Hough Counseling and Assessments PLLC

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” – Aristotle

When working with clients, there is often an assumption that therapy takes place mostly inside the office. That is, the most effective aspect of therapy lies in the discourse between the therapist and client. Though forming a strong relationship between practitioner and client is important to change, much of the important work takes place between sessions. In Cognitive-Behavioral Therapy (CBT), this interim work is called homework, and is assigned by therapists to put into practice the techniques and goals established in session.

For a long time, I was opposed to homework and was under a similar assumption as many of my clients. However, as I became more self aware, I realized that I had unofficially been using homework in my own life to change how I felt and behaved. For example, tracking how many hours I sleep, calories I consume and setting goals each week to improve my sleep schedule and diet.

The key to homework in a therapeutic setting is that it brings awareness to our habits and allows us to note the relationship between our habits, the environments we occupy and how we react to them. Practitioners such as Albert Ellis (REBT), Aaron Beck (CBT), Christopher Martell (BA), and Steven Hayes (ACT) have developed behavioral interventions built around the notion that our habits have a tremendous impact on how we feel and think about our lives.

Below are 4 Ways Our Habits Shape Our Mood:

1. You are what you think. One of the touchstones of CBT is the notion that our thoughts and speech become habitual as well, and that the way we think has an effect on how we feel and behave. For example, using the word “should” can cause us to feel guilty about certain obligations in our life as well as our self image. I should be slim and fit, I should call my parents more often, and I should enjoy my job/house/hobby/life more often. A simple word like “should” externalizes the demands on our lives and can cause us to feel out of control. However, replacing “should” with “I would like to” places the demand and expectation back under our control. Notice how “I would like to call my parents more often” evokes a less guilt-ridden response than “I should call my parents”.

Being mindful of the way we talk and think can have a tremendous impact on how we feel about situations, people, and activities. Check out a list of more cognitive distortions here.

2. What we do affects how we feel. As with our thoughts, the way we spend our time has an effect on the way we feel. For example, spending time in rush hour traffic causes us to feel much different than watching our favorite show or having coffee with a friend. Seems like common sense, no? However, what we often overlook is the role scheduling plays in our lives and happiness. The more we engage in enjoyable activities, the more likely we are to continue doing so and the more we do so, the better we feel.

The cornerstone of Behavioral Activation therapy is the scheduling of activities that are enjoyable or make us feel accomplished. Actively scheduling in more enjoyable activities or rewarding ourselves for accomplishing difficult tasks can help keep us motivated and improve our overall health.

3. Escape can be a trap. One impediment to habit change is avoidant and escape behavior. Avoidant behavior is just as it sounds, avoiding situations that we find aversive or uncomfortable. For example, those who feel anxious in large crowds avoid parties, concerts, grocery stores, etc. in order to escape the feeling discomfort caused by such situations. It is more enjoyable to be away from these situations, so the behavior is reinforced (perpetuated) by the escape behavior.

Since avoidance can be more comfortable than encountering the aversive situation, it becomes habituated. This can cause problems, such as isolation, loss of contact with friends and avoiding situations that are otherwise enjoyable. Gradually re-engaging in pleasurable activities and reducing avoidance can help improve mood by increasing the opportunities to feel accomplishment and enjoyment (Cuijpers et al., 2007).

4. Small steps make a big difference. Starting a new habit can be difficult and changing an old one can seem impossible. This is normal. However, if we recognize the habits that cause us to feel anxious, depressed or just uncomfortable, then we have won half the battle.

Awareness is the first step in changing our habits, both mental and behavioral. After noting the situations, thoughts, or feelings that prove problematic, we can slowly develop ways to combat them. It helps to start small and build gradually towards the goal. For example, if you want to begin a walking routine, start by simply purchasing or wearing the proper exercise clothes for the first week. Next, walk for 5-10 minutes around the house or in the neighborhood. After that becomes routine, add 10 more minutes and so on until you’ve met your goal (ex, 1 hour, 3x a week). If the next step becomes too much, cut the goal back and begin to build it up again.

Through gradual exposure, situations, objects, and emotions become more tolerable and less aversive. After some time and a consistent schedule, they may even become pleasurable! For more detail on gradual exposure and how to design such a program, click here.

Practice Makes Perfect

Like with most skills in life, our physical and mental behavior takes time and practice to shape. Being aware of how we think, feel and behave provides us with a great advantage by allowing us to understand the role we play and how we react to life’s events. While this is a simplified version of the techniques mentioned, even the smallest positive change in our routine and thinking can gradually build into a new habit.

“The greatest weapon against stress is our ability to choose one thought over another” –William James

One afternoon I was hyperventilating while trying to locate an office building in downtown Detroit. “What if” scenarios ran through my head at light speed as my breath seemed to slip away. It was a panic attack. Much of my adolescence and early 20’s were spent in excessive worry. It wasn’t until a co-worker expressed concern after this incident that I began to realize the way I was thinking wasn’t working.

