My favorite CBT and DBT skills
For the past month or so I have been in an intensive outpatient program (IOP) that focuses on cognitive behavioral therapy (CBT) and some dialectal behavioral therapy (DBT). It has been a wonderful experience and honestly, I wish I was taught these skills as a kid. There is proof that children with anxiety do better when their parents have learned CBT skills.
I wanted to share some of the skills I have found helpful but also wanted to mention some things to remember.
1. I am not a clinician or social worker. This is not my expertise. I urge everyone to see a therapist and seek help from someone who is a professional. You have a doctor for your body, get a doctor for your mind.
2. Depression and anxiety are illnesses. CBT and DBT skills can help with the symptoms but are not cures and are not the only thing one should rely on. In fact one of the skills CBT suggests is medicine.
A little back ground about CBT. It is a forum of therapy that focuses on changing unhelpful thoughts and attitudes.
Some of these unhelpful thinking styles or “cognitive distortions” include:
- All or nothing thinking- I messed up one experiment so therefore I am a terrible scientist.
- Mental filter or only paying attention to certain types of evidence- Noticing your failures but not your successes. Sometimes this leads to confirmation bias. If you only look for the data that support that “you are not a good scientist” you can find it but that doesn’t mean that’s the only data out there.
- Jumping to conclusions which can be further subdivided into mind reading and fortune telling. Example- assuming your PI is disappointed in you even though they haven’t said anything.
- Emotional reasoning. Feelings are not facts but sometimes they feel that way. Just because we feel something does not mean it’s true. Just because you feel like you are not good at your job does not mean you actually are not good at your job.
- Labeling. This comes in many forms. Calling ourselves idiots or losers. Sometimes we do it to others as well.
- Overgeneralizing. An example of this is saying statements like everything sucks.
- Disqualifying the positive. Sometimes we discount the good we do or we forget the good things that have happened to us.
- Magnification (ccatastrophizing) or minimizing. For example, catastrophizing could be thinking that failing one test means
- Should and must. Words carry meaning and therefore we need to be careful with the words we use. Words like should and must can make us feel guilty and as if we have failed. When we apply them to others it can lead to use being frustrated. As my therapist says: don't should on yourself!
- Personalization. An example would be putting the blame completely on yourself when a relationship doesn’t work out.
CBT involves using skills to help with these cognitive distortions. Here I would like to share some of the CBT skills I have found helpful. I have also included some DBT skills. That were taught to us during IOP. I should be taking a DBT course soon and will write a post about that as well!
The Three C's (CBT)
Catch. Check. Change. One main idea in CBT is that an incident leads to thoughts which lead to both physical and emotional feelings, which contribute to a behavior and thus consequences. Traditional CBT skills focus on changing thoughts which should influence your physical and emotional feelings and therefore behavior. The idea is to catch what you are thinking. Checking two things: is it true? Is it helpful (i.e. are you falling into the unhelpful thinking styles mentioned above?) And finally attempting to change it.
For example, let’s say an experiment doesn’t work. That can be upsetting and sometimes it’s upsetting because we personalize what happened. We may be thinking “oh I am not a good scientist, I can’t even do this simple experiment.” The experiment itself not working isn’t the main driving force of us being upset sometimes. It is the set of thoughts that creep in afterwards. This is where we can do a healthy thought check, does one “failed” experiment really reflect who I am as a scientist? The three C's d not stop you from being upset but they might turn down the volume.
Sometimes just catching what you are thinking helps. It’s the first step towards understanding your feelings.
Feelings ≠ Facts (CBT)
Once I learned this phrase, I have started repeating it to myself. Often imposter syndrome kicks in and I feel like a bad scientist. Feelings are not facts reminds me just because I feel it, doesn’t mean it is true. It’s a simple yet strong idea.
Creating a Kind Environment
I think for each skill I will be saying this is my favorite, but really I do love this one. Environment does not just refer to home or work, but it refers to your social network online or offline and anything you have to face on a daily basis. Our environment can strongly influence how we feel, but thankfully we can sometimes influence our environment.
For me at home, I redecorated. I hung up pictures and artwork, got new lamps, and rearranged my furniture. Work is tricky because sometimes you have no control on certain parts of the environment but adding pictures or personalizing your desk can help. The online environment is a huge one! Social media can be wonderful, but it can also drag you down. It’s okay to be selective with who you follow and interact with.
You are not at 100% but you are also not at 0%
You are somewhere in between. Many disciplines attract people who are perfectionist, who always want to do their best and when that doesn’t happen it feels like we have done nothing. We rarely ever do nothing and we should give ourselves credit for the things we do, no matter how little we perceive them. Reminding ourselves of these accomplishments is important.
Coping Ahead (DBT)
Anxiety can start before something has even happened. In graduate school that can mean seminars or presentations. Sometimes it can even mean a social event. For some it can help to plan ahead. Think about what causes you anxiety and the ways you can avoid certain situations or deal with your anxiety. For example, a work party can be stressful for some due to social anxiety, or anxiety surrounding food, or comments being made. Plan breaks for yourself. Go with friends to help create a kinder environment for yourself. There are many more things you can do. It helps to think about these skills before the actual event so you are prepared when it happens.
How we tell a story can strongly influence how we feel about said story. It may help to tell the story in a different way. We can use the same facts to tell a story in various ways. A personal example for me involved grants. I was/am awaiting responses to multiple grants. I was feeling anxious thinking about all the possibilities of not getting the grants. After realizing how much it was weighing me down, I decided to look at it in a different way. I had multiple grants out there which meant I wrote those grants and submitted them. For some of them it meant I was nominated and someone believed I deserved it. Both stories used the same set of facts, but one turned down my anxiety a little.
Wise Mind (DBT)
Wise mind is the intersection of our emotional and reasonable minds. How often do we say "I know it's okay that I take a break but I still feel bad"? Your reasonable mind is being....well reasonable. The guilt is being driven by our emotional mind. DBT reminds you that it is good when you join the two. I often find myself employing wise mind when I feel guilt over not going to work for health reasons. I try to rein in my emotional mind and amplify my reasonable mind.
Self Soothing Kits and Mindfulness
Technically these are two different skills but I am putting them together. Creating a self soothing kit is a DBT skill. The kits are meant to soothe the five senses during times of heightened emotion or distress. It can be a small bag or box filled with different items that help you feel better and you are able to keep near you. Keep in mind that an item might soothe multiple senses. Some examples:
- Sight- pictures, artwork, letters from loved ones.
- Touch- lotion, stress ball, fidget toy, clay.
- Sound- music, nature sounds.
- Taste- chocolate, candy, gum.
- Smell- lotion, perfume, candles.
A self soothing kit can also make you more mindful and aware of what your body is feeling.
Remember that recovery from a depressive episode and life in general is like a Krazy straw. There will be ups and downs. You might feel like you are doing better then all the sudden feel worse. That's okay. It's part of the progress. It's important to keep getting up and trying.
If these skills are new to you, they won't always come easy. It will take practice and over time they will become habits.