By David Burns
1. Empathy
When you're upset, you need someone to listen and see the world through your eyes without trying to cheer you up, change you, help you, or give you advice. Although this usually won’t cure you, it’s often a necessary first step. It can be a tremendous relief to feel that someone's listening.
Similarly, you can empathize when you’re trying to help a friend or family member who feels upset. Usually, all they really want is for you to be a good listener.
2. Agenda Setting
Agenda Setting is the most basic and important technique of all. First, try to define a specific problem you want help with. It must be specific as to person, place, and time. Ask yourself, "What is the specific problem I want help with? What time of day did it happen? Where was I? Who was I interacting with? What was going on?"
Second, ask yourself if you’re motivated and willing to roll up your sleeves and work on it now, rather than just talking about it endlessly. Ask yourself, "What would it be worth to me to solve this problem? How hard would I be willing to work on the solution?"
3. Identify the Distortions
Use the Checklist of Cognitive Distortions to identify the distortions in each of your Negative Thoughts.
4. Straightforward Technique
You try to substitute a more positive and realistic thought for each of your Negative Thoughts. Ask yourself, "Is this Negative Thought really true? Do I really believe it? Is there another way to look at the situation?"
Compassion-Based Techniques
5. Double Standard Technique
Instead of putting yourself down, you talk to yourself in the same compassionate way you might talk to a dear friend who was upset. Ask yourself, "Would I say such harsh things to a friend with a similar problem? If not, why not? What would I say to him or her?"
Truth-Based Techniques
6. Examine the Evidence
Instead of assuming that your Negative Thought is true, you examine the evidence for it. Ask yourself, "What are the facts? What do they show?"
7. Experimental Technique
You do an experiment to test the validity of your Negative Thought, in much the same way that a scientist would test a theory. Ask yourself, "How could I test this Negative Thought to find out if it's really valid?"
8. Survey Method
You do a survey to find out if your thoughts are realistic. Ask yourself, "How do other people think and feel about this? Could I ask some friends about this to get some feedback?" For example, if you believe that social anxiety is rare or shameful, simply ask several friends if they’ve ever felt that way.
9. Reattribution
Instead of blaming yourself entirely for a problem, you can think about the many factors that contributed to it. You can also focus on solving the problem instead of blaming yourself for it. Ask yourself, "What caused this problem? What did I contribute and what did others contribute? What can I learn from the situation?"
Logic-Based Techniques
10. Socratic Method
Ask yourself several questions that will lead to the inconsistencies in your Negative Thoughts. For example, you might ask yourself, "When I say that I'm a 'failure at life,' do I mean that I fail at some things some of the time, or all things all of the time?"
If you say, "some things some of the time," you can point out that this is true of all human beings. If you say, "all things all of the time," you can point out that this isn't true of anyone, since no one fails at everything.
11. Thinking in Shades of Gray
Instead of thinking about your problems in black-and-white categories, you evaluate them in shades of gray. When things don't work out as well as you'd hoped, you can think of the experience as a partial success or a learning opportunity. Pinpoint your specific errors instead of writing yourself off as a total failure.
12. Process Vs. Outcome
You evaluate your performance based on the process--the effort you put in--rather than the outcome. Your efforts are within your control, but the outcome is not.
Semantic Techniques
13. Semantic Method
Substitute language that is less colorful and emotionally loaded. Instead of thinking, "I shouldn’t have made that mistake," you can tell yourself, "It would be preferable if I hadn't made that mistake." This method is especially helpful for should statements and labeling.
14. Let's Define Terms
When you label yourself as "inferior" or "a fool" or "a loser," ask yourself what those labels mean. You'll see that there's no such thing as a "fool" or a "loser." Foolish behavior exists, but fools and losers do not.
Ask yourself, "What's the definition of 'an inferior human being' or 'a loser'? What is my definition of someone who is hopeless? When I say I'm hopeless, what claim am I making?"
15. Be Specific
Stick with reality and avoid judgments about reality. For example, instead of thinking of yourself as totally defective, you can focus on your specific strengths and weaknesses.
