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#26 Therapy Demystified Part 2: A CBT Session in Action · College Is Fine, Everything's Fine

I'm Dr. Sarah Olivo. And I'm Dr. Liz Seidler, and you're listening to college is fine. Everything's fine.Okay. All right. So last week you got to learn some of the therapy secrets. What do we write on the notepad? What are some things we're thinking as you're telling your story? We thought about doing this in one episode, but as we were listening to Anishka story, we realized that a big piece was just what it's like to be in the room, how to feel comfortable with your therapist.But there are a lot of elements we wanted to take more time to explain and specifically, to explain the types of therapy we do, which is cognitive behavioral therapy. You've heard us say it a thousand times. We say c b T for short. And really that's just how thoughts, behaviors, and some body signals can work together to either keep you stuck or to move you forward in the direction you wanna go.That's putting it pretty simply. Some of those things Anishka discussed with me, we wanted to draw out a little bit and also maybe add a bit more because you heard what a first therapy session might be like. But a lot of the work, other things you might be curious about, like what does the work look like happens not in the first session.So we're gonna demystify some of the C B T elements for you. Yeah, I think we wanna start with helping you understand what C B T is and you know, Sarah alluded last week to how she's trying to understand kind of what's going on with a person from a C B T framework. When you hear cognitive behavioral therapy, it's just a large umbrella that has like some specific treatments underneath it.That might be dialectical behavioral therapy or acceptance and commitment therapy. or a lot of mindfulness based interventions kind of fall under C B T, but some of the things that we talk about today are pretty integral to all of those different types of C B T treatments. It kind of, there is this core framework in terms of this tri-part model between how our thinking and our behavior influences the emotions that we're experiencing.What would you say across all the CBT therapies, right? What would you say all have in common? One is, I would say that it's pretty collaborative. you want the person coming in working with you, that you're there to assess and guide. They're there to show you what their thoughts are and where the behaviors are that get stuck, but you're not necessarily an expert on them.Mm. have some knowledge about how the mind and body and actions work together, they're the ones very much giving you feedback about what's working and what their goals are. For instance, someone might come in, I might have. told me a lot of different things that they wanna work on, right?Or sometimes people say, I just wanna work on this one particular area. And even if I'm thinking like, oh, I could help with this, or that, or the other, we really say, okay, well this is what you're bringing in today. This is where you wanna start. So it's meeting the client or the patient where they're at. Yeah. And the second piece I would say that goes across all types of C B T is that, the aim is really for you to become your own therapist. That we're educating people who come into our office about what the model of emotions looks like, right? It is skills-based. You're going to learn things, we're going teach you things, and you're gonna fly solo at some point.The goal is for you to graduate treatment at some point. to feel like you have the self-efficacy and confidence in being able to use the skills that we teach you. And then we focus on relapse prevention. Like what are you going to do? How can we cope ahead for, you know, maybe some of the circumstances that got you into my office that those kind of resurface.What are you gonna do differently this time?Right. So it's goal oriented too, in the sense that once you and your therapist decide on what your goal or goals are, At least I know that Liz and I, the way we're thinking is we're constantly keeping our eye on that target. And yes, maybe you have a bad day and you wanna come in, you wanna vent, please do.We wanna feel supportive and warm, and we're always gonna be looking to see what can we do today? How can we use this experience to help you essentially graduate? You know, I say to the people I'm seeing, the students I see, you know, look, if you wanna be here every week, , Right, right.let's talk about that. Most people don't. They'd much rather be spending that hour with friends or a family or doing something fun or just relaxing on their own. So that's our goal too. We want to have them be in a place where they no longer need us and they're internalizing what we talk about. So a lot of times it can feel like, Hey, okay, so you told us about this problem on day one.Let's make sure that we're continuing to work towards. and it's also very focused in the sense that it emphasizes what's going on Right, now. Now, we mentioned last week, it's not that we don't care about the past. The past is a big part that informs why you might be thinking or feeling a certain way.So it's not that, but we're really thinking about