Learning Simple CBT Skills for Mental Distress

In many of my columns I have suggested cognitive behavioural therapy, or CBT, as a tool to help ease stress, depression, and anxiety, and to help control addictions, schizophrenia, and other mental health concerns. In this column I explore what CBT is, give a few simple CBT skills, and link to various CBT supports and programs in BC.

Studies over the last 50 years have shown that CBT skills are often as effective and longer lasting than medication in dealing with many mental health issues, especially mild to moderate depression and anxiety, whether in children, teens or adults. I like to think of some common CBT techniques as basic life skills, like learning to change a flat tire.

First, let's break down the name: "cognitive" simply means thoughts; "behavioural" means actions —so in essence CBT means "thoughts and actions" therapy. The common aphorism, "Don't believe everything you think" is a form of simple CBT.

Research shows that if you change the thoughts, you can change the feelings and the behaviours. Also, since thoughts, behaviours and feelings are all linked together in a self-perpetuating cycle, changing behaviours (such as focusing on calm breathing in a panic attack or other relaxation methods) can alter the anxious thoughts ("I'm going to die") and subdue the uncomfortable feelings (rapid pulse, shallow breathing, extreme fear and anxiety).

Mindfulness meditations, thought stopping, relaxation techniques are among dozens of CBT techniques, some of which work best under the guidance of a trained CBT therapist. (See the end of the column for how to find one.) However, there are four common CBT skills that can be used, for example, by any youth who is feeling very stressed or anxious about school this year. In that situation, thoughts are often looping in their heads (sometimes below their awareness.): "I can't cope"; "I am not smart enough"; "If I fail, my life will be ruined"; "I'm a loser"; "No one likes me"; etc. Here are some CBT steps to help.

1) Thought recording: Write down the thoughts looping in your head. Examine them. Challenge them. Provide examples of why they’re not true. Get them out of your head and on paper and recognize how thinking these thoughts makes you feel. Talk back to them. Problem solve around them.

2) Create a worry time: If worries are constantly nagging, set aside a time each day exclusively to worry. Focus on four key steps: i) identify and realize when you are worrying; ii) set aside a time and place to think about these worries; iii) whenever you find yourself worrying, postpone the worry to the dedicated time and re-focus on the task at hand; iv) use the worry time you've set aside to list and categorise worries, see if there are ways to solve or reduce each worry.

3) Box breathing: If anxious thoughts are making your heart race or your breath shallow, forms of relaxation breathing can take you out of your mind and calm you. Check Youtube for many different guided breathing meditations. An easy, effective one is "box breathing" a.k.a "square breathing": breathe in through your nose for four counts; hold your breath for four counts; breathe out through your mouth for four counts; hold on empty lungs for four counts. Repeat continuously. As you get better at it, increase counts from four, to six, to eight, or longer for each part.

4) Progressive muscle relaxation: Starting with your toes, focus on tensing and relaxing individual muscle groups all up your body. Then tense all your muscles at once and hold for a count of 10, then relax all of them. Repeat. Many guided muscle relaxation videos are on Youtube.

A number of organizations in BC have free, or low cost, CBT resources. Anxiety BC (anxietybc.ca) has online guided meditations as well as a new cellphone app called MindShift with supported CBT skills as part of its program. The BC Chapter of the Canadian Mental Health Association (cmha.bc.ca) has a CBTbased program "Living Life to the Full" both for adults and now teens (bluewavebc.ca). The MCFD Youth Mental Health intake clinics in your region can refer you to CBT resources; call Service BC at 1-800-661- 8773 to find the office nearest you.

An excellent resource for younger children is the CBT workbook "Taming Your Worry Dragons" by Dr. Jane Garland, available through BC Children's Hospital bookstore, email bookstore@cw.bc.ca. The Internet has many guided CBT techniques and videos. To find a CBT practitioner in BC look under "Find Help" at the BC Psychological Association (psychologists.bc.ca)