Thursday, September 5, 2013

Reduce Stress One Piece of Pie at a Time

Today more than ever, there is intense pressure to be productive, multitask, and perform. All of this pressure can be a fertile breeding ground for feeling overwhelmed by stress and anxiety. Unfortunately, the more overwhelmed we feel, the less productive we are. Sometimes juggling numerous responsibilities can leave us feeling helplessly paralyzed, avoiding what needs to be done rather than tackling it head-on.

There are numerous ways Cognitive Behavioral Therapy can address this all-too-common problem. One simple way is the pie-chart technique. Here's how it works:

1. Identify all of the things that are causing you to feel overwhelmed. They can be projects, errands, or even difficult people.

2. Create a pie chart, using each of the items you listed as pieces of the pie. For this, you'll need to rank which things are the greatest contributors to your stress. Then assign each one a percentage, based on how much of your stress you can attribute to it. For example, if your pie chart has three items: returning phone calls, preparing for a presentation, and a difficult co-worker, they might be assigned percentages of 60%, 25%, and 15%, respectively. Make sure that it all adds up to 100%.

3. Identify the most stress-inducing problem, and prepare to tackle it. Although this may seem like common sense, when overwhelmed, most people feel that there are so many problems that it would be hopeless to solve any of them. Consequently they end up avoiding their problems while the problems get bigger. Focusing on only one problem at a time makes feeling overwhelmed and giving up less likely. And by solving the problem that is responsible for the most stress, people generally feel much less anxious and more empowered to solve the rest of the items on the pie chart.

4. Break the identified item into steps. Oftentimes, one project or problem all on its own can trigger feelings of hopelessness and worry. Identifying all of the steps needed to solve the problem is a way of seeing in a concrete way how the problem does have a solution.

5. Complete each step one at a time. Focusing on one small step rather than ten or more steps, makes the task feel more manageable. It works the same was as focusing on one problem from the pie chart rather than all of the problems at once. Additionally, because one step is easier to complete, it promotes confidence and mastery, making the rest of the project feel less difficult. With each step completed, solving the entire problem seems more likely. After completing one step, move onto the next.

6. Continue this process for the rest of the items from the pie chart. You can continue to work in this fashion until all of the identified problems are solved, or at least more manageable. However, most people find they no longer need this approach after completing the first few items from the pie chart, as they feel much more confident in actively solving problems.

For more information about how Cognitive Behavioral Therapy Works, visit Cognitive Behavioral Therapy in Los Angeles

Saturday, August 17, 2013

Reduce Anxiety Quickly with Square Breathing

As human beings, we all experience anxiety from time to time. It's natural. It's normal. And if we didn't, we'd probably get into a lot of trouble. Unfortunately, sometimes anxiety can become too intense and get in the way of our effectiveness (think going blank during a final exam). Cognitive behavioral therapy has numerous treatments for anxiety, and most of them are among the most effective psychological treatments studied by scientists. One that is easy to learn is square breathing, also known as relaxation breathing.

A note of caution: If you have any medical condition that might be adversely affected by slowing down your breathing or holding your breath, please consult with your doctor first. 

Steps for Square Breathing:

STEP 1: Find a quiet place in which you can sit for ten to fifteen minutes without being distracted.

STEP 2: Take note of your normal breathing pattern, and count how many seconds each inhale and exhale take. 

STEP 3: Once you have a baseline measurement, increase the length of the inhalation and exhalation by one second, in essence slowing down each in-breath and out-breath. Once you have acclimated to the new, slower rate, increase the inhalation and exhalation by another second. If you feel uncomfortable or out of breath, it probably means you're slowing down too fast. Continue gradually slowing down your breath until you are breathing as slowly as you can without ANY difficulty. 

STEP 4: Once you are comfortable with a slower breath, experiment by pausing after each exhalation and each inhalation. These pauses can be short, lasting one or two seconds, or long, lasting up to ten seconds. However long the pauses last, just note you will probably have to adjust your rate of inhalation and exhalation to continue breathing comfortably, without feeling the need to gasp for air. The technique is called square breathing because originally the in-breath, out-breath, and both pauses were designed to be the same length, in the same way each side of a square is the same length. However, it doesn't really matter the ratio, as long as fewer breaths are taken each minute. 

STEP 5: Set an alarm and continue this for ten to fifteen minutes. Afterward, you will most likely experience an increase in relaxation, and a significant decrease in anxiety. AMAZING.

