E15. Rewriting the Story of You with CBT (Cognitive Behavioral Therapy)

Welcome to ADHD Crash Course! Today, we're going to take a look at CBT, which is cognitive behavioral therapy. CBT is widely used, it's widely accepted, there's a lot of evidence behind it as an effective form of therapy for managing all kinds of issues with mental health and mental wellness.

Now, just about anyone can benefit from CBT because we all have what CBT refers to as "thought distortions". That's these inaccurate, distorted ways of viewing our world. The way that we view the things that happen to us ends up making a big impact on our beliefs, feelings, and the actions that follow as a result of those.

CBT's approach is to build awareness about these thoughts. Not just awareness about the thoughts, but how they ripple out in our lives. How do they impact what we believe about the world? How do they impact the choices that we make?

Now, like I mentioned earlier, anyone can benefit from this, anyone with a human brain can benefit from this because we all have these thought distortions at times. What I'm going to do right now, is go through some of these distortions and talk about common thought distortions. What do they look like? See if you recognize any of them. And, of course, I will try to share some examples with you, because that's really the only way that any of this sticks for me; thinking of real life examples.

7 Cognitive Distortions and Examples

1. Catastrophizing

The first one is catastrophizing. That's pretty much what it sounds like: focusing on the worst-case scenario. Not long ago, my dad was visiting. Now, I love my dad. I mean, since he's not here, I'm going to make fun of him, but he doesn't listen to my podcast, so it's fine. But my dad is one of those angry worriers; it's like, this is his MO. He just gets anxious and worries about people and it always comes out in this kind of grumpy way. That's just his way.

And so, he was visiting recently, and he was learning about my 16 (almost 17) year old daughter's relationship. She's very much in love and kind of "head over heels". She was talking about her boyfriend, and she was all "starry-eyed" and when she left, he looked at me and said, "Aren't you concerned?"

And I was like, "Well, you know, it's early, it's early for her to be in love. But then, you know, she's 16, whatever..." And he said, "Nothing good can come of this." He said, "All of the outcomes are bad. She's going to get her heart broken. Would you want her to get married now? That would be a disaster." He literally just played out every possible scenario of being 16 years old and in love that you could think of, and all of them ended in catastrophe!

It's not that I don't understand, right? I get it. I get that worrying about these things that you can't control, just imagining all of the possible disasters, makes us feel like we're doing something, but it's not helpful. Anyhow, that's my example of catastrophizing. It's something that a lot of us slip into easily.

2. Mind reading

The second one is mind reading. Now, I can tell you, I'm guilty of this. I've always had a sense of people. I've always been able to read people pretty well and considered this a strength of mine. The shadow side of that strength is that we don't really know what people are thinking, unless they tell us what they're thinking (and even then, we don't really know if that's what they were thinking!) So, mind reading is a trap for some of us, and it's definitely a trap for some of us who consider ourselves more intuitive types.

3. Should statements

Our third one is "should" statements. They say "you shouldn't should on yourself". Those statements are just adding pressure to the way we think; we "should" behave, what we "should" like, what we "should" think. It tickles me because it's very easy to see who is working in mental health or who has done this kind of work personally, because they'll catch themselves saying "should" statements and it's like they dropped an F-bomb. They'll be like, "Well, I should... I mean, I mean... I would like to" or "I would prefer to".

Avoiding these statements is helpful for us because a) they're not very empowering and b) we're adults and we get to choose how we spend our time our priorities. It's good to get in the practice of honoring your preferences and your choices. I won't say you "should do it", but that's number three.

4. All or nothing thinking

Number four is all or nothing thinking. I feel like this happens quite a bit with people with ADHD. I think I've mentioned this in another podcast episode... the debate about whether ADHD is a "superpower" or a "big drag" causes people to get worked up because it's (presented as) this dichotomy. It's either this or that. The truth is, most things in life are not "this" or "that". Most things in life are a blend, even something like ADHD.

It would be disingenuous of me to say, "ADHD has been the best for me, all the time! It's rocked! It's my favorite thing in my life!", but I can recognize that there's things that I've enjoyed about having this kind of brain. There are opportunities, there are possibilities, there are really cool things that having my brain offers me, that might not have been available to me if I didn't have this brain.

Some of us struggle with cognitive flexibility and this can be an issue with ADHD. These extreme ways of thinking may show up a lot for us. This extreme thinking is also the basis of perfectionism, "I'm going to just do this perfectly, or I'm not going to play."

