Substance Use Problems

Many people use drugs, alcohol, and other substances in their lives. In this course, you’ll learn how to find out if your use of substances might be negatively affecting your life. You will also learn how to take steps to cut back or stop your use.

You can use any lesson at any time. However, therapy for substance use problems usually uses this order:

What are Substance Use Problems?

Substance use can increase to the point where it can cause problems in your life.
What are Substance Use Problems Unit Guide

There are many substances that people use in their lives. Often these substances help us cope or improve our lives. Sometimes though, they can also lead to problems. This unit will help you understand your use, decide if there might be some downsides related to your use, and whether cutting back or stopping use might be helpful.

  • The Facts
  • Understanding Substance Use
  • The Symptoms
  • Treatment

The Facts

It’s Common

The vast majority of people have used substances at some point in their lives. Many people start their morning drinking coffee to feel more alert. Advertisements for alcohol products are common. There is a trend for people to use fewer substances as they grow older and their priorities change. Substance use also tends to be less prevalent among women.

Legal and Illegal Drugs

The legality of substances has been contested over the course of history. Substances have been criminalized, decriminalized, or legalized depending on the mores of the day. Legal drugs are easily obtainable and more people develop problems with their use. About 9% of people experience significant problems with alcohol use in a given year. The rate of tobacco use problems is around 13%. In comparison, less than 1% of people experience problems with cocaine or opioid use.

Audio Tip
Dr. Heather Fulton reviews common reasons for people using substances.

Why People Use Substances

Human beings have used substances throughout history for a variety of reasons. The substances covered in this course mostly work by changing signalling in the brain. This change in signalling influences our thoughts, our emotions, our sensations, and our behaviour. Because of this effect, people often use substances to improve their emotional state. Alcohol, for example, suppresses and slows down signalling often making us feel relaxed. People may also be trying to reduce painful feelings (e.g. using alcohol may make someone feel less anxious).

Substance use often has a social component. Substances can make it easier for some people to communicate with others. Alcohol can make some people feel less shy and more connected to others. A group of people may also form around the use of substances. For example, people who smoke cigarettes may find a connection with a group of co-workers who also smoke. Many cultures use substances as part of some rituals. Experiencing a change in consciousness is enjoyable to some people, such as when a sense of transcendence occurs. Some substances can also be used as medicines.

Audio Tip
Dr.Heather Fulton discusses how the problematic use of substances can be identified.

When Does Substance Use Become a Problem?

There is not necessarily a specific amount or dosage where substance use becomes a problem. The effect of dosage depends on many variables, including weight and genetics. You also have to consider the role of substances in your life. What are the positives and negatives for you? What do you value in life and what are your goals? A key question is whether substances are moving you closer to your values and goals or further away from them. An amount that is safe for one person can be problematic for another.

There are some indicators that can suggest problematic substance use. One is being stuck in a cycle of avoiding withdrawal. That is, as the effects of using a substance wear off, you may start experiencing withdrawal. Withdrawal symptoms are a consequence of the body working to restore balance. You will often experience this as something opposite to the changes the drug created. If you used cocaine, for example, the euphoria and energy will fade and you may start feeling depressed and fatigued. To avoid this, you may use cocaine again. This cycle can make you feel trapped, especially if you need to take more and more of the drug to maintain the same outcome (this is called drug tolerance).

The amount of time you spent on obtaining, using, and recovering from drug use can be another clue. If a lot of your time is organized around getting substances, using substances, and recovering from substances, then other areas of your life are likely to suffer. You may have given up things you used to do and enjoy in order to use drugs. Thinking about or craving drugs may also occupy your mind. You may find it difficult to concentrate on other things.

A third clue is experiencing a loss of control. You may keep using more of a drug than you intended, or for longer amounts of time than you intended. You may have had times where you tried to cut down or stop your use, but have been unable. In these sorts of circumstances, drug use may have started interfering with your life.

Finally, consider what other downsides substance use brings in your life. Are you using substances in risky or physically hazardous situations, for example, while driving? Is drug use harming your relationships or work, but you keep using? Have you had problems with your mental health that seem to be related to your use (e.g. anxiety, low mood)?

Symptoms of Substance Use Difficulties

The use of substances can create significant changes in your functioning.


Many substances create significant changes in memory and attention. Your thinking can be enhanced or impaired, depending on the substance you use and the experience you seek. Drugs may also lead to beliefs such as being very capable, being loved by others, or conversely that others are out to harm you. In the longer term, your thoughts may become more occupied with obtaining and using drugs. Some drugs (such as Crystal Meth) can cause long-term harm to the brain.

Dr. Margaret Drewlo

Drugs are often sought for the emotional changes they create. Positive feelings can range from euphoria and serenity to excitement. As the drug wears off, the opposite feeling can increase. You may go from feeling serene to feeling anxious. Drug use can be stigmatized in society and can create strong feelings of guilt and shame. Depression and anxiety are also common as other areas of life start to deteriorate.

Dr. Margaret Drewlo

As with emotional changes, physical changes can range from a rush of energy to complete relaxation. The physical symptoms of withdrawal can range from utter fatigue to seizures. Reducing alcohol and benzodiazepine use can be dangerous due to withdrawal symptoms. Get help from a trusted professional and keep yourself safe when you change your use of these drugs. Other physical concerns can arise from a lack of self-care while using drugs. Damage to internal organs can occur over time, sometimes from the way the drug is taken (e.g., lung damage from smoking).

Dr. Margaret Drewlo

For many people drug use is situational. When circumstances change, drug use is also likely to change. For example, many people stop drinking heavily after starting or leaving college. During drug use, behavioral change is likely to match emotional and physical changes. People may become active or fall asleep. Significant changes in behaviour to get drugs are often a sign of problem use.

Dr. Francois Botha
Audio Tip
Dr. Heather Fulton discusses the core principles of psychotherapy for substance use problems.


The good news is that substance use problems are treatable! Different kinds of therapy and medications can get you feeling better:


There are many types of psychotherapy or talk therapy. Kelty’s Key is based on cognitive behavioral therapy (CBT). This method emphasizes the influence of thoughts and beliefs in changing substance use. CBT also has a focus on learning skills to deal with cravings and urges as well as skills for coping with life difficulties.


Different medications can be used to treat some substance use problems. These medications vary in mechanism and function. Medications may ease withdrawal symptoms, treat concurrent mental health concerns, or treat overdoses. Consult with your healthcare practitioner about medications for substance abuse.

Well Done. You’re on Your Way.

You’ve taken the first step and learned about substance use problems. Knowledge is important. Understanding the problems that can come with substance use will help you moving forward.

I’m using the self-help:
I’ve got an online therapist:
I’m working on my own:

Committed Action

Making changes in how you use substances is easier if changes align with your values
Committed Action Unit Guide

Maybe you started this course because you think life can be better for you if you cut down or stop using substances. It’s challenging to make changes that you can stick with. Your important values will help you along the way.

This unit will look at four areas related to substance use and values:

  • Commitment
  • Identifying Your Values
  • Determining Goals and Actions
  • Obstacles
Audio Tip
Dr. Margaret Drewlo explains how she helps clients increase motivation for change.

What is Committed Action?

Taking action is necessary when we want something about our substance use to change. We might have an idea that we do not like the way things are going, but unless we actually do something about it, nothing changes. Action is required for behavior change. There is no way around it!

Committed Action is behavior that takes you in the direction of what you care about most. In other words, Committed Action takes you in the direction of your values.

An essential part of the learning in this unit is to use your values to help you make changes that you can sustain.

Audio Tip
Dr. Heather Fulton discusses values which help clients change.

Identifying Your Values

Finding meaning in life is an individual process, best determined by our unique set of values. Values are aspirational, meaning that we continually work towards them.

We can differentiate between desires (such as rich, happy, and pain-free) and values (such as contribution, integrity, creativity, and fun). Determining the values that are most important to us can help us gain clarity about goals and what we want our life to stand for.

Knowing our values can help us make decisions about substance use that are true to what is really important to us.

Identify the five values that are most important to you from the list below on the left (use the slider to access the entire list) and drag these one by one from the list to the teal green box underneath Your Values on the right.

