Supercharge Your Therapy Sessions: 35 Essential CBT Tools for Trauma

0:00 CEUs are available at AllCEUs.com/CBT-CEU everybody and welcome to this video on 35 trauma-informed cognitive behavioral therapy techniques i'm your host dr donnelly snipes as the title implies in this video we're going to review 35 cognitive behavioral therapy tools that can be used to help people feel safer and more empowered now if you're looking for a specific tool there are time stamps down in the video notes just fyi because 35 is a lot of tools so that can help you jump around a little bit more if you need to in terms of the principles of trauma-informed cognitive behavioral therapy the goal is to use people's strengths build on what they're already doing

0:45 help people recognize that they are the experts on their own lives and tools and strategies they've developed in order to cope with stress cope with life until now may not be the most effective may not necessarily be the most helpful like in the case of addictions but they were developed to help that person survive help them see the survivor in themselves we want to help them identify secondary effects of trauma like depression anxiety poor communication skills abandonment anxiety you know there's a whole host of things help them see how that's maybe related to trauma and promote self-care help them develop tools

1:31 so they can start moving toward the rich and meaningful life that they envision the first and most basic tool is a behavioral one and that is to create safety we need to help people feel like they are safe so their hpa access or their threat response system can take a break we don't want to have them feeling constantly hyper vigilant constantly being on guard and have an exaggerated startle response so if we can help them feel safer and at home in the car anywhere else they spend a fair amount of time it's going to reduce the intensity and maybe even the frequency that that stress response system is activated it's going to help their body

2:21 start to recalibrate and that is wonderful when they start feeling empowered when they start looking at environments at places and saying you know what there are things that i can do to help myself feel safe that is huge now there's a lot of types of safety though and we need to help them create a sense of physical safety from self and others now physical safety from others is pretty obvious we want them to not be afraid that they're going to be assaulted or hurt in some way physically by another person but safety from self is also important we want them to feel like they have tools to deal with overwhelming emotions so they don't engage in

3:10 self-injurious behavior or addictive behaviors or other behaviors that could potentially be destructive affective or emotional and cognitive safety from self and others is another type of safety we need to help them develop recognizing that that inner critic in their head can feel very threatening can feel very intimidating a lot of times and can intensify trauma helping them figure out how to deal with that inner critic is another aspect of creating safety as well as helping them develop safety from others emotionally and cognitively being able to set those boundaries and say this is how i feel these are my thoughts you don't have to agree

4:02 but you can't i'm not going to let you take them from me i'm not going to let you invalidate my thoughts or feelings and then environmental safety from self and others or from others and environmental safety is different than physical safety physical safety has to do with my body and not letting people injure myself environmental safety means creating an environment in which people don't have to fear for the things that they cherish their belongings they don't have to worry that somebody's going to encroach on their environment that somebody's going to take their environment from them maybe kick them out on the street for example so we need to help them look at all aspects of safety and do as much as they can

4:53 to reduce their feeling of threat and increase their feeling of safety and empowerment i believe it's also important that people create a rescue pack to have with them this safety rescue pack can help people feel grounded safer more empowered in a variety of situations because you can't possibly plan for every situation and how you're going to feel safer in you know every single situation so a rescue pack can be helpful in that rescue pack i encourage them to create a thought list that has distress tolerant mantras such as i can get through this this will this too shall pass i have friends that can help me whatever distress tolerance

5:43 thoughts that they find helpful usually somewhere between three and ten thoughts that they can have that they can just read over when they're feeling distressed can be very very helpful activities is something else they can do to trigger that vagus nerve trigger that relaxation response or sometimes just help them stay grounded or turn their attention completely from whatever is making them feel nervous breathing slow diaphragmatic breathing will help trigger the vagus nerve bubble stuff blowing bubbles blowing up balloons or blowing bubble gum also has the same effect because it slows breathing down and can help trigger the relaxation response

6:31 keeping a phone with them which most people have now so that's not too outlandish is also important so they have the ability to reach out to a friend to reach out to someone who can listen who can provide support who can help them feel safer in the event that they don't have anybody then making sure they have the number of the local crisis line so they have somebody that they can reach out to and narration is another activity that can be really helpful when people are feeling unsafe if they narrate what they're doing it can help them stay grounded avoid dissociating

7:16 and be more aware of what's going on and how they are safe in the moment and sensations essential oils or wax tarts are wonderful because sometimes just smelling something that promotes a sensation of relaxation or brings back a positive memory can help trigger that relaxation response and that can be really helpful likewise having something that they can smell that can displace a trauma trigger a smell that triggers their trauma can also be helpful so if there's a particular cologne that triggers memories of their trauma when they're in the store

8:03 if somebody walks by they have that cologne on then the person can reach into their rescue pack and get one of those essential oils or wax tarts or whatever out and smell that so it displaces that it turns their attention to something else if they want to for people who have a lot of especially olfactory sensory triggers they may consider using something like fix vaporub or some other type of rub that lotion or something that is scented and rubbing it right below their nose so they are smelling that pleasant scent the whole time and they're not waiting until they might be triggered keeping an anchoring object with them something they can hold

8:53 something they can feel whether it's a you know those little tiny um stuffed animals i don't know what to call them that kids used to attach to their backpacks when i was in school those can be helpful because you can stick those in a purse or something a worry stone or prayer beads or something else that the person can hold they can feel that helps them feel anchored can be very very helpful sometimes jolting yourself if you will out of a particular memory is can be really helpful you can splash cold water on your face now i wear makeup so i am not inclined to go into the bathroom when i'm feeling stressed and throw