Quantitative Techniques
16. Self-Monitoring
Keep track of repetitious Negative Thoughts or anxiety-producing fantasies by counting them. You can count your thoughts in a couple of different ways. You can keep a 3x5 card in your wallet or pocket. Each time you have a Negative Thought, put a tick mark on the card. Alternatively, you can use a wrist-counter like the ones golfers wear to keep track of their scores. At the end of the day, record the total on your calendar. Usually, the upsetting thoughts will diminish and disappear after about three weeks of Self-Monitoring.
17. Negative Practice
Schedule several minutes each day to worry or beat up on yourself mentally. For example, if you constantly beat up on yourself because of your shortcomings, you can schedule several five-minute periods each day to berate yourself and feel miserable. At those times, you can be as self-critical as you want and rip yourself to shreds with gusto. You can use the rest of the time for joyous, productive living.
Philosophical / Spiritual Techniques
18. Acceptance Paradox
Instead of defending yourself against your own criticisms, you can find truth in them and accept your shortcomings with tranquility. Tell yourself, "It's true that I have many inadequacies. In fact, there is very little, if anything, about me that couldn't be improved considerably."
Role-Playing Techniques
19. Externalization of Voices
This Role-Playing technique requires two people and transforms intellectual understanding into emotional change at the gut level. It is by far the most powerful of all cognitive therapy techniques, but it can be quite challenging and even a bit upsetting at first.
You and the other person take turns playing the role of your Negative Thoughts and the role of your Positive Thoughts. The person playing the Negative Thoughts attacks, and the person playing the Positive Thoughts defends. Use role-reversals when you get stuck.
20. Feared Fantasy Technique
Like the Externalization of Voices, this is a two-person technique. You and the other person act out your worst fears, such as being rejected because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it.
Your worst fears usually don't turn out to be real monsters, but figments of your imagination that can be defeated with a little logic, compassion, and common sense.
Other Role-Playing Methods
Many techniques are more effective when used in a role-playing format. These include: the Double Standard Technique, the Devil's Advocate, the Acceptance Paradox, the Five Secrets of Effective Communication, the David Letterman Technique, and Flirting Training. Of course, you will need the help of another person, such as your therapist or a friend.
Humorous Techniques
21. Paradoxical Magnification
Instead of refuting your Negative Thoughts, you can buy into them and exaggerate them. Don't try to argue with your NTs. Instead, make them as extreme as possible. For example, if you feel inferior, you could tell yourself, “Yes, it’s true. In fact, I’m probably the most inferior person in California at this time.” Paradoxically, this humorous method can sometimes provide objectivity and relief. Of course, if you’re really feeling upset, this may have the unintended effect of making you feel even worse. If so, go on to another method.
22. Shame-Attacking Exercises
If you suffer from shyness, you probably have intense fears of looking foolish in front of other people. Shame-Attacking Exercises are a specific and potent antidote to these kinds of fears. You intentionally do something foolish in public. For example, you could stand up and loudly announce each stop on a bus or shout out the time in a crowded department store.
When you make a fool of yourself on purpose, you realize that the world doesn't really come to an end, and that people don’t really look down on you. This discovery can be tremendously liberating.
Visual Imaging Techniques
23. Cognitive Flooding
Visualize one of your worst fears, such as feeling trapped and going crazy while riding on a train. Try to endure the anxiety for as long as you can. If you become panicky, tell yourself, "Don't fight it!" Instead, try to make it even worse. Eventually, your anxiety will burn itself out, because your body simply cannot create anxiety indefinitely.
You can use Cognitive Flooding when you can’t expose yourself to the thing you fear. For example, if you have a fear of flying, you can't expose yourself to an actual airplane crash in order to overcome your anxiety! However, you can confront this fear in your mind’s eye using Cognitive Flooding.
24. Image Substitution
Substitute a more positive or peaceful image for a frightening one. For example, during an airplane flight, you can fantasize landing safely or relaxing on a beach instead of picturing the plane crashing in flames.
