The Behavior Therapy Element of CBT

Cognitive behavioral therapy (CBT) consists of two components: the cognitive part (our thoughts) and the behavioral part (our actions and behavior). CBT focuses on how changing the way we think and changing the way we act can change the way we feel and help us feel better. We’ve looked at the cognitive aspect of CBT. Now we’re going to focus on the behavioral part.

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

Cognitive behavioral therapy consists of two components: the cognitive part (our thoughts) and the behavioral part (our actions and behavior). CBT focuses on how changing the way we think and changing the way we act can change the way we feel and help us feel better. I have a number of videos that look at the cognitive aspect of CBT that I’ll link to in the description and that you’ll find in my free CBT self-help course. In this video, we’re going to focus on the behavioral part.

The most common behavioral technique in CBT is the original type of behavior therapy, exposure therapy, developed in the 1950s based on Pavlov’s work on classical conditioning. Exposure therapy was conceived as a treatment for what’s known as specific phobias: fear or anxiety about a specific object or situation, like flying, heights, or animals, as well as agoraphobia, which is a fear or anxiety about being in a situation in public where you feel trapped or unable to escape in the event that you start to feel panicky. I describe exposure therapy and how it works in detail in another video that I’ll link to in the description, but the basics are: we usually try to avoid the things that we fear or that make us anxious, which tends to make us fear them even more and increases our anxiety about them.

With exposure therapy, we gradually expose ourselves to our fears and anxieties in a controlled manner, which helps reduce our fear and anxiety, and eventually, we can extinguish our fear, and these things no longer cause us anxiety or distress. Even though it dates back to the 1950s, exposure therapy is still the most effective treatment for phobias.

The most effective treatment for obsessive-compulsive disorder is a type of exposure therapy called exposure and response prevention, in which we gradually expose ourselves to situations that trigger our obsessive thoughts that lead to compulsive behaviors while preventing ourselves from engaging in these compulsive behaviors until we learn that the situations we’re obsessing over are generally safe and not something we need to be concerned about. We don’t need to engage in these compulsive behaviors or rituals to prevent the consequences we fear or to manage our anxiety and worries about them.

One of the most effective treatments for PTSD is a type of exposure therapy called prolonged exposure, in which we gradually expose ourselves to memories of the traumatic event until these memories no longer cause us stress and expose ourselves to real-life situations related to the trauma until these no longer cause us anxiety or distress.

There’s also interceptive exposure for panic attacks, which involves exposing ourselves to the physical symptoms associated with our panic attacks to learn that these symptoms aren’t dangerous or anything to fear. We may spin around until we’re dizzy, exposing ourselves to this feeling of dizziness until we learn that this feeling is nothing to panic over – it doesn’t mean we’re having a stroke or about to pass out. Or we might induce a racing heart with some rigorous exercise until we learn that symptoms like a pounding heart and gasping for breath don’t mean that we’re having a heart attack. By exposing ourselves to the physical symptoms we experience during a panic attack, we learn that we can have these feelings without anything bad happening, which makes it less likely that they trigger a panic attack.

The other main type of behavioral therapy in CBT is behavioral activation for depression. When we’re depressed, we tend to withdraw from the world and lose interest in activities we used to engage in and enjoy and can really limit how much we do. Behavioral activation involves gradually increasing our levels of activity and starting to do more and taking part in activities that can give us a sense of pleasure or enjoyment, a sense of achievement or accomplishment, and a sense of social connection and closeness to others.

So even though when we’re depressed, we might not have the desire to do anything or feel like we have the energy to do anything, and just want to lie in bed or lie around on the couch all day, once we change our behavior, get up, and start doing something no matter how small, we generally start to feel better, and our depression starts to lift, and we start to have more energy and are able to continue increasing our levels of activity until they’re close to back to what they used to be, and we no longer feel depressed.

Other behavioral interventions in CBT include things like relaxation exercises and breathing training, role-playing and assertiveness training, so learning how to behave differently in certain situations, sleep hygiene, and so on.

So how do we get from behavioral therapy to cognitive-behavioral therapy? Well, while exposure therapy is primarily a behavioral technique, it now usually incorporates a cognitive element as well to help consolidate the learning that takes place during an exposure exercise, in which we assess what we learned as a result of the feared outcome not arising, and the discrepancy between what we feared was going to happen and what actually occurred.