Your Values
  • Beauty
  • Community
  • Compassion
  • Contribution
  • Connection
  • Creativity
  • Dignity
  • Family
  • Friendship
  • Home
  • Hope
  • Humour
  • Integrity
  • Learning
  • Love
  • Loyalty
  • Nature
  • Nurture
  • Parenting
  • Partnership
  • Play
  • Pleasure
  • Relationship
  • Safety
  • Self Expression
  • Self Respect
  • Spirituality
  • Spontaneity
  • Trust
  • Work


    Audio Tip
    Dr. Heather Fulton explains the importance of taking action for learning and making changes.

    Take Action Based Upon Your Values

    You have identified your most important values. Use them to help you take action in the direction of your values.

    Use the next page in the unit to identify some goals. Then at the end of the unit see the worksheet where you can enter actions for each goal and value.

    Remember that to make change we need to act, not just think about making change. By taking action, we involve our whole selves in moving toward the direction of our values.

    If you choose to reduce your frequency of substance use, you will have free time. Think of filling free time with activity that is meaningful to you.

    Sometimes this is called effortful leisure activity. Effortless activity can be characterized by having an hour of free time and not knowing what else to do, so switching on the TV or checking social media. We are not likely to remember what we did in that hour or to have found it meaningful. Effortful leisure activity, on the other hand, is spending free time intentionally. Participating in a sports league once a week, working on a creative project, or meeting up with friends for a meal are all examples of effortful leisure. These require more effort, but also bring more meaning to our lives.

    Audio Tip
    Dr. Francois Botha highlights the importance of internal goals for sustained change.

    Develop New Goals

    Write down any ideas you have, even if you don’t think they are possible or practical. The purpose of the exercise is to get you to start thinking of a meaningful future.

    When you are determining what goals you would like to work on, you will need to ensure that your goals are meaningful and guided by your values.

    • Choose goals that move you in a direction that helps you to live your values.
    • Choose goals that are realistic, achievable, and time-framed. These guidelines help you to be specific about your goals with the result that you are more likely to achieve them.

    Once you have selected some goals, you will need to determine specific, well defined actions you want to take towards each goal. Choose actions that are realistic. You are more likely to take action when you decide to do something that is possible. The sooner you take action, the more likely other activities will not get in your way. It can be helpful to set smaller goals to start with to ensure success in achieving them, rather than a large goal.


    Audio Tip
    Dr. Heather Fulton discusses common obstacles when people work on substance use.

    Dealing with Obstacles

    Obstacles in making changes with substance use are going to occur. Guaranteed.

    Once we accept that making a change in substance use is possible, it is best accomplished when based on our values, and will involve dealing with obstacles, we have a great start.

    Your Top Obstacles

    What are your top three obstacles to making a change in the amount or frequency of your substance use?



    How to Deal With the Obstacle

    Using your values as a guide, what is one manageable and reasonable action you can take to deal with each obstacle?

    Text 1

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    Although judgment and stigma have been associated with substance use for decades, we now know that substance misuse is a medical problem involving influential psychological factors.

    Acknowledge the vital work you are doing, seek out and accept support, and be guided by your values.




    Jordan's Story

    Jordan started to use alcohol and cannabis when he was in high school. First of all he used only with friends and only on some weekends. He never drank alcohol before his soccer games or other important events. After high school ended, Jordan drank and smoked more regularly, but still did not think it was a problem.

    For a long time, Jordan didn’t realize that he was slower on the soccer field or that he had lost direction in his life. When he was 21, his parents commented that maybe his life could be better with fewer hang-overs, but what did they know? It took being fired from his first real job for continually being late before Jordan began to think that maybe his drinking and marijuana use might not be helping him as much as he previously thought. Jordan decided it was time to make a change.

    In thinking about his values Jordan decided that Relationships, Self Respect, Community, Contribution and Nature were his top 5 values. Identifying his values gave Jordan a direction for action he could take with his substance use. He realized that his drinking and smoking had interfered with some things that meant a lot to him. Jordan decided that he wanted to make a contribution to Pee Wee soccer by mentoring younger players. An action he took towards that value driven goal was to fill out a volunteer application for his community’s Pee Wee soccer club.

    Change did not come easily for Jordan. Most of the friends he had partied a lot. Drinking meant celebration and pleasure to him. Using cannabis was his only way to relax. Cutting down felt really hard. It was only by reminding himself every day of his values that Jordan was able to deal with obstacles that got in the way of positive change. There was no magic. Changing was a work in progress.

    Good Job! You’ve Learned about Committed Action

    Download Your Worksheet

    Keep your values in mind when you are taking action to cut down or quit using substances. Remember that changing your substance using behavior requires committed action based on what is most important to you.


    Congratulations! You Are Dealing With Obstacles

    Obstacles are guaranteed to come up. Making a plan will help you deal with them successfully.

    Above all, acknowledge that you’ve started to take action with a problem that has been standing in the way of the person you were meant to be.

    Return to the exercises and re-do them to become more clear about your values and how they can help you to make the changes you want.

    I’m using the self-help:
    I’ve got an online therapist:
    I’m working on my own:

    Coping with Cravings

    Strong urges to use is one of the biggest obstacles in the way of your substance use goals.
    Coping with Cravings Unit Guide

    It is common to experience cravings when you reduce your substance use. It may feel like the cravings will never end unless you use substances. In this unit you will learn about the craving cycle. You also will learn skills for coping with cravings that allow you to resist these urges.

    • Understanding Triggers
    • Understanding the Craving Cycle
    • Working with Cravings
    • Urge Surfing

    Understanding Triggers

    Cravings are usually caused by internal or external events. We call these events triggers. By understanding your own triggers, you can start taking steps to reduce them. This can in turn reduce your cravings.

    External triggers usually involve people, places, or things that remind us of substance use. People may include others who supply or use substances. Hearing about the use of others can also be a trigger. Places may include where you used or obtained substances. Things may include objects such as a vape pen or empty beer bottles. Using other substances or having cash on hand can also be a trigger for substance use. Sometimes events such as sports or anniversaries can trigger cravings.

    Internal triggers include your emotions, physical sensations, and thoughts. Triggers may be experienced as pleasant or unpleasant. You may use when you are sad after breaking up with a partner. But you may also use when you are happy after meeting a new partner.

    Triggers occur because our mind is constantly creating associations. If you use a substance that made you feel euphoric when watching soccer, your mind will build that association. Walking past a TV with a soccer match can now create a craving as your mind anticipates the coming euphoria. The good news is that this association can be weakened over time. For example, the association can change if you watch soccer many times without using substances.

    Audio Tip
    Dr. Heather Fulton highlights common triggers for substance use.

    Identify Your Triggers

    Some triggers are quite common. But your life experiences are unique and your triggers will thus differ somewhat from another person. You may also have different triggers for different drugs.

    Identify five triggers that are common for you. For external triggers, remember people, places, and things. For internal triggers, remember thoughts, feelings, and sensations.

    Feeling Stuck?
    DealersPartiesReceiving moneyUsing other substancesHungryLonely
    Friends who useSports eventsWeekendsSeeing advertisements for cigarettesArgumentsAnxious/Stressed
    Ex-partnerTaking transitBeer in the fridgePainBoredom / Free timeExcited

    Audio Tip
    Dr. Heather Fulton discusses how clients can avoid triggers.

    Avoiding Triggers

    The simplest way to deal with substance use triggers is by avoiding them in the first place. For external triggers, you want to avoid being in a situation where you encounter or are reminded of the trigger. This may mean avoiding certain places and people such as drug-using friends. It could involve changing routes and modes of transportation. In your own home, it can be useful to eliminate all substances and tools associated with use. Make it harder for yourself to get the substance you are trying to cut down or quit.

    Internal triggers can rarely be entirely avoided. We will all experience some sadness and pain. And many of our thoughts are automatic and not under our control. You may be able to avoid some extremes for these triggers though. For example, by eating three meals a day with some snacks, you can avoid getting too hungry.

    Here are the five triggers you have identified.

    Text 1

    Text 2

    Text 3

    Text 4

    Text 5

    Consider what you can do to avoid these triggers (if possible).

