Cognitive behavioral therapy (CBT) assumes psychological problems are caused by negative thoughts and behavior that influence feelings.
We can help clients with a few suggestions on how to change what they are doing when distressed rather than to focus solely on what they are thinking.
Here are some actions a psychologist can instruct a client to take:
Make coping cards
Make coping cards from index cards (or on your cell phone) that are durable, long lasting and portable. On one side, write the negative or dysfunctional thought that reoccurs. On the reverse side write a good comeback or constructive thought. Keep the cards handy to review them frequently. It is important to review the constructive thoughts repeatedly every day.
When a distressing thought arises, do something physical. Walk and get a glass of water. Fidget with a rubber band. Note: aerobic exercise is especially important for people with emotional difficulties: Walk. Bike. Swim. Doing aerobic exercises five times a week for 30 minutes is recommended as good for physical health. It is also good for maintenance and prevention of mental health problems. If 30 minutes is too much, try to exercise for 5 or 10 minutes.
Test negative thoughts
It is therapeutic to test negative beliefs. For example, instruct the client that if the thought is that he or she cannot do anything right, recall something recently accomplished, such as finishing a puzzle. The client should not minimize the accomplishment as being only a small thing. Instead, he or she should document accomplishments so they become permanent reminders.
Test negative predictions
Thoughts such as, “I am going to fail” should be put to a test. Tell a trusted friend the thought and ask for evidence of past successes, then write down what the friend said.
Start with baby steps
Have the client start at the beginning. Take a longer-term goal and break it down into a smaller goal. For example, for the belief, “I’m a failure,“ the client should find some past letter of recommendation, a high school diploma or an award that was won. After reading the reminder of a past success, the client should keep it to look at often.
Another baby step would be to recommend that a client having trouble studying should try reading a few pages at a time, then stand up or take a short break. Another strategy is to limit reading to 15 minutes at a time. It is most important to accomplish a goal to gain the motivation to continue.
A daily activity chart
Have the client keep a journal or appointment book to record each daily activity. Each entry should later be rated for mastery and pleasure on a scale of 1 to 10. After several weeks, the daily activity chart should be reviewed to try to schedule things daily that bring some amount of pleasure or mastery.
A simple rubber band can provide distraction from negative thinking. The client can place a rubber band around a wrist and snap it on the inside of the wrist when such thoughts arise. Another tool is to use temperature as a distraction, such as holding an ice cube for a few moments.
Change the channel
Another strategy is that when a negative thought comes, the client should pretend it is a TV show and “change the channel” to something pleasant.
Make up a safe image
Have the client write a description or draw a picture of a safe place on an index card, either from an actual memory or from imagination. The more detail the better. The client should carry the image at all times and practice using it until it is memorized. Eventually, the card will be unnecessary.
More strategies can be found in books, such as Feeling Good: The New Mood Therapy by David Burns, MD (2009 Harper Collins Publishers).
Mary Jo Fernandez, Ph.D., is a licensed psychologist in Gainesville, Fla. Her experience includes 20 years of clinical work in schools, hospitals and outpatient offices. Her email address is: firstname.lastname@example.org.