How many times have you heard yourself say, "I can't?"
Everyone has these moments. Problems can seem too intricate to solve, and challenges can appear too difficult to face. For people living with PTSD, there is an additional piece that will easily make anything seem impossible: negative thinking.
Negative thinking is choosing to have thoughts that discount any positive, hopeful, or desirable outcome. These negative thoughts often arise out of cognitive distortions. You can use your knowledge of cognitive distortion to better understand the types of negative thinking you engage in. For example, it is easy to have a distorted response to criticism. If my employer tells me that I've done something on a project incorrectly, I could turn that into thinking that the entire project is ruined. This distortion is called "all-or-nothing," the belief that it all must be done correctly or none of it is right.
It is after the distortion that the negative thoughts kick in:
"It's ruined, and I've failed, and I can't do anything to fix it."
These thoughts bring with them feelings of helplessness, self-hatred, shame, frustration--all emotions that will lead only to morenegative thinking:
"I can't fix it, I'm helpless, I don't do anything right, and this is never going to change for me. I can't."
Negative thinking is a learned behavior. We aren't born with it; we cultivate it over time. The bad news is, you're probably pretty good at it: most people with mental health issues are. The good news is, you can learn a new behavior. You can teach yourself to utilize neutral thinking and to apply positive (forward-moving) action.
Notice that we don't use "positive thinking" as the opposite of "negative thinking." Why? Because we want to understand that our thoughts are essentially neutral; they do not automatically have an emotion. We assign an emotion. This notion is a fundamental principle of Cognitive Behavioral Therapy (CBT), and it remains a useful concept regardless of one's opinions regarding CBT therapy.
The goal is to get to an action. When we tell ourselves "I can't," we grind to a halt. We become stuck in whatever the problem is. If we don't change the negative thinking, we will eventually drift into negative action: procrastination, avoidance, self-sabotage, lashing out, self-harm, even developing addiction problems or causing irreparable harm to others.
However, when we learn to create neutral thought, we can then apply positive actions: problem-solving, challenging, and acceptance. We can move forward.
Step 1: Recognize the distortion
Step 2: Name the distortion
Step 3: Challenge the negative thought
Step 4: Create a neutral thought
Step 5: Problem-solve
Step 6: Create positive action using acceptance
You will apply three therapeutic steps when managing a cognitive distortion: recognize, name, and challenge. These steps are taken from CBT, and are part of the larger seven-column thought record process. Simply put, you must recognize that you are distorting the issue, name the distortion type, and then challenge how true it may or may not be, using evidence to support your viewpoint.
Sample situation: Jane's boss sends a completed project back to her, asking for an adjustment to one section and complimenting the other four sections and the work overall. Jane later tells her friend that she "completely ruined" a project at work. Jane shares that she is afraid to fix it because she will make it worse.
Step 1: Recognize the distortion.Jane's friend points out that it was only a section that received criticism, not the entire project, and this helps Jane see the distortion. Often, when we are first learning to see our distortions, we need help from an outsider: a friend, a therapist, a poster on a message board--you can even have your own "outside" eye by writing down your thoughts and then reading them. This is one of the strengths of a place like MyPTSD. We are often better at seeing other peoples' distortions than our own. Eventually you will become attuned to your habitual distortions and you will be able to recognize them easily.
Jane sees that her friend is correct and recognizes the distortion. At this point, whether or not Jane is ultimately right about the project being completely ruined isn't relevant. All she needs to do is recognize that she has gone from one from one thing wrong to all things wrong.
Step 2: Name the distortionNext, Jane will name which distortion she is using. Think of this piece as being able to put a name to a symptom. Initially, she might need to go and look at a list of distortions to figure it out, but after a bit of practice at naming distortions it becomes almost automatic and naturally follows the recognition phase of our process. Jane names this distortion "all or nothing."
Notice: by introducing these two new cognitive--that is to say, thought-based--steps, Jane has stopped the downward spiral of distortion. Instead of having already moved on to believing she can't do anything about her situation and engaging in negative action, she is slowing herself down enough to examine her situation.
It is very important that you give yourself permission to go slowly, step-by-step. You still do not have to think a different thought--nowhere in here has Jane actually changed her mind concerning her belief that it's all ruined. She is simply not following that belief into the greater negative thoughts and actions that would normally follow her initial, reactive belief.
Step 3: Challenge the negative thoughtCBT uses the concept of evidence. What evidence do you have that a particular thought is true?
Sometimes, this is where the cognitive distortion "bubble" bursts quickly. It can be immediately obvious that there is no evidence to support the thinking. Sometimes, we can try and provide evidence but will notice that the evidence isn't proof-based: it's based in emotional reasoning. In other words, we will notice that we are thinking with our feelings instead of thinking with our thoughts.