what are the things that are happening in the present? What do you have control over and not in the present? How is this impacting your life right here and now and dealing. Skills or behaviors or ways to think about things that can help you right. now? Sarah, I have a, I have a metaphorNo. I'm so excited. Oh, Let's see if I nail it, but I was gonna, I actually was talking to a patient about this recently where they were criticizing C B T for being present focused. And then I was, I was basically saying like if you broke your foot and you ended up in the er and the doctor basically was like, how did you break the foot?And you didn't really know what happened or couldn't really explain it. It's not like they wouldn't treat you for your broken foot, right? They would treat you. Um, and essentially your bone will eventually heal. I think it's similar to C B T that I'm not gonna not treat someone if they don't understand or are able to explain how they develop certain problems?Now. That doesn't mean that I'm never going to kind of look at some of the circumstances that might lead to you breaking your foot? Like maybe we can do something to make sure that doesn't happen again in the future, but we're still gonna treat a. Even if we don't understand how you got to that problem, we're gonna focus on the here and now, cuz it's kind of like all we might have discovered at that point.Eventually we might discover other things in the past that might be useful. How'd I do Sarah that metaphor. I love that metaphor. And I'm gonna take it. I'm gonna steal it. I'll give you credit though. Thanks. Thanks, thanks, thanks. You're rubbing off on me, Sarah. Will tell you that one of my favorite mentors growing up had really trained in a psychodynamic way. This was when I did more work with eating disorders and she said, look, I, I am interested in how a person became bulimic.What are the set of circumstances? She's like, but a lot of times that's hard to figure out. That takes time. They're not really aware. Or they are aware and don't wanna talk about it right. just help let them keep suffering and binging and purging while we're trying to figure that out. So she says like, you know, look, I am somebody who does wanna think about the past first, though.We're gonna get someone feeling like they've got the right.nutrients in their body and feeling okay and stable. Then we have all sorts of time to go back and spend that time. If you're really curious, and I thought that was very well said, to sort of say, okay, let's, let's get you feeling okay. First, let's get you steady on your. then we have the luxury of going. right. Um, so, you know, essentially a therapist is equipped with a certain skillset set. They have essentially all these tools that kind of fall into the areas that Sarah started this, you know, episode with around our thinking, how we react to our thoughts, can we change them, have a different relationship with them, how we, how can we change our behavior to maybe be more skillful or effective?Um, and it's our job as the CBT therapist to understand, okay, based upon the problem you're presenting with, , what tools am I kit do I think would be the most beneficial for you to learn? And then you're gonna practice them. It really is, that's the most important part of treatment I think, is what are you doing outside of my office each week to generalize some of the tools that I'm teaching you, um, to your day-to-day life, particularly cuz most people are not in a crisis or struggling the most when they're in my office.It's when they're not there.Absolutely. And there are certain therapies like D B T if someone really does need that coaching in between, that offers that. But you're right?and we said this last week, like the best of all therapists aren't gonna be able to help you right? just thinking about remembering the things you talked about for that.in those four walls in that office, that should hopefully feel like a safe, supportive space. So, and I also think that C B T is quite structured and a lot of people don't like Mm-hmm. word. They automatically think, well that's, you know, it's too, too rigid, or so on and so forth. It's more, again, to say, are making sure that you're getting your needs met, considering your goal and thinking what are the. or actions or processes that we wanna give you so that you can get there. And so it needs to be a little structured. Otherwise it could be sort of like a balloon, you know, that gets let loose after it's fault, like kind of going all over the place.So it doesn't, I think it might feel warmer than you think when you're there, but it does help make sure that we are doing our job and also that you're staying committed and we're on the same page about what, what your goals. right? start with the beginning of the session. You're probably gonna hear me say something like, Hey, let's just hear a little bit about your week.What are the highs and lows? What's your mood like today? Mm-hmm. similar to what you've been feeling? Just sort of a general check-in and review of the week, and then starting to set what we call an agenda. But that sounds a little bit like this. It'd be like, all right?so I know we've been really focusing on.Thoughts that you