And the most common intervention in cognitive therapy, cognitive restructuring, is often used in combination with behavioral experiments in which we expose ourselves to real-life situations to see what actually happens in order to test the accuracy of our thoughts. So if we’re having thoughts like “I’m such a loser, I don’t have any friends,” a behavioral experiment could involve asking some people we know if they want to do something with us, and if anyone says yes, that’s evidence that our thought “I don’t have any friends” may not be that accurate, and I have a whole video about behavioral experiments that I’ll link to in the description.

Now let’s look at some cognitive-behavioral therapies for specific disorders to see how they combine cognitive and behavioral elements.

So CBT for panic disorder can include behavioral approaches like exposure to situations in which we tend to feel panicky, as well as interoceptive exposure to physical symptoms that cause us to panic, and breathing exercises to help slow down our breathing when we do start to feel panicky, and it also includes the cognitive technique, cognitive restructuring, to help counter the catastrophic thoughts we have during a panic attack.

CBT for depression combines behavioral activation with cognitive restructuring to help us recognize cognitive distortions and modify negative patterns of thinking, and so we improve our moods both by changing our behavior and how we act, as well as changing our thoughts and how we think.

CBT for insomnia involves cognitive restructuring to counter negative thoughts about difficulty sleeping, as well as behavioral techniques such as relaxation exercises, scheduling sleep into a regular routine, and sleep hygiene strategies, and I talk more about CBT for insomnia in a couple of other videos that I’ll link to in the description.

CBT for social anxiety disorder combines graded exposure to fear and anxiety-provoking social situations with cognitive restructuring of negative thoughts and cognitive distortions related to social interactions, as well as attentional retraining and attention training.

Social anxiety is associated with what’s known as attentional bias, and during social interactions, we tend to focus a lot of our attention on ourselves, on our thoughts about our performance, and on our emotions and body sensations, as well as on looking for social threats in our environments, which could involve scanning the room for cues about what other people are thinking about us, or focusing our attention on the person we’re talking to is facial expressions or behaviors for signs that we might be boring them or that we’ve said something to offend them.

Attentional retraining and attention training involves learning to shift our attention away from our own thoughts, emotions, and body sensations, and away from looking for social threats in our environments related to what other people may be thinking about us. Instead, keeping our attention focused on our actual social interactions and our conversations with other people. I’ll have a video that looks at how to treat social anxiety disorder in more detail coming out soon, so please subscribe so you don’t miss it, and I’ll put a link in the description once it’s out.

Attention training is related to mindfulness, and elements of mindfulness are now often incorporated into CBT either as an additional component to CBT, or integrated with CBT on a fundamental theoretical level, as in the case of mindfulness-based cognitive therapy, dialectical behavior therapy, and acceptance and commitment therapy. To learn about a behavioral technique that plays an important role in managing and regulating emotions in dialectical behavior therapy, please check out my video on opposite action.

In these therapies that incorporate mindfulness with CBT, they are often referred to as the third wave of CBT. The first wave being behavioral therapy, the second wave involving the addition of cognitive therapy to behavioral therapy to form cognitive behavioral therapy, and then this third wave that also integrates mindfulness with CBT. I’ll talk more about the third wave of CBT in an upcoming video.

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

Change How You Think, Change How You Feel With CBT

One of the basic premises of cognitive behavioral therapy (CBT) is that our thoughts determine our moods and emotions and how we feel. And if we can change our thoughts and change the way we think, then we’ll also change the way we feel, and as a result improve our moods, calm our emotions, and relieve symptoms of things like depression and anxiety.

Changing Negative Thoughts in CBT

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One of the basic premises of cognitive behavioral therapy is that our thoughts determine our moods and emotions and how we feel. And if we can change our thoughts, change the way we think, then we’ll also change the way we feel, and as a result improve our moods, calm our emotions, and relieve symptoms of things like depression and anxiety. And we looked at all of this in a previous video that I’ll link to in the description. And in this video we’re going to look at some characteristics of the new thoughts we want to replace our negative thoughts with. And then we’re going to go through some examples.

When we’re trying to change our thoughts in order to improve our moods and how we feel there are three main things we’re looking for in our new thoughts. Now one is that our new thought needs to be less negative than our original thought.

