(bright upbeat music) - [Presenter] Major support for this program was provided by: Nancy and Nyle Maxwell, (bright upbeat music) Emerson, (bright upbeat music) Kathy and Charlie Izard, (bright upbeat music) Additional support was provided by: Amanda Jensen and Scott Bonneau, Amado DeHoyos, Georgetown Health Foundation, Kristen and John Nelson, (bright upbeat music) and by (bright upbeat music) and also by (bright upbeat music) For more information and a full list of funders, please visit us at howarewetoday.com or aptonline.org.

The information provided in this program is for general educational purposes only and is not intended to constitute medical advice.

This is not a replacement for therapy and does not constitute therapeutic services or a therapeutic relationship.

For personalized medical guidance, or in the case of an emergency, please contact a healthcare provider.

(bright music) (bright upbeat music) (gentle music) - (sighs) Hmm.

I don't know about this one.

Oh, hey, how are we today?

Hope you're doing okay and better than me because I'm in a moment of indecision.

I've a big event tonight, and I don't know which tie to wear, but I want to look good, and voices inside my head, they're fighting over which one 'cause look, red I like, but it's a little bit too bold.

This one, (sighs) just not bold enough.

Oh, and I have blue and I have purple, but blue's a little too old fashioned and purple too trendy.

(sighs) Well, when you're stuck inside your own head, sometimes the best thing to do is to ask for some outside perspective to break through the noise.

Barb, which one do we like?

(gentle music) - Blue.

(gentle music) Not too old fashioned, but classic.

Tyler, you don't have to stress that much.

It's just a local production, not Shakespeare on Broadway.

- Yeah, well, when your friend is the star of the show, it feels like a Broadway production.

- You know, I'm really proud of Mariel for putting herself out there.

- (sighs) Hey, me too.

I mean, this is basically everybody's biggest fear, right, performing in front of a huge audience?

It's terrifying!

- True, although she does have that old English accent to hide behind.

Gosh, she's been doing it for like a month now.

- You're telling me!

(bright music) (Mariel sobbing) - You cannot make me perform!

I cannot go to the play!

(armor clanking) (gentle quirky music) - What is going on with that?

Let's go check it out.

(Mariel sobbing) - Mariel, weren't you supposed to be at the theater like an hour ago?

(Mariel sobbing) - Um, why doth thou protesteth going?

- Well, because everything's already going wrong and everything's gonna continue to go wrong, and everyone's gonna hate me if they don't already!

- Experiencing a little bit of self doubt?

- Maybe some intrusive thoughts?

- Both!

Yes, all of it!

It's like that witch Morgana hath cursed my mind!

You guys, I don't know what I'm gonna do.

- So we're really committing to this accent, aren't we?

Huh?

Okay.

- Tyler, whatever Lady Mariel needeth, we doth answer the call.

(gentle music) Go ahead, Mariel.

Regale us with your tale of woe.

- Yes, thank you.

Thank you.

So, started many ages ago, about 4:30 this afternoon.

(solemn music) I was reviewing the sacred texts, my lines, when ambassadors from the other realms began to arrive.

They immediately took over my focus and filled my head with their words.

Sir Shoulda was the first.

- You shoulda reviewed last night and the weekend before, and you shouldn't have spent all weekend relaxing with your friends, and you shoulda taken this more seriously, you lazy idiot.

- [Mariel] Next came, Sir C. (ominous music) (air whooshing) - Sir Catastrophe, your performance is gonna be a complete disaster, and everyone's gonna laugh at you and throw cabbage at you and get you off the stage, and they'll probably shut down the entire playhouse because of this.

And also, that mole on your arm is looking pretty serious.

- You need to get it checked out!

(tense music) - And finally, the worst one of all, the one I hate the most, (ominous music) - [Mariel] Sir Self-Hatred.

(ominous music) - You are a terrible actress.

(ominous music) You never should have done this.

You will fail.

You are a nobody.

And you are worthless.

(ominous music) - Geez, you've got all that going on in your brain right now?

- Sounds like you're going through some pretty intense cognitive distortion.

- [Mariel] Cognitive distortion?