    Audio Tip
    Dr. Francois Botha considers common misunderstandings about cravings.

    Understanding Cravings

    Some triggers and cravings cannot be avoided. And for some cravings, the triggers may not be clear. For example, many people experience dreams in which they use substances. These dreams can be intense and often leave people wondering if they actually used. Cravings are usually strongest in the first month after changing your use of substances. They can still appear long after this though.

    Cravings may feel like they go on forever, but they often have a wave-like form. They grow, peak, and then dissipate with time. As the craving builds, you may fear that you are going to get overwhelmed. Using may seem like the only way out. Cravings rarely last more than an hour. Understanding the wave-like nature of cravings informs the tools you can use to cope with them.

    Audio Tip
    Dr. Margaret Drewlo explains how people can use distractions to cope with cravings.

    Using Distraction

    Experiencing cravings also affects the mind. In particular, your memory and attention are likely to be affected. You may remember only the positive aspects of your previous use. You may focus on how unpleasant the sensations are that craving produces. Or you may find it challenging to pull your attention away from the dealer you just saw at the transit station.

    The skill of distraction involves giving the mind something else to focus on. You may focus your senses on non-substance related things in the environment. The more engaging the new focal point, the better. Concentrating on completing a puzzle such as a crossword can occupy the mind. Or you can focus on your body by doing relaxation exercises. If you need any tools for distraction, make sure you keep them with you. For example, keep a Sudoku puzzle in your wallet.

    It can be especially powerful to focus on completing one of your goals for the day. This allows the activity to feel more meaningful. You can also ask yourself what need the craving is looking to fulfil, for example, having fun. Then you can engage in a fun activity that does not involve substances. Replacing substance use with other fulfilling activities is an excellent long-term goal.

    What distractions can you use when cravings occur?

    Feeling Stuck?
    Play video gamesRefocus on your current goalListen to musicBrowse a storeSmell some perfumePet an animal
    Deep BreathingWord SearchLook at nature around youFocus on other sounds around youDoodleHave some dessert
    Play cardsRead the paperWalk in the parkHum a tuneSuck on a candyUse a stress ball


    Audio Tip
    Dr. Francois Botha discusses the use of social supports in coping with cravings.

    Use Social Support

    Engaging with others can be an effective response to cravings. This engagement shifts your attention away from the craving. It can also allow you to access thoughts and ideas you may not otherwise have been able to remember. Others may, for example, remind you why you have considered reducing your substance use in the first place. Social contact can also lessen feelings of anxiety and vulnerability.

    It is essential to realize that others likely do not know what you need when craving. You need to let others know what is useful to you. You may also need to tell them what responses can make things harder.

    Finally, you need to consider whether the source of social support can be trusted. Have they encouraged you to use in the past? Have they judged or belittled you? Also, note that there are many different sources of social support. It can be people close to you such as a partner, family, or friend. But it can also be someone such as a substance use counsellor, pastor, or sponsor. Keep these people’s numbers readily accessible and ask them in advance when it is OK to call. Have a coping plan for when nobody can be reached.

    Let’s take a look at how you can use social support.

    What sources of social support do you have available to you when cravings occur?

    What would you like them to say or focus on when you call?

    What would you like them to avoid when you call?


    Audio Tip
    Dr. Margaret Drewlo notes how mindfulness can help people cope with cravings.

    Urge Surfing

    When a craving occurs, you first want to commit to delaying your substance use for a while, say 20 minutes. As mentioned before, the urge to use is likely to continue in a wave-form. The technique of urge surfing uses this idea to allow you to cope with cravings. It is a type of mindfulness practice where you focus on a present experience without judgment and without trying to change it. You acknowledge that cravings are a normal and common experience. You also remind yourself that the craving is temporary and will change with time. This can reduce the suffering you experience while craving. You may also become more in touch with what you really need in the situation. Cravings will reappear, but you will likely experience that the intensity reduces over time.

    Here is an audio clip you can use to practice this technique.

    Listen to the audio file

    Louise’s Story

    Louise was introduced to cocaine at a sorority party. Previous to this, she had experienced several depressive episodes as an adolescent. She loved the feelings of euphoria which contrasted with her low mood before. Over time, however, she had to use more and more cocaine to help her mood. Her grades also suffered and she was put on academic probation in her third year.

    Louise realized that she needed to make some changes. She tried cutting back for a few months but was not successful. Things kept coming up that would lead her to use more than she intended. The cravings were intense and she kept running into reminders of her substance use. She decided that she would try to abstain from using cocaine. In rehab, she worked with a substance use counsellor to plan how she would cope with cravings.

    They first focused on how she could avoid triggers. She decided to move out of the sorority. She moved in with a friend who did not use substances. Eventually she changed schools as she kept running into people she had previously used with. She joined a basketball team and found that practicing helped her deal with cravings.

    She reflected on who she could contact when experiencing cravings. A lot of her previous friends made light of her use and told her she could quit after finishing school. She eventually joined Cocaine Anonymous and worked with a sponsor. She found her sponsor’s reminders of her life goals to be useful. With all these tools in place, she was able to successfully deal with cravings for the first month after discharge from rehab.

    Good Job! You’re Learning how to Cope with Cravings

    Download Your Worksheet

    Keep working away at finding more tools to use when you experiencing cravings. Focus on what works for you. If a lapse occurs, come right back to these tools and consider what more tools you may add. Or adjust your current tools as needed. Download your worksheet to remind yourself what tools you want to start trying out. You can reuse it to consider extra tools as well.


    Congratulations! You’ve Started Identifying Some Methods to Cope with Cravings

    Continue practicing the techniques you identified. Figure out which ones work for you and which ones do not. Keep experimenting and adding more tools.

    I’m using the self-help:
    I’ve got an online therapist:
    I’m working on my own:

    Thinking about Substance Use

    There are certain ways of thinking about substances that make it more likely that you will use them.
    Thinking about Substance Use Unit Guide

    Booze! I will be less anxious after that first drink. And I deserve it for all the hard work I did today. Now that I have had one, I may just as well keep going. These types of thoughts often precede use and continue while using substances. To work on changing your substance use, learn to identify these thoughts and challenge them.

    • Anticipation and Excitement
    • Waiting for Relief
    • Giving Permission
    • Thinking about Lapses

    How Thinking Influences Behaviour

    Human beings are complex. Several factors determine how you will behave. Your thinking is an important determinant. There are specific ways of thinking that are especially likely to influence your behaviour.

    The first type of thinking is how you consider the costs and benefits of your behaviour. People generally seek to increase the benefit and reduce the cost of their actions. If you focus on or amplify the benefit and ignore or downplay the cost, you are more likely to engage in an action. The opposite applies as well. If you focus on or amplify the cost and ignore or downplay the benefit, you are less likely to engage in an action.

    The second type of thinking involves whether you think your behaviour is reasonable and justified. People will usually avoid behaviour that is seen as unusual or not justified, especially in front of others. Thinking about why your behaviour is fair or OK will make you more likely to do it.

    The third type of thinking involves whether you think you are capable of the planned behaviour. You may, for example, be convinced that smoking is problematic for you. If you think that there is no way you could ever cut down, you are unlikely to try. If you consider how you have stopped drinking before, you are more likely to try.

    Working with these three ways of thinking will allow you to feel more capable of making the substance use changes you want.

    Anticipation and Excitement

    One way our thinking may lead to substance use is by focusing on or amplifying the positive effects. This can tip the balance towards choosing to use. Or the thoughts can generate so much excitement that you ignore the negatives of using. These thoughts are not usually very complex. They are often just a single word or simple phrase.

    What thought of anticipation or excitement about substance use often comes up for you?

    Feeling Stuck?
    Weed!We will all feel connectedNobody will be able to perform like me!
    This is going to be fun!It is going to be so relaxing!Let's roll!
    I will get lots of work doneParty time!This game will be even better with drink

    Audio Tip
    Dr. Heather Fulton discusses dealing with excitatory thoughts.