Our thoughts that contribute to our negative moods and emotions tend to be not just negative, but negatively biased. We’re looking at things from a very negative perspective and often seeing them in the most negative light possible. I’ll never get all of this work done and I’ll probably lose my job.

And so in order to improve our moods and how we feel our new thoughts don’t necessarily need to be positive, like this will be no problem and I’ll be done in no time. They just need to be less negative than our original, negatively biased thoughts. So maybe something like, it’s going to be a rough week and I’m not sure how I’ll finish everything, which isn’t really that positive, but it’s less negative than our original thought.

And the new thought needs to be believable. We have to be able to believe this new thought at least as much as the old thought. Because even if it’s negatively biased, we do believe our original thought, so we also need to be able to believe the new thought we’re trying to replace it with. And it helps if we can believe the new thought even more than the original thought, otherwise the old thought will tend to keep coming back up.

In order for us to be able to believe the new thought it needs to be accurate. At least as accurate as our original thought. Because even if our original thought is negatively biased we regard it as being accurate. And so it helps if our new thought can be even more accurate than the original thought in order for us to be able to convince ourselves that our new thought is more believable than our old thought.

So let’s look at some examples. If we’re worried about something that’s coming up and think, this is going to be terrible, I’m not going to be able to cope with it, we’re going to start feeling anxious.

And if we try to change our thought to something like, don’t worry, it’s going to be great, I’m going to love it, well that’s definitely less negative. And if we can actually get ourselves to think that, we’re probably not going to be anxious anymore. But can we actually believe this? Probably not.

When our thoughts are negatively biased, if we try to modify these thoughts but make our new thoughts equally biased in the opposite direction, it’s not going to help. Because not only won’t we believe these new thoughts if they’re overly positive, we can even make ourselves feel worse trying to make ourselves believe them and not succeeding.

So related to whether or not we can believe a modified thought is that the new thought needs to be at least as accurate as our original thought. Because we’re not going to be able to trick ourselves into believing something we don’t actually think is true. And in most cases the new thought will need to be more accurate than our original thought in order for us to change our minds and adopt the new way of thinking.

So what about something like, it’s not that big a deal and everything’s going to be fine in the end. A thought like that is certainly less negative and would reduce our anxiety. And it’s probably more accurate than our original thought. Things usually aren’t as bad as we’re worrying they’ll be and we usually do cope better than we think we will.

But even if this new thought is a little more accurate, that doesn’t mean we’ll actually believe it. It might still require too big a leap of faith especially if we’re already feeling anxious. And so we might settle on something in between that and the original thought like, it’s going to be difficult but I’ll get through it. Which is less negative than our original thought, and probably more accurate. And now maybe something we can actually believe. And as a result of this new way of thinking we decrease our level of anxiety, even though we’re probably still feeling somewhat anxious.

Or another example. Let’s say we’re having a bad day and start thinking something like, I’m such an idiot. I can’t do anything right. Nothing ever goes my way. And then we start feeling sad or depressed. So what if we change this thought to, I’m actually pretty smart, and I’m good at a lot of things, and things generally do work out for me.

That’s certainly a lot less negative and it’s going to help us feel less sad or depressed. And how accurate is it? It’s probably more accurate than the original thought. And can we actually believe it? Well if we’re feeling really down probably not. Or maybe it makes sense and we believe it on an intellectual level. But deep down it doesn’t really resonate with. Us especially when we’re feeling this way. And we might be able to think it for a while, but in the end our original thought will come back again and drown this one out.

So instead maybe we think, i’ve been messing up a lot lately and things haven’t been going my way. And that’s certainly not a positive thought. But it is less negative than our original thought. And it’s also more accurate. And so maybe we can believe something like this.

And even though it’s not a particularly happy thought that’s going to make us stop feeling sad or depressed, it’ll probably improve our moods a bit, or make our feelings and emotions a little less strong or intense, or maybe it just helps prevent us from feeling even worse. And either way any of these is a step in the right direction

So there is no one right way to think in any situation. There are a range of thoughts we can have. And the more we’re able to find thoughts that are on the less negative end of the spectrum, that we can believe, the less sad or depressed or anxious or stressed or angry we’ll feel.

And unfortunately there isn’t a manual we can refer to that tells us, if I’m feeling anxious because I’m thinking x, I just need to start thinking y and then I’ll start feeling less anxious. Because what I can believe about me and my situation, will be different than what you can believe about yourself and your situation, which will be different than what someone else can believe about themselves and their situation.