- Yeah, it's basically what it sounds like.

It's distorted thoughts that don't actually match reality, but they're pretty good at dragging you down.

And sometimes it's just one or two, but it seems like you're dealing with an entire legion.

- Well, actually, with knights, it's called an order.

- Fair enough, your grace.

- Well, how am I supposed to deal with all of these negative thoughts at once?

- Well, sometimes when you're stuck in your own head, the best thing to do is to ask for a little outside perspective to help break through the noise.

(door clicking) - Shall we venture to Camelot?

Hey, I thought y'all said we were dressing up.

- Yeah, we're dressing up normally.

(Mariel laughing) - Oh.

Ooh, I like the purple one; trendy.

- See.

I told you.

- Mariel, what are you doing here?

Shouldn't you have been at the theater an hour ago?

- See, there you go.

Sir Shoulda strikes again.

- Doc, Mariel here is dealing with some pretty intense cognitive distortions, and I think she could probably use the counsel of a wizened mental health wizard such as yourself.

- Hmm, I see.

- Couldst thou please help me slay these foul thoughts, Dr. Erin?

- She's stuck in this Olde English mode, so what I think she's asking, is there a magic fix-all?

- (sighs) I wish there was a quick fix.

The thing with our thoughts and feelings is if there was a quick fix, you would've done it already.

If we could just change the way we think and feel, you would have.

Annoyingly, as we all know, it's not that easy.

- (sighs) What worthy quest ever is?

- The best thing we can do is change our relationship to our thoughts and feelings.

We can't always control which thoughts and feelings show up, which knights come to the table, as you will, but what we can control is what we do with them, what we do next.

So, in that way, the goal therapeutically with cognitive distortions actually isn't to feel better immediately because usually that's not an option.

- Then what is the goal, if not to feel better?

- The goal is changing how we respond to the thoughts that make us feel bad.

When we feel more prepared with how we're going to respond to those thoughts, it can make us feel more capable of tolerating the bad.

That's ultimately the goal, is remembering that we are capable of tolerating any thought that shows up without feeling like we need to hide.

- [Mariel] So you're saying there's no special sword, no Excalibur to defeat these negative thoughts for good?

- [Erin] It's not about defeating the thoughts because we can't do that.

It's about being aware of them and ultimately being in charge of what we do with them so that we can weather the blows.

(tense music) - I just don't know if I can slay that many knights at once.

- Well, first of all, I actually think it's really important to differentiate between intrusive thoughts and automatic thoughts.

It actually seems more like we're dealing with automatic thoughts here, and while they can pop in intrusively, those tend to be a little bit more tied to the circumstance and a long pattern of thinking.

Sometimes they're the same thought, but with an automatic cognitive distortion, those are really a long pattern of thinking over time that are informed by how we were taught, our histories, our beliefs, our feelings, et cetera, and we call them distortions because they're usually emotionally-driven views of reality that are, well... - Distorted?

- Exactly.

There's a bunch of different categories too, so there's the things like catastrophizing and the shouldas and self-doubt, but there's also things like mind reading, fortune telling, disqualifying the positive, labeling, minimizing and on and on.

(bright upbeat music) - Whoa, whoa, whoa.

That's a lot of thoughts for one person to have.

- Well think about how many thoughts we have in a day, like upwards of 80,000 thoughts in one day.

- 80,000 thoughts?

- So many.

But here's the thing with thoughts.

Some thoughts come and go.

Other thoughts come in and really park themselves, take a seat at the table and stick around.

Those thoughts can feel really sticky.

They feel really hard to un-think, and they usually make us feel bad.

- Well, sometimes they all just feel like the same thoughts though, like it's just all the things that my brain tells me that's just making me feel so bad.

- Yeah, I know.

But the key here is training your brain to identify the automatic thoughts as cognitive distortions so that then we can feel more prepared and equipped to take on the patterns of thinking one at a time.

We're challenging the patterns to single combat, if you will, not each individual thought.

Give yourself a moment to really have that awareness of which thought patterns are showing up, and then we can figure out what the best tactic is to use against it.

It's that old phrase, right?

A best offense is a good defense?