    Challenging Exciting Thoughts

    To challenge the anticipation and excitement, you can consider what may have been exaggerated. When we use substances to enhance performance, we may overestimate the extent to which our performance improves. You may, for example, complete lots of work but then receive negative feedback on its quality.

    What is most often the case is that the negative side of substance use is not considered. You want to go beyond the initial excitement and consider what things will be like in a few days. Will you start experiencing withdrawal? How will the substances impact the other important areas of your life, such as relationships?

    Let’s take a look at your thought and start challenging it together.

    Text 1

    Do you know for a fact that the positive things you are thinking of will happen?

    What will happen once the excitement and positive feelings have worn off?

    Does using the substance conflict with your current goals and values? What benefit is there to not using?



    Expecting Relief

    Another way our thinking may lead to substance use is by focusing on or amplifying the expected change in a current negative state. This can tip the balance towards choosing to use. The current negative state can be due to physical or emotional discomfort. Or you may be having thoughts that you just want to shut out.

    What thoughts of substance use often come up for you when you have negative experiences?

    Feeling Stuck?
    I just want to be obliviousThis will help me forgetI don't feel so hungry after using
    This will make all the pain go awayI can’t do anything while I am in painI don’t want to think about this morning anymore
    This is the only way I can copeOnly drugs help me sleepI won’t feel so ashamed anymore


    Audio Tip
    Dr. Francois Botha considers how people may deal with anticipatory thoughts.

    Challenging Thoughts of Relief

    To challenge thoughts of relief, you can consider what may have been exaggerated. Substances can reduce negative emotions, sensations and thoughts. But the experience may be short-lived. You may also have other options for coping with difficult circumstances. Learning new skills can allow you to cope better in the long term.

    The negative side of substance use is often not considered. You want to go beyond the initial relief and consider what things will be like in a few days.

    Let’s take a look at your thought and start challenging it together.

    Text 5

    Do you know for a fact that the relief you are thinking of will happen?

    What will happen once the feelings of relief have worn off?

    What other means and resources do you have for coping with the current situation?



    Giving Permission

    You may have a good sense of the problems substances presented in the past. This often means that before using substances now, you need to convince yourself that it is OK. You may focus an argument on fairness. You may focus on why this time will be different. Or you may just tell yourself that you don’t care anymore.

    What permission-giving thoughts often occur when you consider using substances?

    Feeling Stuck?
    I don’t care anymoreIf you have been through what I have been throughEveryone else does itMany other people get away with it
    I will only have oneI deserve itLast time was just bad luckThe system is rigged anyway
    All my friends drink just as muchI need to test myselfMy spouse’s complaints are the real problemNo one will find out


    Audio Tip
    Dr. Francois Botha explains how to identify and respond to permission-giving thoughts.

    Challenging Permission-Giving Thoughts

    To challenge permission-giving thoughts, you can consider what has been left out from the thought or what is not accurate. Thinking that the present will be different from the past may not be justified if circumstances had not changed much. Arguing about what others do ignores your responsibility for your choices. Thoughts about earning or deserving something depend on your own ideas about effort and reward. There is no global rule that you deserve to use substances. Even if you do not care about the future at the moment, this is likely to change once the drug wears off.

    Let’s take a look at your thought and start challenging it together.

    Text 9

    What evidence do you have that your experience of using substances will be different this time?

    How is your use of substances different from that of others you are comparing yourself with?

    Where did the rule that you deserve or have earned substance use come from? Is this a helpful rule?

    If you are thinking that you do not care, will this change once the effect of the substance wears off?



    Thinking about Lapses

    A lapse is when you use more substances than you intend (or any if you want to abstain). There are many ways to respond when you experience a lapse. A common response is to keep using. The thinking here is all-or-nothing. Because you used, you may as well keep using and give up on trying to make changes.

    Another common way of responding to a lapse may be to think negatively about yourself or trying not to think about the lapse.

    What thoughts come up for you when you experience a lapse?

    Feeling Stuck?
    I just cannot stopI was silly to get my hopes upNothing worksI will be judged anywayI have to start at the beginning again
    Trying is uselessI am pathetic and weakI don’t want to think about itThe harm has already been doneI never learn
    I always mess it upIt is my spouse’s faultI just want to forget itAll my hard work was for nothingI will start again on Monday


    Audio Tip
    Dr. Heather Fulton discusses how to deal with effectively with lapses.

    Challenging Thinking about Lapses

    To challenge thoughts about a lapse, you can consider what may have been exaggerated regarding the consequences of the lapse. You also want to consider the consequences of using more substances. Essentially, you acknowledge potential negative consequences without causing more harm through further use.

    Negative thoughts about yourself as a whole will likely lead to shame. You may want to avoid thinking about the lapse and hide it from others. Being in shame means you are unlikely to learn from the experience. A helpful response is to consider how the lapse happened. You can then plan to avoid lapses in the future. Once you have completed the plan, there is less value in revisiting the lapse.

    Let’s take a look at your thought and start challenging it together.

    Text 14

    Is the thought helping you understand the reason for the lapse?

    How will continuing to use substances after a lapse make things worse?

    Play the sequence of events that led to the lapse out in your head. What triggered the lapse? What need were you ignoring? What clues were present that showed you that you were at risk of lapsing? What risky decisions did you make?

    What will you do in the future to avoid a similar lapse?



    Good Job! You’re Challenging Your Beliefs

    Download Your Worksheet

    Keep challenging how you think about substance use. Remember that problematic beliefs make it harder to cope with cravings and triggers. These beliefs can create increased feelings of excitement, anxiety, shame, and guilt which make using more likely. When you challenge unhelpful beliefs, you increase your tools for coping with cravings and triggers. Download your worksheet to remind yourself how you can challenge your beliefs about substance use. You can reuse it to challenge new beliefs as well.


    Congratulations! You’ve Started Challenging Some of the Beliefs about Substance Use

    Continue challenging your beliefs about substance use. You can reuse the questions in your worksheet to break apart other beliefs you might be holding on to.

    I’m using the self-help:
    I’ve got an online therapist:
    I’m working on my own:

    Thought Challenging

    Your thoughts and feelings are connected.
    Thought Challenging Unit Guide

    Few things in life are as important as talking to yourself kindly. If you want to achieve a goal or live a happy life, you need to talk to yourself like you are your own best friend. It’s hard to stay motivated or positive if we are too critical or feeling hopeless about a situation. When everything feels like too much, negative thinking can become routine and get in your way. In this unit, you’ll learn how to break the cycle and challenge the thoughts that keep you down.

    • Keep a Thought Diary
    • Track Unhelpful Thoughts
    • Find Evidence
    • Balance Your Thoughts
    Audio Tip
    Dr. Christine Korol explains how our thoughts affect our mood, not our situation

    Different Perspectives

    Most people believe their feelings are the result of what happens to them. If you failed a test, had a fight with your best friend, or you lost your wallet — you’re going to feel bad, right? But not everyone will react the same way, even in a tough situation. Thoughts like “I’m such an idiot” will make you feel worse, while thoughts like “I’ll do better next time” will make you feel a bit better. In the end, it’s our thoughts about things or events, not our situation, that determine how we feel.

    Audio Tip
    Dr. Suja Srikameswaran talks about practicing self-compassion when depressed

    Why Challenge Thoughts?

    When you’re worrying or feeling down, most people will tell you to “let it go.” The problem is that’s easier said than done! The only way to let go of an unhelpful thought is to challenge it enough that you no longer believe it. If you try to force yourself to think, “It’s all going to be okay,” when you don’t believe it, you’ll feel worse.

    Audio Tip
    Dr. Theo DeGagne talks about keeping a thought diary

    Keep a Thought Diary

    Sometimes, thoughts can come so quickly that you don’t notice them. The best way to track these sneaky thoughts is to keep a thought diary. Act like a detective. Keep track of the feelings and thoughts you experience in specific situations. It is important to track the strength of your feelings too. Your therapist can help you identify some of your unhelpful thoughts if you are feeling stuck.

    A thought diary looks something like this:

    What was happening? Feeling and Strength Thoughts
    I was sitting on the couch watching TV. Sad → 60%
    Anxious → 40%
    Disappointed → 80%
    “Will I ever get better?”
    “What’s wrong with me?”