9:40 cold water on my face because that's going to make my mascara run that's not a good thing ice packs can be helpful and this was one that you probably aren't going to use a whole lot because they're not reusable but the instant ice packs can be used if you can't access cold water to put on your wrists on your neck or splash on your face to help jolt you out of a particular distress spiral some people have particular music that they like to listen to or playlists that they listen to that help them feel empowered that help them feel safer that help them calm down whatever feeling they're looking for and on the other end of the spectrum sometimes noise-canceling headphones

10:28 can be really helpful if for example one of their triggers is the sound of ambulance sirens you can't make ambulances not run therefore if they are feeling particularly stressed having noise cancelling headphones can be helpful to block out the sound of that particular trigger i know the other morning something was going on in our town and it was early morning so sound was traveling but no joke for 30 minutes it was just siren after siren after siren and for somebody who's triggered by sirens that would have been pretty pretty intense for them

11:14 the next cognitive behavioral technique is distress tolerance and if you're familiar with dialectical behavior therapy you're probably familiar with distress tolerance i have distilled the stress tolerance activities down from accepts and improves which is what linehan uses and they're wonderful but i've simplified it because a lot of people have difficulty remembering all of those tags thoughts distress tolerant thoughts we've already talked about those and having people develop a list of distress tolerant thoughts that can help them feel safer and more empowered activities to reset the hpa axis and improve vagal tone that is

12:00 to trigger the rest and digest to trigger the relaxation response that can be that diaphragmatic breathing that you do just breathing or blowing bubbles or blowing up balloons it can be through a vagus nerve massage where you're massaging one finger behind the ear one finger right on the tragus the little flippy flop thing on the ear and just gently massaging yawning is another thing and now that i rubbed my tragus i'm getting ready to yawn yawning is another activity that stimulates deep breathing but it also triggers the relaxation response guided imagery is another tool in the distress tolerance

12:50 toolbox if you will and you notice on the recovery pack that we just talked about on the rescue pack i had thoughts activities and sensations but i didn't have guided imagery because when people are feeling threatened when they're needing that rescue pack they're not wanting to check out they're not wanting to use guided imagery they're not going to feel safe enough to transport themselves somewhere else a lot of times however when they are in a safe place if they're having flashbacks if they're having intrusive feelings sometimes it's not even a memory it's this feeling that comes from out of nowhere guided imagery can be helpful and that guided imagery can take the form of a mental vacation going to their favorite vacation spot

13:41 and identifying five things that they see when they get to that spot four things they hear three things they smell two things they can feel that can really help people turn their attention to something that promotes dopamine and relaxation chemicals being released which can help down regulate that stress response which is what we're doing with the stress tolerance we're not trying to avoid it we're trying to down regulate the stress response so the person can get in their wise mind another image people can use is one i just call it safety whatever that looks like to them for some people they envision a force field around

14:30 themselves for other people they have an angel on their shoulder for other people they have their god carrying them like you hear in the poem footprints in the sand whatever they envision that helps them feel safer and the moment can be incredibly empowering and if they're hurt in some way distress tolerance can be helpful if they're feeling pain especially physical pain they can envision healing whether it's you know nanobots or their immune cells knitting together or healing the injured part they've actually done studies on people with hiv and aids and found that guided imagery that focuses on the immune system actually does

15:22 increase the the number of t helper cells which i thought was kind of cool and sensory we talked about that briefly here and we're going to talk about it some more because distress tolerance is sort of woven throughout cognitive behavioral therapy but sensory tools can help people trigger that relaxation response so that can be smells that help them feel relaxed it doesn't have to be essential oils it can be anything that triggers a positive memory or a positive feeling like coffee for me if i smell good coffee that's just absolutely amazing and it triggers that little bit of an endorphin rush and that relaxation response

16:10 sites whether it's pictures of their kids or of their dog or of a beautiful landscape what is it that they can look at that may help them feel calmer or more more safer in the moment sights smells sounds what can they listen to that might help turn their attention away from their distress for a moment we're not ignoring it we are turning our attention away from it we're taking a break until the stress response can be dampened some so the person can address it through their wise mind breath work i already mentioned this a little bit but breath work is so incredibly important

16:57 in therapy and cognitive behavior behavioral therapy in just everything well we need breathing we need oxygen to live but slow deep breathing especially diaphragmatic breathing or belly breathing actually can help trigger the vagus nerve they call it respiratory vagus nerve stimulation or rvns so square breathing we've talked about in multiple other videos is when you breathe in for four you hold for four you exhale for four and you hold for four and then you repeat that a couple of times when you slow your breathing it automatically triggers your heart rate to slow down when your breathing and your heart rate slow

17:45 down your stress response system says oh guess i don't need to be freaking out right now so you're manually overriding by slowing your breathing you're manually overriding your stress response now obviously if there is an impending threat right before you no matter how slowly you breathe you're going to be getting other feedback that is going to keep you from becoming completely relaxed but even in the face of stress slowing your breathing can help mitigate that stress response so you can maintain your quote wits about you um a little bit more effectively so square breathing

18:30 is ultimately the foundation of what we're talking about but there's a lot of ways to slow your breathing down some people feel like the square breathing or taking a few deep breaths is corny or they don't feel comfortable doing it whatever okay fine as i mentioned yawning is a wonderful way to slow your breathing and you can force yourself to yawn you can also massage your vagus nerve and that may encourage a yawn you can do different vagus nerve stimulation exercises that can trigger yawning laughter when we laugh especially again belly a good old belly laugh you're going to take a deep breath in and then you go fall until you