It's the same thing with cognitive distortions.

While we can't stop our thoughts from showing up, there's a number of different ways that we can respond.

(drum rolling) - Hello.

Hey, so this part can be really hard.

The first step is noticing what's showing up, the patterns of thoughts and feelings and urges to act.

But why those things are showing up usually involves our cultures, past relationships and patterns, trauma, all those things that make us who we are.

So once we know the what and the why, the next step is figuring out how to change those unhealthy patterns with different actions and sometimes completely different skills, and that's often best approached with professional therapy under the guidance of your own medical provider 'cause each skill is gonna work differently for every person, right?

These examples might be helpful to you, or you might need to do something a little different especially when dealing with things like trauma.

So talk to your therapist for the best approach.

(coconut shells clopping) - Let's say you've got a thought popping in that says something like, "Why did I take this role?

"I always get so nervous, "and then I'm bad in front of crowds."

Once you see that thought showing up in your brain, we can do a number of different things to try to respond to it rather than just letting it yell at you.

With something like that, we might try a technique called cognitive restructuring.

So let's think about the thought.

Maybe you are nervous in front of crowds, but we can examine that claim a little bit because sometimes, even though you're nervous, you are good in front of crowds, right?

This isn't the first time you've done this performance.

You had to audition.

You've done rehearsals.

You performed this in front of the cast and the stage hand and the crew, and some of those times you were nervous, and you still did great, right?

Even if you're nervous and at risk of not giving this the best performance of your life, you're gonna do it anyways because you love it and it's worth it to you.

(tense music) So, even though you think you might be looking for a sword, (tense music) what you're really looking for (sword clanging) (gentle music) is a shield.

(tense music) So at the end you're not just having the thought, but you're hearing it and listening to it and then restructuring with your values in mind.

The key is that we want to remember that we are brave capable knights ourselves, and we can tolerate any of the thoughts that are showing up.

- Well, one of the thoughts that I struggle with is catastrophizing.

How am I supposed to work through thinking that the worst is going to happen because no matter how much I tell myself that it's not, I still worry that it will.

(tense music) - That's a really hard one, and I think one that we can all relate to, those worst case scenario kind of thoughts.

Sometimes our brains go to predicting the future thoughts where we assume we know what's gonna happen, and whatever it is, it's going to be bad.

The tricky thing about those thoughts is that they really trigger our anxiety fight or flight feelings, and then we go into fight or flight mode ourselves trying to reassure ourselves that nothing bad will happen.

Here's the kicker though.

We can't actually ever guarantee that.

Anything is possible.

Instead, what we have to do is notice the thought, acknowledge that it makes us feel anxious, and then remind ourselves that we've survived every bad thing that has happened this far.

(sword clanging) Even if it doesn't go well, we can figure it out.

Everything is figureoutable.

Like if you totally bomb this performance, that would be really disappointing and frustrating and embarrassing, but we would still love and support you, and you would keep going because you love this and it's worth it to you, and you'd probably do better next time.

I mean, we've all seen a movie that isn't an actor's best work, right?

- I know, for me, sometimes I get caught up on what other people might be thinking about me, even if there's no real basis.

- I mean, but sometimes there is a basis like when I'm doing my performance, and then the director gives me a real weird look.

- That thought is called mind reading.

We all do that one.

It's really a hard thought to have, but we have to remember that we're usually pretty bad at mind reading.

We almost always get it wrong.

So what we can do is kind of step back and say, "Wait a minute."

Maybe he gave you a weird look, but there's many reasons why he could have given you a weird look.

A restructure we can do here is thinking the same thought as before.

Maybe he was worried about your performance, but maybe it's just because he cares about this play, and he cares about everybody's performance, and he's always worried.

Or maybe he just had indigestion.

(stomach gurgling) Maybe he was trying to find the toilet.

(bright music) (bright music) (stomach gurgling) (bright music) - [Mariel] Yeah, maybe the director wasn't judging me, but then I remember how I should have been rehearsing a lot sooner.

- Hmm, why?

Are you prepared?

Do you know your lines and your blocking?

- Well, yeah.

