Chapter 9

Chapter 9

MINDFUL CHOICE FIVE

Engage in self-reflection and learn how to manage negative self-talk, distorted thinking, and maladaptive schema

“People are disturbed not by things, but by the views which they take of them.”

Epictetus, first century A.D.

“If people stopped looking on their emotions as ethereal, almost inhuman processes, and realistically viewed them as being largely composed of perceptions, thoughts, evaluations, and internalized sentences, they would find it quite possible to work calmly and concertedly at changing them.”

Albert Ellis

“Crises marked by anxiety, doubt, and despair have always been those periods of personal unrest that occur at the times when a man is sufficiently unsettled to have an opportunity for personal growth. We must always see our feelings of uneasiness as being our chance for making the growth choice rather than the fear choice.”

Sheldon B, Kopp paraphrasing Abraham Maslow

We often disturb ourselves, deepening and prolonging our distress with learned negative self-talk and maladaptive core beliefs. Engaging in self-reflection and dealing with negative self-talk and distorted thinking with awareness, acceptance, defusion, and more realistic self-talk, is a key to transforming a life characterized by stress, anxiety and depression to a life that can be dramatically more satisfying. Strategies and skills for not letting negative self-talk and maladaptive core beliefs dominate your life are discussed in this chapter. Let’s again check in with Matt.

Matt was deep in thought as he entered the final leg of his morning commute. For a change the traffic was light – unusual for a Monday. He was actually arriving ten minutes early. The sun was shining, the temperature was great, sales were up, all the stats were positive, things were good with Bev and the kids – so, what was it then? He had learned deep breathing in his therapy sessions, and was faithfully following suggestions. It was definitely helping. Reminding himself to take three deep diaphragmatic breaths when feeling stressed kept him from feeling perpetually "frazzled" – his term for the state of near panic that until recently was becoming an ongoing condition. Moreover, he was now able to be aware of his level of stress and anxiety on a 1 to 10 scale, and to use awareness of rising anxiety as a reminder to breathe and "take it down a notch or two." It worked! But still... Robin had talked about self-calming skill being in two parts, deep, slow, regular abdominal breathing, or "belly breathing," along with defusing and redirecting self-talk — diaphragmatic breathing coupled with self-soothing inner dialogue. She said that doing one without the other was like driving your car with one foot on the accelerator and the other foot on the brake – not an effective way to drive, and probably not good for the equipment either. It was that second part, the self-talk. I've always been hard on myself, Matt thought, but that's just the way I am. If I don't push myself, I'll fall short of my goals. I might even lose my job. Where would that leave Bev and the kids? Of course! I've got to beat up on myself from time to time. It's all that keeps me from being mediocre. How else can I see it? I'm not sure I understand this self-talk thing. Pulling into the office parking lot Matt reminded himself to take three more deep breaths, immediately feeling his body respond with a wave of relaxation. Yes, it was working. Feeling Un-characteristically calm, Matt put on his happy face and headed through the lobby door. "Morning Sally," he said, walking briskly past the receptionist. Sally glanced up from a pile of memos. "Good morning Matt. Mr. Johnson wants to see you right away, and he looks like he's got a full head of steam up already. Better check in with him as soon as you can." The “wave of relaxation” quickly crashed on a rocky shore. Instantaneously heart rate and respiration accelerated as worrisome thoughts poked their way into Matt’s consciousness. He picked up the pace wondering if he should go straight to see the boss or go to his office first to collect his thoughts – and composure. Have I missed something? Is Jack upset? How should I handle this? What if I screwed something up? What have I forgotten? What if he’s unhappy with my performance? What if...? Taking three deep breaths Matt headed to see Mr. Johnson, his mind racing with "What if?" thoughts, his stomach feeling queasy. Unconsciously he was walking faster and breathing was becoming more rapid and shallow. He caught himself once again and reminded himself – breathe! The breathing was helping, but it was a struggle to keep the anxiety at bay. Struggling for calm and clear thinking, Matt tried to remember – what was that about brake and accelerator?

ENGAGE IN SELF-REFLECTION PRE-TEST

DIRECTIONS: Under each description, choose the number that best represents agreement with your behavior for the past week and record that number on the following table.

Engage in	a	b	c	d	e	Total Divided
Self- Reflection	f	g	h	i	j	by 2= _______

0= not true at all, 1= mostly not true, 2= partially true, 3= largely true, 4=totally true

a. I Am Aware of the Thoughts and Feelings Connection. I am aware the unpleasant emotions I experience often stem from views I have of the situation and beliefs learned in my childhood and from earlier life experiences.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

b. I Am Mindfully Aware of My “Stories.” During my day, there are instances where I am able to slow down my thinking and become more aware, or more "mindful," of my thoughts, accepting those thoughts as only "stories" my mind is telling me, and not necessarily useful, valid, or the stuff of objective reality.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

c. I Am Combining Self-Calming Skills with Mindfulness. During my day I regularly pay attention to everything going on inside myself (thoughts, feelings, breathing patterns, and bodily sensations), as well as outside. This is done in conjunction with self-calming through diaphragmatic breathing and purposefully relaxing tensed muscles.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

d. Distressing Situations Provide Me with Constructive Learning Experiences. I am able to revisit distressing situations, understanding those situations and my reactions to them through an understanding of the role of my self-talk and beliefs. (Note: circle 4 if there are no "distressing situations."

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

e. Constructive Inner Dialogue. When feeling stressed or anxious, I checked in with myself by taking several diaphragmatic breaths and engaging in an internal dialogue. The following are examples of some possible questions I might have asked myself. (Note: circle 4 if there were no instances of feeling "stressed or anxious.")

• What am I telling myself about my coping ability? What do I perceive to be a threat?
• What am I feeling? What are my emotions?
• What's going on in my body? What is my physical experience?
• What am I telling myself that is not accepting or compassionate?
• Are there things I can't control? Are there things I can control?
• Could I be more accepting and compassionate toward myself? What would I be telling myself if I were more compassionate?
• Do I have needs that are not being met? Do I have boundaries that are not being observed, or asserted?
• Am I being realistic? Am I engaging in "what if thinking," or "awfulizing" or “catastrophizing?"
• What are my choices? What options am I aware of when I view my situation from a position of calmness and self -acceptance?

(Note: circle 4 if there were no instances of feeling "stressed or anxious.")

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

f. I Actively Demonstrate My Self-Worth. In thought and behavior, I demonstrate my belief that I am worthy of love and respect.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

g. I Am Eliminating Negative Self-Judgment. I don’t tell myself that I am flawed, defective, unlovable, or basically incompetent.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

h. I Am Eliminating Self-Blame. I don’t dwell on what I perceive to be failures or mistakes, believing instead that mistakes help me learn and I am able to forgive myself for mistakes or failures.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

i. I Am Willing To Take Risks. I am willing to take risks, not needing to avoid new challenges for fear I won’t measure up. I believe I’m competent and at least as capable as the average person.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

j. I Engage in Realistic Threat Appraisal. I am able to ask myself what the worst thing is that could realistically happen, and quickly determine that if and when that circumstance took place, I will be able to handle it. I do not hold back because of fear, self-doubt, or expectations of failure or defeat.

Select 0, 1, 2, 3, or 4 and record on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

Enter your total score on your Mindful Choices Self-Assessment Scoring Sheet and the table above.

The following is an example of the table squares a-J filled in with 10 scores, each square representing the 0-4 score on that particular statement. The scores are then totaled in the last square, for a total of 15 that is then divided by 2 for a final score of 7.5

Begin and End Your	a 2	b 1	c 2	d 2	e 1	Total Divided
Day Peacefully	f 1	g 1	h 1	i 2	j 2	by 2= ___7.5____

The score of 7.5 is then located on the grid below, falling on the dividing line between 7 and 8. This means that for the past week ENGAGE IN SELF-REFLECTION performance was in the “Needs Improvement” category. Overall, this means that the person taking this pretest was not doing well with being conscious and intentional in dealing with negative self-talk and self-defeating beliefs and schema, and there is substantial room for improvement. No set of skills is more important.

Okay, now it’s time to enter your score on the grid below.

How did you do? Remember, no matter how well you have done on this pretest, there is no limit to how well you can do at Engaging in Self Reflection.

The possibilities for growth and mastery are limitless. How good do you want to be in your ability to slow things down, see things more clearly, and respond more effectively?

Let’s first take a deeper look at the rationale behind the 10 statements in our pretest,

The thoughts behind the Life Choice 5 statements

Each of the statements can be thought of as an affirmation, or as a desired state you want to achieve. Rating a statement with a “4” is an indication you are at an optimal level of functioning for a vital component of this particular choice. The 10 statements are repeated here with a brief explanation of the thinking that went into the construction of the statement.

a. I am aware the unpleasant emotions I experience often stem from views I have of the situation and beliefs learned in my childhood and from earlier life experiences.

The actual situation is often less important than what we are telling ourselves about the situation. Beliefs we have carried with us for years, perhaps even from early childhood, have a profound effect upon how we view the present situation, and consequently the emotions we experience. Stress and anxiety, along with feelings such as fear, sadness, anger, dread and despair often result from learned beliefs and expectations.

b. During my day, there were instances where I was able to slow down my thinking and become more aware, or more "mindful," of my thoughts, accepting those thoughts as only "stories" my mind was telling me, and not necessarily the stuff of objective reality.

We emphasize developing the quality of “mindful awareness,” which may be readily accessible by doing a mini relaxation, or engaging in the “Three Deep Breaths” Thomas Crum writes about in his excellent book by the same name. Breathing diaphragmatically with slow, deep, regular, quiet, and gentle breaths allows you to get out of “fight or flight” mode and into a state of heightened awareness of your own thoughts. While relaxed, focused, and centered, you can remind yourself that your thoughts are only thoughts, or stories that your mind is telling you. These stories are just that – stories – and need not be accepted as objective reality.

c. During my day I regularly paid attention to everything going on inside myself (thoughts, feelings, breathing patterns, and bodily sensations), as well as outside. This was done in conjunction with self-calming through diaphragmatic breathing, purposefully relaxing tensed muscles, and having calm and soothing self-talk.