19:20 have exhaled so you're doing a slower exhale you just don't really pay attention to it i encourage people to create a playlist on youtube or i don't know if you can do playlists on tick tock or not but create a playlist that stimulates that guffaw that stimulates that good belly laughter that they can turn to when they need to um trigger their relaxation response i mentioned already bubble gum when you blow a bubble you're going to blow slowly so it doesn't pop in your face bubble stuff and you can get the little tiny uh bubble stuff containers that they use for parties you can get that at target or walmart or online i'm sure and you can carry that with you and

20:12 so you can just pull it out and blow bubbles whenever now being 50 years old people look at me like i'm a little odd if i pull bubbles out in the middle of the parking lot and start blowing them but you know if you don't care then no big deal balloons are another thing and you can do this in your car or so if you're having a bad moment maybe you can go to your car you've got a balloon there you can blow it up again to blow up a balloon you're going to inhale big and there then you're going to blow blow blow so you're slowing your breathing and those are things you can keep with yourself party noise makers and i don't know what else to call them they're the little noise makers that you blow on and

21:00 they make that horrible screeching sound or whatever however you characterize it kids especially love those because they're loud and annoying but that can be one other option or dragon breathers and that's what i have a picture of here you can use a toilet paper roll or you can use one of those plastic cups a red solo cup or something and then you cut strips of tissue paper and glue it to one end and you cut out the other end so it's a tube if you're using a cup and then when the child is distressed they can take a big breath and then they can blow and let all that anger out through the dragon breather

21:45 and last but not least fitness trackers fitness trackers monitor your heart rate so instead of thinking about breathing if you're thinking about lowering your heart rate well you've got to slow your breathing in order to lower lower your heart rate so some people will use their fitness tracker and they will just sit back for a minute and then they will intentionally slow their breathing so they can reduce their heart rate when your relaxation response is triggered your heart rate is going to go down so that is a clear indication that you have manually overridden that hpa axis

22:31 another one of my favorite techniques is defining your rich and meaningful life for people to figure out you know where am i going how should i use my energy what's important for me to focus on ultimately it's important to know where they're going or know where they want to go so what does that rich and meaningful look life look like for them and this is just an example of a vision board that i created you only have so much time and energy how are you going to use yours what people are important in your rich and meaningful life how are you going to use your energy to nurture those relationships what things like health are important in your rich and meaningful life and how

23:19 how much energy are you going to use to nurture that career is another one i've got on mine how much energy am i going to use to nurture that and what does that look like in my rich and meaningful life and then again this is mine so all my critters and my farm are on here too but this gives people something to look at and they can start every day looking at this and saying all right these are the things that are important and this is how i'm going to allocate this is how i'm going to spend my energy today or this week so it helps get them focused and then if they have to make a decision if something comes up during the day they have the ability to reflect look at this again and they can just take a

24:08 picture and keep it on their mobile device they can look at that picture again and ask themself all right is devoting energy to whatever this is that's come up helping me move toward my rich and meaningful life or is it stealing energy from the things that are important in my rich and meaningful life so i really love this vision board as a tool not only to have on the wall but also to have on the mobile device to help people regroup and refocus throughout the day once they've defined their rich and meaningful life then we move on to what haze in acceptance and commitment therapy calls purposeful action

24:54 mindfully acknowledging the present this is where i am right now this is what's going on it's not good it's not bad it just is and then how should i use my energy right now given my context what is the most effective way to use my energy to deal with the current situation that will help me move toward the things that are important in my rich and meaningful life do i need to address it is it something that is in my way is it something that i need to do something about okay if so then let's make a plan is it something that really doesn't matter i'm just getting all tied up about it but in the big scheme of things it doesn't keep me it's not blocking me

25:40 from moving toward my rich and meaningful life i've just got gotten distracted by it or should i change my reaction to the situation moving from anger for example to compassion maybe somebody does something in my life that triggers my anger is holding on to that anger is continuing to be angry at them helping me move towards my rich and meaningful life or is it stealing energy that i could be using spending on nurturing other relationships or even having compassion for them purposeful action is another tool of empowerment because it helps people recognize that they have options and that is so important

26:30 now symptom locks bear with me with the symptom logs because i'm going to show you a few different ways to do it however you know i got some of my foundation knowledge i got my minor in behavior modification so that gave me just enough knowledge to be dangerous sometimes but symptom logs were one of the big takeaways that i got from that and symptom logs are important because you know for example when you're on a diet or if you've got small children or a puppy at home when you are seeing that thing every day when you're interacting with that thing every day whether it's yourself your kid your puppy you may not notice incremental changes and then all

27:18 of a sudden one day you're like whoa you've grown up or whoa you've mastered the piano or something um but so the same thing is true with mental health symptoms when people are dealing with it day in and day out they may not notice the incremental changes so symptom logs can be really really helpful not only for documenting those baby steps toward their rich and meaningful life but also to help people see how far they've come every couple of weeks you can look at it and say okay let's look at the how far you've come and it gives you the ability to look for trends you can look for triggers for particular symptoms

