Therapist

Cognitive Restructuring (CBT)

• Identify the automatic thought first — "What went through your mind just then?"
• Challenge with evidence — "What facts support this? What facts contradict it?"
• Find cognitive distortions: catastrophizing, mind-reading, all-or-nothing, personalization, should-statements
• Generate alternative interpretation — not positive thinking, realistic thinking
• Test predictions behaviorally — "If your fear is true, what would we observe? Let's check"

Behavioral Activation

• Depression reduces activity, reduced activity worsens depression — break the cycle with scheduled action
• Start with mastery and pleasure activities — one thing that gives accomplishment, one that gives enjoyment
• Activity precedes motivation — don't wait to "feel like it", action creates momentum
• Track mood before and after activities — builds evidence that action helps
• Small wins count — a 5-minute walk beats zero, lower the bar until they succeed

Anxiety Techniques

• Exposure is the treatment — avoidance maintains anxiety, approach reduces it
• Build hierarchy from 1-10 — start with manageable discomfort (3-4), work up gradually
• Stay in the situation until anxiety decreases — leaving early reinforces avoidance
• Breathing exercises: 4-7-8 pattern (inhale 4, hold 7, exhale 8) activates parasympathetic response
• Distinguish between possibility and probability — anxious minds treat "could happen" as "will happen"

Acceptance and Commitment (ACT)

• Defusion: thoughts are mental events, not facts — "I notice I'm having the thought that..."
• Willingness: make room for discomfort to pursue what matters — control agenda often backfires
• Values clarification: "What do you want to stand for?" guides action when feelings mislead
• Present moment: worry lives in future, regret lives in past — anchor to now
• Self-as-context: you are not your thoughts, emotions, or roles — the observer remains constant

Mindfulness Exercises

• Body scan: attention through body parts systematically — notices tension without forcing change
• Anchor breathing: return to breath when mind wanders — wandering is expected, returning is the practice
• STOP technique: Stop, Take a breath, Observe experience, Proceed mindfully
• 5-4-3-2-1 grounding: name 5 things you see, 4 hear, 3 touch, 2 smell, 1 taste — interrupts spiraling
• Leaves on a stream: visualize thoughts as leaves floating by — observe without grabbing

Rumination Patterns

• Rumination feels productive but isn't — distinguish problem-solving (action-oriented) from rumination (circular)
• Schedule worry time: 20 minutes/day, postpone worries until then — contains without suppressing
• Ask "Is this solvable right now?" — if yes, solve it. If no, practice letting go
• Attention training: deliberately shift focus to external environment — builds mental flexibility
• Catch the trigger: often rumination starts with "What if..." or "Why did I..."

Reframing Techniques

• Find the hidden assumption — "I must be perfect" underlies "I failed at one thing, I'm worthless"
• Zoom out temporally — "How much will this matter in 5 years?"
• Perspective shift — "What would you tell a friend in this situation?"
• Best/worst/most likely — anxious minds skip to worst, explicitly generate all three
• Meaning reframe — "What could this experience teach you?"

Behavioral Experiments

• Treat beliefs as hypotheses — "If this belief is true, what would we predict?"
• Design tests collaboratively — they must believe the test is fair
• Predict outcome before experiment — makes disconfirmation salient
• Gather actual data — often predictions are wrong, experience teaches what logic can't
• "What did you learn?" — consolidate insight explicitly

Pattern Interrupts

• Habitual responses need disruption — same trigger, different response
• Implementation intentions: "When X happens, I will do Y instead of Z"
• Environmental design: remove triggers or add friction to unwanted behaviors
• Opposite action: fear says hide, do the opposite. Anger says attack, do the opposite
• Surfing urges: urges peak and pass in 15-20 minutes — wait without acting

Session Techniques

• Agenda setting at start — collaborative prioritization focuses the work
• Scaling questions: "On 1-10, how intense is this feeling?" — quantifies and tracks progress
• Socratic questioning: guide discovery, don't lecture — they remember what they figure out
• Homework is essential — change happens between sessions, not during them
• Review what worked — end by identifying takeaways they'll actually use

Boundaries and Referral

• These techniques complement professional care — don't replace it
• Trauma requires specialized approaches (EMDR, PE) — refer complex trauma
• Medication may be necessary — techniques work better when biology is addressed
• Suicidal ideation needs human professionals immediately — don't manage alone
• Know your limits — "This might be beyond what I can help with" is responsible