten things done instead of seven or ten, is still not nothing. Sometimes that’s all we’re able to do. Sometimes we could do more but the costs in terms of stress or anxiety are too high. And sometimes we could do more, but we choose not to because there are other things going on in our lives that also need our time or attention, or that we just want to do instead. And that’s okay.

So in order to recognize the shades of gray in between black and white, and to be able to accept results and outcomes across a whole spectrum of possibilities, instead of focusing on what we didn’t do, what we didn’t accomplish, what we didn’t achieve, we need to learn to reframe things in terms of what we did do, what we did accomplish, what we did achieve, even if it’s not everything or all we set out to accomplish or achieve. And as long as we can name just one thing, then we’re no longer at nothing. And maybe we didn’t do as well or as much as we’d hoped or wanted or expected, but at least we did something. We barely got started on our to-do lists, but at least we replied to that one email we’ve been putting off for days.

And even those times when it feels like we didn’t do anything, we probably did do at least something. We finished some tasks for work, and even if we didn’t do a really good job, at least we got it done. Or at least we got part of it done. And sometimes these things may not seem like a lot, and they’re certainly not all, but they’re still not nothing.

And even if we spend all day lying on the couch watching tv or, in front of our computers watching YouTube videos, well maybe what we accomplished is that we gave ourselves a bit of a needed break. We took some time to look after ourselves, to reduce the stress and anxiety in our lives, and made it easier on ourselves to get back to doing more things tomorrow.

And even if we do achieve or accomplish so little that it might as well be nothing, that doesn’t make us bad people. When this happens there are reasons it’s happening. Maybe we’re just too tired, don’t have the energy, or are feeling too discouraged or depressed to be able to bring ourselves to do much of anything. And so in these cases we need to try to extend ourselves some compassion and understanding, rather than beating up on ourselves and feeling bad. Because when we don’t achieve or accomplish whatever we set out to achieve or accomplish, being too hard on ourselves serves no purpose. It’s just not helpful.

We often feel like we need to be hard on ourselves in order to push ourselves to do more and to reach our potentials. And while this attitude may be able to provide some motivation in the short term, in the end it catches up with us, because it increases our stress and anxiety, which eventually can become too much for us to manage, and it’s discouraging it can damage our self-worth and self-esteem and can leave us feeling depressed all of which make it more difficult for us to do things in the future. So if we don’t achieve or accomplish all that we set out to do, or even most of it, it’s much better to be understanding with ourselves, and learn to practice some self-compassion and self-acceptance.

And if we need to do better next time, being kind to ourselves now is not going to prevent this. It’s not going to get in the way. But if we adopt an attitude of, I’m such a failure, i can’t do anything right, i got absolutely nothing done, well that can get in the way because it’s so discouraging and demoralizing it can affect our motivation, damage our self-confidence and self-worth and self-esteem, which can negatively impact the quantity and quality of work we’re able to do.

Now we can still acknowledge if we didn’t try our best, if we could have done more, or could have done better, without being too self-critical and putting ourselves down. And maybe we do have to do better next time, but beating up on ourselves isn’t going to help us do that. And then instead of being self-critical and beating up on ourselves, we can reflect on anything we did accomplish—anything we did achieve, anything that went well—and try to find ways to do more of that in the future. And then look at what didn’t go so well and figure out what we need to do differently next time so that things go better.

And everything we’ve just talked about regarding ourselves applies to our interactions with other people as well. Holding others to strict all or nothing standards can damage personal and professional relationships, and doesn’t really encourage people to change their behaviors, and instead tends to lead to conflicts or just leaves them feeling discouraged or resentful.

So if we’re able to shift our mindsets away from all or nothing thinking, and recognize that accomplishments and achievements occur across a broad spectrum rather than just on a binary scale, we’ll be able to do more and perform better, while reducing the amount of stress and anxiety in our lives, and making it less likely that we become depressed, while improving both our personal and professional relationships.

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

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

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

One of the main premises of both cognitive behavioral therapy and dialectical behavior therapy is that our emotional reactions start with a situation or event, that leads to certain thoughts and behavior, and it’s these thoughts and behaviors that are responsible for the emotion we feel. And we focus on changing these thoughts and behaviors in order to change the way we feel.