28:05 you can look for vulnerabilities what things or situations make a person more vulnerable to reacting to situations with anger you know sometimes it something may happen and it may not bother them at all they get cut off in traffic for example other times they get cut off in traffic and they just fly into a rage what's different why were they more vulnerable the second time so symptom logs can provide us a lot of information because it gives us a better peek into what happened in dialectical behavior therapy linehan talks about backward chaining ideally the person completes the symptom log when it happens but you can do it at the end of the day

28:52 symptom logs need to at the very least include the date it happens the time is it eight in the morning because some people are more irritable or in a better mood first thing in the morning versus late at night and vice versa so what date does it occur what time does it occur what triggered the symptom if known or if there were distressful thoughts what was the theme what was the intensity of the experience if they're having a flashback or if they're having an anxiety attack was it a one i noticed it but wasn't a big deal was it a two i noticed it it was uncomfortable but i managed to get through it was it a three it was really

29:43 difficult to keep moving forward while i was having this symptom or was it a four and in a four the symptom is just all-encompassing and they can't continue doing what they were it kind of shuts them down for a minute how long did it last was it five minutes or five hours how did it impact their energy mood productivity relationships said another another way how did it impact those things that are important in their rich and meaningful life what vulnerabilities and this goes to that backward chaining what vulnerabilities were present if they had an anxiety reaction were they over caffeinated or dehydrated or was their blood

30:31 sugar low or were they in a particular environment that they tend to find stressful anyway what did they do to cope was it effective and what do they want to try to do the next time maybe they want to do the same thing the next time because it was effective great if it wasn't effective they may choose to try to do something else if the symptom seems ever-present like anxiety some people feel anxious quote all the time okay have them complete the log every hour that they're awake now i know that seems like a lot and if they're working full time that might not be practical if they're not working it's definitely doable if they're in residential treatment it's definitely doable

31:20 so you can adjust how often they do their check-ins but definitely every couple of hours once they get this information once they've got the data then it's going to be important to review the logs for themes in triggers and vulnerabilities i encourage people to make a pictograph of the frequency intensity and duration of their symptom so they can get an idea of how often is this happening and kind of how bad is it in this one you can see from 8 am to 9 am the person was having an anxiety attack it lasted for a whole hour which is why it's as wide as it is and the entire time they were having it it was at a level of a

32:08 three so it felt pretty damn overpowering they still kept moving but it was really overpowering and then at nine o'clock or 9 15 that went away and then at 10 30 they had another little anxiety attack but that only was a one and it only lasted for about 30 minutes and then at 12 30 12 45 whatever they had another one that was a big one i mean it was all-encompassing full-out panic attack and that lasted for almost 30 minutes so then when somebody brings this in i would talk with them and i would say you know what were the triggers and maybe at 8 a.m the person's anxiety ramped up because

32:57 they knew they had to go to work and work is just really really a huge source of stress right now or they knew they had to go to work and they were going to have to ride the subway and the subway is one of their triggers from their trauma so their anxiety went up really really high but then they got to work at nine o'clock everything was okay they de-escalated sweet and then at 10 30 they had to go to a meeting with their boss and that was a little stressful they got along with their boss fine so it's not a big deal but it was a little bit stressful having to do that and then at 12 30 that was after lunch was over and they were getting ready to

33:45 go back to work and they got cut off in traffic and it triggered an anxiety attack that lasted 20 or 30 minutes okay so by looking at this we can see how long they're lasting and then we can more granularly look back and go okay what's triggering and see if there are themes that are triggering anxiety at particular times of day or in particular places because that can help the person gain more awareness and be better able to prepare or adjust in order to reduce their stress now you have a lot of these charts laying around that's great you may be able to look at them

34:33 but it's hard to really get see incremental progress when you're still looking at four or five episodes a day and they're all still pretty high it's hard to know are we making progress are we reducing the frequency intensity or duration and you know sometimes it may be obvious but sometimes it may not be i use a mathematical formula so here the first block is 1.25 hours so for an hour and 25 minutes she was feeling you know huge amounts of anxiety the intensity was at a level of a three so you can see 1.25 hours level of a three and then the next one was at 10 30 that lasted half an hour it was an intensity of a one and

35:27 then we had this other one over here that was a half an hour that was in an intensity of a four in order to take into account the frequency intensity and duration because we're looking for an overall improvement it doesn't matter whether it's frequency intensity or duration i multiply the number of hours by the intensity and add it all up then their average anxiety is the number of total hours they were feeling anxious divided by the total intensity so the mathematical formula here was a 0.36 so if we had to average out her anxiety over the entire day um what we would be looking at is a .36 remember one

36:18 is they're they're feeling it and ideally we don't want people feeling anxious all day every day so i'd like to see that a lot closer to a 0.0 than a 0.3 but next week we would go through and add up the data and do this again now for some people this could be too data-driven and i get that so you can skip the mathematical formula if it's not for you but i think the charts are at the very least very helpful because people can really get a quick vision of do we see things going down now an alternative log if somebody feels like they are anxious all the time they've got

37:07 generalized anxiety then there's not going to be any particular time that they have a symptom or they have an episode it's just kind of all the time so remember i said assessing it on an hourly basis and this is a chart on an hourly basis if you do it every two hours then it would adjust accordingly so each hour the person asks themselves how am i feeling on a scale of one to four and we have three hours that it was a three we have one hour that it was a three and a half and then you can see that towards the evening towards the end of the day it actually went down to a one we want to ask the person you know what was different at 3 pm then at 8 am what

