The Mental Health CBT, DBT & ACT Workbook (2 in 1): 101+ Cognitive, Dialectical & Acceptance + Commitment Based Therapy Skills For Anxiety, Depression, Overthinking & Mindfulness

Contents

Introduction 5

Chapter 1 Introduction to Mental Health 6

Introduction to Cognitive Restructuring 7

Why use a cognitive behavioral approach in the first place? 9

Chapter 2: Anxiety and Stress 10

Workbook – Overcoming worry and anxiety with CBT 12

Module 1: Overview of Anxiety 12

Module 2: Overview of Worrying 12

Module 3: Beliefs and thoughts 12

Module 4: Exercises for Managing Worry and Anxiety 12

Chapter 3: Depression 21

Workbook – Tackle depression with CBT 22

Module 1: Overview of Depression 22

Module 2: Thinking – Feeling Connection 22

Module 3: ACT 22

Module 4: Self-Compassion and Mindfulness 22

Module 5: Narrative Therapy – Story telling 22

Chapter 4: Bipolar Disorder 36

Workbook - Use CBT to combat bipolar disorder. 36

Module 1: Introduction to Bipolar Disorder 36

Module 2: Bipolar Disorder Treatment Options 36

Module 3: Relapse Prevention Self-Monitoring 36

Module 4: Behavioural Strategies for Managing and Preventing Depression 36

Module 5: Cognitive Strategies for Depression Management and Prevention 36

Module 6: Preventing Mania Using Cognitive Strategies 36

Module 7: Preventing Mania Using Behavioural Strategies 36

Module 8: Self-Management and Coping with Psychosocial Stressors 36

Chapter 5: Anger 70

Workbook - CBT for Anger Management 70

Module 1: An Overview of Anger 70

Module 2: Techniques for controlling your rage 70

Chapter 6: Sleep 92

Workbook - CBT can help you sleep better. 92

Module 1: Sleep's Origins 92

Module 2: Your Thoughts and Insomnia 92

Bonus Chapter 100

Behavior, motivation and self-control 100

Bonus Chapter 116

Mindfulness & 2 hours of meditation scripts. 116

Walking with Mindfulness 116

A Meditation for Loss and Grief 119

Arrive, Breathe, Connect: A 12-Minute Meditation 120

Welcome Everything with a 12-Minute Meditation 121

Relaxation Meditation Script of 15 Minutes 122

Meditation script for deep serenity with essential oils 123

Managing negative emotions 123

Inner tranquility meditation script. 124

Meditation in the Forest for Inner Peace 124

Anxiety Mindfulness Meditation Guided Script 124

A 20-Minute Meditation to Examine Interconnection 127

A 20-Minute Meditation to Help You Fall Asleep 129

A 20-Minute Meditation on Loving-Kindness 130

A 15-Minute Self-Acceptance Meditation 130

Meditation on Loving-Kindness 131

Affectionate Breathing (18 min) 132

Introduction

Many of us, it has been said, live in continual fear of failure, which is owing in part to popular ideals about health and success, as well as demands to adhere to these norms. We all have opinions about what it means to be smart, successful, outgoing, and ambitious. People with mental illnesses, on the other hand, are unfairly stigmatized and are rarely thought of in this light – that they can be intelligent, funny, and successful – especially when they are in and out of psychiatric hospitals, medicated and sometimes overmedicated, or have highly stigmatizing illnesses like bipolar and borderline personality disorder, psychosis, autism, and severe alcohol and drug addiction. The goal of this book is for you to become more self-aware and compassionate as you learn and experience more of the text, as well as more in control, less powerless, and more confident in your thinking and experience of the text and the words and phrases that make it up.

Chapter 1

Introduction to Mental Health

What do you mean when you say mental health and illness? What does it mean to be mentally healthy or ill? What pictures and concepts come to mind when you think about mental health? What is the public's perception of persons with mental illnesses, as well as how are they depicted in the media? Are these representations accurate? People with mental illnesses are frequently accused of exhibiting strange, potentially deviant conduct. What, on the other hand, distinguishes normal from deviant behavior? Are the lines between what's acceptable and what's not always clear? Every year, millions of individuals are affected by mental illness, which has significant repercussions on their social, physical, economic, and spiritual health and well-being. Children, adolescents, adults, families, and entire communities are all affected by mental illness. According to the National Alliance on Mental Illness, one out of every five adults and one out of every six children suffers from mental illness each year, resulting in high rates of emergency room visits, psychiatric hospitalization, learning and behavior issues, homelessness, disability, and unemployment or underemployment.