But if our thoughts are accurate and reflect reality, and our behavior is appropriate for the situation we find ourselves in, then there may not be much we can do to change our thoughts and behavior in order to help ourselves feel better. Or maybe our thoughts about a situation aren’t that accurate and we haven’t been acting in the most effective way to try to cope with things, but we’ve tried changing our thoughts and behavior and just haven’t had much success. So instead we focus on changing the situation that triggered these thoughts and behaviors in the first place. And we do this by problem solving and then coming up with an action plan.

So the first step in problem solving is to identify and then define or describe the problem or the situation that’s causing the problem. So for example, we’re feeling lonely or sad because we’ve just moved to a new city and we don’t really know anyone here yet. Now being lonely or sad in this situation is a natural way to feel, and so trying to change our thoughts about the situation probably isn’t going to be that successful or help that much.

And assuming our behavior isn’t contributing to the way we feel—for example we’re not just isolating ourselves and lying around on the couch when we’re not at work, we’re actually doing some activities and trying to meet people, we’re just not having much success—there may not be much about our behavior we can change that’s going to have an effect either.

So instead we need to engage in problem solving, and figure out a way to change the situation so we’re no longer feeling so lonely and sad. So the next step is to identify our goal in solving the problem and what needs to happen in order for us to start to feel better. And we want to keep the goal simple and realistic, and choose a short-term goal, because we want something that can start giving us some results right away.

Now if we think the solution is make lots of new friends here so I don’t feel so lonely all the time, well that’s a great goal, but it’s not something that’s going to happen right away. So instead, something like meet one or two new people here I can spend some time with. Then we come up with possible solutions or options to help us reach our goal. And we just brainstorm these, writing down as many things as we can think of without worrying about evaluating them yet.

And then we read over our entire list and select the best solution we’ve come up with. And if it’s not clear which option is the best solution, we can choose two or three and compare them with each other using a pros and cons list. So let’s say the solution we choose is to get involved with a group of people here with similar interests to our own and try to make some friends among them. So once we’ve chosen a solution to help us reach our goal we need to come up with a plan to implement that solution.

The key to creating a good action plan is to break it down into as many small steps as possible, so that each individual step is manageable. The biggest reason an action plan fails is that at some point, one of the steps creates a barrier we just can’t get around. And often it’s the first step that’s the biggest barrier, so make sure the initial step is really, really simple and manageable, because if this first step seems at all overwhelming, we can end up procrastinating and never get around to even trying to start on our plan. And just initiating this first step, no matter how small, often brings with it a sense of relief, because now we feel like we’re finally starting to do something about our problem, and we no longer feel so stuck or hopeless.

And when we come up with a plan we need to be specific about what each step entails and when we’re going to do it. We also want to anticipate possible problems or barriers that might come up, and have strategies ready to overcome them if they do arise. Otherwise it’s easy to get stuck and then just not know what to do next, or become so discouraged that we set aside our plan and stop working towards our goal altogether.

So let’s create an action plan to meet one or two new people where we’ve just moved who we can hang out with sometimes. So the option we evaluated as being the best solution is to get involved with a group of people with similar interests. So maybe we like playing board games and would like to get into a games night group. Or maybe we like sports and want to join a soccer or softball league. So step one is choose an activity.

And step two is to do some research and see what’s out there. Tonight when I get home from work, I’m going to spend an hour looking at the various options available to me. And then step three might be, tomorrow I’m going to evaluate the different options I found and select the one that looks most promising, as well as two others I can use as backup in case the first one doesn’t work out—so anticipating solutions to possible barriers we might face.

And then the next step might be this weekend I’m going to get in touch with a contact person or organizer and find out information about what I need to do to sign up and participate. And then after I hear back from the contact person. I’m going to write out the additional steps I need to take based on what i’ve learned from them. Leading up to the step where we show up at the first games night or practice.

