Much of what I have published on my website (handouts, blog, and podcasts) has dealt with cognitive therapy. From time to time, patients have asked me, "After the four column technique, what do I do then?"
That question has tended to puzzle me. I would generally say something like, "Once you have challenged the negative thoughts, then most of the work has been done."
I think I understand my clients' questions better now, and I think I have a better answer than the one I used to give.
The key to handling stress is, I believe, a sequence of cognitive therapy, problem solving, and mindfulness.
1. Cognitive therapy. This involves hitting the most irrational thoughts head on. When something negative has happened, we may tend to catastrophize. Or we may gravitate towards another type of negative thinking, such as mind reading, all or nothing thinking, etc. The first step is to use all the cognitive therapy techniques (and mainly the four column technique) to dismantle the irrational negative thoughts.
2. Problem solving. After the cognitive work is done, take time (about 30 minutes or so) to consider all your problem solving options. What can be done about the problem? Which of the available options do you want to try? Consider page 20 in http://www.drbeckham.com/handouts/CHAP05_COPING_WITH_WORRY_AND_ANXIETY.pdf
3. Put the problem on the shelf and let go. Once you have chosen an option to try and fix the problem, then you may be able to implement it immediately. Or you may have to wait until you have the opportunity to actually do something abou it. You may have to wait until the next time you see your boss. Or you may have to wait until the parent teacher conference. Or you may be able to do something right now. If so, you may want to do something immediately. Either way, once you have done what you can do for that moment, let go.
There is no advantage to constant ruminating and worrying. If you try to do the four column technique 24 hours a day, or if you try to problem solve 24 hours a day, what do you gain? Probably very little. If you ruminate about the problem 24 hours a day, what do you have to lose? Probably a lot. You will probably become more depressed and/or anxious.
I realize that putting a problem on the shelf is not always easy. We want to ruminate. Our mind wants to zoom in, laser like. We want to fix things RIGHT NOW. However, after we have taken action (or after we have decided how we are going to take action) there is no advantage in continuing to think about it.
How do we let go of the problem and our negative thoughts? I will be writing another blog entry on that point. The answer is in the techniques offered by mindfulness treatment of depression and anxiety. These techniques help us to let go, rather than being embroiled by and consumed by our emotions.
To summarize, here is the technique in summary:
(For those of you who remember the four column technique)
Column 1: The triggering event.
Column 2: The automatic negative thought
Column 3: The feeling generated by the ANT.
Column 4: Challenging the ANT.
Column 5: Identifying problem solving options available to us.
Column 6: This could be a blank column, because it can involve a nonverbal appreciation of the world rather than being stuck in a series of thoughts. Or it could involve answering the question: "What are my senses experiencing right now?" There is no way to explain this column here in this one blog. That will have to come later after I have written several postings on mindfulness. After that, I will take a stab at coming up with some specific steps or questions for Column 6.
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