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Returning to work Negative thoughts, anxiety and worry.

The real worries you expressed

These are real statements made by pilots at risk of losing their jobs:

“What’s the point of studying? I’m likely to lose my job soon anyway”.

“My wife says I can’t do more than I am, but I don’t believe her”.

Here's Olivia Hendriks to add some perspective to what some of us may be feeling.

Aquila's psychologist, Olivia Hendriks

Negative thoughts and thought challenge

• Negative thinking is a thought process where people tend to find the worst in everything or reduce their expectations by considering the worst possible scenarios, such as the case above. It is common for people to adopt this style of thinking whenever they are experiencing low mood or anxiety, and it is a rational response to negative events that may occur in one’s life. This approach can allay disappointment in some situations; but, negative thinking tends to manifest into a pattern that can cause tremendous stress, worry, or sadness over time (negative thinking styles were explored more in depth in the previous module so I won’t go into much detail here).

• When we’re feeling bombarded by negative thinking, it can be tempting to try to shift things with a giant dose of positive thinking; by telling ourselves to look on the bright side or go searching for a silver lining. This is not an effective way to challenge negative thinking.

• Cognitive behavioural therapy (CBT) uses an intervention called ‘thought challenging’ to combat negative thinking. It isn’t about thinking positively in a negative situation. This technique will help you to consider things from multiple angles, using actual evidence from your life. It involves looking at the whole picture and weighing it up.

• Thought challenging will help you consider things from a more objective perspective, rather than just assuming that your thoughts are the facts or “the truth” (even though some thoughts really do feel like they are facts!).

• In short, thought challenging is an untangling technique, for the mind.

• Now the beauty with this approach is its simplicity. This technique involves asking yourself a series of questions that ultimately open up your thinking.

• Let’s take the example of “what’s the point? I’m likely to lose my job soon anyway”, or “my wife says I can’t do more than I am doing but I don’t believe her”.

• Here are 12 simple questions to get started.

1. Have I had any experiences that show that this thought is not completely true all of the time?

2. When I am not feeling how I do currently, how might I think about this situation differently?

3. Does anything contradict my thought that I might be discounting as not important?

4. Am I jumping to any conclusions that aren’t justified by the evidence?

5. If someone who loves me knew I was thinking this thought, what would they say to me about this thought? What evidence would they point out to me that would suggest that this thought is not 100% true?

6. How might someone else view this situation if it were happening to them? For example, my mother, my friend or a colleague?

7. What happened last time I was worried about this?

8. Do I know that this thought is true, or do I just feel that it is?

9. If this thought was true, what is the worst thing that could happen? What are some of the ways that I could cope with that?

10. Is this the only way to think about this? What are some other ways?

11. What are the disadvantages of thinking in this way versus trying to adopt a more balanced and helpful thinking style?

12. Even if there is a grain of truth in this thought, is it helpful for me to think this way?

'Take your thought to court'

• To simplify it even more, CBT therapists like to use the activity of “taking your thought to court”. If your thought wouldn’t hold up in a court of the law, then it simply isn’t true. There needs to be actual evidence to back it up for it to be worth believing. Statements without evidence would be dismissed in court as hearsay. Would your thought also be dismissed? If not, what’s the evidence that supports it?

• After asking yourself the questions above try summarising the new perspective you have on your thought, with the evidence you have surrounding the current situation.

• For example, for the thought, “What’s the point? I’m likely to lose my job anyway”, you might write something like: “Due to the current pandemic, my job may not be completely secure. However, I have not lost it yet, and I do not know if I will lose it. I have not heard any information regarding the outcome of my job.”

“My wife says I can’t do more than I am doing but I don’t think I believe her”. List all the things that you are doing: are you taking all routes that you are aware of? If yes, then new thought would read “I am doing everything that I currently know about at this moment in time”. If no, then “I am doing ____ but I am not doing ____. I will start working towards the latter”. You can’t beat yourself up for not doing things you are not aware of.)