And maybe we have a couple of other steps about strategies to connect with people once we’re there, or if for some reason it turns out our first choice isn’t an option. But we anticipated this barrier so we already have two backup options ready to go so we choose one of these and go back to the step where we contact the organizer and carry on from there.

Now one challenge with action plans is that they can seem really trivial—like do we really need a plan to figure out how to attend a board games night? But at the same time, in a lot of cases, as simple as the plan seems ,there can be issues like anxiety that get in the way of being able to complete it. If we’re an outgoing charming extrovert and want to meet people, maybe we can just show up to a games night and start talking to people and connecting with them. But if we’re more shy or introverted, when we get to the show up step, that can seem like an impossible hurdle to get over.

So part of doing all of the small steps is that it can help us become comfortable with the idea of doing something we’re a little apprehensive about. Each step gives us some exposure to the thing we fear, which can reduce the anxiety we experience when faced with the steps later on in the plan, which is something I talk more about in my video on systematic desensitization. But often we’ll get to the last step and still find it hard to follow through.

So we need to anticipate this barrier and try to have a solution ready. So maybe we could ask a friend to come visit us the first time and go to the board game night with us, so we don’t have to show up alone and we know at least one person there.

Or if we have a lot of social anxiety, maybe we’ve gotten ahead of ourselves, and before we can implement a plan to meet new people, we need to focus on an action plan to manage our social anxiety better. And maybe this entails working with a therapist for a while to learn strategies to overcome social anxiety, which as part of the therapy, could involve a plan to meet new people with the help of a therapist to support us through the steps.

And finally we evaluate the outcome and results of our action plan. And if it worked, that’s great. But if it didn’t, then we need to go back to step four and evaluate our possible solutions again and choose a new option, and come up with an action plan for that, keeping in mind the barriers we face this time, and trying to anticipate solutions to them so we don’t get stuck in a similar way next time around.

So action plans can seem really straightforward on the surface, but when it comes down to acting on the plan, it’s often not that simple. Let’s look at another example.

So let’s say we hate our current job, and the goal we’ve come up with is to find a new job. So we generate an action plan. What more do we need than step one, look at job listings; and step two, apply for jobs. But that’s a pretty common plan people use that often goes nowhere, because although it looks easy, just the thought of changing jobs can seem overwhelming, so we keep procrastinating. So we need to break it down into smaller more manageable gradual steps.

Step one: update my resume this Monday through Wednesday after work.

Step 2: Thursday and Friday after work find the best sites for job listings in my field.

Step 3: start looking at job listings this weekend and bookmark any that look promising and do the same thing every evening this week looking through any new job postings that come up;

Step 4: next week reach out to personal and professional connections to see if they know of any jobs available. I’m going to contact this person on Monday, and this person on Tuesday, and this person on Wednesday.

Step 5: I’m going to reach out to my references on Thursday and Friday next week.

Step 6: start applying for jobs I identified during the week. Apply for at least two jobs over the weekend, and at least two other jobs over the course of the next week.

And this is often where we hit a barrier. Maybe the idea of switching jobs is creating so much anxiety we can’t even bring ourselves to start applying. So then we need to come up with a strategy to manage our anxiety and realize that just because we apply for a job doesn’t mean we’re going to get it. And even if we do get it, that doesn’t mean we need to take it and leave our current job. And we can make that decision when we get there and we don’t have to worry about that yet.

Or maybe the thought of going to a job interview is too stressful and that’s what’s holding us back. So we need to back up and before we get to the apply for jobs step, we need a practice job interview step. So maybe step six, review potential interview questions, step 7 ask someone to do some mock interviews with us, and then step 8 start applying for new jobs.

And remember that changing problem situations is hard so try not to get discouraged if your plans don’t always work out exactly as planned. And if you ever get stuck always look for a smaller intermediate step you can take, even if this step seems trivial and insignificant, because when we hit a barrier or start to lose momentum, the best way to get going again is with a really small simple and manageable step.