As often as necessary, you can choose to calm down, slow down, relax, and give up having to do anything, choosing instead to engage your well-practiced self-calming skills, turning inward and observing your own thoughts, feelings and bodily sensations. You might consider doing this once an hour, or perhaps every time you perform some routine act like having a drink of water, coffee, or tea. Certainly, you can check in with yourself every time you become aware of distressing thoughts or unsettling emotions. We suggest putting a number from 1 to 10 on your feeling of stress or anxiety, and plugging in your learned relaxation response each time you become aware of rising levels of distress.

d. I was able to revisit distressing situations, understanding those situations and my reactions to them through an understanding of the role of my self-talk and beliefs.

We all have stress, anxiety and distressing situations. Such situations, although difficult and alarming, can be valuable “learning opportunities,” giving you an opportunity to mindfully reflect on the situation and gain important insights that will be helpful in the future. Most of the distressing situations in your life will get repeated, and your reactions may be habitual and stereotyped, a quality we refer to as “mindless.” Sometimes your usual pre-programmed reactions are helpful, but often they create more difficulties. When you can take the time to reflect and learn, you gain the ability to be conscious and intentional rather than mindless and on autopilot. You can move from mindlessness and reactivity to mindful awareness and positive new behaviors.

e. When feeling stressed or anxious, I checked in with myself by taking several diaphragmatic breaths and engaging in an internal dialogue. The following are examples of some possible questions I might have asked myself.

• What am I telling myself about my coping ability? What do I perceive to be a threat?

• What am I feeling? What are my emotions?
• What's going on in my body? What is my physical experience?
• What am I telling myself that is not accepting or compassionate?
• Are there things I can't control? Are there things I can control?
• Could I be more accepting and compassionate toward myself? What would I be telling myself if I were more compassionate?
• Do I have needs that are not being met? Do I have boundaries that are not being observed, or asserted?
• Am I being realistic? Am I engaging in "what if thinking," or "awfulizing" or “catastrophizing?"
• What are my choices? What options am I aware of when I view my situation from a position of calmness and self -acceptance?

Diaphragmatic breathing practiced to the point of being routine is almost always helpful in calming yourself and moving beyond emotional reactivity. High levels of stress and being in “fight or flight” mode often result in impaired judgment and poor decisions. For one thing, when you are in fight or flight mode you only have two options, fight or flight, neither of which is likely to result in helpful choices. Moving to a more relaxed and aware state gives you the ability to engage in a constructive inner dialogue. The sample questions above represent things you can ask yourself to bring about greater clarity, less reactivity, and more positive and realistic outcomes. Be mindful of when you are in fight or flight mode, and never proceed until you have moved from your sympathetic system to your parasympathetic system.

Emotional intelligence has been a popular concept in recent years. It’s about being intelligent in managing your emotions, rather than being managed by your emotions. Mindful awareness is how you do emotional intelligence and diaphragmatic breathing and checking in with yourself is the easiest and most direct way to activate mindful awareness.

f. In thought and behavior, I demonstrated my belief that I am worthy of love and respect.

Low self-esteem, low self-acceptance, a lack of self-compassion, and a lack of assertiveness often originate in long-held beliefs about not being good enough, worthy enough, competent or lovable. Such beliefs inevitably result in greater distress through behaviors that only serve to further reinforce the negative beliefs. It’s a vicious cycle. Often these beliefs are unconscious, or such a solid part of one’s worldview that change is stubbornly resisted. However, with mindful awareness such beliefs can become fully conscious and it becomes possible to simply acknowledge the existence of the beliefs, calmly and without exaggerated reactivity, choosing instead to move in an entirely new direction, a direction that is freeing, self-accepting, self-compassionate, and self-affirming.

e. I did not tell myself that I was flawed, defective, or basically incompetent.

We ask almost every new client the same question: “Inside your head, when you are thinking about yourself, is your self-talk harsh, nagging, and critical, or is it warm, encouraging, and accepting?” What we have noticed with the great majority of our highly stressed and anxious clients, and those suffering from depression as well, is a high level of negative self-talk about self, coupled with highly critical self-judgment. In short, the people we see with “dis-ease” are rarely nice to themselves. Learning to be self-accepting and self-compassionate are key ingredients in good mental health and a sense of well-being. These qualities are not obtainable until you can become mindful of your negative self-talk and make a conscious choice, moment by moment, to simply be kind to yourself in the way you think about yourself and talk to yourself. And yes, we all talk to ourselves.

h. I didn’t dwell on what I perceived to be failures or mistakes, believing instead that mistakes help me learn and I am able to forgive myself for mistakes or failures.

Mistakes are valuable. They inform us. They educate us. They are indispensable in our learning and our growth. Stressed, anxious, and depressed people are often beating themselves up over what they perceive to be irreversible and unpardonable failures. They often feel ashamed and guilty, hiding their mistakes, denying they are mistakes at all, or shifting the blame onto others. More secure people on the other hand simply accept their mistakes as inevitable and even see them as opportunities for new learning and growth. They might choose to tell themselves: “It is what it is,” accepting the reality that mistakes happen, choosing to learn, let go, and move on. It helps to remind yourself that mistakes are human, that you’re human, and one with all humanity – all of us imperfect and mistake prone. Try it! It’s quite liberating.

I. I was willing to take risks, not needing to avoid new challenges for fear I wouldn’t measure up. I believe I’m competent and at least as capable as the average person.

It seems clear that the most successful among us are those who aren’t afraid to take calculated risks. They don’t hold back because of fear of failure or concerns about what others might think. They let go of having to be perfect or needing to be above making mistakes. They see themselves as a work in progress and maintain a curious and optimistic view of the possibilities unfolding before them, rather than fearing dire consequences and harsh judgments. They don’t waste time in comparing themselves to others, instead choosing to focus on their own lives as interesting journeys of self-discovery and growing self-mastery.

J. I was able to ask myself what the worst thing was that could realistically happen, and quickly determine that if and when that circumstance took place, I would be able to handle it. I did not hold back because of fear, self-doubt, or expectations of failure or defeat.

A very useful strategy for dealing with feared situations is asking yourself: “What’s the worst thing that could realistically happen?” The emphasis is on the word “realistic.” For many people the focus is on the worst thing that could “possibly” happen, believing that if it could happen it surely will happen and must be defended against at all costs. Another vicious circle! Telling yourself something is really scary, or even terrifying, propels you into high anxiety and limits your ability to think rationally and objectively. That’s when you start telling yourself even more disturbing things in an inner dialogue we refer to as “awfulizing,” or “catastrophizing.” It’s hard to sort this out and regain your equilibrium when you are uptight and in fight-or-flight mode. This is where learning mindfulness skills and self-calming skills such as diaphragmatic breathing comes to the rescue. With self-calming skill and mindful awareness, it becomes easier to base your actions on evidence-based probabilities rather than baseless scare-talk within your own head.

Extended Discussion of Choice Five

"The most fundamental aggression to ourselves, the most fundamental harm we can do to ourselves, is to remain ignorant by not having the courage and the respect to look at ourselves honestly and gently."

Pema Chodron

We have repeatedly stated our contention that life is about choices, or to be more precise, a meaningful and satisfying life, relatively free of "dis-ease," is one that results from conscious choices based on mindful awareness. Such awareness is the very foundation of being conscious, intentional, and self- empowered.

In our work with eating disorders, anxiety disorders, stress, addictions and relationship issues, mindful awareness, conscious choices, self-calming skills, emotion regulation skills, and corrective self-talk take center stage. Recovery and growth, and transformation to wholeness and vitality, regardless of the problem being addressed, cannot take place without developing mindful awareness and mindful self-management.

We use a variety of tools in developing these qualities, always with the goal of empowering our clients to confidently and enthusiastically make healthy choices.

We are primarily focused on helping our clients be more mindful of present choices and the consequences of those choices, along with increased awareness of more realistic and effective alternatives. Teaching mindful awareness of thoughts, beliefs and feelings is a starting point.

A principal awareness and choice tool that we have used over the years, and a tool that has been quick and easy to teach, yet highly effective, is a type of cognitive behavioral therapy that has been around for more than 50 years – RET or Rational Emotive Therapy. Rational Emotive Therapy (RET, an older version of what is now known as Rational Emotive Behavioral Therapy, (REBT), provides the means for healing and growth through increased self-awareness and effective self-management.

Mindfulness and conscious choice, leading to increased personal effectiveness, constitute basic goals of therapy. These are the transformative qualities that underlie effectiveness in career, relationships, and overall well-being. Rational Emotive Therapy and other approaches such as ACT, Acceptance and Commitment Therapy, constitute the skills and processes for being mindful and consequently more self-aware and effective in self-management.

All of the problems we deal with are perpetuated and made worse by "mindlessness," a lack of conscious awareness, conscious intention, and conscious choice. Moreover, negative self-talk and "scare-talk" thrive in the absence of mindful self-awareness. The cultivation of mindfulness skill is a major part of the solution, and we have used Rational Emotive Therapy as a major tool in bringing about a high level of self-awareness and effective self-management of distorted thinking.

However, in the interest of consistency in our practice, we have made some changes in the original RET structure to make the process compatible with the concepts of fusion and defusion from Acceptance and Commitment Therapy. We use a combination of RET and ACT – RET to develop mindful awareness and ACT to better manage unhelpful thinking and beliefs.

Before getting into the mechanics of how RET works, let's first take a closer look at what we mean by "distorted thinking."

What is Distorted Thinking? Chronic stress, compulsive behaviors, eating disorders, anxiety disorders, and most relationship problems require mindlessness and distorted thinking. This is not unique to those with these kinds of issues. All of us deny, falsify, and distort reality, and all of us are mindless at least some of the time. In fact, none of us are mindful all the time.

These are stressful times. We all have a lot going on in our heads. In fact, our minds cannot be still. Usually there are many things simultaneously competing for our attention in any given moment. Buddhists refer to a busy, directionless, untamed mind as a "monkey mind," and an untamed monkey mind will sooner or later get you in trouble. An untamed mind is a mind that distorts, obsesses, ruminates, and finds things to worry about.

Often, we put our own spin on things and see them in ways that may be highly inaccurate, yet these thoughts are embraced as absolute truth. This is normal. There is a natural tendency for us to accept our own thoughts as reality and to not recognize those thoughts as simply things we have learned to tell ourselves, stories our minds are telling us, stories that may not be true at all.

Again, we all have distortions, and we all have irrationalities and, no matter how well put together you are, like everyone else, you deny, falsify, and distort reality on a fairly regular basis. Try not to get defensive. We all do it. That’s because we are all human. None of us is a purely rational Mr. Spock (the pointed eared Vulcan from Star Trek).