Over 40 million Americans are affected by an anxiety disorder, making it the most prevalent diagnosis in the U.S. It also costs $42 billion each year in medical costs*, not including total cost of lost productivity, unpaid time off, sick days, child care, etc. However, there is hope. Anxiety is also the most treatable and treated diagnoses with one-third of sufferers receiving some form of treatment. Usually A mixture of medication and behavioral therapy is the best combination to overcome anxiety.

With that in mind, here are a few techniques that can be applied today that will help lighten the tension hold of anxiety.

1. Write Out A Control List. First, it’s important to identify what exactly is making you anxious. Is it a fear of public places? A fear of judgment or rejection? A fear of death, injury, trust, love, losing your home, your job, or the apocalypse? Whatever it is, write it down. Next, divide the list into two columns. In the first column, write down the fears you have control over. Be honest here, do you really have control over the apocalypse, when you die, or what other people think? In most cases, we do not. In the second column, make a list of the things you do have control over. This column should include how we feel and react to situations as well as practical matters such as paying bills, maintain relationships and so on.

The first column provides a list of aspects that cannot be controlled, and therefore worrying about them is a waste of our time and energy. The second column is a list of growth areas. A to-do list, if you will. Try focusing energy on the second column. Ask, “What can I do about this today?” If you’re afraid of losing your job, start applying for other position or have a discussion with your boss about your performance. In such cases, anxiety can be understood as a motivating factor with a goal set to resolve them.

2. Develop Awareness. Mindfulness meditation is simply the act of sitting in one place and focusing on a physical aspect of your body, usually the breath, while remaining passively aware of our thoughts. Focusing on our breath entering and leaving the body physically slows down the nervous system, which allows our minds to settle. If we try to control our minds in order to settle them, it will only disrupt it further. However, if we passively observe our thoughts, as if watching clouds in the sky, we won’t get hung up on them. If that sounds too far out, then take time to sit and simply observe the happenings around you. Try not to judge, but rather accept them as if observing the stars or a blowing field. This can be done anywhere at any time.

2. Practice Your A-B-Cs. An important part of mindfulness is becoming aware of how our thoughts and behaviors affect how we feel. Anxious behavior is often a learned reaction to particular conditions and events. A useful tool is the A-B-C model used in Cognitive-Behavioral Therapy (CBT) to analyze and alter troubling behavior. Below is a breakdown of how this works:

A- Activating stimulus, event, action or condition (i.e. a crowded room)

B- Behavior or belief about the stimulus, event, action or condition (i.e. “This is overwhelming,” “I am going to embarrass myself,” sweating hands, shortness of breath)

C- Consequence of belief/behavior (i.e. leaving the room, isolation, avoiding crowded spaces)

Understanding this sequence allows us to become aware of the cause-effect relationship between certain situations and how we react to them. Likewise, breaking our beliefs and behavior down in this manner allows us to pick apart the aspects we have control over, which mainly falls under the ‘B” category. Though we may not have control over how crowded a room may be, we are able to control our beliefs and reactions to them.

4. Face Your Fears…Gradually. After identifying what anxieties you have control over, set aside time to write out the A-B-Cs of the situation. This time can also be used to practice gradual exposure** to the event or condition triggering your anxiety. For example, overcoming a fear of crowded spaces can appear difficult at the outset. Our reaction to the situation seems instantaneous and overwhelming. However, by breaking the situation into more manageable steps, we can slowly overcome our fear of them.

Here is a breakdown schedule used for overcoming fear of public spaces (social anxiety):

Step1:  Visualize a crowded room while remaining aware of how your body reacts and the thoughts going through your head

Step 2: Look at a photo of a crowded room, again, remaining mindful of the way you react

Step 3: Watch a video of people enjoying themselves in a crowd

Step 4: Observe a crowd from a distance, such as a park or farmer’s market

Step 5: Enter a crowded area for 10 minutes

Step 6: Enter a crowded area for 20 minutes

Step 7: Enter a crowded area for 20 minutes and speak with somebody

Step 8: Enter a crowded room and remain for 1 hour

This process should take place slowly, with each step occurring over a span of days or weeks. During the process, write down your beliefs and feelings about each step (ex. “Walking into the grocery store was terrifying”). Then, replace this belief with a more positive one (ex. “Walking in the store was OK, and I did not get hurt or embarrass myself). Continue this process until the fear no longer impedes on your ability to function in the situation.

Gaining Peace of Mind

By accepting what we cannot control, practicing mindfulness and modifying our beliefs, we can relieve the hold anxiety has on our life. These techniques are backed by decades of research and have helped myself and my clients overcome our fears. Anxiety is self perpetuating, which means we fuel the fire through our actions and beliefs. Becoming more aware of how we organize our life and what thoughts we choose is a crucial step. Remember, if you’re suffering from severe anxiety, there is hope. Explore resources in your area and seek help if anxiety is interfering with your work or home life.

*For more info about anxiety check out the Anxiety and Depression Association of America

**For more info about gradual exposure therapy click here.