People who have struggled with depression, anxiety, schizophrenia, bipolar illness, trauma, and PTSD, on the other hand, frequently have tremendous strengths that are hidden by an exclusive emphasis on flaws, deficiencies, mental health symptoms, and disruptions. Stigma, prejudice, and unfavorable or biased ideas and assumptions about persons with mental illness are frequently reflected and reinforced by social standards, media depictions, and mainstream perspectives on mental health (for example, that they are dangerous, sick, and emotionally unstable). Our perspectives on mental disease evolve throughout time. At one point, a behavior may be considered abnormal or suggestive of a psychiatric disorder (for example, psychotic symptoms commonly associated with schizophrenia, such as paranoia), while at another point, it may be considered normal and appropriate behavior (e.g., healthy paranoia, for example, checking to make sure your door is locked either because there have been robberies and break-ins in your neighborhood or perhaps you are nervous from binging on scary movies from your favorite streaming service). Furthermore, for a variety of reasons, including cultural beliefs, norms, values, religion, family system, views on truth, science, and medicine, and their trust in established healthcare systems and practices, including prescription drugs or, by comparison, alternative (complementary) treatments, and rituals, people have different ideas about what constitutes abnormal.

Experts also disagree on what causes mental health issues and what people can do to enhance their physical and mental health. These notions have an impact on how mental health clinicians engage with people who are experiencing psychological distress and seek therapy. Cognitive psychologists, for example, believe that mental disease stems from cognitive dysfunction. They highlight terms like cognitive (thinking) distortions to explain how people acquire mental health issues as a result of poor thinking habits and flawed belief systems. Consider the following example of how one's ideas might lead to mental anguish. You are not alone if you suffer from depression. Depression is one of the most prevalent mental health diseases we see in healthcare, and studies have shown that depression has a reasonably high incidence rate in the general population. In other words, most individuals have been sad or melancholy at some point in their lives, whether or not they have been diagnosed with clinical depression. Others, such as family, friends, teachers, religious personnel, coworkers, and healthcare providers, were called upon in certain circumstances. According to cognitive scientists, sadness drives people to think in ways that, if left unchecked or unchallenged, might be harmful. Depression is thought to be a manifestation of mental disorders, particularly negative (maladaptive) thinking, which affect motivation, mood, self-esteem, perceived competency, decision-making, happiness, and hope.

Introduction to Cognitive Restructuring

Individuals who have suffered depression have reported the following cognitive distortions:

Nobody cares for me. I just don't feel like I'm supposed to be here.

I'm a loser.

My situation will never improve.

I should've realized I wasn't going to get the job.

It's easy to understand how this kind of thinking might skew people's perceptions of themselves and the world. Individuals with depression process information through a depressive lens, focusing on the negative, discounting positive experiences, or convincing themselves that positive moments are fleeting and rare, most likely due to chance, and thus insufficient to help them reframe their depressive belief systems, which may be more comfortable and familiar.

Cognitive restructuring, which is intrinsically related to cognitive therapy treatment, is the process of shifting our thinking from negative to more adaptive and rational perspectives. You may be acquainted with terminology like automatic thoughts or assumptions, reframing or learning to see things differently, erroneous beliefs, biased thinking, and evidence-based ideas to express this and other cognitive concepts. We put our ideas through tests, such as analyzing evidence for and against a belief or hypothesis, but we don't test them for truth or objectivity. Consider the thought tasks below for each distortion to see how cognitive therapists may help people with depression improve and learn to see the world in a more objective way.

Nobody cares for me. I just don't feel like I'm supposed to be here.

What evidence do you have that no one likes you? How do you determine whether or not people like you? What are your standards? Is it true that if one person dislikes you, it means that everyone dislikes you? Is it reasonable to want everyone to like you? What does it signify if someone disapproves of you? Is it necessary for it to indicate something negative about you, or may we consider it in a different light? Isn't it feasible, for example, that they despise themselves? That they despise a lot of people, implying that it's about them rather than you?

I'm a loser — are you always a loser?

What do you mean when you say failure? Can we take a look at occasions when you didn't fail? How would you help someone you care about, such as a family member or a friend, think differently if they told you they were a failure? Some individuals feel that failure is a necessary component of success. Can we consider how this may apply to you? Let's think of a time when you felt successful.

My situation will never improve.

How did you figure that out? What are your hopes and dreams? Are they plausible? Is it possible to truly know what the future holds? Isn't it possible that things will improve for you? What changes can you do to go to a better (or different) place? When you start to believe that things aren't going to get any better, what can you say to yourself? Maybe you might remind yourself that you're getting help and that you're making progress? Perhaps we can shift our perceptions of what it means to improve — perhaps getting well involves talking to someone like you are right now, taking one day at a time, being kind and nonjudgmental to yourself, and remembering that life is always changing. If you believe that life will not improve, you will reaffirm that belief despite of evidence to the contrary.

