If you're living with a chronic illness, you're in the right place.

Monday, March 30, 2015

Cognitive Distortion of the Month: Dichotomous Thinking

2:44 PM Posted by Tiffany Taft , , ,
Greetings.  It's been a while since I wrote a blog entry as I had a baby last October and it's kind of amazing how real baby-brain is, which makes writing feel exponentially harder.  Especially when they don't sleep very well.  He's 5 months old now and is being gracious enough to let me sleep in 3-4 hour increments.  So I have that going for me.

Steph kicked off our 2015 blog series on Cognitive Distortions, or as some say "thinking traps" with a nice piece on using a Negative Filter when evaluating our life.  If you haven't read it, go check it out.

For March, the topic is Dichotomous Thinking.  As it implies, dichotomous thinking is only seeing a situation from two potential angles.  It's all or nothing.  Good or bad.  Black or White.  There's not much room for any grey area.  But, if we take a step back we see that life is full of grey areas and it's actually less likely that we're operating in one of the extremes.  So why do we go there?


How do we know when we might be stuck in a dichotomous thinking trap?  There are certain key words to look out for.  The biggest 2 are Always and Never.

In terms of living with a chronic illness, it might be thoughts like:

"I'm always getting sick when I have plans."

"My treatment is never going to work."

"People always give me a hard time about my condition."

"My doctor never listens to me."

Or, we can fall into this trap more generally:

"I didn't get a perfect job review so I'm obviously a total failure."

"I forgot my friend's birthday so I'm obviously a horrible human being."

Thinking this way can cause a lot of stress, not to mention feelings of helplessness or even hopelessness.  Dichotomous thinking is the basis for perfectionism, which I've found is often behind feelings of anxiety and depression because who can ever measure up to perfection?

What are some ways to combat dichotomous thinking?

Like most cognitive-behavioral therapy (CBT) strategies, we start with pausing and evaluating the legitimacy of our thoughts.  I like to ask clients "Would your argument hold up in court?"  Or, "Would your argument hold up to scientific review?"  If the answer is no, then we have to look at why you might still hold on to those thoughts if they aren't valid.  But that's for another blog entry.

Evaluating our thoughts in a rational and logical way pulls us back from overly emotional thinking, which lends itself to cognitive distortions like dichotomous thinking.  Don't get me wrong, we don't want to be too robotic about life. Rather, we can operate in between, in what some in psychology refer to as our "wise minds."  

The next time you're thinking this way, jot down your thoughts on a piece of paper.  Draw a line with your belief at one end.  At the opposite end of the line write down the opposite thought (e.g. you wrote down "I'm never going to get better" then write down "I will get better.")  Next, draw a short line through the middle of the original line and write down a few thoughts that are somewhere in between the 2 extremes to try to get at the middle ground, or grey areas.  

And then ask yourself:

Are situations where your belief isn't happening.  This is good for the always and never thoughts.  

Would everyone see the situation this way?  What are some alternative arguments?

What would I tell my friend if he/she came to me with this belief?

If I thought of the situation in terms of the grey area, how might my feelings or behavior change?

Reining in dichotomous thinking can help us feel less anxious, down, or defeated.  Evaluating these thoughts help us look at our world through a more realistic lens.  This exercise may seem simple and straightforward as you read it, but it takes time and practice to make this a habit that we use in the moment when dichotomous thinking is kicking up intense feelings.  If you struggle with making the adjustments on your own, getting help from a CBT therapist can certainly help.

Best,

Dr. T.

Tuesday, March 24, 2015

Understanding Anger – Part 2

7:44 PM Posted by Skyler Schuyler , , , ,
As we know, anger is a powerful emotion that can endanger your work, relationships and even your health. Managing anger effectively is important not only for self-care, but also within personal relationships. While experiencing anger is normal, coping strategies to reduce internal frustration can look very different for everyone. Looking to the experts in anger management, the following strategies are found to be the most effective when attempting to reduce internal frustration and anger directed outward.  



First, think before you act. It’s easy to get caught up in the moment and to say exactly what’s on your mind. It takes far more practice and skill to take a moment and pause before speaking. Giving yourself and others around you time to gather thoughts can help deescalate frustrating situations. Once you are able to remain calm, it is important to express your frustration in a nonconfrontational manner. Being assertive without offending others can be challenging in itself. Expressing your anger appropriately takes time and practice, but soon you will be able to offer insight to your feelings without hurting or potentially insulting others.