keep on having over and over again. So I wanna check in on that today. I wanna give you maybe another skillset or see how practice went. I also remember you told me about, um, interaction you had with somebody that was really tough and how you didn't stand up for yourself. So maybe today we can think about some, some phrases or some skills to use there.You can practice in here with me a little bit and then I usually say, what else do you wanna add? Is Mm-hmm. wanna make sure we cover today? Does that sound similar to. Yeah, I was gonna say the things that you just, the way you described the structure of the session essentially highlights what we talked about earlier. It's collaborative. You're on the same page and I think the important part is that it's not whack-a-mole, you're not treating one problem this week, a different problem this week. You're trying to gain traction on the goals that you've put in place. And once one goal is kind of reached, you're moving on to the next goal.Right? Yeah.I always think there's just, I just want there to be a thread between session one to this session and from this session to the end, you know, so that we are tracking it. I, I don't like the whack-a-mole thing. I've seen therapists who are really excellent, make me feel wonderful and supported, but they don't necessarily remember our conversation from week to week.And I'm like, well, , Right, or am I just like, right. of plopping down every week and, um, just venting and, you know, puking out my week and then going back right.into it, you yeah, totally. okay, so Sarah and I are gonna get into some of the C and the B and CBT. And I guess I'll start first and talking about the cognitive component of CBT. So, as Sarah and I mentioned earlier, how we think and examining how we think is a really big component of cognitive behavioral therapy. And in this episode with Anushka, you heard Sarah begin to explore and use some guided discovery techniques to help Anishka identify some thinking patterns that might be unhelpful. So let's take a few minutes to kind of unpack what looking at thoughts looks like in C B T and then we'll listen to a little bit of the therapy session to hear how Sarah elicits some of that from the client. So in C B T. We recognize that everyone has a filter in which they view themselves, the world, and others.And these filters are really developed and kind of shaped by early childhood experiences. And sometimes we're not always fully aware that they are influencing how we react to situations or why we're behaving in a certain way. And part of CBT is to help you become more. Of your thinking patterns so that you can learn skills to either change the way that you're thinking or change your relationship to some of these unhelpful thinking patterns.And you know, the way that I kind of describe it to people is that if you were to take, four people, and they all had the same situation. Like let's say for example, they walked out of their house. , they unfortunately stepped on some dog shit, if you were to go through those four people and kind of examine their reaction to stepping in dog poop, they all would have a different reaction.So, for example, maybe the first person is like, oh my gosh, I'm such an idiot. I never can do anything. I can't even walk out my door and get to the car to go to work without messing things up. The second person, maybe they're like, oh my gosh, I, I, I don't have time to kind of go into the house and change my shoes.What if I go to work like this and like somebody smells the poop on my shoes? What are they gonna think about me? . Maybe the third person is ah, I'm glad that I, you know, didn't wear sandals today and that I wore these sneakers and they find some sort of humor in it. So those are three people, not four. If we take those three people, the thing that changed was how they viewed the situation. and the emotions that they experienced in response to stepping on the poop were all really different. The first person was kind of blaming themselves, likely kind of suffers from sadness or depression.The second person, even my tone of voice, you could tell, was probably anxious in response to this situation happening. And the third person was kinda like, ah, like pun intended, shit happens. Right? So C B T is all. Examining what happens right after we experience the situation. We feel an emotion and asking ourselves like, what were we thinking about right before we started to feel that way?And I'm not gonna get into tons of details about all the different layers of thoughts, but essentially I want you to imagine a tree and the roots of the tree are something called core beliefs. They are. Really ingrained beliefs that we have about ourselves and they're deeply rooted into our belief system and they influence how we view ourselves, the world, and other people. And some of these beliefs could be that they're worthless or they feel like they're not good enough. But the thing is we can't always.See that not every day people are thinking, I'm not good enough. That there's kind of more of these like fleeting kind of thoughts that we have that are negative automatic thoughts that kind of pop up into our head that I think are more like the leaves and the