I should've realized I wasn't going to get the job.

You had no way of knowing. Are you relying on emotional reasoning rather than rational reasoning in this situation? Is there a chance that something better or different is still out there for you to discover? Could it be that, despite your desire for this career, the universe is sending you a sign that this isn't the ideal fit for you? Even if we don't realize it at the time, the things we want aren't always the greatest for us. Can we take use of this chance to work on correcting cognitive distortions?

The cognitive approach to mental health emphasizes ideas, assumptions, and maladaptive thoughts that, if left unquestioned, evolve into thinking habits, many of which are negative. We have the ability to change for the better, and it all starts with believing in new possibilities. Because of its scientific foundations and documented research support, cognitive psychology has grown in popularity.

Cognitive techniques strive to empower people by fostering independence and self-control, particularly in areas of life that can be altered, such as our underlying beliefs and assumptions, as well as our interpretations of events, especially stressful and traumatic situations. People are not characterized by a diagnostic category or sickness, according to cognitive theorists. Thoughts are at the basis of mental health issues, and they may be changed to increase self-awareness, quality of life, interpersonal connections, and problem-solving.

Understanding mental health, adopting self-help tactics, and reframing notions about what distinguishes normal and abnormal behavior are all topics covered in this book. Mental disease is not a static entity or a category that exists indefinitely. People have good days and bad days, and mental health symptoms fluctuate based on a variety of circumstances including the environment, stress, coping, social support, and, most importantly, self-care routines. This book will be a helpful resource for readers interested in learning more about healthy habits for excellent health, as well as different strategies from Cognitive Behavioral Therapy that may be used to a wide range of audiences and situations.

It is believed that by doing so, the method would provide readers with a variety of viewpoints on mental health and enlighten them on how we have come to define wellbeing from various angles, including strengths and resiliencies.

Suffering may be seen in a variety of ways, such as an experience, a symptom, or, by comparison, as a precursor to personal growth and development.

We also have our own cognitive biases and assumptions, such as the fact that we may become accustomed to treating particular patients since we've treated many patients like that previously... Patients' distinctive features, such as their wants, goals, and ambitions, communication style, intersubjective experiences, and strengths, may be overlooked when we describe them by their symptoms. Furthermore, our perspectives, experiences, and therapeutic methods and procedures as healthcare practitioners differ.

Consider the example of cognitive theories that place a higher importance on present-focused thinking than, say, traumatic childhood events, such as ongoing disagreements with main caregivers that might lead to recurrent relationship issues in adulthood.

Sigmund Freud popularized the terms id, ego, superego, and defense mechanisms, referring to unconscious psychological processes that help reduce our experiences of stress, anxiety, and fear, such as denying that a problem exists or displacing our feelings of anger and frustration on others regardless of the circumstances. You may have experienced displacement if you were having a horrible day and suddenly yelled at a loved one for no apparent cause. Displacement is supposedly beyond of our immediate knowledge and control. Happiness, on the other hand, can be contagious.

Why use a cognitive behavioral approach in the first place?

Traditionally, dealing with mental diseases was inspired by the medical paradigm, which saw mental illnesses as chronic, with permanent neuropathological brain alterations and information processing deficiencies. People with mental diseases saw themselves adversely as a result of this negative approach, which frequently created the stigma that they were different from others. Other issues, such as loneliness and low self-esteem, might arise as a result. People with serious mental diseases frequently have low self-esteem, poor quality of life, and poor psychosocial functioning, which is unsurprising. Rather than approaching mental illnesses through the traditional medical model, which focuses on pathology, problems, weaknesses, and failures in people, the cognitive behavioral approach allows various aspects of a person's life with a mental illness to be acknowledged and then changed in order to help the person overcome their problem.

The cognitive behavioral method focuses on an individual's ideas and actions, assisting them in managing their difficulties by altering their thinking and behavior. The focus is on the person's beliefs and activities rather than their flaws, symptoms, or issues. Mental illness is no longer regarded as a taboo subject, but rather as a natural part of life. Individuals' ideas, actions, and talents are theorized and analyzed, and therapy aims to build on these strengths, leading to the accomplishment of desired outcomes.

