Enjoying the Flowers

by Michael Upston, LCSW

Those of us who are familiar with the 1970s and 80s New Wave band Talking Heads might remember David Byrne singing in an eerie voice that the "air can hurt you too." This is from their song Air and it expresses how many people are very understandably feeling these days.

In my previous blog I explored the importance of managing our emotional reactions to the coronavirus by responding to what we have good reason to believe is the case, rather than to what we merely feel is the case. The underlying point being, in order to develop effective strategies, we need to respond to what actually is the case, not merely to what we think is the case. As the saying goes,"feelings are not facts." In that blog I suggested testing our beliefs against the actual evidence. I also talked about how this is a lot easier said than done. In this blog I will explore specific techniques that can help us to know when our concerns are based in actual facts, versus when we are simply responding to our emotions.

Psychology offers many effective ways to manage our emotions, but one that has prevailed in many years of research is Cognitive Therapy, developed by Aaron Beck and Albert Ellis. The theory is that we must identify, challenge, and change our irrational thinking patterns in order to balance our emotional experience. Examining our thoughts is a pragmatic and scientific approach that involves looking for evidence and “checking the facts,” as Marsha Linehan suggests in her incorporation of cognitive therapy into her treatment approach. So if our emotions do not fit the facts and evidence, then one must step back to find a more balanced perspective on the situation. If however, our reaction matches the situation, then the goal is to problem solve. We do need to follow all the sensible safety precautions we have been told, such as practicing social distancing, washing our hands regularly, and avoiding touching our face.  We do this not simply because we feel we should, but because it is a fact that these behaviors will help to reduce the spread of the coronavirus. Those that don't do these things really do put themselves and others at risk.  

However, as cognitive therapy techniques remind us, sometimes our feelings and reactions don't fit the factual evidence. Let's say I'm driving late at night and get a flat tire forcing me to pull over on a road that is poorly lit.  Then let’s say a car comes up behind me and a very big person gets out holding something that looks like a club. This would most likely cause me to feel afraid and the fear would give me the urge to engage in certain behaviors. For example, I might have the urge to get back in the car and drive off, even though I have a flat tire. But let's say that, as the person gets closer, I realize it's my very good friend who has a tire iron and is there to help me. Then I would no longer feel afraid, but rather grateful and relieved. This new set of feelings would give me the urge to engage in different behaviors. For example to run up to the person and say, "great to see you!" The point being, that in each situation my emotional reaction created urges to engage in certain behaviors, and was based on how I was perceiving the situation. In the first situation my perception was not correct, so had I acted on the emotion it would not have helped. This illustrates the need to check the facts before acting on our feelings.

But how do we check the facts?  In cognitive behavioral therapy, a tool that is commonly used to help people assess the accuracy of their thoughts is a thought record. There are many different forms of this, but it essentially covers a few basic categories.

The first step is to identify the thoughts we are having about the situation.  This can be hard to do, especially if we have not practiced it. Often we are first aware of the feeling that the thought is triggering, or the behavioral response to this feeling. For example, I might be aware that I'm feeling anxious, or engaging in the behavior of never leaving the home, without knowing what thought is triggering that feeling and behavior.  A common trick which is helpful in identifying the underlying thought is, when we are having a feeling, to ask ourselves: what is going through my head right now?  The more we practice doing that, the better we will become at identifying the thought (Beck, 2011). For example, in this case let's say the thought is that by going outside I will contract the coronavirus.  

Once we're able to identify the thought, it is helpful to assess if there are any mistakes in our thinking.  These thinking mistakes are often called cognitive distortions. Judith Beck (2011) lists several cognitive distortions that are commonly used.  For the sake of this blog I won't go through all of them, but there are a couple that particularly seem to apply to our current situation.

In the above example, I'm having the thought that if I go outside I will expose myself to the coronavirus. Two cognitive distortions that are operating in this are catastrophizing (thinking that I can predict the future and that the future will be catastrophic), and emotional reasoning (believing that something is true because I feel it is the case, independent of any objective evidence).  I suspect that many of our unrealistic fears regarding the coronavirus stem from thoughts which fall into one of these two categories.  

Once we have identified the thoughts, and possible mistakes in our thinking, then it is helpful to question the thoughts.  Some helpful questions might be: 1) what is the evidence for and against the thought; 2) are there alternative ways of understanding the situation; and 3) what would I tell somebody else who is in this situation?  One can feel free to come up with one's own questions, but hopefully this gives a starting point.  After assessing the thoughts in this way, we should then ask ourselves if there is a more logical, realistic way of understanding the situation.

So regarding my thought, assuming I practice responsible social distancing and wear a mask, there's no real evidence to suggest that going outside poses any serious threat. An alternative way of looking at it would be that it is safe, and emotionally healthy, to go outside as long as I wear a mask and practice social distancing.  This is the advice that I would give to somebody else, and after going through this process a logical conclusion to draw.  

Will this get rid of my anxiety? Maybe not. But it does give me the ability to step outside of the feeling and have some choice over how I'm going to react to it.  If the feelings don't fit the facts, Marsha Linehan (2015) recommends using the skill she calls opposite action. This means doing the opposite of what the feeling is urging me to do. In this case it means to go outside and enjoy the day, while practicing all the sensible guidelines that are involved in responsible social distancing.  

During these very trying times, all of us are going through a lot. Let’s be kind to ourselves and take some time on each of these spring days to enjoy the flowers.  There is no evidence to suggest that this is harmful, and a lot of evidence to suggest that it is just what the doctor ordered.  

References

Beck, J. S. (2011). Cognitive behavioral therapy: Basics and beyond (2nd Ed.). New York: Guilford Press.

Linehan, M. M. (2015). DBT skills training handouts and worksheets. New York: Guilford Press.