It's the beginning of a new year, which for millions of Americans, means it is time to make resolutions that will hopefully result in an improvement in their life in some way. From exercising more, to cutting back on social media/TV, to going to bed earlier, this New York Times article points out that at the root of most resolutions are habits. This article reviews evidence-based strategies that could help you break away from "bad" habits and replace them with healthy ones that will hopefully result in the change you are looking for this year.

​www.nytimes.com/2018/12/31/smarter-living/better-habits-tips-new-year-resolutions-science.html

The holiday season can be a challenging time for a lot of people. USA Today explores ways of preventing depression during this season. If you've had a tough time during the holidays, reach out to us for a free phone consultation to help you get your mental health back on track in the New Year.

https://www.cincinnati.com/story/news/2018/12/19/depression-can-stalk-holidays-what-watch/1836996002/

Author: Katie Leoni, Psy.D.

Do you view uncertainty and lack of control as an unpleasant experience and something that should be avoided? If so, you are not alone and you may perceive worrying to be productive and useful. People who worry excessively tend to regularly overestimate risk. You may think that if you worry enough then you have more perceived control over the situation. For instance, if you are able to predict every worst-case scenario then you will be fully prepared for that situation and there will be no surprises. You feel in control. Then, when the worst-case scenario does not happen, you attribute it to the fact that you worried about it beforehand and thus, the worry is reinforced. It’s kind of like, “Oh it didn’t happen because I worried about it” when in reality, if something catastrophic is going to happen, it is going to happen regardless of whether you worry or not. The fear is if you stop worrying, the bad thing that you’re worrying about will happen/is likely to happen because now you are not prepared for it.

​Let’s look at an example of unproductive worry. Say you are on an airplane and for a majority of the flight you are in your seat worrying about how much training the pilot has, has long the pilot has been flying that day, and stating to yourself “please don’t crash” over and over etc. You spend your time thinking about the plane not crashing and going over reasons why. As a result, you feel anxious and unsettled the entire flight and once you land, you feel a sense of relief. You make a direct link between your worrying and the plane landing safely. What is the effect of this worry on you during this flight? You feel anxious, worried, possibly scared, and you’re spending the whole flight worrying as opposed to being in the present moment.

On the other hand, if you think the opposite during the flight, that the plane will crash, then once the plane lands you realize that just because you were thinking about the plane crashing doesn’t mean that it certainly will.

Worry is not an all or nothing concept. Of course, sometimes worry can be helpful and productive. It’s a natural response to your anticipation of future problems. For example, if you have a flight to catch, it makes sense that you’d be worried a little bit about traffic and making it on time to the airport. You may check the traffic in real time and this results in real change because you might have to leave earlier to get there on time. What is the effect of this worry on you? You problem solve effectively and are not late.

You can worry all the time and ask questions but we just don’t have that kind of control over situations or events. Naturally the question then becomes, what can I do to change this? Here are some suggestions:

• Spend your time in a more value driven way. Ask yourself “If I’m not worrying, what else could I be doing?” That may be hanging out with family and/or friends, cooking, reading a book, sleeping, exercising, writing, working on a project, the possibilities are endless!
• Schedule worry time. Set aside 10 to 20 minutes in the day to help clear your mind of the mundane worries but also start to recognize if there are large thoughts that you can later attend to. Worry time gives you a place to compartmentalize your worries throughout the day and then go through them at a time that works for you rather than having them eat up most of your day.
• Practice relaxation skills such as progressive muscle relaxation, guided meditations, and abdominal breathing.
• Ask a friend how they cope with lack of control. They might be able to provide you with some tips.
• Ask yourself these questions:
  • Is it possible to be certain/in control about everything in life?
  • What are the advantages of requiring control? What are the disadvantages?
  • How likely is it that things you predict will happen? Is it possible to live with the small chance that something negative may happen, given its likelihood is very low?
  • Can you live with some of the uncertainties/lack of control in life? How do you do this? Can you do this in other situations you find difficult?

If you feel like your worry has been negatively impacting your life and/or you’d like to learn more ways to help manage your anxiety and to tolerate uncertainty, please contact us for a free phone consultation.

Author: Kari Kagan, Psy.D.

​In this blog series, we will introduce a variety of skills that you can use to recover from intense emotional experiences.

