This is the second blog in a three-part series on incorporating compassion, mindfulness, and values into your cognitive behavioral therapy (CBT) practice. The first blog was on compassion and behavioral activation. This second blog is on how mindfulness and decentering can help your clients deal with their negative thoughts more effectively. The third blog is on how to help your client identify what they value most, and increase their motivation for behavior change. I will focus on difficulties related to COVID-19, but the information is applicable to non-COVID times as well.
First a bit of theory. We tend to believe out automatic thoughts, and never stop to consider if they are accurate. A key CBT intervention involves helping clients identify their negative automatic thoughts, and then examine the evidence both for and against the negative thought. Usually, your client discovers that the automatic thought did not take into account the evidence against the negative thought, and they develop a more realistic, balanced thought that encompasses all of the evidence. This process is usually very effective, and can elicit strong emotions as clients examine the evidence both for and against their automatic thoughts. You can learn more about this process in CBT Made Simple.
However, sometimes clients examine the evidence for their automatic thoughts and develop a balanced thought, but the negative thought still feels very real. There are lots of reasons that this can occur, and there’s no single solution. However, in today’s blog I want to talk about one approach—using mindfulness and decentering.
I like to define “mindfulness” as paying attention to the present moment without judgment, just accepting what is and not needing or trying to change. What about “decentering?” In CBT Made Simple, I explain decentering as recognizing that thoughts are mental events that are not necessarily true, and that you don’t have to react to or believe. You can just accept that you are having a certain thought. Thus, for example, rather than thinking, No one likes me (and feeling depressed), you can notice that you are thinking, No one likes me, and you may also think, I am having the thought that no one likes me. A decentering stance enables you to recognize that you had a thought, note it, and let it pass. In essence, it enables you to decide how you want to react to a situation rather than automatically following the path of your negative thoughts.
Use Mindfulness and Decentering to React to Negative Thoughts
Helping your client decenter from their negative thoughts involves three steps.
- Be mindful. Teach your client to bring a mindful attitude to their thoughts, quietly noticing all their thoughts, accepting them, and not trying to change them. Encourage your client to be kind and compassionate to themselves about having these thoughts. People usually have negative thoughts for a reason. It can be helpful for your client to engage in a mindfulness meditation practice, but it is not necessary.
- Decenter from the thought. In this step, clients learn that they don’t have to believe their thoughts. Our thoughts are often the result of old ingrained habits that make sense given our past, but do not reflect our present reality. I explain that we tend to think of our thoughts as part of us, but we can put some space between us and our thoughts. In that space we can choose how to react to our thoughts. For example, I could think, I will never feel back to my old pre-COVID self. One possibility is to believe this thought and get depressed; another possibility is to think, Hello COVID thoughts. You may be right, but you may be wrong; I don’t really know. I can just get on with my life. Decentering is not trying to stop a thought, just adopting a different attitude toward the thought.
- Decide how to react. After decentering from their thoughts, clients then decide if they want to pay attention to them and how they want to behave. For example, your thought may say, My boss will think my ideas are stupid; I should keep them to myself. You can note that you are having this thought, but decide this is just a thought and express your ideas anyhow.
Jani was supposed to leave home for her first year at college. She had been really excited. Instead, because of the pandemic, she lived at home and took all her courses online. She had just heard that COVID cases were up again in her city. Jani was sick and tired of COVID. She told her therapist, “Things will never get better. I am going to have the most miserable year again. Maybe I will never get to go to a real class.”
Here is how her therapist helped Jani to use the three steps.
Step 1: Jani became mindful of her thoughts. Jani accepted that she was having all these negative thoughts. She acknowledged that it had been a hard year, and it was scary to hear that cases were going up. Jani treated her reaction with compassion and did not try to change her thoughts.
Step 2: Jani decentered from her thoughts. Jani acknowledged that her thoughts might be true, but also might not be true. She didn’t really know what her college experience would be like, this year and in future years, and how she would react. Rather than believe her thoughts and spiral into a depressed mood, Jani reminded herself that her thoughts were just thoughts and not necessarily accurate. She also reminded herself that the future is unpredictable.
Step 3: Jani decided she did not want to pay attention to her thoughts. She treated her thoughts with kindness—it made sense that they were there—but she wanted to get on with her life as much as possible despite COVID. When Jani did not pay attention to them, her thoughts became less powerful.
Using mindfulness and decentering allows clients to create space from their negative thoughts and put them aside. This opens up the possibility of reacting in a different way. This involves three steps: First, become mindful and accepting of thoughts; second, decenter from thoughts; and third, realize that you can choose how to react and do not have to automatically follow the path set by your negative thoughts.
Nina Josefowitz, PhD, is a psychologist and an acclaimed teacher known for her interactive, experiential approach. She has taught cognitive behavioral therapy (CBT) to mental health workers throughout the world, including psychiatrists and psychiatric residents in Ethiopia, psychologists in China, and graduate students in India. She has given workshops on CBT to social workers, nurses, occupational therapists, counselors, psychologists, and students in North America. For more than twenty years, she has taught CBT to graduate students in the department of applied psychology and human development at the Ontario Institute for Studies in Education (OISE) of the University of Toronto. She has published in the areas of trauma, women’s issues, ethics, the therapeutic relationship, and a variety of issues related to CBT. Her most recent interests include adapting CBT to diverse populations and developing experiential teaching methods. Learn more at www.drninajosefowitz.com.