Jane could try and say that the evidence for the whole project being ruined comes from the last time she made a mistake and everything turned out poorly, but that's not strong proof, because that was a prior situation, and this is a current one. There is no way to know that the same situation will repeat. She could try and say the evidence is that she always fails at fixing things. This assertion is merely using an emotion--despair--to construct a reason, but it's not proof. It is a feeling.
Whenever you think the words "always," "never," and "last time," you can be fairly certain that you are using emotional reasoning. Factual absolute statements are very rare.
Jane notices her "always" and "last time" phrases and sees that she is engaging in emotional reasoning.
She decides to list the evidence for and evidence against her prediction that the project is ruined.
Evidence that it is completely ruined:
- The project is not acceptable in its current form, so right now, it is completely unacceptable according to the boss. It needs fixing.
- the boss gave a compliment on the quality of the project overall.
- a portion of something is not the whole of something.
- the project was returned to Jane for fixing, which indicates a degree of confidence her boss has in her ability to do the job.
Traditional CBT would suggest that Jane move to the next step of the thought record, which would be creating "balanced" thought. But this will not actually support the problem-solving she needs to do in the here and now; it is a part of the CBT process designed to ultimately get at your core beliefs around the distorted thought. Creating a full thought record is good mental-health work to do, but will not help Jane find a way to get to work on the project, because even though Jane has recognized, named, and challenged her distortion, she still quite likely believes in it.
Jane is struggling with the difference between "knowing" and knowing. In dealing with all mental health issues, there are things that the sufferer is taught about their condition. These are the things we "know," the facts that we have memorized and even accept as true. But "knowing" how to address a cognitive distortion does not lead to believing that it is rooted in something negative that was instilled in a persons core beliefs as a result of their trauma. It takes a long time to get to believing--knowing--that these things aren't true: in Jane's case, that she is not always doing things wrong. That particular core belief will need to be challenged many, many times before she begins to believe that it isn't true. Right now, Jane is at only one of those times. However, the more often she completes this process, the more she chips away at the larger, deeper anxieties hiding in her core beliefs. The first, small chip she can make is in creating a neutral thought to replace the negative thought.
Step 4: Creating neutral thoughtInstead of a more nuanced "balanced" thought, let's just get Jane to what I will call neutral thought.
Neutral thought is, in a way, the thought itself without any feeling (or editorializing) applied. Remember, thoughts do not come automatically tied to feelings. Thoughts exist on their own. We add meaning to them, and when we do so, we often add emotion or judgement.
Jane ruined a project and will only make it worse if she tries to fix it.
Jane wrote a report; 80% was as requested, 20% was not. She has been tasked with correcting that remaining 20%.
Now, Jane is clear on the neutral facts of the situation, and she can apply problem solving techniques to find a new, positive action. And this step may strike you as obvious, but it is the most critical aspect to addressing negative thought. Until the negative is re-framed as neutral, it will linger and either grow stronger or balloon out into other situations.
Practicing neutral thought can sometimes seem like adopting an almost robotic view of the world, but I assure you it is not. Neutral thought is what will ultimately provide the gateway to positive action.
Remember: most negative thinking will arise from a cognitive distortion. That cognitive distortion will be the result of a problem or challenge you encounter. Practice applying these first four steps to the negative thoughts you encounter when facing a problem or challenge. Steps one through four, taken alone, represent the tools you need to do something called re-framing. Re-framing is a common therapeutic concept and is useful for anyone working through challenges of perspective. The process of re-framing--moving a thought from one point of view to another--is used for much more than addressing negative thought. However, by learning to apply it swiftly and effectively to negative thought, you will find that other types of re-framing become simple to do as well.
Step 5: problem solveIt's easy enough to tell someone to solve a problem, but we all know that it can be very difficult to figure out where to start, especially when the problem is yours, and you are invested in a good outcome. This step will give you three different techniques you can apply towards problem-solving.
All three techniques have been chosen specifically because they can be used singly or mixed-and-matched; it is easy to flow from one to the other. Different problems call for different approaches--or cocktails thereof--and it is important to have more than one technique you can apply. Moreover, these techniques work particularly well on challenges that incite fear or require stepping into new territory, two scenarios that are very likely to lend themselves to negative thinking styles.
The most common pitfall at this stage of the game is to circle back to the initial negative thought because you cannot find a way to take apart the problem.Use these techniques to avoid that mistake.
Remember, at this point we are no longer working on the larger mental health issue (the thought/belief); we are working on our real-life, in-the-moment problem.
I am going to switch examples, and use a particular negative thought that many people with PTSD have at one point in time or another:
"I can't get therapy".