Because we are human, we process information in accordance with our own set of beliefs. Many of these beliefs are “taught” beliefs, learned in our childhood from those who were closest to us and most significant in helping us meet our needs. Some of these beliefs are rather harmless, such as a belief staunchly held throughout life that you MUST always brush your teeth exactly as prescribed by mother, with absolutely no deviation allowed!

Sometimes however, these beliefs are destructive to our self-esteem and our relationships. We are often unaware of these beliefs at all, yet all too frequently we feel overwhelmed by the unpleasant emotions that stem from them. We choose to think that it’s the event that we are reacting to without realizing that our feelings stem more from what we tell ourselves about the event than from what is actually happening.

In the words of the first century philosopher Epictitus: “People are disturbed not be things, but by the views which they take of them.” All of us have things happen to us. It's what we tell ourselves about what's happening that makes all the difference.

In fact, what we tell ourselves can make the difference between life and death. Sound dramatic? Consider the following examples of two women who have had similar experiences. Each has had her fiance suddenly break off the engagement and run off with her best friend. Each is emotionally devastated.

Susan had never before experienced such deep emotional pain. George was the love of her life and now he had broken off their engagement announcing that he had fallen for Susan's best friend. She was devastated. She knew it would be perhaps the most difficult undertaking of her life, but she knew she would ultimately recover. She knew that other people have been through similar difficulties, sooner or later getting their lives back on track and moving on to happier relationships. She knew that if she made full use of her support system, stayed busy, and took care of herself, she would in time move beyond this experience, and perhaps even grow in her coping abilities.

Susan's pain was real and extreme, yet she was realistic in her belief that people recover and ultimately get on with their lives. Susan will not only survive, she will grow with the experience and get on with her life.

Let's look at the example of Jane and how she dealt with similar loss and emotional pain.

Like Susan, Jane was devastated. She had never imagined that anything could hurt so much. She told herself that the pain was too much, too overwhelming, so much so that she would never get over it. There must be something really wrong with her for him to leave her. She could never love anyone that much again. No one would ever love her that way again. This was the only man she could ever be happy with, and now he was gone. She simply couldn't survive. There was nothing left to live for. It would never get any better. It was hopeless. She was hopeless. Jane chose suicide.

For both Jane and Susan, it was virtually the same situation and let's assume for both extremely painful. In Susan's case, her self-talk was quite rational. She knew her pain would take a long time to go away, but ultimately it would leave her and she knew she had to take care of herself in the meantime. Susan was in for a rough time but ultimately she would recover.

Jane's self-talk was predominantly irrational. She told herself she would never get over it and that she could never love anyone that way again, both irrational thoughts. Despite her certainty about the future, Jane didn't have a crystal ball and there was no way for her to know what was ahead. She might have talked to others about their experiences or consulted a therapist to gain a better perspective. Unfortunately, this didn't happen. Instead, she listened only to her own inner voice and didn't realize that her highly subjective inner dialogue only represented things her mind was telling her, things that were dangerously distorted and erroneous. Her other thoughts were similarly irrational and she unquestioningly believed all of it, and tragically with such conviction and finality that she perceived there was only one choice left to her, taking her own life.

As mentioned above, we all distort reality. We all have erroneous beliefs. We all disturb ourselves with negative self-talk learned early in life, and we each have a number of nutty thoughts that we cling to.

By way of an example, consider that only one of these irrational beliefs might be necessary to generate extreme disturbance.

Suppose you were one of those people who told yourself, and absolutely believed it to be true, “I must please everyone in everything I do, all of the time.” For one thing, it’s an impossible belief; no one can please everyone. There is bound to be someone that you disappoint in some way. In fact, there are many situations where a healthy person is bound to disappoint those around them if only to assert their boundaries and rights in a healthy way. You simply cannot be a person of good self-esteem, with a clear sense of your own identity and boundaries, and be a people pleaser who feels he or she “must” please those around them.

If you have such a belief and you are having a week in which everyone seems to be pleased, you are not off the hook. You are going to be preoccupied with the concern that someone might be displeased, that you might have failed to meet the needs of a family member, friend, or co-worker. If however, you do find yourself displeasing someone, it will be grounds for depression and a sense of failure. Either way, you cannot win. By virtue of this one belief, you are destined to be either anxious or depressed all the time.

It gets worse. Others are quick to pick up on the fact that you are prone to guilt and therefore, quite vulnerable to their manipulations. Because a corollary of this belief is that you cannot express anger (that would displease others for sure), you are going to be someone who stuffs anger and wears a smile on the outside. You will find yourself saying “yes” when you mean “no,” and others will often be quick to take advantage. Repeatedly taken advantage of, you may find yourself resenting other people and seeing others as problematic and a source of major anxiety. In the extreme, others will be perceived as so threatening that the only solution is to avoid them, leaving you with a sense of loneliness and isolation. So, holding this one nutty belief has only two possible outcomes, anxiety or depression. Moreover, having this one belief leaves you feeling powerless and with lowered self-esteem.

That was an example of having only one irrational belief. We all have many, and they occur in teams. People with chronic stress and anxiety tend to have beliefs which serve to keep them stuck in their disorder. An awareness of the ways we tend to distort reality can be quite helpful as such thoughts are usually automatic and enter our consciousness with lightning speed. We are scarcely aware of the existence of these beliefs, if we have any awareness at all.

Much of therapy is aimed at helping our clients slow down their thinking and become more aware, in other words more mindful of their own distortions. Once this is done, they can begin to challenge those beliefs, plugging in more realistic and effective ways of viewing themselves and the world around them. They can begin to make different choices. This is vital to overcoming chronic stress, debilitating anxiety, and painful relationships that may be spiraling downward because of one's own negative self-talk.

In fact, it would be almost impossible to have chronic stress and anxiety without negative and irrational self-talk. Chronic stress requires stress generating self-talk, much of it learned in childhood, and intensified in adult life.

People remain stuck in anxiety by feeding into that anxiety with awfulizing and catastrophizing thoughts, ruminating on dreaded consequences in what we call "what if?" thinking that leads to "anticipatory anxiety." The quality anxious people most need is a well-practiced, calm and realistic approach to life. Again, Rational Emotive Therapy, along with Acceptance and Commitment Therapy, are major tools in bringing about this ability to mindfully pay attention to self-talk and make purposeful and effective choices. You can learn to recognize your self-talk as being only things your mind is telling you, and not necessarily true. Real progress in overcoming anxiety and stress results from learning to defuse the negative thoughts rather than embracing them as absolute reality.

With growing awareness, all that is necessary when your brain generates a disturbing thought, is to remind yourself that the thought is not useful and doesn’t have to be obeyed. This is the transition from RET to ACT. First however, let’s take a closer look at RET.

Rational Emotive Therapy (RET)

So what is Rational Emotive Therapy, or RET for short? It's a type of cognitive behavioral therapy that has been around for over six decades. It was developed by Albert Ellis, Ph.D., and Bill has fond memories of intensive training with Dr. Ellis at his Institute in New York City in the early 1970s. What at that time was RET, Rational Emotive Therapy, has since evolved into REBT for Rational Emotive Behavioral Therapy. REBT, while very powerful, is an approach we find more complex and therefore more difficult to teach and practice. For that reason we emphasize the older and, in our opinion, simpler RET which can be taught in minutes, is easily remembered, and amazingly easy to use. We also see RET is a major method for developing mindful awareness of how we disturb ourselves.

In recent years we have embraced Acceptance and Commitment Therapy (ACT), and with a little tweaking of the RET model our version of RET is made consistent with ACT. We will discuss ACT later in this chapter. First, however, we will talk about RET with our own variations that we have found useful over the past several decades.

RET is best used whenever something has happened that is particularly distressing, shameful, or that produces strong emotions such as rage, guilt, fear, or despair. It's ideal when one is left with feelings of hopelessness, helplessness, and worthlessness, or when you find yourself awfulizing and catastrophizing. It's definitely of great use when you're feeling depressed or anxious.

RET is not meant to get rid of all disturbing feelings as some emotions are entirely appropriate. For example, if you have been mistreated, taken advantage of, or abused, anger is a perfectly legitimate emotion and needs to be expressed effectively rather than rationalized away. The worst things you can do with anger are denying it, avoiding it, stuffing it, or being so frightened that expressing anger is hurtful, makes you a bad person, or certain to evoke painful retaliation, that you do nothing.

RET is for those situations where you are clearly disturbing yourself needlessly, and producing emotions that are not only very troublesome, but unnecessary. It's for those situations where you are disturbing yourself.

RET is usually done retrospectively on paper, although with practice, you will find yourself doing it in your head as events are occurring. Try to use paper wherever possible as writing things down allows you to be more complete and to remember more fully and accurately. Also, there is kinesthetic learning. The act of writing more effectively gets new learning into your memory files.

All you have to remember to use RET are the letters A, B., C., D., and E. What could be simpler? On a piece of paper, vertically list of these letters in the left margin covering the length of the page and leaving extra space at B and D.

Start with C which stands for the emotional consequences of something happening, or "feelings" for short. Following an unpleasant event, list all the emotions you are aware of at C. Push yourself to get a complete list of emotions you’re noticing.

The reason we start with feelings is that you are most aware of unpleasant emotions, and may not be aware at all of disturbing automatic thoughts. Often our clients claim that they are feeling very uncomfortable emotions but not really thinking anything. You can be quite sure however that disturbing thoughts, or at least disturbing images, are there but they may be occurring with lightning speed and beyond awareness until you slow things down and become "mindful" of what's going on "in the now."

Following listing all the feelings you are aware of, go back to A which stands for "activating event" or "antecedent event" (it works either way). It could also stand for “adversity.” A is the "situation," you are responding to. Write only a phrase or short sentence to describe what has triggered strong emotions. Ask yourself if this situation automatically leads to the heavy feelings you have listed at C. Ask yourself if other people would respond in exactly the same way, with exactly the same feelings. The answer is most likely "No." They might have similar strong feelings but those feelings will not be exactly the same as yours. Clearly you are doing something else that is unique to you in producing the feelings you experience. The "something else" can be found at B which stands for your "beliefs," or self-talk.

At B, list all of the things you are telling yourself in response to A, in turn producing the feelings at C. Push yourself to uncover disturbing thoughts that match the strong feelings you have listed. For example, if one of your feelings was despair, you must be telling yourself something quite disturbing such as "I'll never get any better. My situation is truly hopeless."