The acronym ACCEPTS represents a skill from Dialectical Behavior Therapy (DBT) that is designed to help people manage intense emotions until they are able to productively address the situation that is causing the emotions. This skill is particularly useful for coping with situations that cause acute emotional suffering. These tools will help to tolerate intense uncomfortable emotions and once they start to subside, many people feel more equipped to deal with the original cause of distress.
 
ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Push Away, Thoughts, Sensations. Below I will review each coping strategy in more detail. Not all of these tools will work for everyone, but I encourage you to try as many as possible to figure out which work best for you.
 
Activities: Engage in any healthy activity that takes your mind off of the distressing situation. For example, reading a book, going for a walk, or talking to a friend could be alternative activities that give you a break for a short period of time. An ideal activity would be one that requires your full attention, such as cooking a new recipe.
 
Contributing: Try doing something nice for someone else. For example, spend part of your weekend volunteering at an animal shelter, cook for a friend, or send a thoughtful letter to someone in need. Doing something for others takes us away from our own suffering by shifting our focus to someone else.
 
Comparisons: The goal of making comparisons is to put your current situation in perspective. You could start by comparing yourself to you at a different time in your life. For example, if you can recall a time when when you weren’t doing as well or when you dealt with something more intense than what you are currently going through, this could serve as a reminder of how far you’ve come. You could also try comparing your situation to someone who might be experiencing more suffering than you are, such as someone who is in need of food or shelter. This is not to make you feel bad, but to help get perspective. This might not work for everyone, but it does work for some people and might be worth trying to see if it could work for you.
 
Emotions: Try doing something that generates the opposite emotion of the one you are currently experiencing. For example, if you are feeling sad, watch funny videos; if you are feeling anxious, try taking a few deep breaths.  Doing something that gives you the opposite emotion can help to reduce the intensity of the distressing emotion.
 
Pushing away: When you can’t address a distressing problem right away, it’s ok to temporarily put it aside in order to give yourself a break from it. For example, you can try invoking the image of putting it on a shelf in a closet where it is out of sight but you can go back to it when you want. It is important to remember that pushing away is a useful strategy for taking a break from acute distress, but if a problem is avoided for a prolonged period of time, it could make it worse. It is important to return to the problem once you feel you’ve had enough of a break and are better equipped to deal with it.
 
Thoughts: When your thoughts are consumed by a distressing situation, try distracting your mind with other thoughts, such as reciting the alphabet backwards or trying to name all the states. Temporarily occupying your mind with other thoughts can prevent someone from getting stuck in a negative thought spiral that could lead to destructive consequences.
 
Sensations: Try activating your five senses as a way of snapping out of a distressing emotion or of soothing yourself during a time of distress. For example, try holding ice cubes, taking a hot shower, lighting a scented candle, listening to pleasing music, or eating your favorite food.  Using the senses to distract from acute suffering can be very grounding and can help to stop the distress from continuing to spiral.
 
The ACCEPTS tool provides useful strategies for dealing with acute and overwhelming emotional suffering that could potentially lead to destructive consequences if not dealt with in the immediate moment.  Try using these tools to give yourself a break from the distress with the goal of returning to the situation once emotions are more manageable and you can be more effective in dealing with it.  If you would like more help in learning how to cope with intense emotions, feel free to contact us or another professional who can provide useful strategies for dealing with acute distress. Stay tuned for Parts 2 and 3 of the series for additional tips.
 
 

Author: Diana Gordon, Psy.D.

​As CBT therapists, we often have clients come to us to get relief from symptoms that are making it difficult for them to achieve their goals. For example, clients might notice that because of their depression or anxiety, they are having a hard time advancing at work, making friends, or being successful in their romantic relationships. Sometimes when these symptoms have been present for a long time, clients are unsure of what needs to change in their lives in order for them to feel better. Or they may know what types of changes they’d like to see in their lives, but may understandably have difficulty mustering the motivation to make behavioral changes that are difficult and uncomfortable.