You see this a lot of times with ADHD, a lot of perfectionism. It doesn't always look like perfectionism because those perfect results are not sustainable. You see that "I'm not going to play" oftentimes, playing out with us. If I can't do it perfectly, I'm just not going to do it.

5. Locus of control

Okay, the next one, is it number five? I think it is. This next one is a really good one (to be aware of). It is what we call the locus of control. It's either looking at something that is out of your control and worrying about it, being preoccupied about it, planning it, even though it's something that's so far out of your control that you really can't influence it. That's a real burn of your energy. At the base of that is this belief that it is in your control, that there's an amount of thinking or planning that's going to help you buffer from these things. And that's just not true, right?

The flip side of that is believing things are entirely out of your control that are actually within your control. "I'll never be able to do this, I won't succeed in this, this is not possible for me. I am this kind of student, I'm this kind of an employer, I'm this kind of a parent." It's believing that you don't have control over making a difference in your life.

I definitely see this in the work that I do. There are two extremes here, there's the thinking that you have no control over your life, your functioning, or your improvement, and there's the belief that you have all the control and that you can change all the things.

Now, we know that with neuroplasticity, there are brain changes happening all of the time. We know that executive functioning skills can be strengthened; because they're skills, they can be strengthened. We know that strategies combined with understanding your brain help you be able build scaffolding and supports for yourself so you can compensate for areas that are tough for you.

On the flip side, there are some parts of your brain that you're just going to need to accept. For example, if you have a difficult time with emotional regulation, you're going to have more intense emotional experiences. That's not wrong. That's just your brain and you're best served if you learn how to manage it.

An example for me is my working memory. That's not getting any better, guys. I mean, that is what it is. If there's some amazing therapy or treatment that's working for people, let me know, but I've pretty much accepted that I compensate for my working memory. I'm not expecting it to be different tomorrow. That part's out of my control.

6. Fortune telling

Next one is fortune telling. This is not unlike the catastrophizing that my dad was doing about my daughter and her relationship. Fortune telling is assuming that we know how things are going to end. Once again, I see this a lot in the work that I do. A lot of the people that I work with, they weren't diagnosed earlier in their lives, so they've managed ADHD on their own for years.

Even though they've had no support and not a lot of information about their brains, they're still using that old evidence to predict what's going to happen with them next. Even though now they've learned about their brains and now they're using different strategies. That fortune telling isn't serving them. We don't know what's going to happen and using the past to predict what's going to happen in the future is definitely not helpful for people who have had that kind of history.

7. Disqualifying the positive/ Magnifying the negative

The next one is disqualifying the positive and the flip side of that is magnifying the negative. Some of this is just the way our brains are wired. I don't remember who said it (Rick Hansen, btw), but somebody said that our brain is like Teflon for the good and Velcro for the bad. If you think about it, it makes sense. If your brain thinks that a deer is a lion, great! You live for another day. But if your brain thinks that a lion is a deer, that's a BIG mistake.

Your brain is not so concerned with your thriving when you get down to that base level of what our brains do; your brain is more concerned with your survival. We have what is called a "negativity bias", which can mean minimizing the positive and magnifying the negative.

What can we do to shift thought distrortions?

That gives us a good sampling of cognitive distortions and you're probably thinking, "Okay, great. So now I have these definitions...What am I supposed to do with it?"

1. Notice

Honestly, like so many things when you're managing ADHD, the first step is noticing. When you notice these thoughts, when you label these thoughts, you pull them out of the realm of the automatic, the given, and you actually "think about your thinking".

2. Label

You actually think about your thoughts. Now, that doesn't mean you're going to be able to rewrite all of them, but just noticing and labeling and saying, "Hmm, can I really know what my employer was thinking?" Or "Is this thing I'm worrying about really something I can control?" helps.

3. Challenge

The awareness of what's going on with your thoughts helps you build a foundation in order to challenge those thoughts when you're ready to do that. I'm not saying it's easy and it's definitely not automatic. We do lean towards the negative if we're not intentionally turning ourselves in a different direction.

Don't feel bad about that. Don't be negative with yourself about your negative thinking. That's not even fair. But you can make some awesome changes if you start to look at the way you're thinking and notice where it's going sideways and challenge your thoughts.

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