    Start a Diary

    Pick a situation that is troubling you right now. It may be something that just happened a moment ago. It could be something that happened in the past but still continues to bother or worry you.

    What was happening?

    Remember that the situation doesn't have to be the cause of your feelings. Sometimes an event causes a big reaction, like getting fired. Other times your feelings and thoughts aren't related to what you're doing. Like if you started to cry while taking a shower. You can use a thought diary for any type of situation.

    750 characters remaining

    Your Feelings

    How do you feel right now when you think about that situation?

    If it is a past event, don’t try to remember how you felt then. How do you feel at this moment when you reflect on the situation?

    Select up to 5 feelings:

    Rate Your Feelings

    Now rate how strong your feelings are from 0-10. Remember to focus on the feelings you have right now, not during the event.

    We’ll keep track of how strong your feelings are after challenging your thoughts too. This will help us see if the exercise is helpful.

    Your Thoughts

    What is going through your mind right now when you think about this situation?
    If you’re feeling stuck, ask yourself these questions:

    What does this say about me? My future? Why does this situation feel difficult? What does this say about others?

    700 characters remaining

    Keep Using your Diary

    Good job! You’ve started to use a thought diary.

    Just recording your situations, feelings and thoughts can take practice. It’s okay if you don’t feel ready to start challenging your thoughts. Keep practicing with your therapist and come back when you’re ready.

    If you’ve got the hang of keeping a thought diary then it’s time to start challenging your thoughts. Keep going!

    Pick the Most Unhelpful Thought

    It’s common to have many thoughts about a situation. Pick the thought that causes the most trouble, anxiety or sadness. You’ll work on challenging this one thought for the rest of the exercise.

    Sometimes thoughts don’t work well in thought challenging. Use these tips to pick a suitable thought:

    Match Up

    Make sure your thought is connected to one of your feelings about the situation. If the thought makes you feel sad, angry or some other emotion, it's a good thought to choose.

    Audio Tip

    Choose a thought that is testable. If your thought starts with “What if” then you can't prove it true or false. These thoughts are not good for thought challenging.

    Audio Tip

    Here are your thoughts. Which would you like to challenge?

    Rewrite the thought you’d like to challenge and “let go” of.

    500 characters remaining

    Evidence for the Unhelpful Thought

    Do you have any evidence that your thought is true? For example, if your thought is “Jim is mad at me,” your evidence might be that he didn’t return your call. Maybe the email he wrote you seemed cold.

    People sometimes realize that they can’t find any proof to support their unhelpful thought. You might think it, but there are no facts that make it true! That makes it easier to let it go.

    What evidence do you have that your unhelpful thought is true?

    850 characters remaining
    Audio Tip
    Dr. Suja Srikameswaran explains how thought challenging can improve self-compassion

    Challenge the Thought

    It is almost impossible to let go of a thought if you still believe it! The best way to get rid of a thought is to challenge it until you don’t believe it anymore. To challenge a thought, you must find evidence that disagrees with it. Play devil’s advocate. Look for proof that your unhelpful thought is false or just not completely true.

    For example, let’s go back to the thought “Jim is mad at me.” Evidence against this thought could be that Jim smiled at me while saying hello this morning. Sometimes his emails come off as cold when he’s busy.

    Challenge your Unhelpful Thought

    Here's your unhelpful thought:

    What evidence do you have that this thought is not completely true? Include everything you can think of even if it seems too small to mention.

    850 characters remaining
    Audio Tip
    Dr. Colleen Cannon discusses how to talk to yourself in a supportive way

    Balanced or Helpful Thoughts

    Forcing yourself to think happy thoughts won’t make you feel better. If you don’t believe a positive thought is true, it could make you feel worse. The trick to feeling better is to find a balanced or helpful thought. These thoughts take both the positive and negative evidence into account. Balanced thoughts are more encouraging and supportive than positive thoughts.

    Here are some examples comparing positive versus helpful thoughts:

    Positive Thoughts Balanced or Helpful Thoughts
    I’m a great friend. I’m not perfect but I am a good friend. I may not always be there for my friends, but I know that this will get better as my mood improves.
    I can do anything if I put my mind to it – including getting over my problems! It might take some practice, but I feel a little more hopeful that I can feel better by changing how I talk to myself.
    Everybody in my life is supportive and helpful. I’m getting better at knowing who to count on in my life. I’m not 100% confident, but I’m willing to practice trusting a few people who I think are nice.

    Your Balanced Thought

    Take a look at your positive and negative evidence:

    Use this evidence to help you make a new balanced thought. If you’re feeling stuck, don’t worry. Balanced thinking can be tricky and your therapist can help you get the hang of it.

    750 characters remaining

    Re-rate Your Feelings

    Now that you have worked on your balanced thought, take a moment to re-rate your mood. We can compare the strength of your feelings before and after thought challenging. A drop of at least 2 or 3 points in at least one of your emotions tells us that the exercise was helpful.

    Audio Tip
    Dr. Christine Korol discusses the importance of practicing thought challenging

    Practice Makes Perfect

    Thought challenging is one of the harder things to learn in cognitive therapy. Remember that it does get easier with practice and help from your therapist. Most people find after practicing 50 or more times that they have fewer unhelpful thoughts. Also, balanced thinking becomes more automatic. Challenging your thoughts 50 times might seem like a lot, but you’ll get faster at it the more you practice.

    Sean's Story

    Don’t remove

    Sean was finishing up his day at work when he realized that he made a typo in a company-wide memo. He always proof-reads his emails before sending and couldn’t believe he’d missed such an obvious error.

    Sean’s emotions started spiralling. He felt embarrassed, angry, irritated and ashamed. “I can’t cope with normal life,” Sean thought. “I’m such an idiot. I can’t concentrate!”

    But hold on! Sean began to challenge his unhelpful thoughts. He reminded himself “Everybody makes mistakes; even my boss makes typos sometimes.” He noted that “If co-workers tease me, I can handle it.” And finally, “I’m not an idiot because I just finished a big project that was very successful.”

    After challenging his unhelpful thoughts, Sean was able to rework his thinking and create a balanced thought: “I’m not at my best right now, and I make mistakes, but all things considered I do more things right than wrong.” Sean noticed that self-encouragement worked better than self-criticism. He felt better, could focus on his work, and move on with his day more quickly when he shifted how he talked to himself. Sean now tries his best to be kind to himself, especially when he makes mistakes.

    Good job! You’ve Created a Thought Record

    Download Your Worksheet

    Good job! You’ve learned how to make a thought record and challenge unhelpful thoughts. If you’ve been hard on yourself or thinking unhelpful thoughts for awhile, it can take some work to break that habit. The more you practice thinking balanced or helpful thoughts, the more natural it begins to feel. Try challenging a few thoughts a day and share them with your therapist who can help you tweak them until you don’t believe them anymore. If you have a few unhelpful thoughts that keep creeping back, it’s a good idea to write down a few balanced thoughts or responses on a card to keep as a handy reminder.


    Congratulations! You’ve Started to Practice Challenging Your Thoughts

    Continue making thought records and creating balanced or helpful thoughts. If you’re feeling stuck you can review this unit or talk to your therapist or healthcare provider.

    I’m using the self-help:
    I’ve got an online therapist:
    I’m working on my own:

    Problem Solving

    When you've got a problem, you need to do more than challenge negative thoughts
    Problem Solving Unit Guide

    It’s easy to feel overwhelmed when facing a problem like losing your job or a close friend. When you have a problem, changing your thoughts is not the goal; you need to change your situation. In this unit, you will learn how to work through your problems and generate solutions. Take control and create a plan. Even at the worst of times, a good plan will help you get through it.

    • Naming the Problem
    • Brainstorming Solutions
    • Making a Choice
    • Taking Action
    Audio Tip
    Dr. Christine Korol explains how a plan can help you overcome life’s tough situations

    Plan to Action

    Problem-solving plans are the key to helping you face life’s challenges, big or small. Ignoring your problems doesn’t make them go away — it gives them time to get bigger. Instead, take action and make a plan to help you break down your problem and solve it once and for all. Your plan will also help boost your confidence. When you trust that you can handle whatever life throws at you, you’ll worry less and feel better.