Cognitive therapy, behavioral therapy, and mindfulness-based treatments are the three core components of the cognitive behavioral approach. The focus of cognitive therapy is on thinking patterns as the source of negative emotional and behavioral behaviors. In this view, inadequate or exaggerated biases in thinking produce and sustain mental health problems. Identifying dysfunctional or distorted habits and learning to respond to them with more reality-based ideas is the important remedy here. As a consequence, there are less emotional disorders and more effective behavioral patterns. Behavioral treatment emphasizes behavior as the most important factor influencing dysfunctional psychological processes. Issues are addressed and problematic behaviors are recognized in behavioral therapy. Facilitating the acquisition and application of beneficial behaviors to replace dysfunctional or ineffective behaviors is the basic mechanism of change in behavioral therapy. This might include modeling and teaching new behaviors, increasing exposure to previously avoided stimuli, and enhancing rewarding behavior. Mindfulness-based treatments are a newer addition to cognitive behavioral therapy. Mindfulness is a type of meditation that involves focusing and nonjudgmental attention on the work at hand. Mindfulness treatment was developed to help people improve their spiritual training of the mind, but more recently, researchers have employed some of its most successful components to treat anxiety, depression, bipolar disorder, PTSD, OCD, ADHD, and chronic pain. Mindfulness-based cognitive behavioral treatments are effective therapeutic alternatives. Mindfulness for anxiety and depression has been demonstrated to be considerably more beneficial than more standard treatments such as talk therapy in recent research.

Chapter 2: Anxiety and Stress

Research and Overview

Our bodies' technique of informing us that something is amiss and that we need to mend or better is stress. It is necessary for our existence and health. Nonetheless, this warning system might go off for no apparent reason, and we become physically and emotionally tense in order to combat an issue when the underlying problem is in our heads. The inability to tell the difference between actual and beneficial stress, harmful worry, and dread is common. But how can you be certain that a certain circumstance would not result in a problem? You can't, as the truth is. We may, however, learn to distinguish excessive responses, such as being afraid in an elevator. Some people, on the other hand, underreact to a circumstance. They either underestimate or deny the circumstance, such as never preparing for work—both tendencies lead to bad conduct; exaggerating and underestimating the threat lead to poor behavior.

The reality is that we are all anxious at some point in our lives. Each of us has our own level of complexity, and various terms may be used to characterize it: nervous, concerned, terrified, insecure, panicked, and so on. The most prevalent signs of mental diseases are stress and worry.

Internal processes (perception, interpretation of the event, learning, adaptation, or coping mechanisms), emotional reactions (our feelings), and other behavioral-bodily reactions are all included in the definitions: (1) the event that requires some change (external or mental; real or imaginary), (2) internal processes (perception, interpretation of the event, learning, adaptation, or coping mechanisms), (3) emotional reactions (our feelings), and (4) other behavioral-bodily reactions (nervousness, sweating, high blood pressure, and other medical conditions). Stress is defined as the mental and bodily responses to a potentially dangerous circumstance.

Fear is linked to stress and can result in panic attacks accompanied by symptoms such as fast breathing, heart palpitations, and a desire to flee the situation. Anxiety, like the other anxiety states, is a distressing condition.

As previously said, the aforementioned cautions assist us in dealing with situations and achieving our objectives. As a result, warnings must be received and comprehended.

Let's start with the second most frequent mental disease, Generalized Anxiety Disorder (GAD) (after depression). GAD is a long-term condition marked by excessive worry, disruptive anxiety, and tension that lasts at least six months, if not years. It is curable, yet even in wealthy nations, less than 20% of victims receive effective treatment. Hypervigilance, irritability, insomnia, and other bodily symptoms such as perspiration, heart palpitations, and others are among the symptoms.

Because anxiety disorders are beneficial, they are difficult to cease, especially when they become chronic. Anxiety is a complicated process, according to research, rather than a simple conditioned response, a physiological imbalance, or a cognitive mistake. Emotions aren't straightforward; they're always changing and complicated.

Panic disorder, on the other hand, is a mental condition defined by panic episodes, which are the consequence of a complex combination of (1) basic intrinsic biological alarm reactions (emotions), (2) learnt psychological coping strategies, and (3) life pressures.

Stress and anxiety are assessed in a variety of methods due to their complexity, including self-ratings, observation by others, psychometric testing, physiological or medical tests, and others. Unfortunately, no measure can be 100 percent accurate since 1. each of us has a unique response to stress, 2. there is no agreement among these measures, and 3. stress and anxiety definitions are so ambiguous that measurements can't describe psychological disorders.

Workbook – Overcoming worry and anxiety with CBT

Overview

Module 1: Overview of Anxiety

Module 2: Overview of Worrying

Module 3: Beliefs and thoughts

Module 4: Exercises for Managing Worry and Anxiety

Module 1: Overview of Anxiety

Understanding Anxiety

Anxiety is a distressing emotion that everyone encounters from time to time and it can be experienced in different ways. You may describe it as nervousness or feeling tensed up.