37:58 was triggering your anxiety throughout the day and why did it go down at 3 pm but also why was it still present at all at 3 pm what else is contributing or maintaining your anxiety and maybe it's just ruminating or anticipating having to go to work the next day i don't know you can do the same mathematical formula here and for this person based on that chart their average anxiety over the course of the day was a 1.88 so they're still feeling some pretty intense anxiety and we would look for that number to gradually decrease over the course of treatment

38:47 the next technique we're going to talk about is systematic desensitization and ownership and these are similar or similarly related techniques they're not exactly the same but i lumped them together systematic desensitization and ownership helps the person alter their reaction to triggers or stimuli in the environment think about it like an allergy shot for cognitive allergens it creates an environment of safety and empowerment when they start realizing that things do not have to control them then they can start feeling more empowered they mastered the ability to use breathing relaxation and distress tolerance skills to down regulate their stress response when they feel triggered just because i smell this smell

39:36 just because i see this thing it may trigger a trauma feeling but i d it doesn't have to consume me i can address it i can help myself feel safe and i can get control of that situation so the example i use for systematic desensitization is snakes because a lot of people have a fear of snakes but it can be anything the first step is to learn about the trigger learn about whatever it is whether it's snakes or flying or in the case of trauma triggers like the smell of a particular cologne you may not have to learn a lot about that but you recognize that oh okay

40:24 the smell of this cologne triggers a trauma memory all right now what do i do about it well we're going to take away the power of that trigger we're going to take away the power of that stimulus so we have the person think about the stimulus and so think about the snake or think about what that's smelling that cologne and their anxiety is going to go up their stress response is going to go up and then they're going to use distress tolerance skills to trigger the relaxation response to dampen that stress response so they can get into their wise mind once they're in their wise mind then they can effectively address the facts of the situation

41:10 in this situation at this time am i safe i smelled that smell triggered my stress response all right i'm going to push down my stress reaction i'm going to dampen my stress reaction get into my wise mind in this situation at this time does that smell represent a threat to me or is it just somebody that walked past me in the store the important thing is helping people get into their wise minds so they can effectively evaluate the facts in the current context once they can think about a snake and it doesn't trigger that stress response they've been able to decouple that stress so just thinking

41:58 about it doesn't trigger that response anymore then think about being in a room with a caged snake so it's not just some snake somewhere it's a snake in the same room with you it's in a cage but it's in the room and they go through the same process practicing imagining that and down regulating their stress response until thinking about being in a room with a caged snake doesn't trigger that response think about being in a room with someone else holding a snake so now the snake's not even in a cage but somebody else is holding on to it thinking about that we're not nowhere near being in the same room with a snake

42:44 yet we're just helping the person envision imagine these situations and learn how to down regulate the stress response to their cognitions to their beliefs think about petting a snake someone else is holding and then think about holding a snake once a person can move through all of these things and it doesn't trigger their anxiety response it doesn't trigger their stress response anymore then you can move toward you know maybe going to a pet store where you're in an environment with a caged snake and again there would be more steps to desensitizing to that particular stressor

43:30 but it can be really helpful not again not only for snakes or spiders or planes or phobias but also for other triggers so people can think about smelling that smell and then they can get to the point where they can actually smell the smell and it doesn't trigger that stress response for them in terms of ownership or immersion when you're regularly exposed to something and able to manage your response it loses much of its power now this isn't something that i recommend i don't recommend flooding for people to do on their own but it is a technique that people can use especially with what i call annoyance

44:19 triggers it's not a trigger that triggers this cascade this flood of stress chemicals but it's enough to trigger a stress response it triggers their resentment their irritability if it is a smell or a saying sometimes people have have success making it their own making it theirs to control so they start wearing that particular perfume or they start using that particular scent to as a fragrance in their house i had a client one time who had a significant other that had a particular saying and every time he heard that saying after they broke up it just brought back a flood of memories

45:09 and just triggered his anger he's like oh when people say that it makes me want to climb the wall so i encouraged him for the next week to use it himself you start saying that whenever you can you start saying that make it your own so it's no longer associated with her it's something that you do and then if you don't want to say it anymore after that that's fine associated with positive things like smells activities or holidays if something triggers a stress response try to pair it with something else positive as much as possible and regularly expose yourself to it while regulating your stress response and this is one i use for bridges

45:57 because i can't get away from bridges where i live but i don't like bridges however i've gotten to the point where i can drive over them and they don't really bother me that much anymore systematic desensitization should be undertaken with care to prevent moving forward too quickly and causing additional anxiety or trump re-traumatizing yourself it always starts with ensuring you feel safe and empowered and every scenario needs to end with the person feeling safe and empowered so they feel safe and empowered they imagine the stressful situation and then they de-escalate

46:43 before beginning any type of exposure even imaginary exposure it is essential to have mastered the skills of distress tolerance and emotion regulation mindfulness is another wonderful cognitive behavioral tool mindfulness means turning off autopilot and being non-judgmentally aware of your thoughts feelings needs and behaviors in the present moment it helps connect thoughts feelings and behaviors and promotes prevention and early intervention of distress think about how operating on autopilot may contribute to sickness anger outbursts or relapses of depression

47:33 so there are a lot of different kinds of mindfulness and the first one we're going to talk about is personal mindfulness start with being as being mindful as soon as you wake up in the morning at each meal and before going to bed and for a lot of people that i work with i encourage them to set push notifications to remind them to check in and be mindful i know you need reminders to be mindful but each time they check in with themselves throughout the day they ask themselves how do i feel physically how do i feel emotionally and why what do i need right now to continue feeling great if they're feeling awesome great keep it going or improve the next moment if they're feeling tired hungry run down anxious