    Audio Tip
    Dr. Christine Korol clarifies the difference between a 'worry' and a 'problem'

    Name the Problem

    So how do you make a problem-solving plan? The first step is naming the problem. It’s important to make sure you are dealing with a problem and not a worry. Worries focus on something that might happen. They usually start with the words "what if." Problems are happening right now or about to happen very soon. If you aren’t sure if you have a worry or a problem, ask yourself if it’s already happened. If the answer is yes, you’ve got a problem.

    Name the problem. What's going on?

    425 characters remaining
    Audio TIp
    Dr. Christine Korol explains how brainstorming can lead to unexpected solutions


    Once you’ve named your problem, it’s time to brainstorm possible solutions. Try to think up a few ways that you could solve your problem. It’s important not to censor yourself. Write down all your options, even if some seem silly. Sometimes the most ridiculous thought can lead you to the best solution.

    If you're feeling stuck, try brainstorming with someone else. Your therapist, a good friend, or a family member can help you come up with ideas.

    Try brainstorming three solutions to your problem:

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    Pros and Cons

    Take a look at the different options you came up with to solve your problem. What are the upsides and downsides for each possible solution? For example, if you lost your job you might consider going back to school. An upside could be that it would lead to better job opportunities. The downside could be that tuition is expensive.

    What are the benefits of each of your solutions? What are the drawbacks?

    Possible Solution
    Possible Solution: 1.
    Possible Solution: 2.
    Possible Solution: 3.
    Audio Tip
    Dr. Christine Korol explains the benefits of having more than one solution to a problem

    Make a Choice

    The upsides and downsides of each solution can help you decide what to try first. Take a look at each of your possible solutions and rank them in terms of which you should try first, second and third. There’s no perfect way to rank your solutions. A solution could be ranked first because it’s easy to do, has the fewest downsides or seems the least risky.

    Take a minute to order your possible solutions 1, 2, or 3. Which would you like to try first?

    Possible Solution Order
    Possible Solution: 1.
    Possible Solution: 2.
    Possible Solution: 3.

    Give it a Try

    Now it’s time to give your solution a try! If it doesn’t solve your problem, try another solution on your list or brainstorm some new ones. Depending on the nature of your problem, you might be able to try a few ideas at the same time. For example, if you were looking for a new job you might try a few things right away. You could let your friends know you’re looking, send your resume to a few companies and register with a headhunting agency.

    Vijay's Story

    Don’t remove

    Vijay was having a terrible day. Work was busy and he was running late. Everything came to a head when he got into his car and it wouldn’t start. Great. Money was already tight this month. Vijay didn’t know how he’d afford to get the car fixed, and still be able to pay his mortgage and buy groceries. With help from his therapist, Vijay needed to come up with a plan to save money for this month’s expenses.

    Vijay started to brainstorm some ideas. He could ask creditors to skip a payment or borrow money from family or friends. Packing a lunch for work instead of eating-out could save some cash. He could rent out the basement or sell some things online. He was sure he could find a cheaper cell phone plan and ride his bike to work. He even considered delivering flyers in the evenings, like he did when he was a teenager.

    Vijay considered his options. He didn’t want to ask anyone for money. But then he remembered that his brother owed him $200 for a present they bought for their parents. He didn’t mind asking for that back, and his brother apologized for forgetting. Finding a cheaper cell phone plan was easy, but Vijay didn't want to rent out the basement. He saved more money than he expected by bringing lunch to work.

    When it all added up, Vijay was able to buy groceries and make his mortgage payment! He was thrilled with what he’d managed to save over the month. He decided to keep up some of the changes to build up a cushion for the next emergency.

    Your Game Plan

    Download Your Worksheet

    Good job! You’ve got a solution to your problem that you’re ready to try out. If it’s not effective, you’ve got a few backups ready to go. It’s helpful to fine tune your plan with your therapist and keep track of how well your solutions work out. Remember that having a solid plan can help you solve your problems. When you have fewer problems you'll have less stress and more confidence. This will make you feel better and boost your mood. Download this worksheet to save a copy of your plan and keep track of your progress.


    Great Work! You’ve created a plan to solve your problem.

    Remember that making a problem-solving plan will help you cope with life’s ups and downs. The steps are simple:

    1. Name the problem
    2. Brainstorm possible solutions
    3. List the upsides and downsides of each solution and rank them
    4. Test a solution
    5. Evaluate the outcome
    I’m using the self-help:
    I’ve got an online therapist:
    I’m working on my own:

    Core Beliefs

    Beliefs can distort experiences and thoughts.
    Core Beliefs Unit Guide

    We all have beliefs about ourselves, others and the world that we have held for a long time. These underlying beliefs can affect how we interpret our lives. If you hold a negative core belief you may have a habit of only noticing what fits in with it. This bias can get in the way of thought challenging. No matter how hard you work at it, your mood might crash whenever specific thoughts appear. To continue working through your depression or anxiety, you need to tackle your core beliefs. In this unit, you’ll learn how to break apart your core beliefs and start seeing the world from a different angle.

    • Identify a Core Belief
    • Find Evidence
    • Balance Your Belief
    • Daily Reinforcement
    Audio Tip
    Dr. Francois Botha explains what core beliefs are.

    Trapped by Core Beliefs

    If you’ve been challenging your negative thoughts for a while, you’ve probably become quite good at it. It should be easier to review your thoughts and come up with something more balanced.

    However, you may notice that some thoughts are still getting you down, despite your hard work. It may seem like you can’t shake them, no matter how much challenging you do.

    Your problematic thoughts probably fall under a general theme. Are they all about being unlikeable? Maybe they revolve around being unsafe. If this is the case, a core belief is likely keeping you stuck.

    Core beliefs are more than just a group of thoughts. They are deep-rooted ideas or assumptions about yourself, others and the world. Core beliefs tend to be rigid and not easily broken down. To overcome your anxiety or depression, you need to rework your core beliefs.

    Audio Tip
    Dr. Mahesh Menon discusses how core beliefs form and their usual content.

    Fundamental and Powerful

    You may wonder how your core beliefs formed in the first place. Where did they come from? Core beliefs are created through your life experience. When you are young, what you see, hear, and do, gets interpreted into rigid laws and rules about the world. For example, say school was hard as a child, and you got a lot of criticism or negative feedback. This experience could lead to a global belief like “I’m stupid.”

    Core beliefs, as the name suggests, tend to be central and fundamental. In fact, at their root, core beliefs focus on our ability to survive. They often fall into these categories: safety, likability, and capability. Being safe and a valued member of your community can mean life or death. From an evolutionary perspective, it’s no wonder that core beliefs are so emotionally powerful!

    Let’s explore the categories of core beliefs a bit further. Core beliefs about safety may be something like “I’m helpless,” or “The world is a dangerous place.” For likability, you may hold beliefs like “I’m unlovable,” “I’m a bad person,” or “People are judgmental.” Finally, in the capability category, you may find the beliefs “I’m incompetent,” or “It’s a dog-eat-dog world.” A core belief may fit into more than one category at a time. What they all have in common is the suggestion that you won’t prevail. There is something that may prevent you from surviving in our world.

    To protect against this threat, many people cope by creating conditions or rules. You may tell yourself “I’ll be safe as long as I’m in control,” or “I’m lovable if I can make everyone happy all the time.” You might try to live by the rule that “I’m competent as long as I don’t make any mistakes.” As you can see, these conditions tend to be nearly impossible to uphold. No one is immune from making mistakes! How can you keep everyone happy all the time? It’s only natural that you’ll eventually “fail” at maintaining these impossible standards. When this happens, your core belief is exposed, and your anxiety or depression can get even worse.

    Audio Tip
    Dr. Mahesh Menon explains why core beliefs are hard to change.

    The Selective Brain

    Think back to a time when you had an argument or debate with someone, say about politics. Did it seem like facts didn’t matter? Like nothing was going to change your friend’s mind? You were probably left wondering how your friend could completely ignore the side of the story that doesn’t fit with their political view. The same thing happens with core beliefs. It’s not just your friend, we all have selective brains!