- Then it sounds like you should have prepared exactly how you did, and now you're just nervous, which makes sense.

(tense music) (sword scraping) We do this weird thing where we create a whole bunch of should rules based on what we perceive others to be doing or our own self-judgment or for whatever reason something didn't work out the way we wanted it to.

Maybe it didn't go as expected.

There's almost this like whole other should self, right?

(tense music) But usually the should rules aren't actually based on anything.

They're pretty arbitrary.

(tense music) "I should have done it this way," actually might mean that the way you did it just didn't work out, but you wouldn't know that if you hadn't done it that way in the beginning.

Or maybe the should rules are because you see somebody else doing something different, but maybe they're thinking the same about you.

So when we have those should thoughts, we can do something called examining the evidence.

Now, this one doesn't work so much with anxiety because, like we said before, the reassurance doesn't actually help because anything is possible.

But with some of our other thoughts, we can challenge it a little bit.

So the thought is, "I should have prepared earlier," but let's think about it a little differently.

If you prepared earlier, would you still be nervous?

- Absolutely.

- And if you had prepared earlier, would you actually be more prepared than you are now?

- I mean, I guess I'm as prepared as I could be.

- [Erin] So the should thought is really just a pattern of thinking that's brought up because you're nervous because you care about this.

(tense music) But when we really turn and face that thought, we can kind of poke some holes in it.

(tense music) - Well, what about the big one, the really scary one?

(tense music) Sir Self-Hatred (tense music) - That one is really, really hard.

Those are really painful thoughts, and it's such a cutting feeling to have.

It's so hard to have thoughts that pop in that really challenge your whole self-worth.

But I have a little magic trick that I can teach you for when those thoughts feel overwhelming or daunting.

Tyler, do you happen to have any sticky notes perchance?

- Hmm.

That I do, my liege.

(gentle quirky music) So what I want you to do right now is go grab some sticky notes.

You remember, those tiny little yellow notepads?

These guys.

No worries if you don't.

All you need is paper and a pen.

And look, I know we've been talking about a lot of cognitive distortions today, and it seems like a lot, but right now we're about to get real simple.

- Thank you, good sir.

(bright trilling music) So I'm going to equip us with a magic spell called Sticky Thoughts.

- Okay.

- So we have these thoughts that show up, and they can really hook us into feeling bad or feeling really stuck in the thoughts.

Sometimes they even start this spiral where we can't un-think it, and we end up ruminating.

So since we can't change those thoughts, but we don't wanna get stuck in that spiral, we have to do something to unhook ourselves from a thought.

And so I want you to take your sticky note and pause for just a second.

Close your eyes.

Think about a thought that shows up for you that really hooks you into feeling bad or feels really hard to un-think, something that feels really sticky.

Notice what thoughts come up and what feelings come up.

And you don't have to overthink it.

It can be the first thought that comes to your mind.

And then, let's go ahead and write it down.

(gentle music) When you have that written down, just take a second to notice what it feels like, and just any thoughts or feelings that come up with having this thought, that usually makes us feel pretty bad, actually written down on paper.

- I don't like seeing it, doc.

- Yeah, it's a little bit more tangible, isn't it, when you can actually see the words.

Mine says imposter syndrome.

Sometimes I feel like a fake doctor.

- Mine says I'm going to fail.

- Ooh.

Painful.

Barb?

- Something bad is going to happen.

- Like what?

- Everything, all the time.

- [Mariel] Yeah.

- Constantly.

- Tyler?

- I don't know if I can share mine.

- [Erin] It's okay.

Safe space.

- [Mariel] Yeah, we're here for you, bud.

- Nobody's gonna like my tie.

- Really?

You know, we're taking this seriously, okay?

I'm having, like, I'm having a crisis here!

- I put that as serious!

- All thoughts are valid.

It's okay, guys.

So now what we want to do.

We've noticed the thoughts.

We have them in front of us.

Go ahead and put the thought on your forehead.

(gentle music) Remember those 80,000 thoughts?

I said earlier that most of them come and go, and some of them really stick around.

These thoughts are really sticky.