branches of the tree. And that's really, that's surface level is what we're working on in C B T to uncover core beliefs.Maybe. Uh, trunk of the tree is our assumptions, our our, belief system, how we operate in the world. So, CBT is focused on identifying negative thinking patterns. We call them thinking mistakes or cognitive distortions, thinking traps, thinking errors. There's a million words to describe it.You heard Sarah identify some of them, even Anushka knew some of them so catastrophizing, for example, is assuming the worst key is happening, a common one we see in social situations. People mindreading, they're assuming they know what somebody's thinking or feeling, let's say, just based on their nonverbal reactions.Another example could be should statements where we really kind of should all over ourselves or other people have really extreme judgments or simply we tend to filter like most humans on the negative. And we don't kind of pay attention to the positive. You know, sometimes I'll see this with a college student.they'll do really well on an exam and they'll be like, Ugh, that test was so easy that professor. It's such like an easy class and they minimize the significance of like the hard work they put in to doing well in that class. I'm sure they could have failed it if they tried hard enough. So we see this, that's another thinking mistake where we just qualify the positives. So let's pause and kind of take a minute. I want you to listen to the therapy session with Anishka and Sarah. See how Sarah tries to uncover some of these core beliefs and thinking mistakes.   So we've talked a lot about imposter syndrome, some of the thoughts that go along with that.And with all these sort of, you know, people who are quote unquote smart and things come easily to them. We talked about some of the ways that you get some, some hot thoughts, some instant things that perk up and hop into your mind without you really wanting it to. Obviously we can't really help.The first hot thought that comes into our mind that is just chemical, sort of chemicals firing and. it. There's so much about our biology and our history and our experience that give us those hot thoughts, those sort of quick automatic thoughts. And I've seen you even in this session be able to say, okay, I have these sort of automatic thoughts that pop into my head, and sometimes I can kind of go down the rabbit hole with them.Sometimes I can pull back and say, okay, wait, you know, let me problem solve. Or that's just the, you know, catastrophizing part of my mind. Yeah. So I'm already starting to get to know a little bit about how the thoughts work. My question to you, to go back to it was when you have this ADHD and anxiety and you're saying, I sort of know this about my brain, and there's a dialectic there too, right?I know this about my brain. I've fully accepted it. At the same time, I can feel really envious of people who don't have to struggle with it. There's so much that can come up with imposter syndrome. Mm-hmm. . PS I've never met a college student yet who said I've never had imposter syndrome. Mm-hmm. , like, I just never met that person. So you're not alone in having imposter syndrome. And in fact, it'd be so funny if we had like, level of imposter syndrome ratings on people's heads Yeah.As they went by. And you could be like, oh my gosh. You know, like, yeah. . Are there times where you don't feel that? Yeah, it's like important to know when I was like around 14, I was like diagnosed with an autoimmune condition mm-hmm. A rare, condition which resulted in like sudden onset. Of severe, ooc D and depression. Mm-hmm. , um, for like a prolonged period of like three or four. Um, well, and probably would've gone on longer. Um, and that kind of like resulted in a lot of like cognitive, um, deficits in terms of like, um, that's how my a d d started actually.That's a lot to go through. Yeah. So it was kind of like eighth grade, middle school, not the best time in. Oh my gosh. Seriously. Yeah. As if you don't have enough to deal with. Yeah. During that time, , , I like would pretend that nothing was, like, nothing wrong was like happening, that everything was okay. So I'd go to school, um, very severely depressed, going into the bathroom and crying and I was just like, to my dad. Listen, I don't know if I'm gonna ever be able to do anything that I ever thought that I wanted to do.Mm-hmm. . So I think me forcing myself to. , ask those big questions so early on, who am I without everything that I care about right now, who do I wanna be? Um, and will I, like, do I have it in me to like work hard enough to become that person, even though it's gonna be 10 or 15 times harder than it would for someone who's not going through all of these things.Mm-hmm. . And the answer was always, yes, I am worth it. I never had that imposter syndrome until now. It was more of like, because I always had that mentality of like, look at everything that you did. Right. You're sort of like the poster child for grit. So you, you gave this beautiful story about a time where you went through something horrific. You got through it with the help of your family, you created some meaning out of it. Can I make a diamond out of this coal? Yeah. What