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Stress Management for Health Course

How to Change Stressful Thinking

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How to Change Stressful Thinking


. . . . perhaps the most significant discovery of the late 20th Century is the realisation that our attitudes and beliefs shape our perception and our lives, and that we can become aware of and change these perceptions, producing profound effects on the physical body . . . . (Emmet. E. Miller MD)


In order to change our stressful thinking style we use the four steps as outlined below.


Step 1: Become Aware of Automatic Negative Thoughts


The first step in reducing stressful thinking is to become aware of our internal self-talk/automatic negative thoughts.  We all have occasional automatic negative thoughts but these can increase when we are stressed.  Automatic negative thoughts as the term says, can be automatic.  They are not based on logical reasoning, they just occur.


Step 1.  Elicit Automatic Thoughts


Automatic thoughts are habitual ways of thinking.  Together with images, dreams and memories they form the cognition part of social phobia.  The other 2 components of social phobia are avoidant behaviour and anxious mood.  An example of an automatic thought, in the case of a secretary who is having trouble speaking up to her boss, might be, If I say the wrong thing, she will think I am incompetent and fire me.  As in this example, the automatic thoughts of people with social phobia tend to contain cognitive distortions.


Behaviour consists of overt motor activity, physiological responses and verbal responses.  Examples of behaviour, in the case of the secretary, might be taking sick days, palpitations and sweating.  Mood is the subjective emotional experience of a person and can include physical sensations.  The secretarys mood is probably fearful and angry.  As a result of the cognition, behaviour and mood components being interdependent, a change in one is expected to produce a change in the other 2.


Automatic thoughts usually occur spontaneously.  When they do not, any one of the following techniques may be used to elicit them.


1.     Focus on the other components of the problem (ie., mood, behaviour) and ask for associated thoughts.


2.     Focus on an image and ask for whatever words come to mind.


3.  Use imagination in mentally recreating the situation, perhaps with someone else in the role of client.  Ask what thought comes to mind or what they might be thinking.


Step 2:  Identify Underlying Irrational Beliefs


Examine the automatic thoughts for any cognitive distortions that may be present.  These cognitive distortions usually occur as 1 of the 12 unrealistic or irrational beliefs described below.  These irrational beliefs are all based on flawed or faulty logic and have the potential to be highly maladaptive for the person who holds them.  One of the typical maladaptive consequences of these irrational beliefs is a negative mood state such as anxiety, depression or anger.  Other maladaptive consequences are the fact that these beliefs often interfere with our ability to solve problems and may lead to behaviours that get us into trouble or create other difficulties.


Two techniques commonly used to help identify irrational beliefs are the downward arrow technique and the use of thought records to find common themes.  The downward arrow technique consists of challenging statements people make about what they think is causing their negative mood states by repeatedly asking the question, If that were true, why would it be so upsetting? Thought records are a common form of homework given to people in cognitive behavioural therapy that requires they record their automatic thoughts associated with problem situations (e.g., social avoidances or fears) during the week.


Cognitive Distortions


As weve learned our thoughts play an influential role in the perception of the stress that we are under.  Some of these stressful inducing thoughts are called Cognitive Distortions and it used to be believed that there were only a few of them but we now know that there are far more than this.  You will find below some of the most common of these thinking errors.


1.  Black and White Thinking (All or Nothing Thinking)


We tend to see things as being all wrong or all right, for example, if we make one mistake we see ourselves as having failed.  We see things or people as being all good or all bad.  We are a total success or we are a total failure.  We are either completely 100% right or we are 100% wrong.  The reality is we all make mistakes.  Life is a learning process and nobody is perfect.


2.     Overgeneralization


When we experience a single, negative event such as not getting a job that we applied for, we tend to think we will never get a job ever again.  We make a mistake and we think we can never do things right.  We make conclusions based on single events.  Everything I do turns out wrong. 


3.     Catastrophising


We automatically think the worst is going to happen and it will be awful and we wont be able to cope.  My relationship broke up, so nobody will want a relationship with me.