Possibly the greatest problem people encounter in doing RET, is not going far enough in uncovering inaccurate, irrational, and disturbing thoughts at B. Push to go as far as you can. Look at each statement and ask yourself -- "Okay, if I believe that, it mean therefore..." Continue until you have uncovered your most extreme negative thoughts. Don't shortchange yourself on the step. Don't cut corners. Don't try to do it all in your head – at least not until you have had a lot of practice with this technique. The extra work will pay off with major dividends in changing your self-talk.

Next go to D which stands for "dispute." For each of the thoughts you have uncovered, ask yourself "How do I know this is true? What is my evidence? Looking at my own life or other people's lives, is there evidence to the contrary? Is this thought or belief supported by what I know to be true? Is there an alternative view that would make more sense? Is there another way of looking at this situation that has real evidence to support it?"

Note that D is where RET becomes inconsistent with ACT. Proponents of Acceptance and Commitment Therapy maintain that it’s unnecessary and even counterproductive to get caught up in determining whether or not the self-talk is true. Instead, an ACT practitioner would consider A,B. and C as simply noticing what your mind is telling you, with D more properly being “defusion.” Our belief is that it is very useful to first practice RET as presented here. We see it as a process for becoming very mindful of your most frequent irrational thoughts and beliefs. More about ACT will be presented following the RET discussion.

As you become more aware of your thinking and more skillful at successfully disputing disturbing thoughts or beliefs, your emotions change. At E you list new "emotional effects." If you've done the preceding work well you will notice the feelings have changed significantly. Instead of despair, you might be experiencing optimism. Instead of fear, you may have found new courage to deal with a situation that needs to be dealt with. Instead of emotions that are so disturbing that they result in over-eating, under-eating, alcohol abuse, panic attacks, or a fight or flight response to conflict, there may be new opportunities for dealing with situations in powerful and positive ways, and in ways that build confidence and self-esteem.

How about an example? This comes from something that happened to Bill over 30 years ago, something that has frequently provided a useful example of how RET works. The following is the account of the RET situation in Bill's words:

I was scheduled to give a talk to a college class on Rational Emotive Behavioral Therapy. I needed approximately 30 min. to get from my office to the classroom. The class was to start at 5:30 PM and my intention was to leave shortly before 5 PM. Just prior to leaving, the phone rang. On the other end of the phone was a very distraught, seemingly out of control, client apparently in major crisis. I had to take the time to make sure that she was not a danger to herself, that she had someone with her for her own safety, and that she would be available to come in for a session the next morning. This took time, and by the time I hung up the phone, it was 5:10 PM. Okay, I would be late but hopefully not too late to give my talk. I sprinted to my car, quickly got on the freeway, and encountered – gridlock!

No problem! I exited the freeway and got on surface streets only to find myself in one of those situations that we all hate. I was about the 14th car in the left turn lane at what had to be the slowest traffic light on the planet. Two or three cars would turn left with the green arrow before the light once again turned red for what seemed like an eternity. It was very late and getting later. To top it off, on one of the hottest days of the year, my air conditioner suddenly quit. I was dressed in a coat and tie and felt like I was melting. Feeling intensely uncomfortable physically, I became aware of a rising tide of emotion, specifically anger, embarrassment, frustration, and high anxiety.

I decided there would never be a better opportunity to practice RET. Starting with identifying the feelings above (Step C of A-B-C-D-E., I next linked to the activating event or situation at A. In a nutshell, I was going to be very late.

The next step was identifying "beliefs" at B. What was I telling myself? The self-talk had to be sufficient to bring about strong feelings such as anger, embarrassment, frustration, and high anxiety.

I decided I had been telling myself:

1. I am not a late person, and it's unprofessional to be late.
2. I can't stand being late.
3. My students will judge me negatively.
4. This traffic light should be faster.
5. These cars should not be in my way.
6. My car air conditioner should be working.
7. This is a terrible situation, in fact 150% terrible, and I can't stand it.

I next tackled D (for "Dispute"). This one was easy, especially since the last four items above were totally irrational. I began by reminding myself of the Serenity Prayer:

God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.

Living one day at a time; Enjoying one moment at a time; Accepting hardships as the pathway to peace;

--Reinhold Niebuhr

Let's get back to my awareness of the things I was telling myself. The last four thoughts were clearly irrational as I was railing against things totally beyond my control. Consider: “This traffic light should be faster.” What could be more irrational than getting angry at a machine? The first four items were equally unreasonable and based upon faulty evidence.

Each thought was quickly tested by asking myself: "How do I know that's true? What's my evidence? Is it real evidence or is it rather flimsy? Is there evidence to support an alternative view? What could I tell myself that would make more sense and serve me better in this situation?

Alternative thoughts that were far more sensible included: Sometimes being late is unavoidable. Being late is better than getting in an accident or having a heart attack. My students will understand. Anyway, I've been a student for most of my life and students rarely resent it when an instructor is late. They usually enjoy having extra free time. I have no control over my air conditioner, the traffic light or the traffic, and these other folks are in the same situation that I'm in through no fault of their own. I’ll get there when I get there, and whatever happens, I'm still okay with me.

At that point my feelings changed to relief and optimism (E). I loosened my tie, slipped off my jacket, turned on a mellow FM station, reminded myself to breathe diaphragmatically, relaxed my body and proceeded to my class.

My students were still there having enjoyed time to socialize. I had a great class and never got the headache I might've gotten in past years. I used my traffic example and my students got it! It was a very successful class. Without experience and practice in doing REBT my evening would have gone very differently.

How long did it take from my air conditioner quitting to turning on the FM station? It took less than a minute and was probably closer to 30 seconds.

That's the beauty of practicing RET. Disturbing thoughts flow through your mind with lightning speed and just as quickly you can sort them out and choose thoughts that are more realistic and less anxiety producing. The key ingredient once again is PRACTICE! If you take a pencil and paper and regularly go through the RET exercise whenever you find yourself emotionally upset, you'll find you soon develop the ability to quickly catch yourself in the act of disturbing yourself, and just as quickly shift to treating yourself with more acceptance, patience, and compassion. You will find yourself dealing with the same dozen nutty thoughts, over and over again, until you have become instantly mindful of the thought as it’s occurring. That's the real payoff! You catch yourself in the act of disturbing yourself and instead defuse the thought, seeing it as only a thought and not something you have to obey.

With practice, it gets easier and easier to have self-awareness in the moment. You discover that whenever you become aware of feeling stressed or anxious, you can quickly connect with yourself by taking a full diaphragmatic breath and checking in with your cognitive self. The following questions may be helpful:

• What am I telling myself about my coping ability? What do I perceive to be a threat?
• What am I feeling? What are my emotions?
• What's going on in my body? What is my physical experience?

What am I telling myself that is not accepting or compassionate?

Are there things I can't control? Are there things I can control?

Could I be more accepting and compassionate toward myself? What would I be telling myself if I were more compassionate?

Do I have needs that are not being met? Do I have boundaries that are not being observed, or asserted?

Am I being realistic? Am I engaging in "what if thinking," or "awfulizing" or “catastrophizing?"

What are my choices? What options am I aware of when I do view my situation from a position of calmness and self-acceptance?

When we left Matt he was anxiously anticipating his meeting with Mr. Johnson, certain that he must have screwed up, although he couldn’t imagine where he had gone wrong. He just knew that if Mr. Johnson urgently wanted to see him, it could only mean that he was in trouble.

The crisis was over. The “urgent” meeting had only lasted 15 minutes. The anticipated bombshell was not only a dud, but turned out to be the high point of Matt’s week. Jack was in a great mood. He’d been going over the stats and couldn’t wait to tell Matt that he was leading the pack. In fact, he was so impressed with Matt’s performance that he was immediately making Matt team leader, and he was sure he could get Matt’s salary bumped up to the next level. Matt was both surprised and elated.

Walking to his office Matt felt both relief but also frustration. Why do I keep doing this to myself? There’s good stuff in my life, and a lot of it. I can’t complain, but then I can’t really enjoy it either. I keep stressing about all the things that might go wrong, or beating myself up over past mistakes. Why can’t I just relax, be in the moment, and for just this moment, let things go?

Matt recalled a quotation from Mark Twain. He thought it was funny when he first heard it but now he was realizing the truth of it in his own life.

“I am an old man and have known a great many troubles, but most of them never happened.”

Two days later Matt recounted the situation for Robin: “I was on the verge of a panic attack. I just knew I was in trouble even though I couldn’t think of a single valid reason for being so stressed. I just keep doing it – creating upsets in my own mind. I’d just like to be able to let go of stuff and relax.

Robin replied: “When you say you just keep doing it, you’re talking about being on autopilot. It’s a knee-jerk pre-programmed reaction whenever you’re in a similar situation. It’s actually a well-practiced and deeply entrenched cognitive-emotional-behavioral habit and it’s taking place before you’re fully aware of any thought processes at all. What’s needed is the ability to slow things down, be mindfully aware in the moment of what’s taking place, then choosing a direction that makes sense. I’m reminded of one of my favorite quotes. Psychologist Rollo May said:

‘Real freedom is the ability to pause between stimulus and response, and in that pause to choose.’

Even though he may not have known the term at the time, May was talking about mindfulness and the ability to be so aware in the moment that you can actually create some space between the situation and your response, being able therefore to purposely plug-in a reality-based emotionally intelligent response.”

Matt had been listening, but couldn’t wait any longer to ask: “Okay, I get it that I need to be able to slow down, process things differently and make better choices. So how do I do that?”

Robin replied: “First, you can learn and practice a systematic method for becoming aware of negative self- talk. Each of us has our own dozen nutty thoughts, and you become so aware of your dozen that you catch yourself when an unhelpful thought pops into your head. We use a combination of two methods to bring about mindful awareness and the ability to ‘defuse’ unhelpful thoughts. The first process is called Rational Emotive Therapy, a cognitive behavioral approach that we’ve modified to blend with a second powerful set of tools – Acceptance and Commitment Therapy.”

Robin proceeded to explain how we use Rational Emotive Therapy. “After something has happened such as your visit with Mr. Johnson, take out a sheet of paper and begin to fill in A, B, C, D, and E. let’s use the situation with Mr. Johnson as an example. We’ll start with C, the emotional consequences or feelings and the physical sensations that came with the emotions. What were your emotions and physical sensations as you were walking from the reception area to Mr. Johnson’s office?”

