There is a high level of co-morbidity among those with mental health and substance use…
Think This, Not That: How to Use CBT to Manage Stress
Our minds can greatly help or hinder our ability to cope with stress. And it turns out that managing stress well relies heavily on the way we think when we’re under pressure.
The wrong thoughts — what psychologists call “thought distortions,” or errors in how we mentally process reality — can increase stress levels and lead to unhealthy forms of coping, such as substance abuse. So what are the most common cognitive traps we face during stressful times?
I put that question before Louis J. Bevilacqua, PsyD, a clinical therapist who directs outpatient care at Clarity Way, a Pennsylvania-based drug and alcohol rehabilitation center. Dr. Bevilacqua specializes in a form of psychotherapy called cognitive behavioral therapy (CBT). The method focuses on changing how patients think so they can lead healthier lives. After finishing his CBT training with Arthur Freeman, EdD, ABPP, a leading authority in the field, Bevilacqua spent years in private practice applying the technique. He’s written several books on the subject, the latest of which is When You Can’t Snap Out of It: Finding Your Way Through Depression.
CBT as Self-Help
Psychiatrist Aaron Beck and psychologist Albert Ellis — who are often referred to, respectively, as the father and grandfather of CBT — pioneered the therapy in the 1960s. It’s often been used to treat various forms of mental illness, including substance abuse disorders, by focusing on the relationship between thoughts, emotions, and behaviors in order to identify and modify distorted thinking patterns — and in turn, the ways patients behave and relate to other people.
But CBT doesn’t have to be limited to treating mental illness. Bevilacqua says it also can be an effective self-help strategy for coping with life stressors. The mind has the power to both amplify and diminish the volume of stress in our lives.
“Cognitive distortions are … a way in which we think, interpret or perceive something that isn’t really true,” Bevilacqua says. “All of us engage in various distortions or thinking errors every day. The purpose of identifying them is to enable us to create change. By learning to identify how we are thinking, we can create an opportunity to question and possibly change such thinking. When we are stressed out, we are likely to be thinking in a distorted way. This usually increases our stress level, which is something we would want to change.”
The Three Biggest Traps
Bevilacqua said three forms of distorted thinking are the most common in times of stress:
- All-or-nothing thinking, also referred to as black-and-white thinking or polarizing, is thinking in extreme terms. For instance, we might view ourselves as either a complete success or a total failure, instead of allowing ourselves to fall somewhere in the middle of the two extremes. With little room for the “grays,” or the in-betweens that are part of being imperfect human beings, we can hold ourselves up to impossible standards of perfection.
- Catastrophizing, sometimes also called magnifying, is when we expect the worst to happen. Bevilacqua gives this example: Say you sprain your ankle; catastrophizing is when you tell yourself you’ll never be able to walk again. We can let a similar scenario play out in our heads in response to all sorts of stressful situations. We might lose a job, then tell ourselves we’ll be homeless and never be employed again. Or we might go through a divorce, then come to believe we’re incapable of sustaining a committed relationship and doomed to be single for the rest of our lives.
- Jumping to conclusions, also sometimes known as mind reading, is when “we believe we know what others are thinking or how they are feeling without checking it out or asking them,” says Bevilacqua. For example, your girlfriend might be struggling to find the words to tell you something that’s not dramatic, such as that you have bad breath. But if you’re mind reading, you might leap to the conclusion that she wants to break up with you, without first asking her what’s on her mind.
How to Avoid Distorted-Thinking Traps
In times of stress, you can avoid all-or-nothing thinking, catastrophizing, or jumping to conclusions by taking a few simple steps:
- Pay more attention to your thoughts. “In order to change something we must first become aware that it is a problem,” Bevilacqua says. By simply noticing our thought patterns, we can better determine what our problem thinking is. He suggests some practical strategies for increasing self-awareness: You might set an alarm or reminder on your watch or phone to check in with yourself regularly throughout the day for a quick mental inventory. Or you might do this check-in or inventory after meals.
- Identify the problem. In these bite-sized moments for cultivating greater self-awareness, catalogue your recent thoughts. Have you been jumping to conclusions, catastrophizing,, or thinking in all-or-nothing terms? Note what you observe and whether it falls into one of these traps.
- “Interrupt, change, and replace” the distorted thought. If you notice a thought distortion, say it aloud, or write it down in a journal. The goal is to recognize for yourself where your thoughts have gone wrong. Or you can give yourself what Bevilacqua calls a “do-over.” Imagine yourself directing the movie of your life and being able to cut and replace your mental script. Then go ahead and replace that faulty, uninspired script with a healthier, more self-forgiving and motivational one. For example, if you’ve just lost your job and initially see yourself as a total failure (all-or-nothing thinking), remind yourself of the times you’ve been a success and of the ways that even failure has made you a better, stronger person.
- Keep practicing this discipline of identifying, interrupting, and replacing distorted forms of thinking. With a bit of practice and some time, you can develop healthier thinking patterns that lead to more positive behavior and more fruitful ways of relating to people around us. A regular discipline involving the above steps can help us rebound better in difficult situations and make us less susceptible to coping with stress in unhealthy or self-destructive ways.
Bevilacqua shares this story to illustrate how following the above steps can encourage mental health. A college student recently came to him feeling stressed, overwhelmed, and “constantly worried about her grades, despite having a grade point average of 3.5.” She was frequently falling into one or more of the three common cognitive traps. By following the above steps, over time she developed more positive, stress-alleviating ways of thinking about school and its many related pressures.
The takeaway? That sometimes changing our minds really can be good for us.
By Kristina Robb-Dover
Follow Kristina on Twitter at @saintplussinner