happened when you got to nyu? Yeah, so when I got to nyu, when I started taking like the pre-med courses, general chemistry, principles of biology, organic chemistry, all of that, um, I mean, time out. My head is just swimming here in the class names. So when I started taking those, um, courses, I began kind of realizing that I was no longer like the top, like the best student in the class anymore. So I began feeling like I wasn't enough academically. Yeah.And this is what happens, I think a lot in college and why so many people have quote unquote imposter syndrome is because they have come. and their histories follow them. Right? So they come from a certain place where they've had a certain level of academic success and their X, Y, and Z rank in their class.Mm-hmm. , or they're the funniest or they're the most athletic. And then they have to go and suddenly have to recalibrate all that stuff for what, 8, 17, 18 years you've been this one particular sort of person in this one particular world and now you have to recalibrate. So our histories and our experiences follow us. So, I do think for a lot of people that sort of having to reshuffle their identity and it can be really unsettling.So you're taking all these classes that I can't even repeat cuz I'm like, what? And you're seeing that some of the ways that you were able to rise above felt really good, but that can only hold you so much. Now I've gotta do the hard work and I'm in the mode of following my dreams. But wow, it is a lot of work and other people don't have potentially the same exact.um, levels of needing to work harder as I do mm-hmm. , the reason I was starting to think about that part of it, right? So you put yourself as somebody who is to date in your world most of your life, felt like I have a brain that works well and can work fairly quickly.I went through something difficult, got over it, now I'm ready to go and make my dreams come true. And you go in and all these other people are there also making their dreams come true. Probably most of them did not get an autoimmune disease and get sudden ADHD of 14, I'm just guessing. Okay. Just to guess.So in that mode, if you look at it, and sometimes when we have the imposter syndrome piece to it, we can get tunnel vision. And it's because we say, I used to be insert. I used to be the smartest, the whatever. And so imposter syndrome comes up when suddenly you look around and that one word has tunnel vision.I was the smartest and I'm looking around not the smartest anymore, and I have imposter syndrome. When you have that concern about your professor and what he thinks of you, what if you really bought into the thought of, I've disappointed this man so much and I cannot believe that I've done this right. But you really believe that thought hooked into it. How does that make you feel? What emotion would you have with that?Um, just. Just kind of like disappointment in myself. Kind of like self-loathing . So here you are and there's a grade, A number, a product that you're trying to get and if memory serves you told me you worked your ass off.Yeah. And many, many different ways, in ways that I would assume you feel proud of. Yeah. It'd be one thing if you said, I didn't study at all and I made a 50 and I disappointed this guy, I might be like, okay, well let's work with the action part. Right. Let's study more. You told me, I did everything I could.I talked to this person. I tried to study in this manner. You know, I gathered a lot of resources, work my tail off. I didn't get the grade I wanted. and I went up to my professor and even at that point was trying to problem solve. Do I, what could I do in order to make this great or is it not gonna happen?So you are advocating for yourself. You're doing some great problem solving, you're working your tail off you go. And this person whose opinion you trust, right, shows you respect him, says you can't make it happen. And suddenly the disappointment and the sadness come from his potential reaction. So one thing I can see there is a bit of mind reading, right?Mm-hmm. , this professor now thinks I, you know, insert whatever word doesn't. I've disappointed him or thinks I didn't try hard enough or thinks. And what, what sort of things did you assume he was saying to you, um, in his head? What sort of things did you assume he was, I thought, thinking about you, that she was kind of comparing.He had my sister, so I thought that like, he was kind of saying, oh, like she, her, the sister was able to do it, but like, she's not, you know, like, She's not as smart as like her sister or, um, yeah, she's like not as capable or, um, just like that kind of thinking, well, let me be clear. Did he say those things?No. Do I need to go talk to this guy? No, not at all. No, he didn't say these things, right? He, in your head, making an assumption., I guess like I never really realized that like I feel like when something bad has happened to me, um, I kind of take that as like, okay, now the only emotion I can feel is like sadness. Mm-hmm. or guilt or disappointment. And sometimes people can buy into that idea, I deserve this, so I'd really need to go.And someone's like, you know, whip myself and kinda punish myself because I don't deserve