• Thinking in a more evidence-based and rational way will ultimately affect your negative emotions, unproductive behaviours and possible uncomfortable physical symptoms you may be experiencing due to low mood and/or anxiety, as all of these areas have a knock-on effect on the other areas. In CBT this is called the “vicious cycle”. It can keep you in a spiral of feeling anxious, low and worried. If you break into this vicious cycle in one area (in this case, your thoughts), you can have a positive impact on the other areas.

When looking at behavioural activation, the intervention I discussed in the module (increasing activities), it is the behaviour area of the cycle you are breaking. This then has a knock on effect on your thoughts, physical symptoms and emotions. The vicious cycle can work in all directions. It is harder to alleviate physical symptoms and change emotions, which is why CBT generally tends to focus on the behaviour or thoughts areas of the cycle, as these can be more easily controlled. This vicious cycle is basically the foundation of all CBT interventions.*

A few things to keep in mind when practicing thought challenging:

Thought challenging often feels forced and unnatural at first. It can take practice before it starts to feel genuine and believable.

To build your confidence, it’s a good idea to practice with thoughts that feel a little more flexible and less upsetting. Initially it also helps to try this technique when you’re feeling reasonably neutral. It’s a big ask to try it after a tough day or when you’re feeling tired or stressed.

When you first try thought challenging it’s useful to jot down your responses. Often when people try to do it in their head, they wind up going around and around in circles, which sometimes actually just makes the thoughts feel more intense and believable.

The other benefit to writing things down is that if a similar thought comes up in the future, you can refer back to your notes to try to tap into a more balanced way of thinking.

It can also be a real eye-opener doing thought challenging with a family member or friend you trust and don’t feel judged by. They might be able to help shed some light on some of the blind spots in your thinking (we all have blind spots by the way!) or offer a different perspective.

When practicing this technique, it’s best to focus on a single thought, rather than a series of thoughts. Break your thoughts down into single sentences and challenge these individual sentences. Trying to challenge a pile of thoughts at once doesn’t really work and ends up being confusing.

Plan to do something distracting after you’ve worked your way through some thought challenging questions. It’ll give your mind time to allow some of new thoughts to settle.

Background worries that can overwhelm us.

“I'm on 50% pay and I can’t pay my bills. How will I focus on the job?”

“my family needs me to earn income and my savings are running out”.

• Worrying at an extremely stressful and uncertain time such as the present is a completely natural response that everyone would have.

• In order to cope with these worries more effectively, it is important to firstly classify the worry. There are two main types of worries: practical worries and hypothetical worries.

• Practical worries are often about a current situation that you can do something about. For example, worrying about being underprepared for a job interview will motivate you to prepare more, and thus the worry is alleviated. We have an element of control over these types of worries. It’s something we can act upon now or put a plan in place for later. In this case it might be “I’m on 50% pay and can’t pay my bills”.

• Hypothetical worries on the other hand are often about the future and what might happen. These worries are about things that we do not currently have control over and therefore cannot do anything about. Hypothetical worries often come in the form of a “what if”. In this example, it’s “what if I can’t focus on my job due to my current money issues?”

• If your worry is practical, CBT recommends the use of ‘problem solving’ as a helpful technique to create a manageable action plan to start solving the worries.

• If your worry is hypothetical, then problem solving would not be helpful. Instead the technique to use is ‘worry time’, to learn to let go of worries that you cannot do anything about.

Problem solving intervention (practical worries)

Step 1: Identifying one problem:

It may be that you have more than one problem at a time, therefore the first step of problem solving is to choose one problem, perhaps start with the problem that will make the most difference if it was not there. It is important that we define the problem as clearly as possible, try to be clear about what aspects of the situation make it a problem.