“Let me see,” Matt said as he reflected on the question. “Certainly I was feeling a lot of anxiety and fear, even to the point of feeling panicky. I was dreading the meeting and had a strong urge to avoid the whole thing. I know it’s not an emotion but I was reacting physically, breathing hard, feeling a tightness in my chest and around my forehead. I was sweating profusely, and I was even a little lightheaded. Along with the dread I was feeling confused, having a tough time thinking straight.”

“This is a great start,” said Robin as she filled in the RET sheet. “You were feeling anxiety, fear, dread, and confusion. Backtracking to A, the situation, it was simply an unscheduled meeting with Mr. Johnson. Would you say that such a meeting automatically generates such strong feelings? Would everyone else have the same kind of feelings? Of course not, but you did in this situation so something else was happening, and that something else can be found at B, your learned beliefs or self-talk. What do you suppose you were telling yourself on the way to the meeting?”

“I was searching my memory banks,” said Matt. “I was asking myself if I’d missed something that would upset Jack. I was trying to think of something I’d screwed up. I was telling myself I was in trouble. I instantaneously moved from that thought to telling myself my job was in jeopardy. I imagined having to tell Beverly that I’d lost my job. I thought about the bills and what a disaster it would be without my paycheck. I began strategizing on what I would do. I guess I worked myself up into quite a state, and this was only a one minute walk to Jack’s office.”

“You seem to do a lot of ‘what if’ thinking when something unexpected happens or when you don’t have control over the situation. Is that accurate?” Robin already knew the answer.

“Yes, absolutely,” replied Matt. “I can ‘what if’ myself to death. There is no end to it and I make myself sick.”

Robin proceeded to take Matt through D, the dispute section of the RET sheet. There was plenty of evidence Matt was secure in his job. He was good at what he did and there was no rational reason for him to worry excessively. His “what if” thinking was a habitual reaction that could be traced back to his childhood. Learned negative self-talk left him perpetually anxious and insecure, and greatly impacted his quality of life and that of those closest to him as well.

Robin continued: “As we look at the situation from a more realistic perspective, you can readily see alternatives that are better supported by the evidence. What might you tell yourself that would make more sense?”

“Well, now that I’m thinking more clearly, and calmer about the whole thing, I can tell myself that I perform well, I have a long history of performing well, I have great experience and a lot of ability, the company is lucky to have me, and it wouldn’t be too hard to get a job elsewhere. Also, there’s lots of evidence I’m appreciated for what I do. The Mark Twain quote really hits home. I worry needlessly.”

“And what are the feelings you’re left with?” Robin was moving on to E, New Emotional Effects.

Matt responded immediately: “Well,” the anxiety is gone. I’m feeling optimism and also rather proud of myself for what I’ve accomplished. This was very helpful. I’m not only seeing things differently, but it feels good.”

“Great!” Robin proceeded to congratulate Matt on the work he was doing, but also to help him understand that old habits die hard, and that it would take repeated practice to rewire his brain. “What I’m suggesting Matt, is that you do an RET sheet each time you’ve found yourself in a similar situation. Over time you will become so aware that you catch yourself in the act, and instantaneously choose a different course of action – a different way of thinking, feeling, and behaving. With this kind of practice, you have the power to literally rewire your brain, finally moving beyond an old habitual way of thinking and reacting.”

“With growing awareness of how you disturb yourself, and when you start ‘catching yourself in the act, ’ you need to move from RET to ACT, Acceptance and Commitment Therapy.” It will no longer be necessary to do an RET sheet for this particular ‘nutty’ thought. All you will need to do is be aware, notice the thought, and tell yourself: ‘I’m noticing my brain is once again generating my old what if thinking. That’s not very useful to me and it doesn’t fit in with what I want. I accept that the thought pops into my head, but I’m not going to get caught up in it or be controlled by it. I’m going to keep on moving toward my goals and choose to remain positive.’ I don’t really have control over my brain generating the thought, but I can mindfully be aware and accepting of the thought, choosing to do what’s best for me anyway.”

Matt was definitely onboard. “I can clearly see how this works. It’s working already!” “Good,” Robin replied. Bring some RET sheets with you next time and we will keep this process going.”

ACCEPTANCE AND COMMITMENT THERAPY (ACT)

Acceptance and Commitment Therapy, or ACT, is a powerful change modality based on two principles: mindfulness and values. The purpose of ACT is the effective handling of painful thoughts and feelings while creating a rich, full, and meaningful life. Three essential skills are central to the awareness and openness of being mindful. 1. Defusion is being able to detach or unhook yourself from disturbing thoughts and self-limiting beliefs so these qualities lose their power to control your life. 2. Expansion means making room for unpleasant thoughts and feelings so they simply flow through you rather than sweeping you away. 3. Connection means being fully present in the here and now, rather than being preoccupied with the past or anxiously focusing on the future. ACT is about connecting with your values and finding meaning, purpose and direction in life through values-based committed action.

The ABC steps of Rational Emotive Therapy are very consistent with ACT. The ACT philosophy is that our thoughts consist of words making up stories. When we get so caught up in negative stories that we fuse with them, we become cut off or disconnected from the things that we value and the things that make life meaningful. In both RET and ACT, holding on to negative thoughts and beliefs to the point that you believe them, think you have to give them your full attention, have to obey them, do what they suggest, or simply react to them as dangerous and frightening, leads to disturbing yourself unnecessarily. Russ Harris, author of The Happiness Trap, refers to this as “dirty pain.” We refer to it as “elective suffering,” suffering that is self-inflicted, serving no useful purpose.

Working the ABC steps of Rational Emotive Therapy can make you more aware of thoughts, beliefs and images that are disturbing. RET maintains that you disturb yourself by buying into, or uncritically accepting, negative self-talk, and self-defeating beliefs. In ACT language, the problem is “fusing” with the stories you are telling yourself. It’s much the same thing with both approaches, and our view is that working the first three steps of RET can help you become more aware, and better able to do the work of ACT.

The difference occurs with the RET emphasis on disputing (D) negative self-talk, checking facts, correcting mental errors, debating the validity of the story, and creating a better story. ACT maintains that this is not useful, and focuses instead on defusion. According to ACT, practitioners, it’s not particularly important whether or not a thought is true, but instead asking yourself whether or not it’s helpful to hold onto it, and whether or not it supports you pursuing and living your values.

Defusion means seeing thoughts as simply words and unhooking yourself from having to react to them. Instead, you can pursue what matters most, engaging fully in living a values-based life. It’s not necessary to struggle with disturbing thoughts and painful feelings. This just makes them stronger. Instead, ACT practitioners utilize their “observing self,” stepping back and noticing thoughts, created by the “thinking self.” While being in your observing self, you can choose to let thoughts come and go, aware of when you are fused with the thought, then proceeding to unhooking from the thought and refocusing on moving toward your values. It’s important to let go of judgment or expectations, simply accepting what comes. You may have to “unhook” yourself many times, but that’s how you become skillful at defusion. Simply step back and say to yourself: “I’m noticing that my mind is telling me…” Make space for the thought, and choose to commit to doing the things you need to do anyway.

ACT is a fascinating approach and takes traditional cognitive behavioral therapy to a whole new level. Several very fine ACT books are found in our reading list at the end of this chapter. Meanwhile, let’s take a closer look at distorted thinking and self-talk. An awareness of how we humans can’t help but deny, distort, and falsify reality, enhances both traditional cognitive behavioral practices such as RET, as well as Acceptance and Commitment Therapy.

Distorted Thinking and Self-Talk

Maintaining high stress or developing an anxiety disorder requires distorted thinking and negative self-talk. Distorted thinking is the basis of our preoccupation with fearful things that might happen in the future, or things we deeply regret having happened in the past, along with those obsessions and compulsions that keep us stuck

The following are specific styles of distorted thinking that apply to many with anxiety, depression or severe stress. Each description is followed by examples to illustrate how highly stressed or anxious people might unconsciously utilize that style as a way of protecting themselves, while in reality maintaining and deepening their distress. Note that these distortions overlap and usually occur in teams.

Personalization

When you personalize, you tend to relate things happening around you to yourself in a most negative way. A central aspect of personalization is the habit of continuously comparing yourself to other people, always believing you don’t quite measure up.

The opportunity for comparison with others is limitless. A basic assumption for personalization is that you have worth only if you compare well with others, and your worth is therefore tentative, temporary, and questionable. Personalization means continuously testing your worth as a person by measuring yourself against others. If you meet someone with major flaws, you may experience brief relief; however, this is not often the case. Personalization usually means that you find ample evidence of your flaws. You therefore feel diminished, inadequate, and not quite good enough.

Personalization also means that you interpret each experience, each conversation, each glance from another as hard evidence of your inherent unworthiness.

Betty felt extremely uncomfortable in her first Anxiety and Stress Management group meeting. She was quite sure even before she arrived that each of the other participants would be handling their anxiety better. Additionally, she was expecting they would be more intelligent and successful. It never crossed her mind that because it was a stress and anxiety group that the others had similar problems. Upon sitting down in group, she was filled with fear. In her mind, she excelled in being out of control and debilitated. Her perception was that each of the other members was more together and, more capable at meeting their needs. Certainly they must be showing rapid improvement. Their normal curiosity about a new group member was perceived by Betty to be a clear indication that they were thinking critical thoughts about her. When several group members talked among themselves prior to the start of group, Sally was convinced they had to be talking about her. Only with additional group time, the sharing of other group members, and their obvious friendliness toward her, did Betty begin to relax. When the group expressed insecurities similar to her own, Betty was shocked. Could it be possible that others felt the same way? It would take many more group sessions before Betty realized fully how her perceptions were distorted. In reality, she was accomplished and talented. Her intelligence was above average. Personalization, however, virtually always leaves an individual feeling inadequate and depressed.

Overgeneralization

This is a distortion that leads you to take a small piece of evidence or a single event and make a sweeping generalization that colors your entire life. Overgeneralizations are usually thoughts in the form of absolute statements, such as “always” or “never.” These are distortions that almost always lead to an increasingly restricted life and a gloomier view of self.

Whenever you conclude that “Nobody loves me” or “I’m never going to recover,” you are over- generalizing. Usually your conclusion is based upon some small piece of evidence and involves turning your back on everything you might have heard to the contrary.

