CHAPTER
23

Maintaining Gains

In This Chapter

• Watching out for triggers
• The return of negative core beliefs
• Facing negative thoughts promptly
• Developing self-therapy strategies

Life is filled with ups and downs. After learning CBT strategies, your life isn’t going to have only ups. You will still have times you feel down or feel that you are sliding back into old habits. These are called setbacks. In this chapter, you learn techniques to help make sure those setbacks are temporary and are a part of continuing to learn and improve your thinking and behavior.

Move New Beliefs to Your Inner Being

You spent the last several months working diligently on the exercises in this book. You challenged your thinking and changed the way that you think…most of the time. But occasionally you are going to run into old situations that trigger your negative thoughts to come flooding back. Your insecurities flare up. These old situations re-trigger your core belief. For example, suppose you run into an old classmate from high school. During high school, you didn’t have many friends and felt you didn’t fit in. Seeing your classmate triggers your core belief, “I am not good enough; I am not accepted by others.”

STOP AND THINK

Core beliefs often hide under other issues. For example, suppose you are overweight. You shy away from making friends or being in an intimate relationship. You blame being overweight for your social problems, thinking, “Other people don’t want to be around me because I am overweight.” If you dig deeper, below the issue of being overweight, you might find that you think you are “unlikeable” or “not a nice person.” You rely on the overweight issue because it is easier than facing the real belief. Ask yourself, “Is this the real issue?”

Core beliefs develop over a long time, often beginning in childhood. They are buried under your problematic thinking patterns and even after you address those, your core beliefs remain intact. When one of these core beliefs is activated, you focus on information that backs up the belief. When you notice negative thoughts cropping back up, don’t worry. Setbacks are normal; making changes in your life takes time, patience, and commitment. If you take steps to manage these thoughts right away you have a better chance of this being a short-lived setback.

The first step is to identify situations, events, people, or places that trigger these core beliefs. To do this, start your thought log again, paying close attention to what is happening around you when you notice the negative thoughts taking over. You might write down:

CBTIDBIT

Uncovering your core beliefs sometimes requires you to behave contrary to what makes sense to you. It involves moving out of your comfort zone to test new beliefs. For example, you might think, “I am unlikeable.” You can’t test whether this is true if you continue shying away from other people and isolating yourself. You need to accept that you have this belief and deal with discomfort to test it. You have to talk to people and make an effort to make friends.

You might notice that when certain situations occur, the same negative thoughts you were sure you had conquered come back. Using the same example, you previously combated thoughts of not having friends, realizing that although you weren’t popular in high school, you have friends now and get along with your co-workers. Go back and review the strategies in Chapter 11 to help you reframe your thoughts in a helpful and healthy way. When your co-worker cancels lunch, you might think, “There was probably something she needed to do today. I am sure we will have lunch together tomorrow.”

Digging Down to Your Core Belief

Find the underlying core belief the same way you did before. Extend your thoughts to reveal your hidden thoughts. Ask yourself questions, such as:

• What does it mean to me when I feel this way?
• What are the negative consequences of this happening?
• What does that say about me?

As you continue to ask these questions, you should get down to a very basic, core belief about yourself. For example:

When I feel this way, it means:

No one likes me.

What are the negative consequences?

I don’t have any close friends.

What does it say about me?

It means something is wrong with me.

What does it mean about my future?

I will always be lonely.

What does it mean about me as a person?

I am unlikeable.

Your core belief is “I am unlikeable.”

While you managed to combat a number of negative thoughts using the techniques in this book, you didn’t get far enough down to combat your core belief. When this happens the negative thoughts pop back up in stressful situations. It means you still have some work to do, but doesn’t mean you are a lost cause.

GIVE IT A TRY

Think about your core belief and come up with a behavior or activity that is completely against this belief. Go ahead and do it. For example, if you think no one wants to talk to you, spend a day making conversation with your co-workers or attend a party and “pretend” you are outgoing. Your subconscious will begin to believe you are good at talking to other people. You will have started the process of breaking down your core belief.

This is where coping thoughts coming in. When you are starting to feel that no one likes you and that you are not likeable, you can resort to your coping statements:

• I am a likeable person.
• No one is liked by everyone.
• I am successful in many areas of my life.
• My happiness does not depend on the acceptance of others.
• I am a great person.

All True or Sometimes True?