E.g “I’m on 50% pay and can’t pay my bills”/”my family needs me to earn income and my savings are running out”

Step 2: List all possible solutions:

List as many solutions as possible: Don’t worry about how practical, good or reasonable the solutions are at this stage. Try for a list of at least five possible solutions. It can be difficult to come up with solutions when we are feeling overwhelmed, therefore it is important that we try to be as creative as possible so you can come up with solutions you may not have thought about previously. It can also be helpful to ask a trusted friend or family member to help you come up with solutions, or even to look online.

E.g ask to borrow money from family, take out a loan, ring billing company and ask for an extension due to current situation, etc...

Step 3: List the advantages and disadvantages of each solution:

E.g “ask to borrow money from family”

Advantages: easily done, pandemic isn’t affecting them financially, don’t have to pay interest when paying back, etc...

Disadvantages: not sure how long my 50% pay will last so I may have to repeatedly ask them for more money, I don’t want them to worry about me, etc...

Step 4: Select one solution:

After reviewing the advantages and disadvantages of each solution, select one solution that you feel at the time will have the best chance of the most positive outcome. It may be difficult to choose a solution as you are concerned that it will not work, however keep in mind that you have gone through the strengths and weaknesses of each. If several solutions seem equally good then pick the one that requires the least effort.

Step 5: Make an action plan:

Develop an action plan of how you will carry out the solution step by step. Some useful questions to consider while developing the action plan are: What is the first step I need to take? Where will I be? Who will be involved? When will I carry out the plan? Carrying out the plan may be difficult it is important that we are very specific about each step of the plan and to break it down into manageable steps.

Step 6: Implement the plan and review:

Carry out the solution as outlined in the action plan you developed in Step 5. Once you have carried out the plan evaluate how effective the solution was. Think about what went well, or what you might do differently in the future. If the solution did not fully fix the problem, then consider whether the action plan needs to be revised or return to Step Four and choose another solution instead. Learning from an attempt can be invaluable in identifying the best solution.

Worry time intervention (hypothetical worries)

Worry time is a set period of time each day allocated to worrying. Worry time can be helpful in reducing the time we spend each day worrying, allowing us to enjoy our day to day lives. When we worry during the day, instead of focusing on these worries we postpone them for our allotted worry time.

Step 1: Choose your worry time:

It is important to set aside, what you feel, would be a sufficient time each day for worry time, when you will not be interrupted or distracted. This time should ideally be in the evening, but not too close to bedtime, to mull over the day's worries. It is important to stick to the same time each day in order to build a routine e.g. 5pm before dinner for 20-30 minutes. You may find that the more you use worry time the less time you need each day, then you can reduce your worry time accordingly.

Step 2: Capture your worries:

When you notice that you are worrying during the day, write them down. You can do this on a notepad or even your phone. If the worry is a practical worry, use problem solving to solve it. If the worry is a hypothetical worry go to Step 3 of worry time. If you find that you are worrying a lot at night, it can be useful to keep your diary or a note pad near your bed.

E.g “how will I focus on my job if I’m worrying about financial issues?”

Step 3: Refocusing:

Once you have captured your hypothetical worry and written it down, it is then important to refocus. This may sound difficult at first but remember you will spend time worrying about it later, in your scheduled worry time. Meanwhile, refocusing involves paying attention to the present. Pay attention to whatever task you were doing when the worry came into your mind. Refocusing from our worries can be very difficult to do when we are not used to it. Using our 5 senses can help us to do this. Concentrating on our sight, hearing, smell, touch and taste can help to ground ourselves in the present. For example, if you are doing something like the washing up focus on the scent of the bubbles, the temperature of the water or the sound of the splashing. A popular mindfulness technique is naming 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell and 1 thing you can taste. Other ways to refocus might be to engage in a different task, such as cooking, reading a book or exercise. Some people find that listening to music is a good way to refocus. Find whatever is best for you to be able to attend to the present. When further worries come into your mind through the day, repeat the process. Write the worry down and then refocus on the present. You might find the more you practice this the easier it becomes.

Step 4: Worry time!