Jane is always on guard. She tenaciously clings to the belief that her next mistake will be her ultimate undoing. There’s simply no margin for error and she’s waiting for that one big screwup that will cascade into a never ending descent into oblivion. To Jane, one small leak in her boat means the boat will surely sink and she will drown. Consequently, Jane leads a more and more restricted life, clinging to the familiar and avoiding risks. Of course, this avoidance inevitably leads to boredom, loneliness, and the extreme stress of unmet needs. All Jane can think of are past failures and her conviction that the future only holds more of the same. Catastrophizing and awfulizing , and being hypervigilant are the dominant themes of her life.

Generalization means that you carefully ignore everything you know about yourself that is contrary to the sweeping conclusion you have drawn from one or two pieces of evidence. Key all- or-nothing words that go along with overgeneralization are “”all, every, no one, never, always, everybody, and nobody.

Catastrophizing

We are reminded of a Woody Allen movie in which his headache was certain evidence he had brain cancer. Catastrophizing means that whenever bad things can happen, surely they will occur. For stressed out and anxiety disordered people, it means that if it is possible for things to get progressively worse, surely they will. If it is possible to be an anxiety "basket-case," then of course that outcome is a certainty.

Catastrophizing self-talk often starts with the words “what if.” What if this happened or that happened? If it can, then it will. The list of possible calamities is endless. Anxiety disordered individuals are worriers. In particular, they worry about being out of control and never getting better. There is also a lot of worry about having serious medical problems. Since these things are possible, they are already guaranteed to happen.

George has struggled with his anxiety for years. He has had frequent trips to emergency rooms resulting in a multitude of medical tests. No medical basis has been found to explain his symptoms but for George, this only means that his doctors have missed it, whatever "it" is. The panicky feelings he experiences during an anxiety attack have been so unpleasant that he's convinced there must be some terrible physical problem. He's fearful of dying, or losing his mind. He’s certain that his rapid heart rate when he's stressed means he's about to have a heart attack. Meanwhile, George seems unaware that there are real issues in his life that he has ignored. His search for the "real" problem continues.

Polarized Thinking (also known as Dichotomous Thinking)

The central theme of this distortion is the belief that the world consists of black or white choices. Things have to be either one way or the other. There is very little room for middle ground. People and things are good or bad, wonderful or horrible, successful or miserable failures. Polarized thinking leads to an either/or world where reactions to events swing from one emotional extreme to its opposite. Perhaps the worst problem with polarized thinking is the effect upon self-image and self-esteem. If you are not perfect or wonderful in every respect, then you are surely reprehensible, a “worm” of a person beneath contempt. There is no room for mistakes. Each new day brings with it a thousand more tests, and anything other than a perfect score is ultimate failure.

Louise weighs herself incessantly. Like many people with food and weight problems, Louise thinks if she is not perfectly thin, she must be terribly fat. If she is not totally in control of her food, then she is absolutely out of control. Food is either good or it is bad. The bad food is to be avoided at all costs. One small slip, one small bite of the bad food, means that you, the dieter, have gone from being a good, in control dieter to a horrible out-of-control foodaholic. Of course, Louise does not see the connection between over-control and being out-of-control. She does not realize that this extreme restraint and polarized thinking leads her to abandon all control once she perceives perfect control is no longer hers. This means any attempt to modify her food and weight behaviors ends with the first deviation, the first small slip. To Louise, any change from her plan is total failure. Either the plan runs perfectly smooth or it is a disaster and readily abandoned, and Louise has once again proven herself unworthy. Each Monday Louise begins a new diet. By midweek, she has abandoned the diet and the incredible self-restraint that goes with it. She once again promises: “Monday I will begin again.” Meanwhile, Louise perceives herself as weak and ineffectual, someone who has no will power. After all, you either have it or you don’t.

Don has never felt good enough. A natural athlete, he's never been able to take it all the way to the championship. As a result, he tells himself he's a complete failure and will never measure up. Praise from others in regard to his athletic accomplishments are meaningless. If he's not the best, he tells himself he's just a "loser." After all, isn't that the way it is? If you're not a winner, then you just don't have what it takes.

Filtering

The distortion of filtering means you have tunnel vision. It means you perceive only an element of a situation and ignore everything else. A single detail or perceived flaw is focused on with extreme intensity. A real or imagined physical blemish or imperfection is obsessed over, worried over for hours or days.

Everyone has his or her own particular brand of tunnel vision. Many are often hypersensitive to anything suggesting a personal defect and blind to any indication of good qualities. They tend to have heightened awareness of elements of their environment that suggest personal inadequacies. Of course, if human beings are intent in finding imperfections in themselves, they certainly will find them. Even the process of remembering can be selective. From an entire personal history and warehouse of experience, people who filter will remember certain negative events. Those prone to anxiety tend to review their past and experience memories that leave them feeling inadequate, anxious, or depressed.

Filtering means magnifying and distorting thoughts and memories in isolation from all other evidence. If negative qualities and events are taken out of context, they are at the same time isolated from all the good experiences that may have surrounded them. In the filtering process, they become larger than life and much more punishing than they would be if viewed accurately. The end result is that your consciousness becomes filled with all of your fears, all of your losses, and all your irritations. These things have become exaggerated to the point where your total awareness consists only of negative perceptions and damning evidence of your lack of worth.

John was a chubby kid. In the process of growing up, he had to endure many insults. Classmates teased him and sometimes bullied him. Gym teachers scolded him and made him run extra laps. Even his parents constantly belittled him about his weight and put him on diets. As an adult, John would be described as successful by virtually anyone’s standards. His income puts him in the top two percent. He is extremely well educated and widely respected for his knowledge and judgment. John has a loving family and an extremely bright professional future. It would seem that everything in John’s life is wonderful. John, however, has a deep sense of self-hatred. No matter what good things befall him, John cannot forget that he was the chubby kid who was the butt of so much ridicule. There is an abundance of good in John’s life, but it seems to do him no good, for it cannot pass through his negative filter. Nothing penetrates his awareness of self unless it reinforces his basic dislike of his physical self. This self- image colors every aspect of John’s life.

Mind Reading

This distortion involves making instant judgments about others. In mind reading, it seems you know exactly what other people are thinking, what motivates them, and what they intend to do next. There may be little evidence for these beliefs, but they feel right. This distortion occurs most commonly in conjunction with personalization, as it involves making assumptions about how people are reacting to you. You may believe people are thinking critical thoughts about your qualities or about your appearance.

Mind reading is also found in conjunction with another process called projection. In projection, you believe people are thinking the same thoughts about you that you are thinking about them — or about yourself. Because you spend so much time focusing on other people, you are absolutely sure others are focusing on you and thinking unkind thoughts.

Sara, a twenty-four year old college student and summer lifeguard, finds herself being extremely self-conscious in her bathing suit at pool side. She is absolutely certain others are examining her, scrutinizing every detail, committing every flaw to memory. She also imagines they cannot wait to tell their family and friends about the “fat lifeguard.” She feels like quitting her job. The pressure is unbearable. The anxiety builds as she feels all eyes upon her, knowing the rejection and criticism behind those eyes. She cannot imagine they might be thinking of other things or have their own worries and insecurities to keep them occupied. She is certain their primary focus is upon her.

Joe is convinced his therapist wants to give up on him. After all, it's been four weeks since his first appointment and he’s still struggling with his anxiety. True, he's no longer having panic attacks, but he continues to be a "worrywart." He knows his therapist thinks he should have gotten over it by now. He believes his therapist secretly believes he is a hopeless case, someone who is so far gone that he can never recover. Perhaps the therapist continues to see him only because he feels sorry for him.

Blaming

Blaming means that when things go wrong, someone must be at fault. Many beat themselves up on an ongoing basis for being worthless, inadequate, and out of control. At least half of our clients tell us their self-talk is harsh, nagging, and overly critical, as opposed to warm, encouraging, and accepting. In fact, for most of the anxiety disordered people we see, the main source of their anxiety is their poor sense of self and negative self-talk.

Control Fallacies

There are two possible ways people distort their sense of power and control. Those prone to anxiety seem to employ both distortions. On the one hand, you can see yourself as powerless and controlled by everyone around you. On the other hand, you can see yourself as omnipotent and responsible for the well-being of all the important people in your life. Many anxious and stressed people perceive themselves as largely trapped and powerless, often unable to make important life changes in their lives. At the same time, they may tend to be rather codependent, feeling responsible to find solutions to the problems friends and family members experience.

One of our students defined codependence as figuring out how you feel by taking someone else’s temperature. For many of our clients, there is such an extreme focus on other people, their concerns and expectations, that there is little time and energy to figure out who you are, what you feel, or what you want. It is quite possible to feel ineffectual in your own life, yet believe you must instantly fix anything that is wrong for others. It means always being on duty, always being vigilant, always striving to do a better job at taking care of others. You do not believe you can do anything that really changes the shape of your life, yet you carry the world on your shoulders and believe you are responsible for other people’s happiness. Powerlessness and omnipotence can occur simultaneously.

James believes that everyone at work and at home is depending on him. His friends are also depending upon him. He worries he might neglect his responsibilities to others and that he might leave them in pain and angry. He thinks he has to right all wrongs, fill every need, soothe every hurt. Failing to do this, he feels extremely guilty. With the guilt comes resentment. He is angry that he must always be there for others; He wonders when it will be his turn but his turn never seems to come. It seems he can never deal with his own needs without feeling selfish and unentitled. He is tired of the caretaker role and believes his own needs have long been neglected, but he does not know how to break out of the pattern. Experiencing extreme stress from unmet needs and repressed anger, James turns increasingly to unhealthy ways of nurturing himself and distancing himself from his emotions.

Fallacy of Fairness

Children are often observed bickering over what is fair. Pieces of cake have to be the same size. Certainly it is not fair if one child gets more slices than the other. Usually, Mom intervenes with the pronouncement, “Life is not fair. You need to get used to it.”

Sue felt overwhelmed by resentment. She worked so hard to be in shape, yet others at the gym seemed to have time to socialize. They seemed carefree, relaxed in their workout, and yet they appeared to Sue to have perfect bodies. It just was not fair. Time and time again, Sue had doubled and redoubled her efforts only to be disappointed. In fact, it often seemed that the harder she worked, the more disappointment awaited her. Others seemed to easily attain what she found so illusive. It just was not fair. She seemed unaware that much of her behavior was self-defeating and in fact contributed to her lack of results. She also was quite unaware that we are not all meant to have ideal bodies, or that her distorted perception slimmed others while adding many pounds to her own mirror-image. In her mind, an ideal body should be attainable if you work hard enough. It just was not fair.