You may also describe it as fear, a highly severe form of anxiety that is usually a reaction to an immediate and specific event. This fear might develop in social circumstances or while thinking about an upcoming social occasion, thus we referred to as social anxiety. Others have severe fear in response to relatively particular things, such as snakes, heights, or water. Phobias are the name given to these anxieties. Others, on the other hand, experience fear that feels like terror, and these are referred to as panic attacks.

General anxiety might go on for a long time – sometimes it can go on for weeks. You might have thoughts about yourself, others, and the world around you and what is to come in the future.

Anxious people generally think negatively about:

Themselves

✔ I cannot cope

✔ I am not safe

✔ I am going to die

Others

✔ I cannot trust people

✔ People don ’ t like me

✔ People I like will get hurt

The world

✔ The world isn ’ t safe

✔ The world is a dangerous place

Symptoms of anxiety

✔ Do I have symptoms of anxiety?

✔ Do you spend a large time of your day worrying?

✔ Do you find it difficult to relax?

✔ Do you feel constant nervousness, panic and stress?

✔ Do you experience frequent somatic symptoms such as tense/sore muscles, shortness of breath, heart palpitations and upset stomach?

✔ Do you experience difficulty concentrating and memory problems?

If you answered ‘yes’ to two and more of the above questions, you may be suffering from anxiety.

Because anxiety is unpleasant, and many of the physical symptoms mimic other serious medical conditions, you may be concerned that you may have a serious health problem. This can make you even more anxious, which creates a cycle of anxiety.

What causes anxiety?

You may feel anxious for a number of reasons, which you might not be aware of, at the moment.

Psychological reasons

✔ Negative thoughts about yourself, others and the world

✔ Early childhood experiences / Traumatic events

✔ Modelling anxious behaviours seen in others in your environment. E.g., growing up with an anxious parent.

Social and environmental reasons

✔ Bullying

✔ Stress at work

✔ Relationship problems

✔ Financial problems

✔ Expectations

Biological

✔ Anxiety disorders run in families.

Module 2: Overview of Worrying

Understanding Worrying

Worrying may be thought as a self-talk activity in which we speak to ourselves over and over about potential future bad situations that we are scared of. We mentally replay the incident in our head over and again, imagining what would happen if it happened. Worrying is therefore a sort of alertness for any threat, as well as an effort to solve a problem that has yet occurred.

What Triggers Worrying?

Worrying can be induced by a variety of factors. Some triggers may be more eident and connected to external factors such as: Seeing a specific picture (e.g., on the news), receiving specific information (e.g., on the radio), being placed in a specific setting (e.g., perform a task at work) and others. Some triggers may be less subtle such as random ideas or pictures that come to mind out of nowhere. Most of the times, questions that start with the initial ‘’What if…’’, are a trigger for worry.

Exercise:

What was a recent ‘’what if’’ thought that came to mind, and what did you do then?

___________________________________

___________________________________

___________________________________

Write down any information, events, internal images or thoughts, that have triggered worry for you:

___________________________________

___________________________________

___________________________________

What Maintains Worrying?

Chronic worriers are frequently troubled by the fact that they appear to spend the majority of their day thinking excessively about a variety of things. They are perplexed as to why this mental activity persists. A worrier’s most common question: ‘’Why do I keep worrying?’’ The following are the three things that keep our worrying going.

Beliefs

Worriers typically detest the fact that they worry so much, but they also frequently have positive ideas that worrying is good and helpful. It is our positive ideas that cause us to worry in the first place. Some examples of positive beliefs included: ‘’Worrying helps my problem-solving abilities’’, ‘’Worrying drives my to action’’, ‘’When I worry I am safe’’.

Because of this positive view about worrying, when a problem arises that we are concerned about, we draw negative ideas closer.

In addition, worriers may hold negative beliefs about worrying. For example, people may feel that: ‘’Worrying is harmful and will drive me crazy’’, ‘’I cannot stop worrying’’. Holding these negative views makes worrying more stressful, causing even more anxieties, prolonging this process.

Attention

People who worry frequently have trouble diverting their attention away from their annoying thoughts in order to focus on the current job at hand, partly because they are unaware they are doing it and partly because they believe it is beneficial to think more about things. Focusing on negative ideas and thoughts

Useless Strategies

People who worry frequently try and fail in a variety of unhelpful ways to stop their unpleasant thoughts, including cognitive and behavioral techniques.

Cognitive techniques may include:

❖ Suppressing their thoughts

❖ Reasoning

❖ Distracting their attention

❖ Positive thinking

Behavioral techniques may include:

❖ Seeking excessive reassurance from others

❖ Substance/alcohol abuse

❖ Checking excessively for information related to their worry.