When your worry time comes around, it is time to worry! Get out the list of the hypothetical worries you have written down during that day and select a worry to start to worry about. It is useful to ask yourself questions about each worry:

- For each worry consider how you felt when you wrote the worry down and how you feel about it now, has this changed?

- Did the thing you were worrying about happen?

- If so, how did you cope?

- Are any of the worries no longer a problem?

- Would continuing to worry about it during the day have made a difference?

- What could you be doing now instead of worrying?

Once you have done this for each of your worries and get to the end of the worry time it is important to stop worrying. You may find it helpful to destroy the list of worries: rip them up or throw them away at the end of each worry time and start with a fresh sheet every day. As you practice this technique you may find that outside of your worry time you are more able to manage the worries. As you progress with this technique you may find you are using less time than you originally thought each evening to worry. If this is the case, you can reduce your allotted worry time in line with your current needs. You may find that eventually you don’t need this time at all. Also, as you progress you may find it is not necessary to write down your worries and you can refocus without this step.

Feelings of worthlessness or of being a failure

We tend to go through life evaluating ourselves and others according to a scale of worth. The concept of self-esteem is the amount of value that we consider we are worth. These values vary from person to person. Whilst we might rate ourselves as being of little value, others might rate us much higher. If we get into the habit of thinking negatively about ourselves or comparing ourselves against others, then low self-esteem, worthlessness, or placing little value on ourselves, is the result.

Low self-esteem or worthlessness can be a result of negative life experiences such as failing to get a job.

Low self-esteem can stay low, because of our own self-critical thoughts, which can be triggered by criticism, or perceived criticism (even if none is intended, we believe we are being criticised).

It can cause us to feel depressed, hurt, angry, frustrated, anxious, ashamed, guilty, stressed and much more. It can create negative and self-critical thoughts such as: “I'm stupid, I'm worthless, It's my fault, I'm a failure, I'm not good enough, I'm incompetent” etc. We may engage in unhelpful thinking styles (discussed in previous module e.g all-or-nothing thinking, mind reading, personalising). It may shape our behaviours as well. We may get defensive when we believe we're being criticised, under-achieve or work harder to compensate and cover up our perceived incompetence, become shy and passive around others, avoid situations and people, or neglect or abuse ourselves.

The Malevolent Parrot:

Imagine you're given a parrot. This parrot is just a parrot - it doesn't have any knowledge, wisdom or insight. It’s bird-brained after all. It recites things ‘parrot fashion’ - without any understanding or comprehension.

However, this particular parrot is a poisoned and poisonous parrot. It's been specifically trained to be unhelpful to you, continuously commenting on you and your life, in a way that constantly puts you down, criticising you. For example, the bus gets stuck in a traffic jam, and you arrive at work 5 minutes late. The parrot sits there saying: "There you go again. Late. You just can’t manage to get there on time can you? So stupid. If you’d left the house and got the earlier bus, you’d have arrived with loads of time to spare and the boss would be happy. But you? No way. Just can’t do it. Useless. Waste of space. Absolutely pathetic!"

How long would you put up with this abuse before throwing a towel over the cage, or getting rid of the parrot? We can often put up with the thoughts from this internal bully for far too long.

We can learn to use the antidote: notice that ‘parrot’ - and cover the cage. "There's that parrot again - I don't have to listen to it". Go and do something else. Put your focus of attention elsewhere. Be persistent in your practice! Eventually this poisoned parrot will tire of the towel, tire of you not responding. You'll notice it less and less. It might just give up its poison as your antidote overcomes it, or perhaps fly off to wherever poisoned parrots go.

Feelings of worthlessness and low self-esteem can be alleviated in many ways.