anything different. And it keeps them sort of in that self-punishment place. I can imagine you stay in bed and then if you're staying in bed, what kind of thoughts tend to come up? Um, just like. Kind of like overthinking, like the same, the same thoughts again though, like I'm, I'm a failure.I'm not as smart as other people I know who've taken this class and have done well. Um, there's like a lot of like pre-med who are smarter than me. I won't be able to like, um, just become a psychiatrist in the future and like, whatever, la Yeah, exactly. And just go right down that rabbit hole and so that when you go and you have no sort of distraction away from those thoughts, what happens to your sadness? Does it get bigger? Does it stay the same? Does it lessen, ? It elevates, it becomes bigger. Okay.  In this section of the session, you can really see how Sarah is uncovering that there's this fear of inadequacy. That being smart and achieving things in life is really important to an Scott and anything that's threatening the possibility that that's not true. Causes her to get really anxious or sad. So this would be an important core belief, inadequacy, or sense of worthlessness or not feeling good enough that in future session, Sarah would target. Once you uncover some of these thinking traps and core beliefs, , the CBT therapist is going to help you learn certain strategies, to either change the way that you think to a rational, more realistic way, more balanced way, or potentially accept some ways in which you think and change the way that you relate to your thoughts.Maybe you won't get stuck on them as so much. Maybe you can let them go. , maybe you can exist with them being there without them causing as much of an emotional reaction. all right, so Liz, you were talking a lot about what the cognition were or the thoughts were, and now we have these behavioral pieces that we wanna pay attention to. So, A big goal that I have is what actions are based on anxiety, low mood, or an emotion of some sort.And what are actions that are keeping you stuck versus what are some things that you might not be doing as much of either because you. don't know how, or it's really hard that are keeping you stuck or keeping you upset, keeping you depressed, sad, or in toxic relationships and so on and so forth. There's a lot of different ways to do this.All right, so I, I'll give a few ideas, unless maybe you have some you can share, but some of the ways that I might do it is to say, okay, so we might say you're really anxious and you aren't going out as much as you'd like to, or you're not meeting as many friends as you. , let's get you feeling a bit more comfortable being anxious in social situations because that gets easier over time, and we will work together to figure out what pace you wanna go with that.And at a certain point you will feel eventually more comfortable in those situations because we've worked together collaboratively, step by. To do something that feels okay for you. And the goal would be at some point you can feel like going up to that person at a party or in the cafeteria or in the quad, wherever, and starting the conversation.So that's an example of how we might say, Hey, face your fears bit by bit. Another word for that is exposure or if you're feeling down and you know, the psychology word for that is behavioral activation., how do we get you doing things that might help your mood?Now, sometimes the action has to come first and then the mood comes afterwards. Here's a little clip where Nka talks about some of her actions despite her mood. we're gonna talk about what you do when you're in those situations, and then to see are there times where you're buying into this imposter syndrome?And what I mean by that is when we have these hot thoughts, when we have our sort of first initial thoughts, oftentimes we start to act in them really instinctively. Mm-hmm. . When we're feeling anxious, we tend to, you know, our action urge we tend to have is humans, is to avoid or escape in some way. Yeah.When we feel sad, we have a sad thought. Our action urge is to withdraw, to isolate, you know? So these are some things that are just sort of tried and true things that all humans have So what are some actions, like, you know, as you're tied in, you're sad and you're disappointed and, you know, if I think about sadness, disappointment, what tends to go with that? Kind of isolating over apologizing, not trying in a different way.Did any of those urges come up? Yeah, isolating. I think a lot of times when I feel I disappoint myself, I realize that I feel as if I'm not allowed to have fun or I'm not allowed to have something good happen when I receive that bad grade, the rest of my weekend is like kind of like, well, well at least the rest of my day was like messed up. Like it's me in bed crying. I guess part of me like isolating and like just not wanting to see my friends or anyone else.Yeah. I mean, so there's some grief around that loss, right? Yeah. That loss of hope that you could make it through this class. Yeah. And I think there's, that's totally justify that You wanna say, I wanna have some time to just cope with that and deal with that.Yeah. What if, right. I'm not saying you did this, but