25. Memory
Rescripting
If you've been a victim of sexual or physical abuse, you may experience flashbacks and vivid memories of the traumatic episode. These mental pictures can be likened to an internal movie that accompanies the negative, self-blaming thoughts. You can edit these images in much the same way that you can change your Negative Thoughts.
Editing the painful images creates a sense of mastery and helps you overcome the feelings of helplessness that result from being a victim. Exposure to the painful memories desensitizes you so that the traumatic event loses its power to upset and intimidate you.
Uncovering Techniques
26. Hidden Emotion Technique
This technique is based on the idea that when you're anxious, you may be avoiding a personal problem that you don't want to face. Bringing this problem to conscious awareness and expressing your feelings will often eliminate your anxiety.
Ask yourself, "Am I focusing on my anxiety to avoid dealing with something upsetting? What's the real problem that's bothering me? Do I secretly resent my spouse or my job? Am I unhappy about being in school? How do I really feel?"
27. Individual Downward Arrow
This technique will help you pinpoint the Self-Defeating Beliefs that make you vulnerable to depression and anxiety. For example, you may be a perfectionist and base your self-esteem entirely on your accomplishments.
To use this technique, draw a downward arrow under a Negative Thought and ask yourself, "Why would it be upsetting to me if this thought were true? What would it mean to me?” A new Negative Thought will come to mind. Write it down under the arrow and repeat the process several times. The NTs you generate will lead to the underlying beliefs at the core of your suffering.
28. Interpersonal Downward Arrow
This technique will help you pinpoint Self-Defeating Beliefs about intimate relationships. For example, you may believe that you always have to please other people, even at the expense of your own needs and feelings.
To use this technique, draw a downward arrow under a Negative Thought and ask yourself, "If that were true, what would it tell me about the type of person s/he is, the type of person I am, or the type of relationship we have?" A new Negative Thought will come to mind. Write it down under the arrow and repeat the process several times. The additional thoughts you generate will help you uncover the beliefs that lead to problems in your relationships with other people.
29. What-If Technique
This technique is similar to the Downward Arrow Technique, but it's geared specifically to anxiety. Draw a downward arrow under a Negative Thought and ask yourself, "What if that were true? What's the worst that could happen? What do I fear the most?"
A new Negative Thought or fantasy will come to mind. Write it down under the arrow and repeat the process several times. You will generate additional thoughts until you uncover the fantasy that frightens you the most. Then you can ask yourself, "How likely is it that this would happen? And could I live with it if it did?"
Anti-Procrastination Techniques
30. Daily Activity Schedule
When you're depressed, everything seems overwhelming, and nothing seems worth doing, so you may give up on life. The Daily Activity Schedule can help you overcome do-nothingism. Record what you do each hour from the time you get up in the morning to the time you go to bed at night. Rate how satisfying each activity was on a scale from 0 (not at all satisfying) to 5 (the most satisfying). A review of the schedule will show you which activities boost your mood the most.
31. Pleasure Predicting Sheet
Schedule a series of activities with the potential for pleasure, learning, or personal growth. Indicate whom you plan to do each activity with. Include activities you can do by yourself (such as jogging) as well as activities with other people.
Predict how satisfying each activity will be on a scale from 0% (the least) to 100% (the most). After you complete each activity, record how satisfying it actually turned out to be on the same scale. Now compare your actual satisfaction ratings with your predictions. Many depressed people find that lots of activities turn out to be more rewarding than they predicted. This discovery can boost your motivation.
You can also compare the satisfaction you get from being alone with the satisfaction you feel from being with other people. This can help you test Self-Defeating Beliefs such as, "If I'm alone, I'm bound to feel miserable."
32. Little Steps for Big Feats
If you have trouble with procrastination, you can break large, overwhelming tasks down into small steps that you can tackle one at a time. If you tell yourself you have to clean the entire garage today, you'll never get started. Instead, break it down into small steps. Tell yourself you only have to carry two cardboard boxes out to the trash. That will feel far less overwhelming and you may end up doing a great deal more than you planned.
