It’s a Friday in late February, and David is in English class. Ms. Washington, the teacher who triggers his anxiety the most, is passing back graded papers. She hands them back face down on each student’s desk as they file into class. David sees her approach his desk, and his anxiety rises some, but not as much as it used to. He looks up and meets her gaze, and suddenly it’s like his throat is on fire and his heartbeat is smashing against his chest. Her face is sharp, her mouth small and serious, and in that moment, David is certain he knows what she is thinking. He can almost hear her thoughts saying, “This paper is pathetic, and I am very disappointed in you, and your parents are disappointed in you, and everyone is disappointed in you.”
He knows that when he turns that paper over, it’s going to be a bad grade, a D or an F. He’s sweating as he flips it over and—he can’t believe it. It’s an A-, the best grade he’s gotten from her all year.
Hello, I’m Corey Busch and you’re listening to the Teen Mind—the show where we follow one teenager and his family and learn to change the way we understand our minds and the minds of the people closest to us.
So, today, we take a close look at David’s mind using a model that has probably helped more people with anxiety and depression than any other mental health model.
And a few quick notes: David and his family are fictional characters. Any resemblance to real people is strictly coincidental. Also, if you haven’t already, I recommend starting from episode 1 and working your way through before listening to this one.
So David feels relieved by this A-, but he also feels stupid and embarrassed. He was sure that this paper was a disaster. How could he have been so wrong?
And as he thinks about it, he realizes how ridiculous he was being. Why would he think that he could figure out his grade based on Ms. Washington’s facial expression? She made that face all the time. That’s just how she looks.
By this time, David has practiced talking with his anxiety enough, that he decides to ask it, “why did you get so worried just because she made a mean face?” And a few seconds later, in his mind, he hears it reply, “Because I don’t want you to get rejected, and that face looks like rejection.”
Up until now, David hadn’t been paying much attention to the thoughts brought on by his anxiety. He’d been focused on the feelings of it: the burning in his throat, his pounding chest, the vague sense of dread. But after this episode with Ms. Washington, he decides, again, to just pay attention. So over the next few days, he carries a small notebook, and records a tick mark every time his anxiety makes him think irrationally. And he is surprised by what he finds.
His anxiety makes him think he can read minds.
Not in an ESP kind of way, but in just the way he did with Ms. Washington. For example, almost every time he talks with his friends, he feels a low-level anxiety, which is accompanied by a running narrative of what he imagines his friends are thinking. And sometimes it’s positive, but it’s often not.
“she thinks I’m an idiot; they don’t actually like me, they’re just being nice because they feel sorry for me; they must think that was a stupid thing to say.”
And so he’s keeping track of these mind-reading thoughts, and , after several days, something starts to happen: He notices fewer tick marks each day. His anxious thoughts are decreasing. And after about 3 weeks, the whole feeling of anxiety, burning throat and everything else that comes with it, has actually calmed down.
And so after months of fighting this anxiety, it is finally decreasing thanks to some tick marks in a pocket-size notebook.
How does that work? How is it possible that such a simple strategy can affect a problem as difficult as anxiety?
Well, to understand this, we need to talk about a concept from episode 2, the anxiety cycle. Think back to David’s first anxiety attack, when he got that C-. Let’s take a close look at that again: It started with his amygdala perceiving a dangerous situation and starting up the fight or flight response, which he then felt in his body as a burning in his throat, increased heart rate, and all those other fun feelings that come with anxiety. Then, a few seconds later, his automatic thoughts took over, saying things like, “Everyone is going to think you’re a failure, and you’ll probably never be loved again.”
And remember, these thoughts are so powerful, that his amygdala believes he is in real danger, and it triggers David’s fight or flight response again, starting the whole cycle over.
So, if it weren’t for these automatic thoughts, whispering apocalyptic things into his mind, like “no one is ever going to love you again,” Then there would be no cycle, and the anxiety would just end after an hour or so.
And this idea of breaking the cycle of anxiety by interrupting automatic thoughts: That is the strategy of the model we’re focusing on today: Cognitive Behavioral Therapy, or CBT.
Now, if you know one thing about modern psychotherapy, it’s probably CBT. It is one of the most widely used models of therapy, and is very effective at treating lots of mental health problems, like anxiety and depression.
To understand CBT, we need to first take a close look at the automatic thoughts themselves. All of us have experienced them. They are negative and extreme, but there’s more to it than that. What makes automatic thoughts different is that they are untrue.