48:23 checking in with themselves and figuring out what is it that i need to do to improve the next moment grounding can be thought of as another kind of mindfulness and it's a technique to help people feel connected to the present moment and not swept up by emotions or thoughts two of the most common grounding activities are the 54321 and the describe an object in 54321 when the person starts feeling stressed they identify five things they see four things they hear three things they smell two things they feel and if possible one thing they taste describing an object can mean holding an object it can be your phone it can be your purse it can

49:14 be your grounding object and just describing it to yourself is it cold is it hot is it soft is it bumpy whatever sensations you get from it but that encourages the brain to stay anchored in the present moment which can help with dissociation it can help with anxiety and it can help with triggering that relaxation response as people turn their attention away from the anxiety provoking stimulus to what is helping them stay relaxed in the moment i find the describing object is really helpful when i go in to get shots because to this day i am terrified of needles but that helps me a lot i'll be holding

50:02 a grounding object and thinking about what it feels like and all those things so when i get the shot i'm not thinking about that i'm not anticipating it hurting i'm not tensing up general mindful awareness uh encourages people to be aware of the moment not just themselves but the moment in general become more mindful in your actions as you're doing them what do you see what do you hear what do you smell when you're out on a walk have that open awareness where you're just noticing anything that's there it's not necessarily good or bad you're just noticing it you'll be surprised at all the things that you typically probably overlook

50:55 and mindful reflection is an activity in which people reflect on their activities at the end of the day by asking themselves what did i do and for each of each thing that they did throughout the day was doing this an effective use of my energy to move toward the things that are important in my rich and meaningful life or was doing this whatever it was what a happy healthy successful person would do some people like the rich and meaningful life you know does it help me move toward my goals other people want to act as if fake it till you make it as they say so they ask themselves was i acting like a person who was happy healthy and successful would have acted examples

51:48 you know when you're reflecting on the day if you got sucked into video games for three or four hours it's easy to do asking yourself was this an effective use of my time to move me toward my rich and meaningful life if you were playing video games with your best friend and it was good bonding time well then maybe it was if not maybe it wasn't you know it's up to each individual to decide was this important is this something that you really like doing is it a hobby does it promote relaxation well then maybe it was an effective use of energy you can do the same thing for dwelling on resentments or eating unhealthfully was it effective at helping you move towards your goals

52:34 was it something that a happy healthy successful person would typically do an ounce of prevention is worth a pound of cure mindfulness is essential to health and well-being because it can help you become your own consistently empathetic responsive best friend it can help you become more aware of the situation and notice the good and the beauty in in life in addition to the stressors and also become more aware of how how you're using your energy and whether it is moving you forward or keeping you stuck authenticity is the next tool we're going to talk about and i love authenticity it means being

53:22 true to yourself people often become inauthentic because they're trying to get approval from others their self-esteem is low so they're looking for somebody else to tell them they're okay they may be inauthentic because they're afraid of being rejected abandoned or in today's society cancelled or they may be inauthentic because they're just operating on autopilot they're not acting mindfully they have always just kind of done whatever happens and hadn't haven't really stopped to think about is this me is this me being authentic or is this me just being impulsive i use the metaphor for chocolate chip cookies when i talk about

54:08 relationships and when i talk about authenticity when you have chocolate chip cookies you've got sugar cookies and you've got chocolate chips both of them are just fine on their own thank you very much one doesn't pretend to be the other they are authentic in who they are now if you put them together in relationships when you have two authentic people that join together you can get something that is potentially infinitely better than either one of those things all by themselves because they enhance each other they don't complete each other they're already complete by themselves they enhance one another when you're practicing on authenticity it's important to become mindful of your thoughts

54:56 feelings and needs and act in accordance with them instead of being a chameleon so mindfulness is a precursor to authenticity it's also important to help people separate approval or disapproval of behaviors from themselves not everybody's going to like what you do if you're behaving authentically not everybody may like your choices but does that mean they dislike you or they dislike your choice it's important for people to ex explore and address their fears related to being authentic and a lot of people have fears about being authentic for very legit reasons these days unfortunately and if it is an office because of that radical authenticity or being yourself a hundred percent

55:49 of the time may not be safe for everybody in every situation so it's important that they practice being assertive and authentic sharing themselves with safe other people first and then deciding is it important for me to be authentic here is it important for me to be authentic on social media is it important for me to be a hundred percent authentic at work and only the individual can figure that out and if they can't be a hundred percent authentic is that an environment that's healthy for them to be in and again only they can decide but that's part of the empowerment of cognitive behavioral therapy

56:34 helping people recognize that they are good enough they are deserving of love they are in a position they are empowered to help keep themselves safe and that also means safe from harm from others and safe from others being mean to them if you will if they're authentic from taking away their authentic selves authenticity means moving from what moving from being aware of thoughts wants and needs to acting in a way that's in accordance with them so if you know that you like italian over mexican food or that's what you want an authentic person would be mindful they would recognize hey i want to go

57:25 for italian food and they would tell people that they would assert that if you're being inauthentic then you may know that you have a craving for italian food but you know what no i don't care where we go i don't have any preference well that's inauthentic yes you do have a preference being authentic can be scary at first and is often advisable to not advisable to suddenly start practicing what i call radical authenticity which can make the person feel really vulnerable not suddenly deciding that okay starting today i am going to be a hundred percent authentic all the time that is a radical shift not only for the individual but for everybody around

