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Cognitive Distortions
Understanding and Addressing Them
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Objectives
~    Define Thinking Errors
~    Explore the different types of thinking errors
~    Cognitive distortions
~    Irrational Thoughts
~    Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure
~    Identify ways to
~    Increase awareness of thinking errors
~    Address thinking errors
~    Address basic fears

Why I Care/How It Impacts Recovery
~    Thinking errors, or stinkin’ thinkin’ plays a large part in keeping people miserable
~    Addiction, depression, anxiety, anger and guilt often stem or are made worse by faulty thinking
~    Addressing these thought patterns will help clients:
~    Not make a mountain out of a molehill
~    Focus on the things they can change
~    Identify and eliminate thought patterns that are keeping them stuck
What are Thinking Errors
~    Cognitive Distortions take a thought and manipulate it to
~    Fulfil people’s expectations of a situation
~    Conform to their current head space (negative sees negative)
~    Irrational Thoughts are beliefs/thoughts that you may hold that
~    Are usually extreme (I must have love and approval from everyone all the time)
~    Are unrealistic
~    Create feelings of failure, inadequacy, disempowerment

Causes of Thinking Errors
~    Information-processing shortcuts
~    Using outdated, dichotomous schemas
~    Mental noise
~    The brain's limited information processing capacity
~    Age
~    Crisis
Causes of Thinking Errors
~    Emotional causes
~    I feel bad, therefore it must be bad
~    Moral causes
~    It was the right thing to do
~    Social causes
~    Everyone is doing it
Impact of Thinking Errors (Fight or Flee)
~    Emotional upset
~    Depression
~    Anxiety
~    Behavioral
~    Withdrawal
~    Addictions
~    Sleep problems/changes
~    Eating changes

~    Physical
~    Stress-related illnesses
~    Headaches
~    GI Distress
~    Social
~    Irritability/impatience
~    Withdrawal

Thinking Errors & Interventions
~    Emotional Reasoning –Feelings are not facts
~    Learn to effectively identify feelings and separate facts
~    I am terrified
~    About what are you terrified?
~    What is the evidence that you are in danger now?
~    In what ways is this similar to other situations?
~    How have you dealt with those situations?
~    Develop distress tolerance skills
~    Develop emotional regulation skills

Thinking Errors & Interventions
~    Cognitive Bias/Negativity/Mental Filter– Focus on the negatives and worry about the future
~    Questions
~    What is the benefit to focusing on the negative?
~    What are the positives to this situation?
~    What are all the facts?
~    Coin toss activity

Thinking Errors & Interventions
~    Disqualifying or minimizing the positive
~    Questions
~    Would you minimize this if it was your best friend’s experience?
~    What is scary about accepting the positive?
~    Sometimes we disqualify the positive because it fails to meet someone else’s standards, might that be true here?
~    Availability Heuristic: Remembering what is most prominent in your mind
~    Questions
~    What are the facts

Thinking Errors & Interventions
~    Egocentrism– My perspective is the only perspective
~    Question: What are some alternate perspectives
~    Personalization/Mindreading
~    Questions
~    What are some alternate explanations for the event that did not involve you
~    How often is it really about you?

Thinking Errors & Interventions
~    Magnification
~    Questions
~    Are you confusing high and low probability outcomes?
~    How much will this matter 6 months from now?
~    What have you done in the past to tolerate events like these?
~    All-or-Nothing
~    Questions
~    Love vs Hate
~    Perfection vs. Failure
~    All good intentions vs. All bad intentions

Thinking Errors & Interventions
~    Availability Heuristic: Remembering what is most prominent due to (frequency, intensity or duration) in your mind
~    Questions
~    What are the facts
~    How often does it really happen
~    How long has it been since you have seen that behavior
~    The good times are amazing, but how frequent are they compared with the bad times?

Thinking Errors & Interventions
~    Belief in a just world/fallacy of fairness
~    Question:  Identify 4 good people who have had bad things happen.
~    Attributional Errors (Labeling yourself not a behavior)
~    Global vs. Specific
~    I am stupid vs. I do not have good math skills
~    Stable
~    I am (and always will be stupid) vs. I can learn math skills
~    Internal
~    It is about me as a person vs. It is about a skill/skill deficit

Questions for Clients
Belief = Thought/Fact + Personal Interpretation
~    What are the facts for and against my belief
~    Is the belief based on facts or feelings?
~    Does the belief focus on one aspect, or the whole situation?
~    Does the belief seem to use any thinking errors?
~    What are alternate explanations?
~    What would you tell your child/best friend if they had this belief?
~    What do you want someone to tell you about this belief?
~    How is this belief
~    Moving you toward what and who is important to you?
~    Moving you away from what or who is important to you?