And so changing our negative thoughts can be challenging, because in the end we need to come up with our new less negative thoughts for ourselves, because that’s the only way to ensure that we can believe them. Someone else’s thoughts or suggestions won’t necessarily resonate with us.

And it can often be hard to see things in a less negative light. But there are some techniques that can help us come up with less negative ways of thinking, and to make these new thoughts more accurate and more believable than our original negative thoughts. This process is called cognitive restructuring or cognitive reappraisal, and I have a number of videos that describe how we can do this as well as some worksheets to help guide you through the process.

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 the first post in this course. 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.

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

CBT and Exposure Therapy for Anxiety

When we’re anxious about something, it’s natural to want to avoid it. But avoidance is only a short term solution. Eventually we to need to face our fears. And the longer we’ve been putting something off due to anxiety, the more anxiety we’ll feel when we have to do it. Or we may be able to avoid something that’s causing us anxiety altogether this time. But then the next time we’re in a similar situation, it’s going to cause us even more anxiety.

In CBT, exposure therapy is an important B-for-behavioral technique to combat avoidance behaviors and reduce anxiety. Exposure therapy involves exposing ourselves to whatever is making us anxious, rather than avoiding it. And as we start to expose ourselves to the source of our anxiety—in other words, when we do things that cause us anxiety—we learn that these things aren’t as threatening or dangerous as we fear. Our predictions about the negative consequences that we expect are going to happen usually don’t occur or aren’t as bad as we feared. And even if we do experience uncomfortable emotions such as anxiety we’re able to tolerate it. And as a result the situations begin to provoke less anxiety.

Exposure Therapy for Anxiety

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Exposure therapy is a type of behavior therapy that’s an important component in treating many types of anxiety as well as PTSD.

When we fear something or something causes us anxiety, our natural inclination is to want to avoid it. And avoidance can provide some short-term relief. As long as we can avoid whatever we’re afraid of, there’s nothing to feel anxious about. But in the long term, avoidance only increases our fear and anxiety because each time we avoid something that we’re anxious about, we’re reinforcing the idea that this thing is scary and dangerous. So we begin to fear it even more, and it causes us even more anxiety.

Avoiding things we’re anxious about deprives us of the opportunity to have new experiences and new learning that teach us that these things aren’t as threatening or dangerous as we fear. And that even if we do have some anxiety while we’re in these situations, it’s okay to have some anxiety. It’s uncomfortable, but anxiety itself isn’t dangerous, and we’ll get through it. We don’t need to avoid things just because we’re going to feel anxious while we’re in those situations.

Now the opposite of avoidance is exposure. Instead of avoiding the things that make us anxious, we expose ourselves to them. Put ourselves in those situations, and as we do this, they start to cause us less fear and anxiety.

There are a couple of ways of doing exposure therapy that we’re going to look at in this video. The traditional method involves what’s known as graded or graduated exposure. We make a list of about eight to ten situations related to what we fear or are anxious about, and then rank them into a fear hierarchy or ladder based on how much fear, anxiety, or distress they each cause us. Then we gradually expose ourselves to our fears by starting with a situation that causes us the least amount of anxiety and working our way up the list.

Now most of you watching this video aren’t going to set up experimental exposures to practice putting yourselves in situations that cause fear and anxiety. But these situations arise naturally in our lives, and we can still apply the things we’ll learn in this video, especially with regards to the second type of exposure therapy we’ll be talking about to everyday situations to help decrease the amount of fear and anxiety they cause us over time.

So each exposure exercise involves putting ourselves in one of the situations from our exposure list and then staying in that situation until our fear begins to subside and we experience some level of reduction in anxiety. And we repeat each exposure situation until it no longer causes us significant fear or anxiety, and then we move on to the next item in the list.

This is known as habituation-based exposure, and habituation is the process through which we experience a decrease in our fear or anxiety responses as a result of repeated exposure to a situation or stimulus. As we become less sensitive to it, we get used to it.

And there are three types of exposure. In Vivo, we simply put ourselves in real-life situations that cause us fear or anxiety. If we have a fear of dogs, we put ourselves in a situation where there is a dog.