One technique that we use often with our clients is values clarification. Values clarification is a process by which we work together to identify what values are most important to the client, and we rank them in a hierarchical fashion. In doing so, we identify the 5-10 most important values that a client holds, and we help them set clear goals that allow them to live more in alignment with these values. When one is living in alignment with their most deeply held values, they tend to experience greater happiness, contentment, and clarity when confronting difficult decisions and experiences. Being aware of one’s values can also help people develop motivation to make difficult changes in their lives. When our goals are linked to deeply held values, we can more easily tolerate the discomfort and difficult work that sometimes comes along with achieving our goals.

Often our deeply held values are not things that we can name off the top of our heads. Some of them certainly are, but others might be things that we are afraid to admit out loud to ourselves or to another person. We may hold judgements about what “should” be important to us, and those judgments may influence the values we identify. As CBT therapists, we have several techniques we use to help people identify their deeply held values. Often clients report that some of the values we come up with are ones they would have named on their own, and some of them are ones that they are surprised to see make it to the top of their list.

If you’d like to start thinking about some of your own values, you can check out this free worksheet which lists common values and helps you rank order them. You might also try asking yourself some of the following questions:

1. What do I want to stand for in life?
2. What things are most important to me in life?
3. What type of person do I admire?
4. What do I want others to think and say about me? What qualities do I want to be known for?
5. What types of values are important in my family?
6. How do I want to relate to other people?
7. What types of behaviors or attributes are important to my success at work? In relationships? In life?

    If you’re interested in learning more about values clarification and how this intervention might be helpful for you, feel free to contact us for a free phone consultation. In Part 2 of this blog post (coming soon!), we will explore the difference between values and goals, and will discuss how to use your values to set goals to improve your life.

Author: Katie Leoni, Psy.D.

Therapy session frequency is often a once a week occurrence, however this can vary depending on several factors. Regardless, the time in between sessions is extremely important in order to practice skills, gain confidence in one's ability to cope, and to hone in on what is helpful and unhelpful. Growth and progress happen both in and outside the therapy room. This article looks at the effects of intensive sessions over a short period of time (month or less) on several types of anxiety disorders. The pros and cons of such treatment are discussed and explored.

​https://www.nytimes.com/2018/08/13/health/ocd-concentrated-therapy-cbt.html

Author: Diana Gordon, Psy.D.

As cognitive behavioral therapists, the clinicians at SFBayCBT use a variety of techniques to help people cope with distressing thoughts. What we think impacts how we feel, which in turn impacts how we behave. When we can intervene and use strategies to cope with negative thoughts, we can often change both how we feel and how we behave in challenging situations.

Sometimes, we have negative thoughts that are really hard to modify or change. This might be because these thoughts are not actually distorted or inaccurate (as described in this blog post). Or it might be because they are so distressing that it’s difficult for us to calm down enough to engage with them intellectually. One strategy that we use to work with thoughts like this is Cognitive Defusion. Cognitive Defusion is simply the process of stepping back from your thoughts, and recognizing that they only have as much power as you give them. While thoughts can bring up a lot of really difficult feelings, ultimately we decide how much we believe them. They are not always factual. We can have a thought, but we don’t have to “buy” it. We don’t have to accept it as truth. And we certainly don’t have to act on it. Cognitive Defusion strategies allow you to step back, evaluate, and decide what to do next.

Cognitive Defusion can be challenging because when we are having thoughts that bring up a lot of strong emotions, it is really hard to not get caught up in believing everything our mind is telling us. Below, we will outline some great strategies to start experimenting with Cognitive Defusion. Remember that sometimes you might have to try more than one of these before you start to calm down, step back, and recognize that you have control over what you do with these thoughts.

1. Label your thoughts- “I’m having the thought that I’m worthless” instead of “I’m worthless.” Notice how labeling it as a thought reminds you that it’s just a thought, not necessarily a statement of fact.  
2. Pragmatism- if you buy into that thought and let it control you, where does that leave you? What do you get for buying into it? How does that thought work for you in the long run? Can you ignore that thought and do as you please, even though your mind is telling you not to? Try thanking your mind for the input (thanks for that thought, mind!) and behaving however you please.
3. Meditative- Let your thoughts come and go like passing clouds or cars
4. Bullying Reframe- What's it like to be pushed around by that thought/belief/idea? Do you want to have it run your life, tell you what to do all the time?
5. The observing self- take a step back and look at this thought from your observing self. Observe the thought with curiosity and without judgment.
6. Insight- When you buy into this thought, or give it all your attention, how does your behavior change? What do you start or stop doing when it shows up?
7. Secondary gains- When this thought shows up, if you take it at face value and go along with it? What feelings, thoughts, or situations does it help you avoid (in the short term)?
8. Distraction- do something enjoyable for yourself, and don't invite the thought with you! If the thought comes up while you are doing something else, let it know it's not welcome.
   