It might be because there isn't anyone near enough for you to get to, it might be because of money, it might be time, it might be having had a bad experience in the past, it might be fear of what could happen inside therapy, or fear that someone will find out you are in therapy, or believing you can't do therapy, that you are incapable of it, or one of a hundred other reasons.
For our example, let's use,
"I can't get therapy because I am too afraid to talk. I don't know what will happen if I do, but I know it will be so unbearable. I will never recover".
Quickly, lets review steps 1 through 4 - Recognize, Name, Challenge, Create. First, you can recognize there is a likely cognitive distortion in the concept of 'so unbearable, I will never recover'. Indeed, the name for that cognitive distortion is 'catastrophizing'--believing that an action will lead to the worst kind of disaster, an unrecoverable catastrophe. The challenge against this distortion is straightforward, because there is little to no proof supporting the fear, even if you have had multiple failed attempts at therapy in the past, you still cannot knowit will result in something unbearable, nor can you know that you will not be able to bear the difficulties of it now, even if you couldn't bear them in the past. Create your balanced thought:
"I don't know how to go about getting therapy. I'm afraid of even talking about my problems, because I don't know what will be the result, whether it will be positive or negative."
Excellent. But now, we need to be firmly in step 5. We need to solve the problem. How do we get from the re-frame to a solution?
This problem is intensely personal and likely to be encumbered by many negative thoughts. In order to solve it, you will need to create some cognitive space between the problem and yourself. Cognitive space means exactly what it sounds like. It is room to think, without the distraction of the problem itself.
Technique #1: As If It Were Someone Else
"What if someone else thought they couldn't get therapy because they didn't know what would happen there, and they feel afraid? How would they solve this problem?"
Notice two things about that last question. It begins with "how," which keeps us rooted in action, not "why," "can," etc., which are more passive and contemplative. Then, the use of the word "solve," which assumes that there is a solution. This is the exact opposite of assuming there is no solution- and while that might sound unbelievably simplistic, you'll find it to be incredibly powerful.
So, how would 'they' solve this problem? Take the problem apart into pieces. You might want to do this on a piece of paper. Remember, it's about someone else. Keep using the language of 'they' and 'them' in order to maintain cognitive distance.
They don't know what will happen in therapy if they talk.
This indicates that 'they' don't have much knowledge of what goes on in a therapy session, and they literally don't know what will happen to themselves--emotionally and physically, in and out of the process. How can they solve these issues?
They can learn about what therapy really is: look up "types of therapy." Search psych forums (like this one!) for different types of therapy and experiences others have had. When they encounter something they don't understand, search a little deeper, or call their local library; most people don't know that librarians worldwide are trained to help people find the answers to questions. Keep track of what they are learning using a journal.
Note: never be afraid to learn what you think you already know. Even if you can rattle off five types of therapy, go and look up what else there might be, or even continue to look more deeply into what it is you think you understand already. You'll be going over some familiar ground, but that only means you are a few steps ahead. Remember, you're researching this in order to help "someone else," the mysterious 'they' referred to in this technique.
They can talk to some mental health practitioners; if they find you aren't learning enough specifics from reading, find a way to ask a therapist what they do. They might be able to do this by writing into blogs, or scheduling a meeting with a resource they learn of through the preliminary research. Be creative on behalf of your imaginary person!
Remember: learning about something doesn't mean it's going to happen - it's just learning.
They can talk to people on mental health forums about their experiences in therapy, good and bad, and ask them questions, even write about their own fears and get other peoples' responses.
After going through this process, your 'someone else' will have learned a great deal about what options are out there. At some point, you may even have stopped thinking of it as their challenge and started identifying it as your own. By educating yourself, you have addressed and neutralized many of the individual components of your fear. It is likely that along the way, you discovered what your first avenue for your positive action might be, and then you can move along to step #6.
But what if all the education did not move you past the fear? You can try the next technique.
Technique #2: Listing
For some people, making lists is a very enabling action. It brings order to the chaos. If you have never tried making a list, you should see if it is a technique you enjoy.
Lists begin with topics. When using lists for problem-solving, it is a good idea to think in terms of two columns: whatand how. Like our examples in Technique #1, using whatand howstatements will keep everything practical and doable.
Remember our initial problem:
"I can't get therapy because I am too afraid to talk. I don't know what will happen if I do, but I know it will be so unbearable, I will never recover."
Let's identify the what and the how.
First, what are all the pieces of the fear? What are you afraid of? Here is a potential list:
- Hearing a diagnosis that is frightening (being told you are "crazy")
- Being hospitalized
- Falling apart and not being able to fulfill daily responsibilities
- Having to take medication
- Having to talk about the past
- Never getting better
We will use four tools. Each is suited to a specific kind of question. If you need help remembering them, you can use the acronym BAD FOG.