Paul has a long history of using alcohol to deal with his stress. For several years, his alcohol dependence has been an increasing source of concern for family and friends. Last month Paul was arrested for drunk driving. He gets angry at suggestions that he stop drinking. It's just not fair! Other people can drink. Why should he stop when everyone else can go out, drink, and have a good time. It's just not fair!

“Heaven’s Reward” Fallacy

This is a plan for living your life that involves always doing the right and proper things, always meeting or exceeding others expectations, all in the hope of ultimately being rewarded. There are those who never fail to sacrifice or work exceedingly hard in the belief that they are collecting points to be cashed in some day when it’s their turn.

Both men and women share this belief, but women especially in our society have been raised to be there for others and to be perfectly nurturing in every respect. Of course, many wives and mothers also believe they must be perfect in their career in addition to being perfect in their homemaking. They believe that after a day of pleasing the boss and anticipating his every need, they should also be able to cook elaborate meals for the family and make sure that their house is in perfect order. They might carry on this way for years, expecting that there will ultimately be appreciation or some special reward. Such rewards may never come and many become increasingly angry and frustrated. The essential problem here is that if you are living your life trying to touch all the bases, please everyone around you, always do the right thing to the exclusion of your own needs and feelings, you may be physically and emotionally disintegrating.

Lisa works very hard at her job. For several years she has been earning regular promotions. She prides herself on never missing any details. She regularly brings work home and often goes in on weekends to work additional hours. She is extremely involved in her children’s activities and in supporting her husband in his career. She is often tired, but there seems to be so much to do. She rarely takes time off and cannot seem to relax without feeling terribly guilty. It always seems that she should be working harder. Additionally, it seems that the harder she works, the more others expect of her, her family included. She believes all of this will pay off someday, but someday seems so long off. She seems barely aware of her own needs, and certainly there are so many other things that take priority. She is vaguely aware of a lot of unpleasant emotions and substantial stress. She is becoming increasingly distressed but believes she should just try harder.

Emotional Reasoning

This distortion is centered around the belief that whatever you feel must be true. If you feel like a

failure, then surely you are a failure. If you feel guilty, for sure you have done something terribly wrong. If you feel fat and ugly, then of course you are fat and ugly. In other words, if you believe anything negatively about yourself, with the resulting unpleasant emotions, then it must be true because it feels true.

Something often misunderstood is that feelings in and of themselves have little validity. Our feelings stem from our thoughts and beliefs. If our thoughts and beliefs are distorted, then our feelings will be quite out of proportion to the real events. Previously, an example was given of how the belief that you must please everyone all the time, in everything you do, will lead to constant feelings of anxiety and depression. Similarly, many of our clients feel fat, ugly, and stupid, and they take this belief as absolute reality, unaware that many distorted and perfectionistic beliefs are at the root of these erroneous surface perceptions. In short, distorted thoughts and beliefs lead to emotions that reflect those distortions. Feeling fat, ugly, and stupid is really another way of saying you believe you are worthless and hopeless. The reality, to paraphrase Shakespeare, is that your thinking made it so. All the distortions we have discussed so far seem to combine to produce a sense of being worthless and hopeless.

Elaine cannot remember when she was not depressed. She was always pessimistic about the future and about her own abilities. Whenever good things happen, she seems unable to enjoy them. Instead, she dwells on her negative perceptions of self. Elaine can think of nothing positive to say about herself. Instead, she readily calls herself names, puts herself down, and predicts failure in anything she undertakes. Elaine is most self-conscious about her appearance and her intelligence. She is totally convinced she is extremely unattractive, and stupid, and that those qualities are readily apparent to everyone she encounters. She feels these things so strongly, they have to be true. It has never occurred to her that the beliefs underlying these self-perceptions are without evidence and are in fact gross distortions of reality. All she knows is that the feelings are ever-present and color everything.

Global Labeling

It is impossible to think of something more complex than a human being. In point of fact, there is nothing more complicated in the entire universe than the human brain. Any one of us could be described in terms of thousands of qualities and traits. Some of these traits are praise-worthy, others are things that could and should be improved upon. The overall picture of any person is quite complex and defies any attempt to quickly and simply summarize the whole person. In fact, it is really quite irrational to slap a label on the total person and believe that label is the person. How can you possibly explain a complex human being with one global label? For example, labeling someone a “loser” or “stupid” is quite absurd. All of us are capable of making mistakes. None of us seems to win all the time. It would be far more accurate to talk about specific instances of poor judgment or mistakes that have proven to be a learning experience. Above all, it is important to see beyond mistakes to the total person.

Jeff sat in my office complaining of his constant lack of success in controlling his stress and anxiety. For him, his difficulties simply represented more proof that he was a “born loser.” Like virtually everything else in Jeff’s life, his attempt at managing his anxiety was begun while already expecting a lack of success. After all, if you are a born loser, what else can happen except failure? Talking to Jeff, it soon became apparent that here was a man incessantly calling himself names like "loser, jerk, and stupid". Jeff actually believed that you had to talk to yourself this way if you are ever going to get anything done. You had to whip yourself into shape and keep yourself in line or else you will really mess up. When told that lots of people are quite successful and never call themselves names or label themselves in any negative fashion, Jeff was incredulous. How could anyone succeed at anything if they were not tough on themselves? Jeff protested: “I do not believe there is anyone that does not talk this way to himself or herself.” Over time, Jeff would learn that global labeling had everything to do not only with his lack of success, but also his ongoing depression and anxiety.

Shoulds and Musts

This distortion involves using a list of inflexible rules about how you and other people “should” act as sacred commandments guiding every aspect of your behavior. These rules are seen as right and indisputable with no deviation allowed. Any departure from strict adherence to these rules is accompanied with extreme guilt and anxiety. Key words that signal the presence of this distortion are “should,” “ought,” or “must.”

One of our therapy groups got to brainstorming a list of musts and shoulds they believed applied to them. It is fascinating that people with addictions, compulsions, anxiety disorders, depression, and extreme stress can all relate so well to the same set of rules. Our belief is that many disorders have an underlying anxiety disorder, and many of the following will apply to anxious or stressed people in general. The list put together by the group follows.

1. I should not put myself first. I should always be there for other people

2. I should not have or express anger. I should always be pleasant. 3. I should not have conspicuous needs or wants. 4. I should not make waves. 5. I should not make time for myself. 6. I should not waste time relaxing. 7. I should not have fun. I should always be productive. 8. I should not have expectations for others. 9. I should not get too close to others or they will discover my flaws. 10. I should not be a burden to others. I should be selfless.

11. I should not trust. I should always be cautious with others.

12. I should not ask for help. I should be self-sufficient. 13. I should not make mistakes or fail in any way. 14. I should not be imperfect. I should perform perfectly. 15. I should not lose control. I must be in control at all times. 16. I should not say no. I should always be agreeable. 17. I should not disappoint others or fail to be nice. 18. I should not be my own person. I should please others. 19. I should not be too visible. 20. I should not be comfortable with compliments. 21. I should not be comfortable with criticism. 22. I should not be overly optimistic or helpful. 23. I should not be assertive. 24. I should not have strong opinions. 25. I should not love myself or even like myself. 26. I should not act as though I have rights. 27. I should not be fat. I should be perfectly thin.

Years ago the famous psychiatrist Karen Horney called this kind of thinking the “tyranny of the shoulds.” Some of these “shoulds” have very destructive and far reaching effects. For example, if you believe you should not express anger, the result will be much free floating anxiety, lowered self-esteem, and relationship problems. Other shoulds have similar negative consequences.

As you look over this list of distortions, you will no doubt spot some that are quite familiar and others that you may not utilize to any great extent. Probably you have favorite distortions. Those are the ones you need to become more aware of so that you may begin to dispute them and change them.

Schema

Schema are patterns of thoughts, feelings, and behaviors that usually start in childhood and continue throughout life. They often begin with something done to us by families or others, such as abandonment, excessive criticism, overprotection, abuse, rejection, or being deprived. In some way we were damaged and the schema became part of how we see the world. Schemas, when triggered by present events, determine how we think, feel, act, and relate to others, and trigger strong feelings such as anger, depression, or anxiety.

The psychoanalytic concept of repetition compulsion helps explain why we get repeatedly get drawn into behavior patterns that don’t work. For example, many of us habitually and mindlessly get into dysfunctional relationships, cling to feelings of defectiveness or incompetence, are overly accommodating to others, see the world as negative and threatening, or persist in feeling unhappy, unfulfilled, and undeserving, in spite of evidence to the contrary. Learned schema have become part of our way of seeing the world, and our place in it. As such, schema are difficult to change without working on noticing the schema, and working to end its influence.

The most common schema are what Jeffrey Young, co-author of Reinventing Your Life calls “Lifetraps.” These include emotional deprivation, vulnerability, subjugation, mistrust and abuse, abandonment, defectiveness, entitlement, dependents, failure, unrelenting standards, and social exclusion.

The reference list contains some excellent resources on understanding schema.

Perfectionism

No discussion of styles of distorted thinking would be complete without reference to perfectionism. In fact, perfectionism is a central ingredient in most of the above styles of distorted thinking. Most of the time, if you’re going to be perfectionistic, you’re going to be miserable. As reported by Stephen Guise, author of How to Be an Imperfectionist: The New Ways to Self Acceptance, Fearless Living, and Freedom from Perfectionism: “The poison of perfectionism can remain undetected in small doses, simply impairing your life; in larger doses, it can be lethal to your well-being.”

Guise cites a study by Fry and Debats showing that elderly subjects with perfectionistic tendencies were 51% more likely to die in the course of the six and a half year study. Other studies have linked perfectionism to higher rates of depression and suicide and indicate that the risk of perfectionism has been underestimated.

Sydney Blatt, in an article entitled The Destructiveness of Perfectionism: Implications for the Treatment of Depression found perfectionism “to be a primary disruptive factor in the short-term treatment of depression, whether the treatment is pharmacotherapy (imipramine), cognitive-behavior therapy, interpersonal therapy, or placebo.” Stephen Guise concludes: “this suggests that depression may not be the condition we should be treating. Maybe we need to focus on the underlying perfectionism mindset that leads so many people to depression and suicidal thoughts.”