Now, with imaginal exposure, we don’t actually put ourselves in a situation. We imagine the situation. This is common in treating PTSD. Imaginal exposure helps us process traumatic experiences in a safe and controlled environment, revisiting the traumatic event in our minds and imagining it in detail. This helps us gradually reduce the distress and anxiety associated with traumatic memories.

Interceptive exposure involves exposing ourselves to physical sensations in our bodies that cause us fear and anxiety. Usually, these are sensations that lead us to start panicking. So we might do some exercise that increases our heart rates and leaves us short of breath to help us learn the symptoms we have when we’re feeling anxious, like a racing heart or shortness of breath. This teaches us that these symptoms don’t necessarily mean we’re having a heart attack. Or we might spin around until we’re feeling dizzy to teach us that feelings of dizziness don’t mean that we’re having a stroke or about to pass out.

But if you’re not sure that your physical symptoms are the result of anxiety and are concerned there may be an underlying medical condition, then please consult a medical professional before trying interceptive exposure.

Recent research suggests that habituation isn’t the most effective or reliable way to reduce anxiety through exposure, and there’s been a shift towards what’s known as inhibitory learning-based exposure. Inhibitory learning involves new learning that takes place during the exposure that inhibits or suppresses our previously learned fear or anxiety response in that situation. Our goal isn’t to experience a reduction in anxiety during the exposure, although that may happen. Instead, there are two main things we want to accomplish: we want to violate our expectations about what we fear is going to happen, which leads to new inhibitory learning that inhibits or suppresses our previously learned fear and anxiety responses to these situations that stem from our beliefs that these situations are threatening or dangerous. And we want to learn that we can still do things even if they cause us some fear or anxiety.

We can apply this inhibitory learning-based approach to fear and anxiety-provoking situations that arise naturally in our lives to help learn new ways of thinking about these situations that lead to a reduction in our fear and anxiety responses. So keep that in mind as we look at the formal process of inhibitory learning-based exposure therapy.

So let’s look at how this works in practice using social anxiety as an example. First, we come up with a list of exposure exercises related to our social anxiety. With traditional exposure therapy, we would rank these situations based on how much distress they cause us and then start from the one that causes us the least amount of distress and then work our way up the list in order. But now it seems to be more effective if we go through the list in a quasi-random order.

We can still start with the situation that causes us the least amount of anxiety if that makes it easier for us to get started, or we can prioritize situations that seem most important or relevant to us. So, if we’ve been criticized at work for not speaking up enough at meetings, we might prioritize doing an exposure exercise related to this, even though it may cause us a great deal of anxiety compared to some of the other items on our list, like talking to a cashier, which may not seem like a particularly valuable situation for us to prioritize.

So now, let’s go through some examples of inhibitory learning based exposure for social anxiety, and you can download a copy of an exposure therapy worksheet that guides you through this process from the link in the description. Let’s say our anxiety prevents us from attending a lot of social events that we’d like to go to because we’re just too uncomfortable being around people we don’t know, and we decide that talking to someone we don’t know in a social setting would be a useful exposure exercise to prioritize, even though the thought of it causes us a lot of anxiety.

So first, we need to set a specific and measurable goal for the exposure, not just something like, “next time I’m at a social event, I’m going to try to talk to people I don’t know,” but something like, “at Mia’s party this weekend, I’m going to talk to two people I don’t know for at least five minutes each.” We want to make sure that the goal is something we expect is going to be challenging because we want to give ourselves a chance to violate our expectations about what’s going to happen as much as possible because that’s going to lead to the greatest amount of learning.

So, something like, “I’m going to say hi to someone I don’t know, and then if I’m feeling uncomfortable, I can excuse myself to go to the restroom,” isn’t going to be that productive. First, because we don’t expect that anything that bad is going to happen, so there’s not that much opportunity for inhibitory learning to take place. Second, we’re getting out of the situation as soon as we start to feel uncomfortable, so we’re depriving ourselves of the opportunity to learn that it’s okay to have some anxiety in these situations, that we can tolerate this anxiety, and it’s not something we need to avoid.

Then we predict what’s going to happen and write down our expectations and the feared outcome or outcomes we’re most worried about, and the feelings and emotions we’re worried that we won’t be able to tolerate. “I’m going to feel so anxious it’s going to be difficult for me to speak properly,” “My anxiety will be so bad I’ll start having a panic attack,” “I’m not going to have anything to talk about, and the other person is going to get so bored they’ll make an excuse to get away from me before the five minutes are up.” Then we rate on a scale from zero to a hundred how much we expect that these outcomes will actually happen.