Cognitive and behavioral techniques such as the above seldom succeed.

How do you try to stop your worries?

___________________________________

___________________________________

___________________________________

Module 3: Beliefs and thoughts

Automatic thinking and beliefs

What you think and the ideas that run through your head have a big impact on how you feel. Consider this for a moment: what kind of thoughts run through your mind while you are feeling good? In contrast, what kinds of thoughts do you have when you are feeling down?

Patterns of dysfunctional thinking

Dysfunctional thoughts that come into your mind without conscious effort are referred to as automatic thoughts. They are plausible and generally distressing, which might have an impact on your emotions and actions. It is critical to keep in mind that a thought is not always a fact. You may feel the thoughts that arise in your head, but it is critical that you examine them. Knowing the basic patterns that dysfunctional thoughts follow will assist you in recognizing and challenging them before the affect your mental health.

Here are some examples of automatic thinking:

✔ I don ’ t have control over this

✔ I will be embarrassed

✔ What if I don ’ t get a job

✔ What if they don ’ t like me

Here are some examples of dysfunctional thinking:

Emotional reasoning: The practice of considering feelings as though they are facts

Black and white thinking: When someone is nervous, they typically perceive things as either black or white, with nothing in between.

Catastrophizing: People believe that anything has happened is considerably worse than it is.

Labelling: People labelling themselves negatively.

Neglecting the positives: People disregard the good parts of a situation and focus on the negative.

Personalization: People think that everything has something to do with them, and blame themselves for no rational reason.

Must statements: People frequently live by a set of rules, about what they ‘’must’’ do and feel, and they are extremely self-critical if they don’t fulfil these expectations.

Overgeneralization: People believe that all future events will follow a similar pattern of one isolated experience, and they tend to dismiss a one-time occurrence as an accident.

Jumping to conclusions: People believe they know what others are thinking.

Challenging your thoughts

Before we start challenging your thoughts, we need to know how much you believe your worrying is uncontrollable. Do you totally and completely believe this? Do you believe this all the time?

Do I have control over my worry? (circle the percentage that describes the strength of your belief

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

I don’t believe Strongly believe

You must do two things to change your belief that your worry is uncontrollable. To begin, you must confront your belief. This entails processing the belief by determining if its factual and truthful, as well as assessing the information on which you base your belief. Think of yourself as a detective trying to solve the case. Experimenting with the belief will help you determine whether or not worrying is uncontrollable. If you are able to demonstrate that the belief is not true, it means that you can manage your worrying.

Challenging automatic thoughts

By asking the following questions, you may now confront your automatic thoughts. Work your way through the questions below.

Example:

‘’My professor was supposed to send me the exam results one week ago and they didn’t yet. I must have failed the exam’’

Is there any evidence against this thought?

Is there any evidence to support this thoughts?

Are there any patterns of dysfunctional thinking that you can identify?

What would you say to a friend who was thinking the same thing in a comparable situation?

Is there another way to look at this situation?

Is there a proactive way to deal with this negative automatic thought?

Exercise:

Module 4: Exercises for Managing Worry and Anxiety

Managing your worry

Anxious people might spend a lot of time worrying, which is only beneficial when it drives you to act – otherwise it’s just damaging thoughts running in circles. One of the most upsetting thing about worry is the feeling that you have no control of it. Learning to control how much you worry can help you feel less anxious. Setting aside some time to worry consciously is one method to accomplish this. It may give you a feeling of control in your worrying, so that you will not feel overwhelmed in other situations.

Exercise:

1) Establish a 10 to 15 minutes worry time every day.

2) During the day try not to think about your problems and remind yourself that you have already scheduled worry time.

3) When worry time approaches, start timing yourself, so that it doesn’t last more than 15 minutes.

4) Allow yourself to worry during this time. Don’t try to fight your worry and concentrate solely on the process.

5) As soon as your worry time is over, STOP.

Automatic Thinking

You are not just going to be focusing on those worries. You are also going to start looking at the automatic thoughts and situations from different perspectives. Cognitive behavioral therapy says that it is not the event which causes our emotional and behavioral reactions, but the meaning we give that event. This will help you develop more helpful ways of thinking.

Thought/situation/belief record sheet

Exercise:

Summary

❖ Worrying is a primary symptom of anxiety

❖ Worrying often takes the form of ‘’ What if.. ’’ questions

❖ Anxiety and worrying are common.

❖ Anxiety when in normal levels is helpful as it motivates us to act. When it is extreme, anxiety can cause deliberating symptoms for our mental health

❖ There are different types of anxiety, such as fear and panic.

❖ Anxiety and Worrying are maintained because of:

✔ Beliefs

✔ Attention to automatic thoughts

✔ Useless strategies.