Your core belief is usually an overgeneralization; you believe this statement is true all of the time. To combat core beliefs, focus on experiences that prove it is sometimes not true. Using the previous example, you might list the following:

• My co-worker usually wants to join me for lunch.
• I get along with my co-workers.
• No one at work makes fun of me.
• I have a few friends at my church.

Continue to list as many experiences as you can, even if you don’t think they are relevant. Come up with a more balanced core belief. You might state:

Not everyone is going to like me, but I am likeable to some people.

If your core belief is not always true, it can’t be true “all the time.” Write your new belief on an index card and carry it with you. Reread the card when you are in a high-risk or stressful situation. When you find yourself thinking negatively and reinforcing your original core belief, change your thoughts to focus on the experiences that contradict this belief.

Make a list of activities and tasks that reinforce your new belief. Ask yourself, “What would I do if I didn’t have this belief?” You might write down the following:

• Attend groups and meetings at church.
• Volunteer for community outreach activities at church.
• Ask someone from church to go out for coffee.
• Smile and say hello to co-workers.
• Ask another co-worker to join me at work.

You might want to write these activities and tasks on the back of your index card where you wrote your new core belief. When you reread your belief, you can turn the card over and reread the tasks to remind yourself of what you need to do.

STOP AND THINK

There are two types of core beliefs: those that remain stable and those that change depending on your mood. For example, when you are experiencing stress or anxiety, you are more apt to believe certain negative core beliefs. The beliefs that change with your mood are sometimes easier to tackle because when you are feeling happy or content, you don’t believe or believe it less.

Starting over can be disheartening, but if you find core beliefs returning, it is time to be aggressive at challenging these thoughts. You want your new belief to become part of your thinking. The more persistent you are at combating this thought, the more it becomes integrated into your belief system.

Deal with Problems Immediately

You see negative thoughts resurfacing and want to push them away. You want to avoid it and any situations that bring on these thoughts. But denying the negative thoughts only makes the problem worse. You might…

• Feel like a failure when negative thoughts resurface.
• Believe that setbacks are a catastrophe.

Remember, setbacks are normal. CBT isn’t a quick fix, it is a lifestyle change and that means making the techniques part of your everyday life. Think of it as you do an exercise program. While you are focused on the program, you lose weight and stay in shape. As soon as you stop, you start losing your gains. You need to refocus on your program and make permanent changes in your life in order to stay in shape and keep your weight consistent. CBT is like that. When you were focused on keeping thought logs and analyzing and challenging your negative thoughts, it was easier to think in new ways. Once you stop, negative thoughts creep back in. Instead, see CBT as a lifestyle change. Consistently monitoring your thoughts and addressing negative thoughts as soon as they pop up helps you stay on top of your progress and keep moving forward.

Prepare for Triggers

When you completed your thought log, you might have noticed there were certain types of situations that caused you to slide backwards. Some common triggers include the following:

• Physical illness
• Not sleeping
• Relationship problems
• Family illness
• Financial difficulties

When you understand your triggers, you can take steps to prepare. Create a plan of action for when you are in one of your high-risk situations. Chapter 24 covers how to create a crisis intervention plan that can help in these situations. In the meantime, use the following statements to help you prepare for common stress areas in your life. Fill in the blanks to fit your situation.

When I feel _________________, I will _________________.

If _________________, I will _________________.

Some examples include the following:

• When I feel angry, I will do deep breathing exercises for 10 minutes.
• When I feel lonely, I will reach out to a friend.
• When I feel sad, I will go to the gym.
• When I have an argument with my partner, I will use the ABCD chart and change to a more positive way of looking at the situation.

Write statements for your common stressors. Keep the statements with you to refer to when faced with a situation or overwhelming emotion.

CBT as Part of a Healthy Lifestyle

Changing your thoughts is only one part of a healthy lifestyle. Adding relaxation, mindfulness, and healthy eating habits increases your overall feelings of well-being and makes you feel more motivated to continue your CBT practice. You are working on getting healthy at the same time as getting rid of the unhealthy habits.

IMAGINE THAT

A positive attitude has been associated with better health, but it can also work the other way. One study showed that living a healthy lifestyle, which includes exercise, good sleep habits, a healthy diet, not smoking, and taking preventative measures to maintain your health resulted in a more optimism, assertiveness, and sociability.