58:12 them and it could upset the apple cart so to speak it may take people a minute to get used to someone suddenly becoming authentic so which can set them up for not so great reactions from significant others but also when you're authentic you're putting your true self out there you're making yourself vulnerable and making yourself vulnerable can be extremely scary especially for people with a history of abandonment rejection or trauma so it is important to use this with care yes it's great when people feel like they can be authentic but it's something that a lot of times people need to build up to

58:58 as people become more authentic have them notice how it impacts their mental and physical health thought stopping is the next tool thought stopping helps us redirect our brain and we can engage in thought stopping by simply telling ourself no not now not thinking about it sometimes that helps sometimes people need to replace the thought with a mantra a prayer or grounding activities to sort of drown out whatever that thought is to turn their attention if the thought keeps coming back okay then ask yourself what's the benefit to ruminating on this thought

59:47 why does it keep coming back why do i keep feeling like i need to think about this is there anything that the person can do to address the thought and improve the issue at this moment so for example if you're waiting on test results from the doctor that aren't going to be in for another six days what's the benefit to ruminating on that why does it keep coming back is there anything you can addre do to address the thought in the moment and the answer is no you just gotta wait and be patient so sometimes people will write it down and put it into their thought box a lot of times it can be helpful for people who have um persistent thoughts ruminations whatever you want to call

1:00:32 call it they write these things down and then they schedule 30 minutes a day that's their worry time so these thoughts pop up and instead of saying no i'm not going to think about it ever it's no i'm not going to think about that right now i will think about it this afternoon during my worry period encourage people to start small try to stop having the thought for five minutes and if they make it to five minutes then great thought may come back let's try 10 minutes now see if you can make it 10 minutes without thinking about it and it can be empowering to the person to recognize that they are getting better at learning how to stop some of those annoying thoughts or those annoying voices that want to chime in

1:01:25 perspective taking is another tool look perspective taking means looking at the bigger picture to understand the reactions of other people as sometimes as well as yourself you know stepping back and trying to get a different perspective there are four p's in perspective taking predisposing what were the background factors that contributed to the behavior whether it's another person or yours if the client has a history of trauma that's one of those predisposing factors that may contribute to them reacting with fear or anger in particular situations for example precipitating factors so you have somebody who's been

1:02:13 exposed to trauma somebody who's endured trauma and so they already have an hpa axis that's you know turned on they already tend to be more hyper vigilant precipitating factors are vulnerabilities and contextual factors that precipitate their reaction they have this history and then they're in a situation in which they feel somewhat unsafe they're in this situation where there's lots of hustle and bustle maybe they're at the airport and there's just lots of people going around and bumping into one another and they start feeling really stressed out because it is feels like an unsafe environment they feel vulnerable provocations what provoked or triggered that behavior and if you're talking about trying to

1:03:01 understand somebody else's reaction then looking at your own behavior and saying in what way might i have inadvertently provoked that behavior and i say inadvertently because a lot of times we may trigger somebody's anger and we didn't even mean to we didn't maybe we didn't think clearly before we said something or maybe we have no idea what we did to trigger that person's behavior but recognizing um that there may be something that we did okay doesn't mean we meant to and plans if you reacted with anger or anxiety and you regret it recognizing where that came from and asking yourself well did i have good intentions did

1:03:50 i go into this situation saying yeah i'm just going to be kind of nasty about this or did i have good intentions but the predisposing precipitating and provoking factors led me in a different way same thing with when you're dealing with somebody else if you're interacting with them and they react strongly to something that you say it's important to ask yourself you know why are they perceiving it differently than i am what predisposing factors what historical or experiences might they have had that caused them to interpret this situation differently in what way might have i have inadvertently provoked the behavior

1:04:35 and did the person really ultimately have good intentions they may have not intended to get into an argument with you but it just it ended up there self forgiveness is the next tool we're going to talk about remember that forgiveness does not mean that you agree or condone the situation or what happened but you're choosing to stop using your energy to beat yourself up the four r's of self forgiveness responsibility yeah you need to take responsibility for the aspects that you're responsible for but that's it only take responsibility for the aspects that you're responsible for if something

1:05:24 happened between you and someone else as they say it takes two to tango there are probably a lot of other factors that were out of your control take responsibility for what you're responsible for the second r is remorse well if you're work working on forgiveness then you do feel remorseful you feel guilty but just feeling guilty keeps you beating yourself up guilt is self-anger so feeling remorse is your body's way of saying okay here's some energy now you can use this energy to learn from this situation so you can stay safe in the future or you can fix the mistake you made which takes us to rectifying or making amends what do you need to do to

1:06:12 fix this situation make amends or just learn from it sometimes you can't fix it and the final r is releasing past hurt and accepting imperfection forgiving yourself and saying all right you screwed up it doesn't make you less lovable it just means you're human you're fallible you're imperfect and you forgive yourself you're going to choose to not continue using energy beating yourself up for something that you have rectified and taken responsibility for

1:07:00 forgiving others is very similar forgiveness still means choosing to stop giving energy to that person or memory that is causing you distress forgiveness can involve recalling the betrayal recal recalling what happened that is causing you to feel angry or resentful explore why you might be afraid to forgive them why are you wanting to hold on to this energy why are you afraid to learn and let go altruism visualize forgiving this person as a gift to yourself and your significant others i'm forgiving this person over here so i'm not tying all my energy up in it anymore which is great because now