Norma is an excellent student. In fact, Norma is the student her professors point to when discussing academic excellence. You might think that would give her a “swelled head,” or at least deep satisfaction and pride in her accomplishments. Not so!, Norma is plagued by self-doubt and the nagging fear that she has missed something, or is about to make a crucial mistake. She’s unable to relax, and virtually never stops worrying. In her words, “Every moment is an opportunity to fail.” When asked if she’s perfectionistic, Norma shrugs it off with a laugh and says: “Of course, that’s just who I am, I can’t change it.” Like many perfectionists, Norma sees it more as a badge of honor than something that is in reality crippling and irrational.

Ted punishes himself mercilessly for making mistakes. He drives himself relentlessly for success in his career. Setbacks mean failure. Setbacks mean he has absolutely screwed up and failed not only himself but his family. There is no possibility of being kind to himself or easing up on extreme, self-downing until he has once again achieved flawless performance. Even then, he will have to be on his guard to prevent future failure.

Mario grew up with a harsh punitive father. Desperate to win his father’s approval, it never quite worked out that way. His father continues to be his harshest critic, and Mario has become obsessed with pleasing not only his father but everyone he values. Mario relentlessly strives to be perfect in every way. He readily concedes that he is driven by one belief: “You have to be perfect, or people you care about will abandon you.”

Perfectionism is often the hidden culprit behind much of our dis-ease. If you are indecisive, socially anxious, a procrastinator, prone to depression and anxiety, or suffer from lack of self-acceptance, it’s a good bet that a root cause is perfectionism.

Positive self-talk?

Many of our clients suffer from extreme anxiety and panic. It's not at all unusual to see first time clients who are having multiple panic attacks daily. They come for their first appointment in great distress, desperate to find relief from their panicky feelings. While much of the focus is on corrective self-talk and helping our clients recognize negative thoughts as only thoughts, there are also positive thoughts and beliefs that we would like them to embrace.

People who experience panicky feelings and panic attacks most dramatically illustrate the power of your thoughts to make you intensely uncomfortable. For panic disorder clients in particular, there are eight major positive beliefs that they need to completely adopt. In fact, holding these beliefs without reservation would effectively negate the kind of thinking that gives rise to panic attacks. These beliefs were developed by Bill after his recovery from panic disorder in the early 1970s.

Please note that these beliefs, although designed to be used with panic disorder, also have great relevance for stress and anxiety in general.

New clients are often asked to rate their confidence in these beliefs scale from 1 to 10. Early on, scores are quite low. With subsequent sessions, scores rise and there is a corresponding rise in the ability to cope with panicky feelings and panic attacks.

Eight things you have to believe completely to overcome your panic disorder:

1. It's only anxiety. Panic attacks are terrifying. When our clients think scary thoughts, their bodies react with a wide range of physical sensations so intensely uncomfortable, they are sure something is terribly wrong and their very survival is at stake. It's absolutely important that clients come to believe that their experience is understandable and nothing more than a normal physiological response to perceived danger –it's only anxiety!

2. It can't hurt you. Panicky feelings may involve a whole range of sensations such as rapid heart rate, sweating, difficulty breathing, and feelings of unreality. The sensations are so unsettling that it's quite easy to jump to the conclusion that you're about to have a heart attack, die, or have something absolutely terrible happen. However, the panic itself can't hurt you; it just feels terrible.

3. You can handle it. This belief is a natural progression from the previous belief. If it can't hurt you, then you can handle it. In the case of people who have had previous panic attacks, we point out that they have always gotten through them, and have never been physically harmed. Yes, it feels terrible, but you will handle it and get through it. You always have and you always will.

4. It will pass quickly enough if you let it. Panic attacks are time limited. We are talking about a short-term physiological reaction. That surge of adrenaline will quickly dissipate. However, if you struggle against it and allow yourself to become panicky about being panicky, the reaction can be perpetuated. On the other hand, if you can simply breathe from your diaphragm, think peaceful thoughts, and allow it to pass – it will quickly pass.

5. You can develop all the tools you need. The good news about anxiety disorders is that they are the most treatable of all psychological problems once people get a correct diagnosis and begin working within a program where anxiety disorders are understood. The tools exist, and people typically get much better once they begin working on their anxiety in ways that make sense.

6. You don't have to worry about it in advance. This "anticipatory anxiety," fearing that another attack is imminent is what brings on the next attack. People would be much better off if they could say to themselves: "If it happens, it happens. I don't have to worry about it in advance. If it happens, I'll handle it." If this belief: "You don't have to worry about it in advance" is given a 10 on our 10 point scale, it would be extremely unusual to have a panic attack.

7. You will manage your anxiety not by conquering it, but by accepting it. It’s like being stuck in quicksand; the more you struggle the more you are stuck. It’s paradoxical. Slow down and accept your anxiety and you can begin to work effectively with it.

8. Thoughts are just thoughts and while you don’t have much control over the thoughts that pop into your head, you can have complete control over how you react to them. This is the main point of Acceptance and Commitment Therapy. You can simply notice the thoughts and decide whether or not they are useful or workable. If not useful, you can move on in the direction of values-based choices.

Tips for Improvement: The Short list

Re-read this chapter paying particular attention to the discussion on integrating Rational Emotive Therapy or RET practices with Acceptance and Commitment Therapy, and the descriptions of styles of distorted thinking and schema. Write down your thoughts about how specific ideas relate to you. Follow the RET prescription when you are aware of disturbing thoughts and beliefs. As you become more easily aware of your particular “nutty” beliefs, you can move on to practicing the ACT skill of defusion.

Cultivate mindful awareness by revisiting distressing situations and linking stress, anxiety, and depression to specific thoughts and beliefs.

Practice breath awareness and breath retraining, following the guidelines in the Choice 1 Action Planning Guide.

Consider Journaling as described in the Choice 9 Action Planning Guide. This is an excellent technique for sharpening mindfulness skills. You might choose to journal daily on Choice 5 topics.

You will find an abundance of material relevant to becoming more aware of automatic negative thoughts and core beliefs in the Choice 4 Action Planning Guide. Other helpful material is found in the discussions of Mindful Choices 6, 7, 9, and 10. Our choices are interrelated. Improvements in one choice area often lead to improvements in other areas as well.

Re-take your Choice 5 self-test. If Choice 5 was rated as “Needs Attention,” or “Urgent Attention Needed,” and you are choosing to focus on this area, the self-test should be taken daily, preferably each morning looking back on the preceding 24 hours. Focus on steadily improving your score to the “Good,” or “Optimal” levels. If other areas are more important, we recommend that you focus first on those areas, reassessing Choice 5 approximately every four weeks.

If you find yourself running into difficulty, you might try answering the following questions:

Life Choice 5 Personal Development Worksheet

Step 1: Identify a foundational value, or values. In other words, why is this Life Choice important to me? For example, why do I value noticing and defusing? What is the area of greatest benefit to me? For example, do I value dealing with negative self-talk for helping me be more conscious and intentional in my relationships?

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Step 2: How would I describe my present Mindful Choice 5 performance?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Step 3: In regard to my self-talk, what is the behavior I want to change?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Step 4: What is my personal vision for Mindful Choice 5? Imagining some point in the future. What Do I see myself doing in regard to Mindful Choice 5?

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Step 5: What do I hope to get from Mindful Choice 5:

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Step 6: To pursue Mindful Choice 5 to the point that I much more aware of my self-talk and beliefs, and much better able to manage self-talk and beliefs, how will I have to be in ways that might constitute a major stretch for me? Do I need a new way of being that would constitute a paradigm shift? Are there radically different ways of being (thinking, feeling, acting) that contribute to doing Mindful Choice 5 and getting what I want to get?

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Step 7: In regard to Mindful Choice 5, How will I have to act on a daily or ongoing basis so that I wind up doing what I want to do, and getting what I want to get, and being the way I want to be? How do I have to discipline myself to have consistent, routine, and well-practiced daily or ongoing actions that steadily contribute to the results I really want and value in my life?

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Step 8: What are the barriers such as negative self-talk or lack of time that might prevent me from reaching my Mindful Choice 5 goals?

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Step 9: Who will be helpful or supportive in my Mindful Choice 5 change efforts?

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Step 10: How will I be rewarded while I am accomplishing the changes I desire?

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Step 11: how important is this to me on a scale from 1 to 10, with 10 being extremely important? How might I sabotage the plan, or allow others to sabotage the plan?

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Step 12: I am committing to the following SMART goal (Specific as to actions I will take, Meaningful and in alignment with my values, Adaptive in that I strongly believe my life will be improved, Realistic and achievable, and Time-framed with specific time dedicated).

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Further Reading

Blatt, S.J. ‘The Destructiveness of Perfectionism: Implications for the Treatment of Depression. ‘American Psychologist 50.12 (1995): 1003-1020.

Ellis, A. (1975). A New Guide to Rational Living. New York, NY: Wilshire.

Ellis, A. (1998). How to Control Your Anxiety before Controls You. New York, NY: Citadel Press Books.

Ellis, A. (2016). How to Stubbornly Refuse to Make Yourself Miserable about Anything: Yes, Anything. New York, NY: Citadel Press Books.

Forsyth, J. & Eifert, G. (2016). The Mindfulness and Acceptance Workbook for Anxiety: a Guide to Breaking Free from Anxiety, Phobias and Were Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications. Oakland, CA: New Harbinger Publications.

Fry, P. S. , & D. L. Debats. ‘Perfectionism and the Five Factor Personality Traits As Predictors of Mortality in Older Adults.’ Journal of Health Psychology 14.4 (2009): 513-524.

Hayes, S.,Strosahl, K. & Wilson, K. (2016). Acceptance and commitment therapy: The Process and Practice of Mindful Change. Oakland, CA: New Harbinger Publications.

Hayes, S. (2005). Get Out Of Your Mind and into Your Life: The New Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications.

Luoma, J.,Hayes, S. & Walser, R. (2007). Learning ACT: An Acceptance and Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger Publications.

Strosahl, K. & Robinson, P. (2008). The Mindfulness and Acceptance Workbook for Depression. Oakland, CA: New Harbinger Publications.

Young, J., Klosko, J. & Weishaar, M. (2006). Schema Therapy: A Practitioner’s Guide. New York: The Guilford Press.

Young, J. & Klosko, J. (1993, 1994). Reinventing Your Life. New York: Plume Books.