Then we do the exposure, and afterwards, we compare our expectations of what we thought was going to happen with what actually happened. The first conversation went on for a couple of minutes, and then someone they knew joined us, and I felt a little awkward and didn’t have much to say after that, but they didn’t abandon me or seem to mind that I was still there. The second person I talked to turned out to have some friends in common with me, and so we talked about them for a while, and after some initial anxiety, I felt pretty comfortable once we started talking.

And were we able to tolerate the distress? I felt anxious but not so anxious that it was hard to speak. I did feel pretty anxious a couple of times but never close to panicking.

And how was this outcome different from what we expected? I felt anxious but not as anxious as I thought I would, and my anxiety never made it difficult for me to get my words out. Once we started talking, the other person was really friendly and easier to talk to than I feared.

And what did we learn from this experience? Even when anxious, I’m able to carry on a conversation with someone I don’t know, and once we start talking, I start to feel more comfortable. I didn’t really need anything that interesting to talk about; we just talked about random stuff, and it was fine. So through this exposure, we’ve experienced quite a bit of discrepancy between the bad things we feared and expected were going to happen and what actually occurred. This learning will help inhibit our fear and anxiety responses in similar situations in the future. We can apply this process to situations that arise naturally in our lives: look at what we expected was going to happen in a situation we were having some fear or anxiety about and how that was different from what actually happened, and then ask ourselves what we can learn from this result that can help reduce our fear and anxiety in similar situations in the future.

And here’s an example from an article I’ll link to in the description that has examples and case studies of how to use exposure therapy to treat a wide range of issues, and also covers everything we talk about in this video in much more detail. I like this example because it demonstrates the type of exposure exercise that might not occur to us on our own to help test the hypothesis that the emotions we’d experience in certain types of situations would be intolerable and therefore need to be avoided at all costs. In this case, the emotion being embarrassment or humiliation in public. So the goal of the exposure is to ride the elevator at the local mall for 30 minutes, calling out the number of each floor in a loud voice.

What are we worried will happen? People will look at me angrily and ask, “What’s wrong with you?” I’ll feel so humiliated and embarrassed I’ll start crying and have to run out of the elevator.

And then we do the exposure, and afterwards we look at what actually happened. When I called out the floor numbers, some people looked over at me with a confused look on their face, but nobody seemed angry, and most people just kept their heads down and ignored me. I did feel really embarrassed and humiliated, but not to the point of crying, and I was able to stay in the elevator the whole time.

How is this different than what I’d expected? Well, people seem more confused than angry, and nobody said anything to me, and most people just ignored me altogether. And even though it was really humiliating to embarrass myself like that, and I did feel really uncomfortable, I was able to tolerate these feelings and stay in the elevator until the end of the exercise.

And what did I learn as a result of this exposure? Even if I do something really embarrassing in public and humiliate myself, it’s not the end of the world. And this exercise seems way more embarrassing and humiliating than anything that would actually happen in real life. So if I can get through this, I can get through whatever embarrassment or humiliation I may experience in the course of any sort of typical real-life situation.

So as a result of this exposure exercise, we’ve experienced new learning about the effects of feeling embarrassed or humiliated in public, which has taught us that these experiences are actually tolerable. So in the future, if we find ourselves in situations in which we fear we may be embarrassed or humiliated, or if we do in fact embarrass or humiliate ourselves, this new learning will help inhibit or suppress our previously learned fear or anxiety responses regarding these types of situations or these emotional responses.

Exposure is an important component in treating many types of anxiety, as well as PTSD, because it gives us the opportunity to learn that the bad things that we fear or expect or predict are going to happen in certain situations usually don’t actually happen or aren’t as bad as we’d worried they’d be, which helps inhibit and suppress our fear and anxiety responses in these situations. And we learn that we can still do things even if they cause us some fear or anxiety, and so we don’t need to avoid things, especially things that are important to us, just because they provoke fear or anxiety.

Here’s a great article that goes in to a lot more derail about inhibitory learning based exposure along with a number of case studies, and you can download the Exposure Therapy Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd ed.). The Guilford Press.

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5–27.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.

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.


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

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

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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

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

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.