what if you didn't just take that day and you said, Ugh, I'm a disappointment and I'm really sad and I'm not, you know, what if you even went further and into it and you just bought into some of these initial difficult emotional, hot thoughts.Yeah. You stay in bed. Okay. I did do that . So you did do that? Yeah. Tell me more. I think more of the example I was giving you of like the withdrawing from the class, that action.And like, when I finally did it, , I was just like so upset that I just was like in my, in my room and like in my bed for like a while. And I wasn't, like, it wasn't until my dad has my , location. So he saw me in my apartment basically like the entire day. And he called me and he was like, you haven't left yet I felt like I shouldn't be allowed to like, be happy when, when I disappointed myself and so let's say that you stay in bed and you get sadder. What happens to the sadness if you get out of bed, even if you're feeling sad and you sort of trudge over and you text a friend, Hey, let's meet up for coffee. Right? What could you imagine what happened to sadness if you acted on a value of friendship instead of the sadness if you go to coffee and what? You know, when I'm feeling sad, what happens if while I'm feeling sad, I act as if I'm not right. I act on the value of community with my friends and that connection I have that leave my action. Mm-hmm. , well, I think that like, obviously like it would, I would be, I don't know if it would, it wouldn't go away, but. be redirected towards like something else, like the positive emotions of like friendship and like seeing someone I care about, um, and spending time with them. And I guess like it's kind of like a distraction.Mm-hmm. , which can be good because when you go back to your room or whatever it is, you come back with like the knowledge that like this feeling isn't, it's like temporary, right? Yeah. It's, it's not permanent because look, you just went for an hour and you had a good conversation, a good time. So like, it makes it more manageable I guess, like, um, when you realize that like sadness is, is just temporary . And you've also enacted a part of your identity that has nothing to do with school.  so that's an example of behavioral activation or trying to do something that feels pleasant. Trying to make sure that you're engaging in things that feel either good or fun to you or purposeful, or get you feeling like a little bit more organized maybe or accomplished in some way. So we've talked a little bit about thoughts and how that impacts mood. behaviors also impact mood and behaviors. Also impact thought, right? It's all working together. My first goal is really to say, what is your action urge? What is your body telling you to do? What is your mind telling you to do? And we also then say, and then what do you actually do? Sometimes those are the same. I wanna stay in bed, so I stay in bed. , A lot of times we are able to do things despite what our mood tells us to do. I really wanna stay in bed, but I knew I had to get up cuz if I'm missed class, I'm gonna, you know, get a lower grade and I have to turn something in. So the first thing is how do we differentiate, how do we define what is an urge? Sort of I wanna do it and an action, which is what I actually do so there's also assertiveness training. How do I say? And stand up for what I want and maybe we'll practice a little bit of that in small ways. We also talk a lot about values-based action. That's something I say a lot, which is to say, all right, your mood tells you to do a lot of things. You have an excuse generating machine in your head that says, don't do this for this, and that would be another reason., what are the other things that you want to guide your actions? Right? Sometimes you need a day off. Fine. It could be that self-care allows you to take a day off cuz you've been so busy. If you've been in bed all week and you're in failure of losing. Friendships or failing your classes? I wouldn't say staying in bed and kind of having a nothing day is a values-based action. If you're telling me I'm really committed to having some discipline or keeping my friendships, or achieving something in school, then I would say, okay, so that's a mood driven action and not a values-based action. So there's just a lot of different ways. , the therapists in the C B T world are gonna talk to you about what actions are there and how that's different from an action urge, kind of the want to do, and the action is what you actually do.Okay. This was a lot. Sarah, and I hope you leave this episode with a little bit more of an idea about C B T, what we're working on in C B T sessions beyond that first initial kind of meet and greet. Yeah. I hope this just sort of opened a bit more of a window into what can feel like a really mysterious world. Thank you so much for letting us geek out on C B T. As always, we'd love to hear from you. If there's anything that Sarah and I did not cover in these two episodes about coming to therapy and about cbt, you can always email us at colleges fine podcast gmail.com. , we'd love a voice memo. You can call us at (929) 500-2231 and of course follow us on Instagram and TikTok at College's Fine Podcast. Have a great week. \