❖ It is important that you keep practicing the exercises you learned through reading, as this will help you integrate them into your lifestyle.

❖ Expect setbacks and be patient. Change takes time!

Chapter 3: Depression

Overview and Research

This is one of the most common mental health disorders across the world. Depression has been linked to thoughtful and reflective thinking, particularly in individuals who have dysthymia, low-grade depression that is longer-term, often for two or more years. You see this type of depression in high achievement persons, including lawyers. I want to convey that depression is phasic/temporary and that it could be viewed as: showing that you care about what upset you, that you care enough to respond with depression which means that something bothered you, enough that you are taking time to think through it, that you are sensitive and care about the wellbeing of others, that you are communicating that you need help at this time, etc. there must be ways of helping people think through depression.

Depression affects our behavior, feelings, motivation, mood, and at last, our physical functioning and health. Lewinsohn (1975) have summarized the symptoms of severe depression:

- Behavioral deficits: isolation, social withdrawal, loss of appetite, slower speech, difficulty communication, loss of sexual activity, loss of interest.

- Behavioral excesses: aggression, rebellion, feeling guilty, poor memory.

- emotional reactions: sadness, irritability, loss of interest in relationships, nervousness, restlessness.

- Lack of skills: poor social skills, lack of humor, critical, indecisive.

- Attitudes and motivation: lack of self-confidence and motivation, low self-concept, self-blaming, self-critical, helplessness.

- Physical symptoms: sleep problems, hyperactivity, mood swings, low libido, loss of appetite, weight loss or gain, headaches, pain, constipation, dizziness, and other somatic complaints.

There are three critical types of depression: (1) major depression, (2) situational or reactional depression, and (3) bipolar disorder or manic depression.

Anxiety and depression are frequently and closely related, sharing the same features. Barlow argues that anxiety and depression result from

generic contributions,

early childhood experiences, like abuse or rejection, and

psychological vulnerabilities or personality tendencies that certain direct individuals toward a specific disorder.

Theories trying to explain depression describe, in short, that depression is the normal, natural reaction that we have when we lose something of value. A survey at the Medical College of Virginia, for example, found that interpersonal losses (loss of a friend, marital problems, death) increased the risk of depression. On the other hand, Seligman and Steinem suggest that baby boomers grew up to find a cold and unsupportive world. It is believed that our values and lifestyle affect our outlook on everything we do in our lives. The values determine what is good or bad, important and unimportant, and so on. Whenever our values are at risk, it is considered a loss. Thus, if we are depressed, it is crucial to realize the connection between values and losses, recognize the losses we may be responding to, and try to reduce these losses.

Biology is also vital in depression, as studies of identical twins and several generations within a family suggest that depression is partly inherited. Numbers account genes for 41% to 46% of the variance in depression.

Another theory of the general adaptation syndrome suggests that exhaustion comes after an alarm reaction and resistance, making depressed people feel tired and drained of energy, with symptoms also regulated by the hypothalamus.

Other theories suggest that various factors influence the transmission of nerve impulses, currently called neurotransmitters, in the brain, whereas too few neurotransmitters result in depression.

Believing just one of the abovementioned causes affects diagnosis, and of course, it interferes with the individual taking responsibility for changing themselves. We cannot expect to magically treat depression with medication, primarily when their condition is caused by something else.

It is imperative to understand that symptoms found in the disorders mentioned above vary and the judgment of the one who is making the diagnosis. For example, a GP, clinical psychologist, partner, friend, or self-evaluation can all judge that someone is depressed. However, no one will agree, and that is causing complications in proper diagnosis and treatment. Thus, even when you know that you are unhappy, you still get conflicting opinions from others, making it harder to get help.

Workbook – Tackle depression with CBT

Overview

Module 1: Overview of Depression

Module 2: Thinking – Feeling Connection

Module 3: ACT

Module 4: Self-Compassion and Mindfulness

Module 5: Narrative Therapy – Story telling

Module 1: Overview of Depression

What is Depression?

Depression is a term used in plain English to express a variety of emotions such as sorrow, frustration, disappointment, and, at times, apathy.

Many people who are suffering from depressive symptoms may begin to question whether there is something really wrong with them. One common concern is that they are becoming insane. Unfortunately, other people's emotions and statements, such as Don’t act like a child! are not particularly helpful.

Although you may feel alone in your battle against these emotions, the fact is that many people experience these moods frequently, if not on a daily basis. In fact, it is expected that one out of every four people will experience a seriously low mood at some point in their lives.

Depression may strike anyone at any age or stage of life. You may be an introvert or an extrovert, outgoing or reserved, young or old, male or female, rich or poor. You can get depressed regardless of your status. So keep in mind that you are not alone in this.