Cognitive Distortions Review
~    Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure
~    Personalizing
~    Mindreading
~    All-or-Nothing/Polarized
~    Catastrophizing
~    Overgeneralization
~    Shoulds
~    Recency/Availability Heuristic

ABC-DEF
~    Activating Event (What happened)
~    Beliefs
~    Obvious
~    Negative self-talk//Past tapes
~    Consequences
~    Dispute Irrational Thoughts
~    Evaluate the Most Productive Outcome
~    Is this worth my energy?
~    How can I best use my energy to deal with or let go of the situation?
Triggers—Coping Skills
~    Distract don’t react
~    Talk it through to:
~    Identify the distortions
~    Find the middle path
~    Urge surf
~    Notice how you are feeling
~    Remind yourself it increases and decreases like a wave
~    Notice changes as the urge goes out
Constructive Self Talk
~    Have clients pinpoint what they tell themselves about an urge that makes it harder to cope with the urge
~    Use empowering self-talk constructively to challenge that statement. An effective challenge will make them feel better (less tense, anxious, panicky)
~    What is the evidence?
~    What is so awful about that?
~    You are a regular human being and have a right to make mistakes
Distressing Thoughts Worksheet
~    What is the evidence
~    Am I assuming causation where no exists?
~    Am I confusing thought or feeling with fact?
~    Am I close enough to really know what is going on?
~    Am I thinking in all-or-none?
~    Am I using extreme words like always or never?
~    Is the source of the information credible?
~    Am I confusing low with high probability?
~    Am I focusing on irrelevant factors?
~    Is this thinking getting me closer to what I want?
~    What are the advantages/disadvantages to thinking this way?
~    What difference will this make in a month/year.

Group Activity
~    List thinking errors and discuss how those patterns protected you until now
~    Example: Prevented you from being disappointed if you expected to fail or expected people to leave
~    Identify thinking errors that you can, currently, eliminate and a countering mantra
~    I need to be loved by everybody all the time
~    I need to love myself all the time and not everybody is capable of loving.  It is about them, not me.
~    Identify thinking errors that you still hold onto and why, then develop a plan to start addressing them.

Decisional Balance
~    This thought pattern was learned over a long period of time
~    It served a purpose and was more beneficial than the alternative
~    Changing your outlook means seeing how this thought pattern is destructive, and alternate thought patterns may (now) be more helpful.
~    Example: In an addicted home the mantra is don’t talk, don’t trust, don’t feel.  For a child from an addicted home negative thinking helped you align with the primary caregiver and provided safety. As an adult, you no longer require that safety.
Summary
~    Cognitive Behavioral Therapy is a technique that helps people:
~    Understand how thoughts create feelings and vice versa
~    Identify and address negative self talk
~    Issues and events from the past do not need to continue to negatively impact a person
~    Thinking errors are learned and can be unlearned
~    These thought patterns help to form and maintain a negative or vulnerable self image.
~    Healthy thought patterns can help people feel more empowered and worthy of love.
Nashville Counseling Un-Conference
A grass-roots conference put together by clinicians for clinicians.
Up to 20 CEUs from a NAADAC approved provider are available for addiction and mental health counselors and people seeking certification as addiction counselors

~    WHEN: February 23-25, 2018
~    WHERE: Nashville Metro (exact site TBD)
~    The main speaker each hour will also be simulcast online.  Virtual attendance is possible for those who do not need “face-to-face” hours.
~    COST:
~    Whole conference (20 CEUs): $99 in advance;  $149 at the door
~    One Day (8 CEUs): $45 in advance; $65 at the door
~    Registration will open in October 2017
Nashville Counseling Un-Conference
Call for Papers

~    Theme: Addressing the Growing Problem of Co-Occurring Disorders.
~    Suggested Topics:
~    Techniques and Effectiveness of Technology Assisted Therapy (e-therapy, text-based coaching, apps, online support and educational programs etc.)
~    Special Needs of Rural Populations
~    Transdiagnostic Approaches to Treatment
~    Relapse Prevention for Co-Occurring Disorders
~    Multidisciplinary Approaches to Treatment
~    Prevention and Early Intervention Strategies for Co-Occurring Disorders
~    Developing Self-Esteem and Emotion Regulation Skills in Youth
~    Case Management is not a counselor's job, but…It is
~    Exploring pharmacotherapy in the treatment of co-occurring disorders (SSRIs and their impact on compulsive behaviors for example)