    Imagine your mind as a house. Your core beliefs come first. They are the foundation or bedrock of the whole building. When you experience something, your brain takes in all the pieces that fit with your core belief. These experiences add bricks and walls to the house. What doesn’t match the foundation is ignored and left out. In a sense, the human brain takes shortcuts. It’s easier to cast aside experiences that don’t fit into our core beliefs than it is to tear down the house and rebuild from scratch.

    The selective power of the human mind ensures that core beliefs are always reaffirmed. The connections in your brain relating to your core beliefs are very strong. Reworking a core belief means you’ll need to look out for the experiences your mind tends to ignore. You need to offset the selective nature of your brain. It’s not easy, but you can do it.

    Audio Tip
    Dr. Francois Botha discusses how to identify a core belief.

    Find a Core Belief

    The first step to challenging a core belief is to identify one. This task may not be so easy. You may find you see the rooms and windows of the house but not the foundation. If that's the case, it may help to work in reverse. Start by writing down a common negative thought. Then ask yourself, "What does this say about me? Or others? Or the world?" Keep doing this exercise until you reach the central idea, your core belief.

    Keep in mind that core beliefs tend to fall into the categories of safety, likability, and capability. It may also help to think of a core belief as a statement starting with "I am...," "People are...," or "The world is...." Other core beliefs may start with "God is…," "My life is…," or "The universe is…"

    Start with a problematic negative thought and work down to your core belief.

    300 characters remaining

    What does this say about you, others, or the world?

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    What does this say about you, others, or the world?

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    What does this say about you, others, or the world?

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    Feeling Stuck?
    Safety:I am powerlessThe world is dangerousI am out of control
    Likability:I am unattractivePeople will reject meI am toxic
    Capability:I am ineffectiveEveryone is better than meI am defective
    Please only select one


    Audio Tip
    Dr. Margaret Drewlo explains how to identify evidence that a core belief is not entirely true.

    Challenge your Belief

    Once you've identified a core belief, you can start to challenge it. Remember that your brain is selective. It has a habit of only letting in the experiences that fit with your core belief. For this reason, it may be hard to find evidence that shows that your core belief is not true. You may need to work at it. If you are feeling stuck, there are a few things you can try. You can ask friends or family members for help or think about recent activities you've done. It may also help to look at examples in your thought diary.

    Here's your core belief:


    What evidence do you have that your core belief is not completely true? Include everything you can think of even if it seems too small to mention.

    750 characters remaining

    Balanced Beliefs

    Similar to thought challenging, the key to reworking a core belief isn’t to make it 100% positive. You need to create a balanced belief. Pretending that life is all sunshine and rainbows won’t help. You need a belief that is realistic. It should capture both the negatives and the positives about yourself, others or the world.

    Here are some examples comparing negative, positive, and balanced core beliefs:

    Negative Belief Positive Belief Balanced Belief
    I am useless. I am competent at everything. I can do certain things well, but not everything. I make mistakes sometimes, but I am also able to learn from them.
    Nobody loves me. Everybody loves me. I have a few good people in my life that love me.
    The world is better off without me. I am a really important part of this world! While my existence might not be important to the world at large, I do my best to help out my community. The people I connect with are happy I am in their lives.
    Audio Tip
    Dr. Mahesh Menon describes the important characteristics of a good balanced core belief.

    Your Balanced Core Belief

    Take a look at your evidence that does not support your core belief:


    Use this evidence to help you make a new balanced core belief. If you’re feeling stuck, don’t worry. Reworking core beliefs can be tricky and your therapist can help you get the hang of it.

    750 characters remaining
    Audio Tip
    Dr. Francois Botha discusses techniques that help reinforce a balanced core belief.

    Boost Your Belief

    Creating a balanced core belief is a good step forward, but you won’t feel real change until you reinforce it. Remember that your brain is selective and ignores information. Just writing down a new balanced belief won’t be enough to change your thinking. You need to start doing little things every day to strengthen it.

    Start by writing down experiences each day that support your new belief. Keep a diary or notebook. This exercise will help you notice what your brain tends to dismiss. You don’t need big events! Small things count. A conversation or minor situation can be good evidence for your new belief.

    Audio Tip
    Dr. Margaret Drewlo explains how to address setbacks.

    Don't Sweat It

    Some people worry when new evidence for their old belief comes up. You might panic and think that your old belief was right after all. The truth is, life happens, and sometimes things won’t go your way. Your new core belief is balanced and includes the positive and negative. Evidence that supports your old belief doesn’t automatically oppose your new one. In fact, finding the negative has never been the problem! Nobody is perfect, and that’s not the goal. Try not to sweat it and keep working on finding evidence that supports your new balanced belief.

    Adeline's Story

    Adeline always believed that if she had a good job, she was a success. At her work, she was able to climb the ranks until finally reaching her dream job as a sous chef. Unfortunately, after a few months, Adeline's boss told her it wasn't working out. Out of work, Adeline felt her world crashing down and became depressed.

    Adeline began to work through her depression with the help of a therapist. She started to reconnect with friends and challenge her negative thoughts. She also got a position volunteering at a soup kitchen. On the outside, everything seemed to be going well. But despite her hard work, Adeline's mood still plummeted every time she made a mistake. It was as though some thoughts were too strong to challenge away.

    Today, Adeline and her therapist work through her thoughts and identify a core belief. "I am incompetent and defective." They begin to look for evidence that this belief is not true. Adeline points out that she is valued and trusted by her friends. She also notes that she gets good feedback when volunteering. Adeline's therapist agrees with this evidence and suggests there is more. He reminds Adeline that she doesn't usually give herself credit for what she does well.

    Adeline and her therapist develop a new balanced belief. To help reinforce it, Adeline keeps a diary. She writes down little things that happened each day that support her new belief. This exercise helps her notice the daily achievements she was ignoring. It also stops Adeline from discrediting her abilities. A few months later, Adeline is still hard on herself when she makes a mistake. But her mood doesn't crash. She's able to see that one mistake doesn't define her.

    Good Job! You've Started Working on a Core Belief

    Download Your Worksheet

    Good job! You’ve learned about core beliefs and how to reframe them. Remember that core beliefs are deeply ingrained and will take time to break down. Keep working on your new balanced belief with your therapist. Record evidence that supports your new belief every day to help strengthen it. A diary of positive experiences can be handy to look on back on if your original core belief creeps up.


    Congratulations! You’ve Begun to Rework a Core Belief

    Continue identifying core beliefs and reworking them. Create new balanced beliefs and reinforce them with daily evidence. If you’re feeling stuck, you can review this unit or talk to your therapist or healthcare provider.

    I’m using the self-help:
    I’ve got an online therapist:
    I’m working on my own:


    Practicing relaxation interrupts the anxiety cycle giving your mind and body some rest.
    Relaxation Unit Guide

    When you become anxious, your body gets ready for conflict. You breathe faster and shallower to take in more oxygen. Your muscles tense as your body gets ready to fight or run. When you are worried about something that might happen in the future, your body can stay tense for a long time. This can make your muscles hurt and feel sore. You may end up feeling exhausted and more anxious. Learning to relax can help you break this vicious cycle. You need to give your body and mind a rest.

    • The Skill of Relaxation
    • Deep Breathing
    • Progressive Muscle Relaxation
    • Overcoming Obstacles

    Muscle Overdrive

    If you came face to face with a wild animal, your body would get ready to either fight or run away. You would start breathing faster and your heart would start pumping like crazy. Your muscles would tense up, like a sprinter getting ready to run. When the danger was over, and you’d escaped, your body would calm down and go back to normal.

    When you’re worried about something, your body gets ready in the same way. The difference is that you aren’t in danger. There’s no wild animal in front of you. Instead, your body is preparing itself for a wild animal that you might confront some time in the future. Because you can’t escape from a “what if”, your body doesn’t get to calm down and relax. You can stay ready for danger for a long time and send your muscles into overdrive. Learning to relax can help you give your body and mind some rest.