33. Anti-Procrastination Sheet
This is similar to Little Steps for Big Feats but it’s more sophisticated. Break a large task down into small steps and predict how difficult and how satisfying each step will be on a scale from 0% to 100%. Record these predictions on the Anti-Procrastination Sheet.
After completing each small step, record how difficult and satisfying it turned out to be on a scale from 0% to 100%. Now compare your predictions with the outcome. Many people discover that each small step is far easier and much more rewarding than they expected.
Anti-Resistance Techniques
34. Straightforward Cost-Benefit Analysis (CBA)
List the advantages and disadvantages of a Negative Thought (“I’m such a loser”) or Self-Defeating Belief (“I should be perfect”). You can also do a CBA for a negative feeling (like anger, guilt, inferiority or anxiety), a habit (such as drinking, using drugs, overeating or procrastinating) or a relationship problem (such as blaming your spouse for your marital problems).
In each case, ask yourself, "What are the advantages and disadvantages of this belief, feeling or habit? How will it help me, and how will it hurt me?" After you list all the advantages and disadvantages, balance them against each other on a 100-point scale so you can see whether the costs or the benefits or your mind-set are greater.
35. Paradoxical Cost-Benefit Analysis (CBA)
List only the advantages of a negative thought, belief, feeling, addiction, or relationship problem. The list will make you aware of all the powerful forces that keep you stuck.
Ask yourself, "Given all the advantages of this thought (or attitude or behavior), why should I change?"
36. Devil's Advocate Technique
This is a Role-Playing Technique. Another person plays the role of the Devil who tempts you to drink, overeat, procrastinate, or date the wrong person. You talk back to those thoughts in real time. Role-reversals can be helpful when you get stuck.
For example, if you are overweight, imagine being in a mall where fast food is sold. The Devil might say, "Gee, why don't you get one of those hot, buttery cinnamon buns? They just came out of the oven. They'd taste so good. You deserve it!"
You would fight back and say, “I don’t need a cinnamon bun, and I’ll feel terrible if I give in. I’m determined to stick with my diet, and I’m looking forward to fitting into more attractive clothes.” The Devil can try to break you down again, and you will fight back.
This method is surprisingly challenging, especially if the Devil is familiar with your own rationalizations and expresses them in a seductive and persuasive manner.
37. Stimulus Control
If you're trying to break a bad habit, such as alcoholism or overeating, you can reduce temptation rather than struggling with it. For example, if you drink too much, don’t go to places where alcohol is served, and get rid of all the alcoholic beverages in your house. Stimulus Control is not a complete treatment, but an important part of a more comprehensive program.
Other Motivational Techniques
38. The Decision-Making Form
If you're having trouble making up your mind about something, you can use the Decision-Making Form. This form will show why you're getting hung up and will help you finalize your decision.
The purpose of the Decision-Making Form is not to tell you what to do, but to show you what the real issues are and how you feel about them.
Exposure Techniques for Anxiety
39. Gradual Exposure and Flooding
Gradual Exposure and Flooding are both forms of exposure therapy for anxiety disorders. When you use Gradual Exposure, you expose yourself to the thing you fear in small steps so that it won't be quite so terrifying. In contrast, when you use Flooding, you expose yourself to the thing you fear all at once. For example, if you have an elevator phobia, force yourself to get on an elevator and stay there, no matter how anxious you feel, until your fear disappears.
Gradual Exposure is less traumatic, but it takes longer. Flooding is much more frightening, but it works more rapidly. Both approaches have been used successfully in the treatment of nearly all forms of anxiety.
40. Response Prevention
Response Prevention is an important key to the treatment of all forms of anxiety. It’s often combined with Exposure. For example, let's say you have a powerful urge to check the mailbox over and over after you drop a letter in. Using Response Prevention, you would drop a letter in the mailbox and walk away without checking it as you usually do. Your anxiety will temporarily get worse, and you’ll feel compelled to check it. But if you refuse to give in to the urge to check the mailbox, your anxiety will eventually disappear.