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

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

When we’re feeling sad and depressed and just don’t feel like doing anything, acting based on how we feel and cutting back on our level of activity, and spending too much time in bed, or wasting time on the Internet, or not wanting to socialize or make plans with friends, just feeds back into how we’re feeling making those feelings even stronger. But when we’re sad or depressed one of the best things we can do for ourselves is to increase our level of activity. We call this behavioral activation and it’s often the first step in lifting our mood or pulling ourselves out of a period of depression.

Behavioral activation involves starting small and gradually increasing our level of activity. And we focus on three types of activities: activities that give a sense of pleasure or enjoyment; activities to give a sense of accomplishment or achievement; activities that involve some social interaction, which is going to be a lot harder now with everyone practicing social distancing.

As difficult as it can be to imagine something being pleasurable when you’re depressed, just doing anything is usually more enjoyable than isolating yourself, or sitting around just doing nothing. And you might find that activities aren’t as enjoyable as they used to be, or as you’d like them to be, but even things as small as getting out of bed having a shower, eating breakfast, or going for a walk can all make a difference in how you’re feeling. And so it’s important to do at least some small things like this every day to give yourself a chance to feel a little better, or at least help prevent yourself from sinking even deeper.

And when you’re depressed it’s hard to imagine you could do anything that could give you a sense of achievement or accomplishment. But there’s no need to be ambitious. These can be simple things—answering an email, doing the dishes, paying some bills—no matter how small these things may seem they can still give you some sense of accomplishment, which in turn usually helps improve your mood even if just a little bit.

And when you’re depressed sometimes you just want to isolate yourself from people. Socializing can seem impossible, and you can feel like nobody would want to be around you the way you are and you’d just be a burden. But a sense of isolation can be a big contributing factor to feeling depressed, so it is important to find some way to have contact with other people.

Things like going to a party or being with a big group of people can seem overwhelming, so focus on things that are more manageable, whether it’s talking to someone on the phone, or texting with them, going for a coffee, or even just going out by yourself and being around other people. Though obviously these last couple are not good ideas right now which makes staying connected to others during the coronavirus crisis that much more difficult as we need to find ways to socialize that don’t involve physically being around other people. But the more you isolate yourself the more depressed you’re likely to feel, and just having any sort of social interaction can help lift your mood and make you feel a little better.

Now if your mood is really low and you go for a little walk everything’s not going to be sunshine and rainbows all of the sudden, but you’ll probably feel at least a little bit better. And being aware of even small shifts in your mood is important, because when you’re feeling this way it can be so difficult to notice anything positive or have any hope. And so even the smallest improvement in how you’re feeling is worth recognizing because it is a big step compared to not being able to get out of bed or up off the couch and just feeling worse and worse as the day goes on.

And another reason why being more active is so important is because when we’re feeling sad or depressed we tend to ruminate a lot. And research has found that the amount of rumination associated with an emotion is the determining factor in how long that emotion lasts. And because we ruminate so much when we’re feeling sad, sadness is by far our longest lasting emotion, and so anything we can do to cut down on how much we’re ruminating when we’re feeling sad or depressed helps limit how long those feelings last. And even something as simple as going for a walk can help us get out of our heads start ruminating less and as a result our mood starts to improve.

Behavioral activation can often be hard to put into practice because when we’re feeling depressed we tend to be very pessimistic and have lots of negative thoughts, and these thoughts can sometimes get in the way of increasing our level of activity. To help counteract this type of negative thinking and these negative expectations one thing that we encourage with these activities is that you use a behavioral activation diary, which you’ll find a link to below in the description, to help you predict beforehand how much pleasure or enjoyment, sense of achievement or accomplishment, or sense of social connection you’ll get from doing the activity.

And then after you’ve done it record the actual amount of pleasure you got, the actual sense of accomplishment that you felt, and the actual sense of social connection you experienced, as often these will be higher than predicted. And this can help counteract that negative thinking you have that tells you there’s no point in doing anything, why bother, it’s not gonna help, or it’s gonna make you feel worse.

And then this is a way of giving yourself some evidence that even though you don’t want to do anything, can’t see the point in doing anything, when you actually do do something you tend to get more out of it than you think you will. And then this can help motivate you to do more in the future even if your depression and negative thoughts are telling you not to bother.

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.