This works in the same way that the half-smile technique works: Normally when we are anxious, the result in our body is that our breathing rate increases, and we take shorter, shallower breaths. When we are relaxed, the opposite happens. By slowing down the breath, we trick our brain into thinking we are relaxed, and all of the relaxation neuro-chemicals are released. 

Research has shown engaging in this technique has immediate effects in the brain. More importantly, studies have proven that engaging in square breathing twice daily lowers overall levels of anxiety long-term in people who are prone to excessive worry. 

Try it out to see how it works. If it's helpful, the next time you're freaking out in a doctor's waiting room, or biting your nails before a job interview, pull out your square breathing and take things down a few notches.

For more information on this and other cognitive behavioral approaches to anxiety and depression, visit Cognitive Behavioral Therapy Los Angeles

Monday, July 29, 2013

Opposite to Emotion Behavior

Emotions love themselves. The more we feel an emotion, the more we engage in behavior that makes us feel that emotion even stronger. When we're sad, all we want to do is curl up in bed for hours on end, usually not eating, not talking to anyone, listening to sad music... Sound familiar? The problem with this, is the more we lie in bed not doing anything, the more physiologically depressed we become. This then leads to us feeling even sadder, and eventually we can be pretty demoralized when we look around and realize we've wasted the whole day.

To break this feedback loop, we need to engage in a behavior inconsistent to the emotion we're trying to manage. This is a technique called opposite-to-emotion behavior. To do this, identify the emotion (sadness), identify the mood-dependent behavior (inaction/isolation), then do the opposite of that (exercise, social interaction, productive behavior). After a while, the feedback loop is broken, and you have successfully managed that painful emotion. This works for any emotion:

Anger: Instead of engaging in conflict, act opposite to that emotion by gently withdrawing, or even better, doing something nice for someone else.
Fear/Anxiety: Instead of hiding or avoiding, approach what you are afraid of with full commitment.
Unjustified guilt or shame: Instead of trying to keep something (that is not shameworthy or morally wrong) a secret, expose it with the spirit of acceptance.
Justified guilt or shame:  If you did something that was out of line with your values, do something in-line with your values that overshadows that other thing.

Please note this is not intended to be a way of not feeling your feelings. Emotions are important cues that something important is happening. This technique is merely a way of managing emotions if you're afraid they might become too intense, or last a little too long. Give it a try the next time you have an urge to hide in bed and listen to sad music. You might be surprised at how you can turn around what might have otherwise been a day wasted!

For more information on cognitive behavioral treatment of mood disorders and anxiety, visit Cognitive Behavioral Therapy in Los Angeles

Friday, July 26, 2013

Treating Pain with Mindfulness Meditation

Pain is a pain. Suffering through a long day with a headache or chronic back pain can make it seem like time is standing still. Coffee doesn't taste as good. Little things set you off. And most of your mental real estate is focused on how terrible everything is... which doesn't really help.

Enter mindfulness. Mindfulness is a practice borrowed from Buddhism by cognitive psychologists due to the many beneficial effects it can have, including reducing pain. How does it work you ask? Well, the entirety of the Buddha's teachings take up more than 100 volumes of written work, so it can take a while to explain. But the quick and dirty version is to simply notice the pain.

Usually we try to distract from it, which is very, very difficult to do. When we're not distracting, we're spending all of our energy struggling with it - wishing it weren't there, getting angry at it, etc. None of this is helpful. It just adds additional suffering to what is already a painful experience.

The mindful approach is to allow the pain to be there. Rather than trying (somehow) to make it go away through sheer will, just notice it, and make space for it. Dropping the struggle with the pain can provide a lot of relief.

While you're allowing the pain to be there, just sit with it, and notice it. Put words to the experience. Where is the pain? Is it tingling? Is there pressure? Where does it begin and end in your body? Are there warm parts? Cool parts? By describing the experience without adding a lot of catastrophizing and negative judgment, we experience the pain in a new way. A lot of people report that just the mere act of sitting with pain and describing it, eliminates the pain entirely. A friend recently used this approach when he was having his wisdom teeth extracted... WITHOUT ANAESTHESIA! He reported he noticed pain, but relating to it in this way made it tolerable. Just another event in his body that he was noticing, like the hiccups, or a yawn.

It definitely takes practice, but with a little effort you can transform pain into something that is much more tolerable, and creates much less suffering.

To learn more about mindfulness-based interventions, visit Cognitive Behavioral Therapy in Los Angeles

Thursday, July 25, 2013

Would You Really Tell THAT to a Friend?