   

    Rather than judging thoughts as good or bad, Cognitive Defusion helps you evaluate whether thoughts are helpful or unhelpful. Once you’ve defused from your thoughts, you can decide what to do with them. Will you jump into problem solving mode? Will you practice some self-care to help yourself feel calmer and more centered while you’re coping with difficult feelings? Cognitive Defusion techniques help you regain your sense of control so that you can decide how to behave, rather than feeling compelled to behave in a particular way. If you’d like to learn more about this and other strategies for managing challenging thoughts and feelings, feel free reach out to us for a free phone consultation.

Author: Kari Kagan, Psy.D.

All of us encounter problems in our lives. Problems can range from as simple as figuring out how to change a light bulb to as complex as figuring out how to help a family member who is struggling with mental illness. Not all problems are going to be solvable immediately, or ever. For those problems, there is a different set of strategies to help cope with issues we cannot fix. I encourage you to read more about acceptance here. For those problems that we are able to solve, it is important to take steps toward figuring out how to deal with them as soon as possible. When problems linger and remain unresolved, they can contribute to an increase in anxiety, depression, sleep issues, and other distressing symptoms. Further, as more problems build up, people can feel overwhelmed and engage in unhelpful behaviors that only further distress, such as avoiding dealing with the problems or turning to substances to help them “forget.” As such, this blog aims to provide a step-by-step guide to problem solving that can be applied to any problem, big or small. Below I will walk you through a tool that comes from the DBT Skills Training Manual and will use an example to help demonstrate how to use it.
 
Step 1
Figure out what the problem is and describe the situation. Be specific.
 
Example: I have two different work projects due on the same day. I am worried I will get fired if I ask for an extension on one of them.
 
Step 2
Check the facts to be sure you have the right problem situation. The problem to be solved should be based on the facts of a situation, not on parts of a situation that you cannot know for sure, such as what someone is thinking or feeling.
 
Example: It is a fact that I have two work projects due on the same day as both of my managers told me when they want the project sent to them by. My worry about getting fired is not based in facts but more in my fear of what could happen if I don’t meet expectations.
 
Step 3
Identify your goal in solving the problem.
- What needs to happen or change for you to feel ok?
- Keep it simple, and choose something that can realistically happen.
 
Example: My goal is to try to get an extension on one of the projects in order to allow me the time to do both the projects with full effort and to help reduce my stress levels.  
 
Step 4
Brainstorm lots of solutions.
- Think of as many solutions as you can. Ask for suggestions from people you trust.
- Do not be critical of any ideas at first. (Wait for Step 5 to evaluate ideas.)
 
Example:

1. Pull “all nighters” in order to get both of these projects complete by the original deadline
2. Turn in a project late and hope that my manager doesn’t get upset
3. Quit my job
4. Talk to the mangers to explain the situation and request an extension on one of the projects
5. Ask a colleague to help me with some parts of each project in order to reduce the amount I have to do

 
Step 5
Choose a solution that fits the goal and is likely to work.
- If you are unsure, choose two solutions that look good.
- Do pros and cons to compare the solutions.
- Choose the best to try first.
 
Example: I am most interested in options 4 and 5
The pros and cons of option 4:
Pros:

• If I get an extension then I will have more time to work on the projects and feel less stressed overall
• It might help increase my managers’ understanding of my workload and prevent future conflicts

Cons:

• Worried that my managers will think I am a slacker (not a fact but a fear)
• I will have to work harder for a longer period of time as opposed to getting the work over with quicker

The pros and cons of option 5:
Pros:

• Getting help will decrease my stress levels and help me to complete the work on time

Cons:

• I still have to manage what my colleague is doing so this option might take up more time than I think

 
*I will start with option 4 then try option 5 if option 4 doesn’t work.
 
Step 6
Put the solution into action.
-  It might be helpful to write out a step-by-step plan for how to take action on the solution.
- Take the first step, and then the second . . .
 