And this is important. Just because a thought is negative doesn’t mean it’s unhelpful. For example, David could have the thought: “My friends hate it when I don’t answer their calls and texts.” Well, that thought is negative, but if he’s gotten that feedback from his friends, then it’s probably accurate and helpful: not an automatic thought. But if his next thought is, “My friends hate me and think I’m a jerk and probably just hang out with me out of pity,” that’s a different story, because it’s not at all true: that is an automatic thought.
And right here, I want to talk about how teenage brains are especially susceptible to these types of automatic thoughts, where they mistakenly imagine someone is having mean, nasty thoughts about them. So for the first time in their lives, teenagers really care about what other people are thinking, so they’re constantly interpreting body language and facial expressions, trying to decipher others’ thoughts. The only problem is that their brains aren’t very good at this yet. Our ability to take another person’s perspective, to imagine how they see the world, isn’t fully developed until the end of adolescence. And as far as our brain is concerned, adolescence doesn’t end until we’re 25. So when David thinks he knows what Ms. Washington is thinking, but is so dead wrong, a big part of it is just that he’s not very good at that skill yet.
And so one of the characteristic of automatic thoughts is that they are untrue, and we know now that teenagers are especially susceptible to untrue beliefs about other people’s thoughts. But the reason they’re so powerful is because we believe them. When his thoughts tell him that everyone thinks he’s a failure, in that moment he believes that is the truth. And think about that. If it really were the truth, if everyone did actually believe he was a failure, then that really would be terrible, and an anxiety attack would be a perfectly reasonable response.
So, we’re learning that automatic thoughts are negative, extreme, and untrue. And there’s one more feature, that’s maybe the most important, that at their core, automatic thoughts tell us that we are worthless and that no one loves us and no one ever will.
Again, let’s look at an example: another common automatic thought for David is: “I can’t be late to class.” Now, at first, we might think this isn’t an automatic thought at all, that it’s accurate and helpful. After all, it is good for him to be on time. But the important word is, “can’t.” This is extreme, and untrue, because he can be late. It might be unpleasant, but it is an option. Now, the other question is, is this thought somehow saying that David is worthless or unlovable. And we’ll answer that using one of the magic questions of CBT: “why would that be so bad?”
Let’s give it a try:
“I can’t be late to class”
“why would it be so bad if you were late?”
“Because the teacher would be mad at me.”
“And why would it be so bad if the teacher got mad at you?”
“Because she would probably think I was lazy and a bad person?.”
“And why would it be so bad if she thinks that?”
“Because she would probably hate me never want to help me.”
“And why would that be so bad.”
“Because then everyone would probably hate me and never want to be with me.”
There we go. We just showed how a seemingly innocent thought like, “I can’t be late,” can really be saying, “you’re going to end up miserable and alone.”
Now, you may be thinking, “I also worry about being late, but I don’t think it goes that far.” And you’re probably right. Not all worry is the same. But for David, we can safely say that his automatic thoughts do go that far because the threat of being late triggers intense anxiety, meaning fight or flight mode is kicking in. And biologically, there is no reason for his amygdala to kick in the fight or flight response for something as minor as tardiness. But, if his amygdala believes that being late will then cause everyone to hate him and reject him, well, then that’s a pretty good time to sound the alarm.
And the thing about the “why would that be so bad?” method is that the automatic thoughts that come in response to this question are usually unconscious, and we’re going to see in a moment how helpful it can be to bring unconscious automatic thoughts into the light of consciousness.
So, to sum it up, automatic thoughts are very powerful. They can mentally cripple someone who is otherwise a very capable, confident person. And they get their power by taking an unpleasant event and distorting it so badly in your mind, that it seems like a reputation-destroying, self-worth sucking disaster.
Okay, good to know, but how do you get automatic thoughts to calm down? What do we actually do about it? Well, let’s start with David’s tick marks in his little notebook.
All he did was keep track of his thoughts over the course of a few weeks, and they began to calm down. David used a little notebook, but that’s certainly not the only way. There are actually apps that help you keep track of and fight against automatic thoughts. There’s one called Pacifica, that I haven’t used myself, but that I’ve heard lots of good things about. You might start there with your own thoughts or your kid’s.