41. Distraction
If you feel anxious, you can distract yourself from your upsetting thoughts. For example, if you’re feeling anxious during an airplane flight, you can distract yourself from the frightening thoughts by concentrating on something else. For example, you could do a crossword puzzle or engage the passenger next to you in conversation. You can combine Distraction with Self-Monitoring and exposure therapy.
Interpersonal Techniques for Relationship Problems
42. Relationship Cost-Benefit Analysis
List the advantages and disadvantages of blaming the other person for a relationship problem. For example, if you blame the other person, you can feel self-righteous and morally superior. You won’t have to change or examine your own role in the problem. You’ll feel like truth is on your side, and you can get back at the other person without having to feel guilty.
There are also a number of disadvantages. For example, you won’t be able to resolve the problem or get close to the person you’re mad at. The conflict will go on and on and you’ll feel frustrated all the time.
Once you’ve listed all the advantages and disadvantages, balance them against each other on a 100-point scale. This will help you decide whether you want to maintain this mind-set.
43. Revise Your Communication Style
You can use the Revise Your Communication Style form to improve your relationships with family members, friends and colleagues. There are five steps. First, write down one thing the other person said to you. Second, write down what you said next. Third, use the "Good Vs. Bad Communication Checklist" or the "Bad Communication Checklist" to identify your communication errors. Fourth, ask yourself what the consequences of your response will be. Finally, use the "Five Secrets of Effective Communication" to generate a more effective response.
44. Five Secrets of Effective Communication
The Five Secrets can help you resolve virtually any relationship problem quickly. The acronym, EAR, will help you remember them. The E stands for Empathy and includes three listening skills: the Disarming Technique, Thought and Feeling Empathy, and Inquiry. The A stands for Assertiveness, using "I Feel" Statements. The R stands for Respect (Stroking). These techniques require considerable practice and will backfire if not done skillfully.
45. One-Minute Drill
This technique practically ensures nearly perfect communication. It breaks the pattern of accusation and self-defense, and shifts the dialogue to the level of emotion and intimacy.
You and your partner take turns playing the roles of Talker and Listener. The Talker spends 30 seconds expressing his or her feelings about a relationship problem. The Listener paraphrases what the Talker said as accurately as possible. The Talker rates the Listener's accuracy from 0% to 100%. Once the Listener receives a 95% or better rating, you can do a role-reversal.
Interpersonal Techniques for Shyness and Loneliness
46. Smile and Hello Practice
If you are shy, you can smile and say hello to 10 strangers per day. Use a 3x5 card to record how many people respond positively, neutrally, or negatively. You’ll often discover that people are much friendlier than you expected—unless you happen to live in Manhattan. I’ve tried this in Manhattan and everyone ignored me! Of course, even that can be helpful, because you quickly get over your fears of rejection.
47. David Letterman Technique
You learn how to make casual conversation using the Five Secrets of Effective Communication. The idea is to focus on the other person in a friendly way. Get them to open up, rather than feeling like you have to impress them by talking about yourself. These are the same skills used by successful talk-show hosts like David Letterman. They appear charming and relaxed because they always keep the spotlight on the other person.
48. Self-Disclosure
Instead of shamefully hiding your feelings of shyness or nervousness in a social situation, you disclose them openly. This technique requires a good sense of self-esteem to be effective.
49. Flirting Training
You learn to flirt in a light-hearted way, rather than interacting with others in an overly serious, heavy manner.
50. Rejection Practice and Rejection Feared Fantasy
If you're shy and afraid of rejection, you can accumulate as many rejections as possible in order to learn that the world doesn’t come to an end. For example, when he was young, Dr. Albert Ellis, a noted New York psychologist, asked 200 women for a date during a two-week period. All but one turned him down, and she failed to show up! Although he didn't get a date, he did conquer his fears of rejection and ultimately developed a robust social life, to say the least!
You can combine this technique with the Rejection Feared Fantasy. You need a partner if you want to try this technique. Your partner will play the most rejecting, hostile person you can imagine. She or he will be far worse than any real human being would ever be, and is really just the projection of your own fears. When you confront this fantasy figure, you will discover that you had nothing to be afraid of in the first place.