Doing things differently:

Communicate with others assertively,

Set achievable and realistic goals. When you achieve them, congratulate and treat yourself, and allow others to congratulate you,

Accept compliments and praise,

Visualise positive change,

Look after yourself - eat healthily, exercise, do more things you enjoy doing (behavioural activation),

Reward yourself for achievements and successes - however small,

Thank others - show your appreciation, and others will appreciate you,

Do things for others - help someone out. It makes us feel better about ourselves. Set limits and agree what you will and won't do,

Write a compassionate letter to yourself,

If you can do something well, let others notice - when they notice your work, so their opinion of you will be raised, which in turn, raises your own self esteem,

Engage in ‘problem solving’ intervention: this helps people take a more active role in proactively solving problems, rather than feeling like a ‘victim’ or passively allowing the unhelpful status quo to persist. Problem-solving can take the form of actively seeking to target factors that result in poor performance and remedying them.

Think differently

STOPP:

S = Stop: Just pause for a moment.

T = Take a breath: Notice your breathing as you breathe in and out. In through the nose, out through the mouth.

O = Observe: What thoughts are going through your mind right now? Where is your focus of attention? What are you reacting to? What sensations do you notice in your body?

P = Pull back – put in some perspective: Don’t believe everything you think! What's the bigger picture? What is another way of looking at this situation? What advice would I give a friend? What would a trusted friend say to me right now? Is this thought a fact or opinion? What is a more reasonable explanation? How important is this? How important will it be in 6 months time? It will pass.

P = Practice what works – proceed: What is the best thing to do right now? What is the most helpful thing for me, for others, for the situation? What can I do that fits with my values? Where can I focus my attention right now? Do what will be effective and appropriate.

What am I reacting to? What have I been thinking about here?

Is this thought: fact or opinion? (thought challenging)

Is that "Internal Critic" operating again?

There's that parrot again! I don't have to listen to it.

Thoughts are just thoughts!

Am I getting things out of proportion?

How important is this really? How important will it be in 6 month's time?

Am I expecting something from myself that is unrealistic?

What's the worst (and best) that could happen? What's most likely to happen?

Am I using that negative filter? Those gloomy specs? Is there another way of looking at it?

What would I think about someone else in this situation? What would I say to a friend?

Am I spending time ruminating about the past or worrying about the future? What could I do right now that would help me feel better?

Am I putting more pressure on myself, setting up expectations of myself that are almost impossible? What would be more realistic?

Am I jumping to conclusions about what this person meant? Am I mis-reading between the lines? Is it possible that they didn't mean that?

What do I want or need from this person or situation? What do they want or need from me? Is there a compromise? How could I act in a way that was more effective or helpful?

Am I just focusing on the worst possible thing that could happen? What would be more realistic?

Am I focusing on the negative, putting myself down? What would be more realistic?

Is there another way of looking at this?

Am I exaggerating the good aspects of others, and putting myself down? Or am I exaggerating the negative and minimising the positives? How would someone else see it? What’s the bigger picture?

Things aren’t either totally white or totally black - there are shades of grey. Where is this on the spectrum?

What would be the consequences of doing what I normally do?

Is there another way of dealing with this? What would be the most helpful and effective action to take? (for me, for the situation, for the other person)

Be compassionate with yourself - just as you might be with someone else

What would a caring friend say to me in this situation?

What is a kind and constructive way to think about how I can improve this situation?

Whoever said human beings are supposed to be perfect?

Would a caring mother say this to her child is she wanted the child to grow and develop?

How will I learn if it's not okay to make mistakes?

Acknowledge your strengths - write out a list of things you're good at, or what others have or do say about you.

Notice the positives - carry a notepad around and write down whenever you notice something good or helpful that you've said, or done, or what others have said about you.

At the end of each day, ask yourself: What have I done or tried today that I've never done or tried before? What have I done to help other people today? Who has helped me? What have I enjoyed doing today?

We hope you found this presentation useful. Remember, many of your colleagues, peers as well as managers are probably feeling much the same as you right now.

If you are worried, please keep talking. Whether it's to your friends, workmates or family. Don't suffer in silence.

Here are some organisations which can offer help if you feel unable to cope:

Credits:

Aquila Jet Training Ltd