Okay, but how does something as simple as tracking your thoughts actually improve anxiety? Well, we don’t know exactly how it works, but one theory uses the idea that automatic thoughts live in a different part of our brain than deliberate thoughts. Automatic thoughts are in a category we’ll call, “fast thoughts”, which is the same category as the thoughts required to tie your shoes, or to find the answer to 2+2. These types of thoughts happen in the background. And they’re very different from the other category, “slow thoughts”, which are deliberate and conscious. Slow thinking is required to write a difficult email, or to follow directions to a place you’ve never been, or to find the answer to 159 + 243. Yeah, you gotta think about it for a while, right? It’s 402 by the way.
So, according to this theory, one of the reasons automatic thoughts wreak so much havoc on our minds is that they are fast thoughts, and that they are, well, automatic. If I tell you, don’t think of the answer to 2+2…, the number 4 probably popped into your head anyway. And so one of the things that might be happening when David keeps track of his automatic thoughts, is that he is forcing these thoughts into the slow-thinking part of his brain. Because the process of tracking requires slow, deliberate thinking. And when you take a thought like, “everyone is going to reject me” and put it under the rational scrutiny of slow thinking, it falls apart. Because when you really think it through, that automatic thought completely asinine. No, everyone in your life is not going to reject you because of a bad grade on an English paper.
And this is really at the heart of CBT. Taking an automatic thought, like, “I’m a loser” or “nobody likes me” or “I’ll never succeed so what’s the point in trying,” and subjecting to the scrutiny of slow, deliberate reason.
Now, it’s really important to know that you if you do this once or twice, it’s not going to magically cure you or your child’s anxiety. Instead, its more like training your brain. Think about potty training a puppy. You don’t expect the puppy to learn when and where to pee after two or three tries. It takes a lot of repetition to train that puppy. Well, same thing for your automatic thoughts. It doesn’t work to do it once or twice, which is why it took David 3 weeks to see results. Changing patterns of thoughts and behavior takes time. There are no shortcuts. Believe me. I wish there were.
So, David is feeling better, but his anxiety is still pretty strong, and he’d like it to calm down even more. And tracking his automatic thoughts can only do so much. So, his counselor walks him through the process of arguing against his automatic thoughts. Remember, anxiety is a cycle, and automatic thoughts play a crucial role in maintaining that cycle. And if you disrupt the automatic thoughts, if you discredit them, then the cycle breaks down and the anxiety fades. (this works for depression, and a bunch of other things too).
So, this is what it looks like for David to argue against his automatic thoughts. His counselor gives him a worksheet that has three columns. In the first column, he writes down his automatic thought: “Mrs. Washington thinks I’m a lazy failure.” In the second column he writes down the type of automatic thought, (now, we didn’t get to talk about it here, but just know, there are different categories of automatic thoughts, or “cognitive distortions” as they’re also called). And the category that David’s thought falls into is “jumping to conclusions” and finally, in the last column goes the rational, slow-thinking response to the automatic thought, which is, “There is no reason for her to think you’re a lazy failure. Sure, you’ve made some mistakes, but you turn in your work, you try hard. That’s just not true.” And as he continues to notice automatic thoughts, he writes them down, using this three-column method.
Again, doing this once doesn’t make much of a difference, but after a few weeks of regularly noticing and arguing against his automatic thoughts, they will gradually be pushed into the slow-thinking part of his brain, causing them to be less extreme, and more rational, and productive.
Now The other cool thing about this method is that it’s easy for David’s parents to be involved. Asking your son to talk about a worksheet is much easier than asking him to talk about his anxiety.
Also, this episode is meant to give you an understanding of CBT and it’s generally philosophy. It’s not a how-to guide on how to do CBT with yourself or you child. For links to resources that can help with this, go to theteenmind.com.
So, that’s it for today. Next time on the teen mind, there is an untapped force that has the potential to make a huge impact on the anxiety of millions of Americans. We’ll learn what that force is and how it can help you and your family. See you in two weeks.
The Teen Mind is a production of Elements Counseling Inc. Find more, including full text of each episode and how to get a hold of me at theteenmind.com. Thanks to paragraphs for the theme music, find them at paragraphs.bandcamp.com
I do counseling with teens, parents, adults and couples in Minneapolis, and I do workshops for parents and teachers throughout the Twin Cities Metro.
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Thank you for listening.
Note: For those keeping score at home, fast thoughts and slow thoughts are from Daniel Kahneman’s book, Thinking Fast and Slow, and he actually labels them as system 1 and system 2.