When confronting a frustrating event, using ‘I’ statements can greatly reduce feelings of criticism. If a person feels blame is placed on them, it’s difficult for them to hear what you are saying. Using ‘I’ statements reduces the likelihood of someone becoming defensive in the moment and may give them a chance to listen to the feelings you are trying to express. For instance, “I’m upset when I come home and feel like I have to clean up the house by myself.” It’s also important to evaluate and identify as many possible solutions. When you start to feel anger build inside, ask yourself if what is making you mad could be changed with reframing your thoughts. If you burn dinner, can you make something else instead? If traffic is backed up, can you spend that extra time as self-reflection? If a room is messy, is it possible to shut the door for that day? Creative solutions and reframing frustrating moments can instantly change your outlook for the day.


Using humor is also an effective way to manage stress and reduce frustration. When you can lighten up a mood, tension will diffuse. Humor can help you look any possible unrealistic expectations that are driving your anger in the moment. However, tread lightly with sarcasm. Sarcasm has a tendency to escalate circumstances that already invoke irritability. Remember, forgiveness is powerful. If you hold a grudge towards others, the only person it truly impacts is yourself. Negative feelings you harbor towards others may go unnoticed, leaving you feeling bitter and possibly enraged. If you are able to, and can forgive, you may be surprised at how much both parties can learn from the situation.

Combating anger requires the use of relaxation skills and exercise. With flared tempers, relaxation strategies such as deep-breathing, reciting calming words or phrases, or listening to music can reduce irritability in the moment. The right song or choice of words may look different for each person, so it’s important to figure out what works best for you. This may take some time and practice, but is well worth the effort when you experience success. Movement and exercise can physically help reduce blood pressure, change chemicals released in the body and improve your mood. Try going for a brisk walk, yoga or playing a sport with friends to transfer negative energy and emotions into positive use.

Finally, take time out for yourself and know when to ask for help. It’s challenging in the heat of the moment to take a step back and give yourself space. Some scenarios that make us mad can be worse than others. Recognizing events that require additional space can save you time and energy. However, sometimes, no matter how much you try, you might need a little help. Seeking assistance from anger management counselors, social workers or therapists can help increase your coping strategies.



Anger is powerful, and it can be destructive. Do not let your anger control you. Find the right coping strategies that work for you. This may mean you might have to get creative, but that’s ok. Praise your efforts and remind yourself that anger did not get the best of you – because you made that choice.







Monday, March 2, 2015

Understanding Anger - Part I

7:15 PM Posted by Skyler Schuyler , , , ,
Emotions are powerful responses that are unavoidable. As unique individuals, we express our emotions in various ways depending on the situation and people around us. You may have a friend or know someone who is always happy and cheerful or someone who is cranky and moody.
But what about anger? Do you know someone who expresses anger frequently? Perhaps you find yourself feeling angry more often. Understanding your emotions is the first step to knowing how to appropriately express these feelings.
What is Anger?
According to Dr. Charles Spielberger, anger is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” Exploring the nature of anger, irritability and agitation are accompanied by both physiological and biological changes. For instance, when you experience frustration or agitation, your blood pressure and heart rate increase, energy hormones increase, as well as adrenaline and noradrenaline. – Family fighting during holidays, a delayed flight, wrong food order, argument with a friend, the kids arguing in the back seat – Anger is the result of external or internal (even a combination of the two) events. Either an individual person or an event can stir up irritability.
Why Do We Feel Anger?

It’s normal to question why we experience anger. Leading experts within anger management programs have offered several responses why irritability occurs more often for some. However, several of these reasons are worth taking a moment to consider. For instance, anger occurs because someone wants to harm themselves. Depression can play a big role in anger directed towards oneself. If you feel powerless or isolative, it may represent a desire for self-destruction.
We may experience anger in an effort to achieve control. It has been suggested that anger is used to intimidate or manipulate our circumstances. Fear, irritation and even sadness can drive your intent for control. People will experience anger to feel powerful. Making someone feel small when you’re feeling down can make you feel bigger in comparison. Additionally, the need to fight injustice can fuel anger. While personal morals and feelings of social justice look different for everyone, some people experience outrage at any inequality committed against themselves or others.
As we continue to explore causes and consequences of anger, remember that anger is typically goal-driven. ‘Why’ we experience anger will be different for everyone. Anger can be triggered and leave people feeling worse than the start of their irritability. Regardless of what causes your frustration, what you do with those feelings of agitation counts! Over the next post, I will review some of the best approaches to reduce anger and some practical steps to limit agitation and irritability daily.