Example:
Email managers to set up a meeting to ask for extension
Explain that I have 2 projects due on the same day and more time would be helpful to be able to do the best job I can on each project
Negotiate a reasonable extension that still gets the projects complete in a timely manner
 
Step 7
- Evaluate the results of using the solution.
- If it worked, great! Problem solved. If it didn’t work, go back to step 5 and choose a new solution to try.
 
Example: The first option worked! My managers understood and I was able to get an extension on one of the projects.
 
To get comfortable with this tool, I encourage you to try it on a relatively simple problem. Even if you think you know the solution without going through all of the steps, practicing using the step-by-step model could help you apply it to the more complex problems that are difficult to solve. If you are struggling to solve problems in your life or are feeling overwhelmed throughout the process, I encourage you contact us or other professional help to learn how to better manage problems. 

Author: Katie Leoni, Psy.D.

What Are Cognitive Distortions?
The idea behind CBT is that all of us sometimes think in ways that are inaccurate or irrational. We call these cognitive distortions, and they occur when our mind convinces us of something that is not actually true and we unknowingly reinforce this belief over time. It is normal to have cognitive distortions, no one is immune from them. The difference is in the quantity and the impact these distortions have on a person’s life. When a person is anxious or depressed, they tend to have more irrational thoughts and cognitive distortions. When you’re less anxious or depressed, you tend to have more rational thoughts. This makes sense from a CBT perspective as thoughts, feelings, and behaviors affect one another. The goal of treatment is to teach clients how to recognize certain thoughts that might be getting in the way of living the life they want to live as well as teaching clients how to modify those thoughts to be be more rational.

Common Cognitive Distortions
Identifying cognitive distortions that you engage in is an important first step to balanced thinking. Once you know what they are, you are better able to challenge them and question their truth. Below are common cognitive distortions. Remember, this list exists because we all experience cognitive distortions on a daily basis!

• All or Nothing/Black and White Thinking
  • ​Viewing the situation in only two categories instead of on a continuum.
  • “If I don’t succeed, then I am a failure.”
• Over-generalizing
  • Seeing a pattern based upon a single event, or being overly broad in the conclusions you draw.
  • ​“I did a horrible job on this project, I am a bad employee.”; “I will never be able to speak in public because I once had a panic attack before giving a speech.”
• Mental Filter
  • Only paying attention to the negatives as opposed to the whole picture.
  • “Because I got one low rating on my evaluation, it means I’m doing a poor job.”
• Disqualifying the Positive
  • Unreasonably discounting the positive things that have happened or that you have done.
  • ​“I got promoted at work but only because no one else wanted it.”; “I didn’t have a panic attack today, but it’s only because I was too busy to be worried.”
• Jumping to Conclusions
  • ​Mind reading: Assuming that you know what someone else is thinking.
    • “He thinks that I don’t know what I’m talking about.”
  • Fortune telling: Assuming you can predict the future.
    • ​“I know I will draw a blank during my presentation tomorrow."
• Magnification/Minimization
  • When evaluating yourself, another person, or a situation, you unreasonably magnify the negative and/or minimize the positive.
  • “Getting a mediocre evaluation proves how inadequate I am.”
• Catastrophizing
  • Blowing circumstances out of proportion and making things out to be a lot worse then they are without considering other, more likely outcomes.
  • ​“I will be so upset, I won’t be able to function at all.”; “He’ll never want to be friend after what I said to him."
• Emotional Reasoning
  • Interpreting your experience of reality based upon how you are feeling, ignoring or discounting evidence to the contrary.
  • ​“I feel so embarrassed so I must be an idiot.”
• “Should” and “Must” Statements
  • The tendency to make unrealistic and unreasonable demands on yourself or others. 
  • “I should never make a mistake.”; “I must work out every day this year.”; “She should have been considerate and left earlier like I did.”
• Labeling
  • Making global statements about ourselves or about others based on situation specific behavior.
  • ​“I’m a loser”; “They’re such an idiot.”
• Personalization
  • Blaming yourself or taking responsibility for something that wasn’t completely your fault. Or, blaming other people for something that was your fault.
  • “The waitress was rude to me because I did something wrong.”

If you are interested in learning more about cognitive distortions and the way they are impacting you, please contact us to set up a phone consultation.