They come in, and they make us feel really uncomfortable, and they get stuck, and we have a hard time un-thinking them, but the key is that most of our thoughts that come in and go, come and go quickly.

These ones stick around because they're important to us, right?

This weird thing happens where when a thought is meaningful to us, maybe it's about something that's really important, our integrity or the way we present ourselves in the world or our careers, the thoughts can become fused with the truth.

So we believe it as if it was real or fact.

But part of the work here is diffusing that so that we can start to see our thoughts as just thoughts.

When we try to change the thoughts, we actually end up thinking about them more.

So, instead, what we want to do is we want to just acknowledge the thought as being there but then change how we respond to it.

I don't know if you've noticed, but when you have the thought there, how well can you see?

- Not well at all?

- Not at all.

- Can only see half of Tyler.

(Erin laughing) - Probably a good thing.

(Erin laughing) - So the thought is taking up a lot of space.

It's covering a lot of our vision, and maybe it's the only thing we're thinking about.

When it's on your forehead, it feels really sticky, and it's all that we can see, and when you're trying to grapple with it or get rid of it, even if you're trying to crumple it or throw it away, it ends up taking all of our focus.

So what we're gonna do is take the thought, acknowledge that it's there, and that it makes us feel bad.

Go ahead and just move it to your shoulder.

(gentle music) It's still there.

We still hear it.

We still feel it.

But how well can you see now?

(gentle music) - Pretty good.

- Much better.

- (laughs) 20/20, - Right?

Gosh, I wish I had 20/20.

(all laughing) But when we have the thought acknowledged, and then we move it down, it gives us a little bit of our power and control back.

We're not fighting with it anymore.

It's still there, and it's still uncomfortable, but we can sort of say, "Okay, thought, I see you, I hear you, and I have things to do, and then eventually maybe it moves from our shoulder to our waist or to our knee, and when you stop fighting with it, eventually it just kind of falls off.

(gentle music) - Thanks, Barbara.

(Erin laughing) - It gets less sticky.

- It gets less sticky.

Exactly.

Instead of really fighting with a thought and trying to get rid of it, we allow it to exist.

We're gonna say, "Okay, thought, I see you, "but I've got important things to do," and we just continue on with our day.

(tense music) And when the thought has less power, it actually gives us some power back.

It makes us feel more confident and powerful and really capable to tolerate any thought that shows up and still do the things we want to do.

(inspiring music) (sword scraping) (inspiring music) (gentle music) - You know, doc, feeling a lot better.

- Good.

- I'm feeling confident.

- [Erin] Nice.

- She looks more confident, doesn't she?

- Yeah, you look good.

- You look regal.

- Oh, it's my posture.

- Ooh!

That's the magic of sticky thoughts.

(gentle music) (Mariel sighs) - Thou art my most noble of bannermen.

Thanks guys.

I really appreciate it.

I'm really so lucky to have friends like you.

(gentle music) - We'd go to battle with you any day.

(sighs) You have my sword.

- And my bow.

- And my ax, to all therapeutic techniques to use with cognitive distortions while reminding you to do this with your medical provider.

- I'll call her up.

Yeah.

- Okay.

That is too much fantasy for today.

(Erin laughing) - Let us take leave - Onward, my noble bannermen.

Oh, actually, if we leave right now, I think I can make it before curtain call.

Let's go!

(gentle music) - (sighs) I know what I must do.

I do not know the way to tie a tie.

- [All] Tyler!

- (sighs) Until next time, take heart, and take careth... T-taketh care.

Be well.

All right, I gotta go.

(bright upbeat music) (bright whistling music) (bright music) - [Presenter] Major support for this program was provided by: Nancy and Nyle Maxwell, (bright upbeat music) Emerson, (bright upbeat music) Kathy and Charlie Izard.

(bright upbeat music) Additional support was provided by: Amanda Jensen and Scott Bonneau, Amado DeHoyos, Georgetown Health Foundation, Kristen and John Nelson, (bright upbeat music) and by (bright upbeat music) and also by (bright upbeat music) For more information and a full list of funders, please visit us at howarewetoday.com or aptonline.org.

(gentle music) (bright music) (bright quirky music) (bright music)