Review what you learned by reading and doing the exercises in this book. Make a list of which techniques work best for you. Spend time each evening to review your day, looking out for unhealthy rigid ways of thinking. Pay attention to when you avoided situations to make you feel better or when you required perfectionism in your thinking or actions. Then, make a plan for each of your unhealthy thinking patterns.

Continue to keep moving forward. When you conquer a negative thought pattern or confront a fear and combat it, start on a new one. As you notice negative thoughts or fears, write them down. Don’t spend too much time on trying to correct them if you are still working on other fears or thoughts. Simply note they exist and continue working on your original goal. This list is your “to do” list. Your goal is to continually be moving forward.

Your Turn: Plan Self-Therapy Sessions

It is often helpful to plan a weekly “therapy” session with yourself each week. Block out one hour for you to review your progress and plan for the upcoming week. A typical session might address the following:

• What positive things happened this week?
• What strategies did I use that helped the situation?
• What problems came up through the week?
• How did I resolve these problems?
• Did I overreact?
• What were my common problematic thinking processes?
• Are there other ways I can look at this situation?
• Are there problems I anticipate coming up during the next week?
• What can I do to prepare?
• What skill did I work on this week?
• What skill can I work on during the upcoming week?

As you become more comfortable with your skills and your ability to use them in difficult or stressful situations, increase the time between your sessions.

Your Turn: Create Behavior Markers

In CBT, it’s important to monitor yourself and respond immediately to backsliding. One method for doing this is to create behavior markers, or benchmarks, which signal you are starting to backslide. When you reach or surpass these particular behaviors, you then need to reactive your CBT methods and put the brake on old habits.

DEFINITION

Behavior markers are specific behaviors that signal a return to old habits. For example, if you have depression, behavior markers might include not leaving the house for two days, sleeping during the day, or a loss of appetite. Knowing your behavior markers helps you notice a setback immediately.

Some examples of this include the following:

• Skipping two social events in a row to avoid anxiety
• Consuming dessert two days in a row if you are weight conscious
• Going to the gym five days in a row if you are body conscious
• Sleeping more than 12 hours when you are depressed
• Cursing or yelling if you have a tendency to get angry

Once you see yourself in signaling situations, your job is to return to CBT strategies that worked best for you.

List at least three behavior markers to signal you are starting to backslide. Don’t wait until you backslide to create these points. If you do you will end up returning to old bad habits and feel guilty, lose motivation, and start to blame yourself or others.

Tips for Maintaining Your CBT Gains

Keep a lookout for unhealthy thinking patterns that keep cropping up. Develop a plan of action immediately rather than avoiding your thoughts or avoiding certain situations.

Monitor your progress. Compare your previous unhealthy ways of thinking and what you have learned in this book. Noticing the differences helps motivate you to continue.

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Always celebrate your accomplishments and successes. Take time each evening to review situations and events where you noticed and challenged negative thoughts. While you need to take responsibility for setbacks, don’t get so caught up in your mistakes that you forget to pay attention to the times you used CBT techniques to rethink a situation and react in a more helpful way.

Make a list of the CBT techniques that work best for you. Keep the list handy for you to use when you are in a stressful situation.

Remember that setbacks are normal. Don’t catastrophize your setbacks. Accept they will happen and as long as you have a plan to deal with them, you can quickly address a setback.

Look back at your progress. Remember that you have faced this problem before and have learned techniques to solve it. This time it shouldn’t be as scary and shouldn’t take as long to overcome.

Continue to practice CBT techniques. Without practice you become rusty. Practice and consistency helps keep your skills sharp.

Learn from your setbacks. Take note of what happens when you backslide and come up with prevention strategies for the future.

Put your setback in perspective. How much have you improved? Is the setback a disaster or is it a wrinkle in your progress?

Accept responsibility. Recognize that you are responsible for your setback but don’t criticize yourself. Remind yourself that unhealthy thinking may return from time to time. Remember you are overcoming years of thinking in a certain way. It will take time to change these thinking patterns. Think of CBT as a lifetime change, not a one-time therapy.

The Least You Need to Know

• When you run into old situations, old beliefs might return.
• When you find your negative thoughts returning, dig deeper to find the core belief that keeps resurfacing.
• Create a list of possible triggers and write a plan for each one to help you combat negative thoughts before they take control.
• Plan time each week for a “self-therapy” session where you review any problems that came up through the week and how you handled each one.