- Following the thought
- Guessing the worst
First, we remind ourselves of what the fears are - and then, we apply the tools (BAD FOG), in order to discover howwe might move past these fears.
Hearing a diagnosis that is frightening (being told you are "crazy"):
- If you don't like what you hear, if the diagnosis scares you, you don't have to go back. (Bargaining)
- Find a kind of therapy where you feel safer than an office, perhaps at home, online, or in a group (Diminishment)
- If you fell apart and couldn't keep up with daily things, what would you do then? You would need to get rid of daily responsibilities. How? You could go on medical leave, invest in day-care, etc. (Following the thought)
- What is the very worst thing that could result from being told to take medication--needing to say "no"? Being labelled as sick? Notice that you were advised to take medication, not forced to take medication. This technique will uncover the assumptions inside of fears and neutralize them. (Guessing the worst)
- What technique would you use? Try one out!
- Here, we have actually uncovered a new and different cognitive distortion. Put this on a list of its own; it needs to be worked on separately.
Technique #3: Making Steps
When all else fails, this technique will succeed. It is the most direct way to move yourself to a positive action. Indeed, if you come through the first four stages of addressing negative thought (recognize, name, challenge, re-frame) and you are emboldened by that process, you can use this technique to get you quickly to your goal.
It works like this: assume that you are going to address the challenge, regardless of lingering fears. Remember that anywhere along the way you can stop, back up, and try another technique.
Break the challenge or problem into steps. They must be precise and narrowly defined. The important thing is to convert the one big thing--in this case, getting therapy--into many smaller steps that are easy to do.
Your first job in this technique will always consist of breaking the problem into those smaller steps. In the case of our current example, your list might look like this:
- Do internet or library research on what therapy is.
- Do internet or library research on how to start the process.
- Make a list of questions to ask my insurance company or government agency.
- Call (or visit) and get those questions answered.
- Write out your requirements and restrictions (how far I will travel, cost, type, gender, age, etc.)
- Use your requirements and information from your insurance/government agency to search for five possibilities.
- Call one per day until all have been called in order to ask for an evaluation session or an intake appointment.
- Schedule appointments.
A good list will end with the last thing you could possibly do before you finish addressing the initial problem or challenge. Now, you are ready for the final step.
Step #6: Create Positive Action Using Acceptance.In the case of our current example, the final step--the positive action--is to go to the appointments. The assumption is that, after having re-framed your negative thought and broken down the problem into something soluable, you will be empowered (and therefore able), to take action.
Remember Jane from part one? Lets go back to her story. She has re-framed her negative thought ("the report is completely ruined") into a neutral one: the report needs corrections in one section out of five, and her employer is confident in her ability to do the work. How does Jane create positive action?
Her task is simple: address the corrections needed for section five. She used a combination of the What If It Were Someone Elseand Making Stepstechniques in order to organize an approach. These led to the final step of scheduling a time in her work-day to begin re-writing. Now, she needs to accept that she is prepared to address the challenge, and do so. Jane needs to do the re-write that her boss has requested.
Acceptance is an important component of positive action. Notice what Jane needs to accept. She only needs to accept that she is prepared to address the challenge.
This is much simpler than accepting that she is good at what she does, for example. To accept that would be a major shift in her core beliefs, it would take quite awhile, and it's not even necessary here. Acceptingthat you are prepared is different from accepting that you are ready. Readiness usually invokes ability, and accepting that you are able to do something takes more work and hours than accepting preparedness.
In our other example, the acceptance piece is very similar. The positive action is to go to a therapy session. The acceptance piece is again rooted in preparedness. You have preparedyourself by addressing your fears through increased knowledge, and now there is nothing left but to go.
Acceptance is an often-misunderstood mindfulness concept. Acceptance does not equal positivity or negativity; acceptance is only acknowledging things as they are. It is easy to accept that 2 + 2 = 4, but when we are dealing with negative thoughts, it is a real challenge to accept that we have gotten to a point where we are, in fact, reasonably prepared to take positive action against the problem at hand. Hopefully, by using the concepts laid out in this series, you have a better understanding of your own tendencies concerning negative thoughts, and you now have a process you can apply in order to address them.
Like any new skill, this process takes practice. As you work with it, notice how you adjust it to suit your own cognitive style. You will soon find that many steps become automatic, and that you are beginning to have less general anxiety around common problems and challenges you encounter. Eventually, all the good work you are doing in re-framing your negative thoughts, and uncovering solutions for your real-world challenges will have a significant impact on creating new, and healthier, core beliefs.
You are re-building your brain, one positive action at a time.
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