Once a patient has decided they are willing to pay the price and to roll up their sleeves and get to work we then set goals and a plan of action. We start to identify what it is they want as the desired outcome and how they will achieve it. However, resistance to change often sets in again at this time, so a homework assignment I often give is to read the book Who Moved My Cheese by Dr. Spencer Johnson, MD. It is a short parable that identifies and explains our emotional reactions to change and how it can lead us to destruction. It is also an excellent book for managers to go through with their teams when an agency is restructuring.
The plan of action will be to challenge their fears, phobias, and thought distortions that keep them stuck. The absolute key to mental health is how we respond to change - whether we are able to adapt or are resistant. Resistance leads to anger, anxiety, helplessness, low self-esteem, a victim mentality, and destructive relationship choices. Our immersion in change and flexibility leads to making choices that promote a healthy and happy lifestyle.
In challenging their fears it is good to look at the specific thought patterns that are keeping them stuck in destructive behaviors. Some common thought distortions according to Dr. David Burns which can be read about in his book The Feel Good Handbook are:
All or nothing thinking – Thinking of things in absolute terms, like "always", "every", "never", and "there is no alternative". Few aspects of human behavior are so absolute.
Overgeneralization – Taking isolated cases and using them to make wide generalizations.
Disqualifying the positive – Continually deemphasizing, or "shooting down," positive experiences for arbitrary, ad hoc reasons.
Jumping to conclusions – Drawing conclusions (usually negative) from little (if any) evidence. Two specific subtypes are also identified:
- Mind reading – Assuming special knowledge of the intentions or thoughts of others.
- Fortune telling – Exaggerating how things will turn out before they happen.
Catastrophizing – Focusing on the worst possible outcome, however unlikely, or thinking that a situation is unbearable or impossible when it is really just uncomfortable
Emotional reasoning – Assuming reality to reflect emotions, e.g. "I feel it, therefore it must be true."
Should statements – Patterns of thought which imply the way things "should" or "ought" to be rather than the actual situation the patient is faced with, or having rigid rules which the patient believes will "always apply" no matter what the circumstances are.
Labeling and mislabeling – Explaining behaviors or events, merely by naming them; related to overgeneralization. Rather than describing the specific behavior, a patient assigns a label to someone or himself that implies absolute and unalterable terms. Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
Personalization – Attribution of personal responsibility (or causal role) for events over which the patient has no control. This pattern is also applied to others in the attribution of blame.
The last step in treatment is exposure and homework. No one rids themselves of anxiety by talking about it; that does the opposite, feeding and intellectualizing the fears; makes it worse!!! Talk therapy alone does not work for retraining the brain from believing it is anxious. Negative behaviors lead to negative cognitions and feelings. Repetition of positive behaviors leads to good feelings. One cannot have good feelings without the good behaviors.