4.  Mental Filter


We filter out all the good things that life has and overly focus on negative parts of life.  We pick on a single negative detail and dwell on it.  We overly dwell on the negative and totally ignore the positives.  We make predictions about what will happen to us in the future based on little information.  ie Someone says we have done well, but we discount this because we say it was only said to be nice, it wasnt really meant, or 100 good reviews and one bad review and we focus on the single bad review.


5.     Magnifying or Minimising (Binocular Vision)


We blow things out of proportion.  We make mountains out of molehills. We tend to minimise our and others strengths and qualities and magnify and exaggerate the supposed weaknesses, mistakes and errors of ourselves and others.


6.     Personalisation and Blame


If something bad happens we assume its our fault.  We tend to blame ourselves solely for situations and events that we were not entirely responsible for.  On the other hand we take no personal responsibility, we blame other people and situations.


7.     Shouldisms


Critical statements, we believe things must or should be done in certain ways.  We use should, must, ought, shouldnt statements about ourselves and other peoples behaviour.  We feel guilty when we dont do things we think we should and get angry and frustrated when others dont live up to our shoulds.


8.     Labelling and Mislabelling


We call ourselves and other people by negative names for supposed shortcomings, such as Im an idiot, Shes a moron,, Im stupid.  These are not based on the facts, but on only one or two negative incidents.


9.  Jumping to Conclusions


We tend to make a negative interpretation even though we dont have all the facts to support our view.


a.    Mind Reading We think we know what other people are thinking about us, for example, that they think we are stupid, incompetent, and may disapprove of us; we dont bother to check this out.  If a friend walks by on the other side of the street we mind read and think we may have offended them and they are ignoring us because of this.


b.    Fortune Telling We anticipate that things will turn out badly and are convinced that our prediction is an already established fact.


10.    Emotional Reasoning


We let our feelings guide our interpretation of reality.  We may be so stressed that we have difficulty with our emotions and therefore conclude that our marriage isnt working, when in fact it is our blunted emotions that are causing the problem.  We reason from how we feel, I feel an idiot, so I must really be one.


11.    Discounting the Positive


Here we trivialise the positive things about ourselves and others saying that they dont count.



Step 3: Challenging the Irrational Beliefs


Once the irrational belief underlying an automatic thought has been identified from the list above, it is important to refute these beliefs by examining the evidence for them and by looking for alternative explanations.  Generic questions called dispute handles originally developed by Sank and Shaffer (1984) can be used to refute irrational beliefs in 2 ways.  Questions about how certain we are a particular outcome will occur are referred to as probability dispute handles.  Questions about the worst thing that could happen and how bad that is are called coping dispute handles.  Refer to the lists below for examples.



Probability Dispute Handles


1.   What are the other possible outcomes?

2.   What evidence do we have that ________ will happen?

3.   Does ________ have to equal or lead to ________?

4.   What has happened in the past?  Any exceptions?

5.   What are the chances of it happening/happening again?


Coping Dispute Handles


1.   What is the evidence to suggest the consequences will be disastrous?

2.         Could there be any other explanation?

3.   Is ________ really so important that my whole future depends on it?

4.   Does ________s opinion reflect that of everyone else?


Step 4: Replace the Irrational Beliefs with Suitable Alternatives


Often the replacements for automatic thoughts become evident in the course of refuting the irrational beliefs on which they are based.  The following excerpt from a fictional case illustrates how this might happen.


Jim is a 25-year-old male with a fear of negative evaluation and rejection from females he would like to approach for a date.  The therapeutic contract he negotiated with his therapist established the following goals.


1.         Increase the number of opportunities for meeting women by joining a health club, taking a course and by participating in some functions of a local singles club.

2.         Initiate conversations and engage in small talk with women he hasnt met before.

3.         Initiate follow-up conversations with women he met previously.

4.   Ask a woman to join him in a social outing.


The following automatic thoughts were reported by Jim in response to anticipating a role play of initiating a conversation with a woman.  Listed below his automatic thoughts are the underlying irrational beliefs, the rebuttal he used to challenge these beliefs and the alternative beliefs he substituted.


        Automatic thought: I wont be able to talk.

        Irrational Belief: Fortune telling

        Rebuttal: Im able to talk to men and women for whom I have no attraction.

        Alternative Beliefs: I have been able to talk just fine in other situations.


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