1:07:48 i have all this energy freed up that i can give to myself and my significant others learn from it and adjust your expectations sometimes people ain't gonna change therefore recalling the betrayal what happened and what do you need to learn so you don't get hurt in the future living in the and is another tool that can be helpful for forgiving you can have a rich and meaningful life and not be able to trust this person anymore if that's what has to happen it doesn't mean you're going to continue to be angry at them you you've just learned that they're not trustworthy

1:08:33 so living in the and means you can have a rich and meaningful life and forgive other people sometimes it's easier to forgive smaller things first it can help to empathize without minimizing you can empathize and try to understand why somebody did what they did maybe even have compassion or pity for them but not minimize it you're not saying oh i have pity for you i understand why it happened and you know i guess it wasn't really that bad no i i can empathize with what you were going through and maybe why you reacted with such anger however this is how it impacted me and i am not going to diminish the impact it had on me

1:09:24 just because you were going through a bad thing so i'm going to empathize without minimizing safely share your feelings this isn't always possible but sometimes it can be helpful to safely share your feelings with that person or maybe even with your higher power or just your journal but sometimes you need to get them out sometimes there are things that quote need to be said that are going to keep bouncing around in your head until you can say them so say them in a safe way and then practice thought stopping even after you've chosen to forgive somebody every once in a while that resentment or that anger is going to creep back up and you're going to remember what happened and that's when thought stopping comes in handy and you can say

1:10:13 nope handled that already not going to revisit it and then the abcdes of cbt a and if you remember back to basic cognitive behavioral therapy this is one of your basic tools a is the activating event what happened c is the consequences of the activating event and we want to consider all of the consequences not just your emotional reaction but your physical reaction your cognitive reaction how did it change the way you think about people and the world your relationship reaction how did it change the way

1:10:59 you feel about your ability or the trustworthiness of people in the world so the activating event and the consequences but between the time that something happens and you get angry or that hpa axis that stress response gets triggered you have a litany of automatic beliefs that come from schema come from past experiences your brain's going okay let me tell you how to interpret this a lot of times these beliefs because they're based on past experiences may not be a hundred percent accurate in the present context which is why we go down to d after you've identified what those beliefs are then you dispute each one of them based on the facts in the current

1:11:46 context is this belief still a hundred percent accurate based on the facts in the current context once you've identified what is actually true in the current context then you can evaluate the effectiveness of your reactions for helping you use your energy and time to move toward your rich and meaningful life so okay maybe something happens it triggers rage in you you get really angry that somebody did something you go through your beliefs and you dispute them and you determine yeah you know they betrayed me it was a big hurt okay so evaluate the effectiveness of your reaction is holding on to anger is dwelling and stewing on anger and holding

1:12:37 on to this resentment is that an effective use of your time and energy to help you move towards your rich and meaningful life or would something like forgiveness be a more helpful tool cognitive distortions is another basic cognitive behavioral therapy tool that we look at and there are five maybe six uh big ones that frequently come up when i work with people and all or none thinking this person always does this or this person never does this i encourage people to pay attention to their cognitive distortions to their um extreme

1:13:24 language and if they say always or never to reframe that and start saying sometimes or often look for exceptions if you say that jane never calls when she's going to be late look back are there exceptions are there times when jane did call personalization means taking what somebody else does personally it's my fault or they looked at me with this horrible look they must be angry at me what are three alternatives that have nothing to do with you magnification or catastrophing which means making a mountain out of a molehill or assuming that the worst case scenario is going to happen

1:14:10 look at the facts in the situation based on the facts how accurate is your belief minimization is the same way and sometimes people will minimize the impact of drinking for example and that can be faulty if they are having if they're in recovery for alcoholism they may also minimize their strength and their power and their ability to move towards their goals they may minimize their own effectiveness and so it's important to look at the facts is it true that you are powerless in this situation and then assuming can be broken down into mind reading and jumping to conclusions

1:14:59 a lot of times when people grew up in dysfunctional environments they learn to try to anticipate other people's needs in order to get approval and prevent punishment and they carry that with them into adulthood unfortunately it's not common to be able to effectively read other people's minds open communication is a whole lot more effective so if you are mind reading if you're assuming that you know what somebody is thinking or wanting check it out what are the facts what do you actually know versus what are you assuming related is jumping to conclusions maybe your best friend doesn't text you back or stands you

1:15:47 up for lunch a lunch date that you made three weeks ago you jumped to the conclusion that um something terrible happened and she's as my mother would always say lying dead in a ditch somewhere um that's jumping to conclusions so look at the facts based on what you know you don't know why they didn't show up for your lunch date when i'm working with clients i have a cognitive distortions worksheet that i give them and i encourage them to go through it when they have stress when they feel anxious when they feel angry when they feel distressed they write down what the activating event was what the trigger was and then b is the beliefs they write down those beliefs

1:16:37 and then they evaluate each one of those beliefs for cognitive distortions alternate problem formulation is another cool one or i think it is and i use the mnemonic peace corps for this and this kind of puts together a lot of what we've been talking about so the person identifies the problem they identify early experiences they've had that may impact how they perceive the situation so maybe they have their um anxious around authority figures that's the problem early experiences we look back at early experiences with authority figures well not so good so yeah it makes sense why this person might have anxiety around authority figures

1:17:28 a stands for assumptions rules and attitudes what are your assumptions about people who are in authority positions based on your early experiences so you're seeing how this is all starting to connect our past helps us try to interpret the present but it's not always a hundred percent accurate so we need to understand why am i assuming this to be true c is core

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