We are constantly telling ourselves things all the time, a running commentary buzzing around in our minds. It's how we make sense of and interact with the world. Unfortunately not everything we tell ourselves is necessarily helpful, or even true. "I'm too fat..." or "I'll never get this job," "why bother..." - Sound familiar? Cognitive therapy, developed by Aaron Beck in the middle of the last century, identified this problem and developed a very straightforward solution: to look at  our thoughts rather than looking from our thoughts. It's a process cognitive scientists term metacognition. It refers to the ability to examine our thinking process rather than assume every thought we have is true. It is the foundation of cognitive therapy.

To illustrate how dysfunctional thoughts cause problems, let's use an example. Peter, a college freshman, has a crush on a young woman he sits next to in class, Kim. Peter has wanted to ask her out all semester, and now he only has one class left with her before summer break. Committed, he decided he would ask immediately after class. While trying to pay attention in class, Peter had an onslaught of self-defeating thoughts, such as "She'll probably turn me down" and had lots of images in his mind of her laughing at him and ridiculing him in front of the whole class. This heightened his anxiety to a fever pitch, so much so that his mind "froze" and when he approached Kim. His mind went blank, and she gave him an uncomfortable smile and wished him a nice summer vacation.

Had Peter used a little metacognition, he probably would have noticed that his thoughts were mood-dependent, meaning that they are thoughts triggered by anxiety, rather than by the actual evidence around him, which is that Kim seemed too nice to try to humiliate him. In reality, it would probably have been highly unlikely for Kim to try to hurt his feelings by ridiculing him. But his thoughts triggered more and more anxiety until he couldn't think straight.

One tool to accessing that elusive metacognition is to ask yourself, "What would I tell a friend if he were in this situation?" It's very simple, but helps to take all of the emotions we have wrapped up in our own situations, and de-personalize them a bit. Here's how it might go:

Friend: If I ask her out she'll probably turn me down and laugh at me in front of everyone. That would be humiliating.
Peter: Well you don't know if she'd turn you down, but what I do know is that you really don't stand a chance with her if you never try. And do you really think she would laugh at you? I don't think that happens very often. She'd probably politely make up some excuse, and it wouldn't be great, but it certainly wouldn't be humiliating.

A simple method, yes. But it is a very effective one at helping us to take a more realistic perspective. It's interesting how we have more access to our own wisdom when we remove ourselves from the situation. The next time you notice an inner monologue of self-defeating thoughts, ask yourself, "What would I tell a friend if she were in my shoes?"

For more information on cognitive behavioral therapy, visit Cognitive Behavioral Therapy in Los Angeles

Wednesday, July 24, 2013

Turn That Mood Upside Down With the Miraculous HALF-SMILE

One of my favorite techniques from cognitive behavioral therapy research is the "half-smile." This is a technique borrowed from Buddhism, and it's quick, easy, and free. Research has shown this technique can improve your mood after only ten minutes of practice. Compare that with the four to six weeks it takes for an antidepressant to start working! Just kidding - it's definitely not a replacement for medication or therapy, but it can really turn a lousy mood around.

Here's how it works:
Begin to smile with your lips, but stop just when you notice a small amount of tension at the corners of your mouth. If someone were watching you, he/she probably wouldn't notice any change in your face. It's a subtle, tiny smile. (If you try to keep up a big toothy grin for ten minutes, nothing will happen other than your face will start to hurt.) Now wear this for ten minutes without stopping, and notice how your mood has shifted. Most people report a significant uptick in their overall mood. If you don't notice any significant change, some people find it helpful, in addition to the half-smile, to "smile with their eyes."

The way this works is the bi-directional nature of behavior and emotions. Most of the time, when we experience a positive emotion, such as joy, we smile as a consequence of the joy. But what the most current cognitive-behavioral research as shown time and again, is that it works the other way too. Smile for a few minutes and you feel happy. Furrow your brow and you experience anger. Breathe short, shallow breaths, and you can induce panic. Basically, engage in the behavior and the emotion will follow (aka fake it 'til you make it).

Give it a try the next time you're sitting in traffic or waiting in line at the DMV, and see how it works.

For more information on cognitive behavioral and mindfulness-based therapies, visit Cognitive Behavioral Therapy in Los Angeles

Introducing Cognitive Behavioral Therapy Hacks

This is just a brief post to announce the existence of this blog. The intention is to bring concepts and techniques from cognitive behavioral therapy to a wider audience. Cognitive behavioral therapy is the most well-researched mental health treatment that has consistently proven to be briefer and more effective than traditional talk-therapy. For more information on cognitive behavioral therapy or to find a cognitive behavioral therapist, visit Cognitive Behavioral Therapy in Los Angeles