In psychology, the term Depression differs from the usual everyday feelings of symptoms in three main ways. Major depression is: 1) more intense, 2) lasts two weeks or more, and 3) it leads to inability to function normal in day to day tasks.

As a disorder, depression is a set of experiences and behaviors that characterize depressed people. You may find yourself experience all or part of these feelings and behaviors. The amount of symptoms and the level to which distinct symptoms are experienced vary greatly between individuals. These symptoms are discussed more below.

Mood

Depression is classified as a mood condition. Individuals who are depressed experience low mood that has lasted more than two weeks. Individuals suffering from moderate depression may not feel horrible all day, but they do experience a negative outlook and low mood. A great event may improve their mood, but even a slight disappointment might cause it to drop again. Low mood may remain throughout the day in severe depression, failing to rise even when pleasurable events occur. The mood may change during the day, being worse in the morning and somewhat better in the afternoon. This is known as 'diurnal variation,' and it is frequently associated with a more severe form of depression. In addition to low mood, the individual may experience feelings of inadequacy and worthlessness, guilt, anxiety and anger.

Cognitive symptoms

People with depression tend to see life in negative lenses. Individuals who are depressed have low self-esteem and low self-confidence. They constantly think about how bad they feel, how hopeless everything is and how bad life is.

Physical symptoms.

People with depression may experience problems with sleep. Some of the have difficulty falling asleep, others may wake during the night, or wake up early in the morning. Other may find difficulty staying awake.

The appetite changes and some people find themselves eating more than usual, while others eat less. Body weight changes as well.

People with depression have lower sexual interest.

They also have less energy and less motivation and may stop doing things they used to enjoy.

Module 2: Thinking – Feeling Connection

The Thinking-Feeling Connection

People frequently assume that their moods and emotions are influenced by the behavior of others, external events and the environment. My partner made me so stressed, My neighbor made me so upset, The traffic lights made me feel so anxious, or I'm feeling bad because I didn't get the job I wanted. We automatically assume that someone or something else is controlling our emotions.

We reach these conclusions without questioning whether or not the assumption is correct. However, if we learn how to stop analyzing we will find that there is a process in between.

How Do Our Thoughts Affect Our Feelings?

What truly causes us to feel and behave in the manner we do is frequently not the circumstance or another person's words or actions, but how we interpret that situation or that person's actions. How we perceive something or someone, as well as what we think about it or them, has a significant impact on how we feel. Our emotions and actions are heavily influenced by our ideas and beliefs about an event.

Here’s an example. Suppose you went to a job interview. As you talk to your future employer, you notice that he does not look directly at you but often looks at the screen of his mobile phone. How would you feel if you though, He is a very rude guy! What if you thought, "I must be really failing in this. He seems not to like me. At this time, you probably realized that you felt different emotions as a result of the above mentioned thoughts. In reality, we do not have so much time to analyze our thoughts, because they are automatic and happen instantly. But, this is an example that our thoughts are there, and they affect the way we feel. Often, we find it difficult to find words for our feelings, so the words below can be a useful starting point in becoming able to understanding the connection between our thoughts and our feelings.

Words that describe feelings:

Angry Triggered Tired Happy Excited Joyful Annoyed Unhappy

Anxious Calm Scared Sad Cheerful Upset Nervous Irritated Bored

Automatic Thoughts

Just as we are not always conscious of the way we talk or walk, we are often not aware of our thoughts, which can vary from 70000 to 100000 every day. Our thinking, even automatic, helps us interpret the world around us, explaining us what is happening, interpreting events, sounds, smells, feelings and much more. Thoughts come and go all the time, especially automatic thoughts, that play important role in our well-being.

There are three kinds of automatic thoughts:

Neutral thoughts, For example: ‘’I think I will go to the bank today’’

Positive thoughts, For example: ‘’I like dancing, I am so skilled at it’’.

Negative thoughts, For example: ‘’I cannot complete this task, I must be stupid.

How Do Our Thoughts Affect Our Feelings?

Automatic thoughts frequently represent fears and anxieties, but they may also be about anything we have ever seen, heard, or learned. Furthermore, it might be anything we know about from any source. Negative automatic thoughts, on the other hand, are clearly the ones that might give us emotional pain. People who are depressed have bad views about themselves, the world around them, and their future, and it is these negative beliefs that may be modified to help you overcome your depression

Cognitive behavioral therapy says that following after an event, we give meaning to it through our thoughts and then we starting to feel the way we feel.

 Shape 2  Shape 5 EVENT Meaning we give to the event Feelings

These thoughts result in our physical and emotional reactions.