    Audio Tip
    Dr. Theo DeGagne shares his approach to relaxation and why it’s important

    Relaxation as a Skill

    Some people think that relaxation should be a natural process. “I’ll just sit down on the couch, turn on the TV, and do nothing.” But you might find that relaxing is actually harder than you think. Some people find that their worries take over when they try to relax. They might even feel guilty that they aren’t doing errands or taking care of things.

    Learning to relax is a skill. It might not be enough to just distract yourself with a TV show or a hobby. Instead, you might need to practice specific ways to focus on relaxation. These techniques can help give you a break from the way anxiety affects your body. They can also teach you how to deal with worries that might come up when you’re relaxing.

    When to Relax

    A lot of people think you should relax when you are very anxious. But it’s really hard to relax when you are at the height of panic or worry. In fact, research shows that trying to relax during these stressful moments doesn’t work. It can actually make your anxiety worse!

    Relaxation is not good for emergencies. You can’t relax away the intense physical symptoms of anxiety. Instead, you should practice relaxation regularly at times when your anxiety is under control. Make it part of your self care routine. With practice you can do relaxation exercises throughout your day. You can practice on the bus, at work or before you go to bed.

    Types of Relaxation

    There are lots of different ways to relax. Some focus on your breathing, others focus on your muscles. You might find that some techniques work better than others. Everyone is different. What works well for you might not work at all for someone else.

    We’ll focus on two different ways to relax: Deep Breathing and Progressive Muscle Relaxation.

    Audio Tip
    Dr. Francois Botha discusses the deep breathing technique

    Deep Breathing

    Babies breathe in a slow and deep way. As life becomes more stressful, people’s breaths tend to get quicker and shallower. This becomes a habit unless people learn to revert back to deep breathing. Some people master how to do this when they learn to sing or do yoga.

    You can check your own breathing style by placing one hand on your chest and the other on your stomach. When you breathe in, notice which part of your body rises the most. If it’s your chest, focus on slowing down and deepening your breath. You want to arrive at the point where your stomach expands, but your chest barely rises. You also want to aim for about 8 seconds between in-breaths. Make sure to also slow down your out-breath to about 4 seconds.

    Practicing Deep Breathing

    You can practice deep breathing anywhere! It’s invisible to the people around you. You can practice while waiting in line, on the train or at the movies.

    In the beginning, you can practice deep breathing for only 5 minutes at a time. As you progress, you can start using it anytime and anywhere you have a few moments to spare.

    You can also use this technique when you notice that your breathing has become fast or shallow. Slowing your breathing sends a message to your brain that there is no danger. This allows your body to take a break and can reduce your fatigue over time.

    Audio Tip
    Dr. Reena Sandhu describes the progressive muscle relaxation technique

    Progressive Muscle Relaxation

    This relaxation technique focuses on your muscles. The idea is to squeeze your muscles tight and then relax them. It might sound strange to tense up your muscles first, but this can make the relaxation feel deeper. Think of it working like a rubber band. The more you pull it tight in one direction, the further it snaps back in the opposite direction.

    Progressive muscle relaxation can help you become more aware of your body. People often keep their muscles tight without noticing it. You might be tense even when you aren’t worrying! As you practice relaxation you’ll get better at recognizing the state of your muscles. Once you notice your anxiety and tension building up during the day, you can take steps to relieve it.

    Practicing Muscle Relaxation

    There are many different muscle groups where you may store tension. You shouldn’t try to squeeze all the muscles in your body at once! To do progressive muscle relaxation you need to work through the muscle groups one at a time. You can do it in any order. We’ll start from the head down to the toes.

    Facial Muscles


    To tense the muscles in your forehead, lift your eyebrows up as much as you can. This should cause your forehead to wrinkle. Feel the tension in your forehead and scalp. Hold it for 5 seconds, then let go. Notice how the muscles relax when your eyebrows drop.


    Close your eyes and squint them as much as you can. At the same time, wrinkle your nose. Focus on the tension around your eyes, nose, and cheeks. Hold it for 5 seconds. Then stop squinting and wrinkling your nose, while keeping your eyes closed. Feel how the muscles around your eyes, nose, and cheeks relax.


    Make a big grin and clench your teeth. Also draw your mouth and chin inward. You should feel your mouth, jaw, and neck tense. Hold it for 5 seconds, then let go. Focus on how your jaw muscles and neck muscles relax.

    Practicing Muscle Relaxation

    Upper Body Muscles


    Move your elbows up and back so that your shoulder blades gets pushed together. Focus on the tension this creates in your shoulders and back. Hold the tension for 5 seconds. Then relax your elbows and shoulders and focus on the relaxed feeling in your shoulders and back.


    Take a deep breath and hold it in by tightening your chest. Focus on the tension in your chest as you pull it in. Hold the tension for 5 seconds. Then breathe out slow and focus on the looseness of the chest muscles.

    Upper arm

    Start with your dominant arm. Tense your bicep while keeping your forearm relaxed. You could also press your bicep into the side of your body. Focus on the tension in your upper arm. Hold the tension for 5 seconds. Then relax your arm and focus on the relaxed feeling in your upper arm. Now repeat this with your other arm.

    Lower arm

    Start with your dominant arm. Tense your forearm as much as you can. Make a tight fist. Keep your upper arm relaxed. If you have arthritis in your hands, make sure you do not keep your fist so tight that it hurts. Also if you have long fingernails, do not dig them into your hands. Focus on the tension in your hand and forearm. Hold the tension for 5 seconds. Then relax your forearm and hand and focus on the relaxed feeling in these body parts. Now repeat this with your other arm.


    Tighten your stomach muscles. Make them as hard as possible. Focus on the tenseness of these muscles. Hold the tension for 5 seconds. Then relax your stomach muscles and focus on how they change from tense to relaxed.

    Practicing Muscle Relaxation

    Lower Body Muscles

    Buttocks and Thigh Muscles

    Tighten your buttocks by squeezing them together as much as you can. Focus on the tension in your gluteal and thigh muscles. Hold the tension for 5 seconds. Stop squeezing your muscles together. Focus on the relaxed feeling in your gluteal and thigh muscles.


    Start with your dominant leg. Lift your foot off the floor and point your foot. Tighten your lower leg. Focus on the tension in your foot and calf muscle. Hold the tension for 5 seconds. Then return your foot to the floor and focus on the relaxed feeling in your calf and foot. Now repeat this with your other leg.


    Start with your dominant leg. Lift your foot off the floor and flex your foot. Tighten your lower leg. Focus on the tension in your foot and shin muscles. Hold the tension for 5 seconds. Then return your foot to the floor and focus on the relaxed feeling in your shin muscles and foot. Now repeat this with your other leg.

    Overcoming Obtacles

    Obstacles to relaxation vary from person to person. But some are pretty common. We’ve got a few tips to help you:

    Distracted by Pain

    If you have an injury or feel pain for any reason, don't squeeze your muscles too hard. Pain will make your muscles tense up, making it hard to relax. If an area really hurts, skip making it tense and try to relax it directly.

    Dr. Theo DeGagne
    Distracted by Worry

    While trying to relax, you may become distracted by worries. Don't try to argue with your worries or push them aside. This will only distract you more. The best approach is to bring your attention back to the relaxation exercise.

    Dr. Francois Botha
    Other Techniques

    If you don't find deep breathing or progressive muscle relaxation effective, don't worry. There are other ways to relax. Ask your therapist for advice.

    Dr. Theo DeGagne
    Falling Asleep

    If you find it hard to stay awake during a relaxation exercise, try sitting up instead of lying down. It can also help to do your relaxation earlier in the day. It's easy to fall asleep if you do your exercise right before bed.

    Dr. Reena Sandhu

    Try a Relaxation Exercise

    It’s time to try relaxing! Many people find it useful to follow an audio recording. Everyone does relaxation a little different, so you might prefer some recordings to others. Try them out and see which ones you like.

    Dr. Lori Brotto

    Dr. Lori Brotto guides you through a body scan focusing on acceptance and awareness. This mindfulness exercise will take about 40 minutes.

    Dr. Lori Brotto
    Dr. Theo DeGagne

    Dr. Theo DeGagne presents Quietude, with music by George Blondheim. This guide takes you through breathing relaxation, deep relaxation, and visualization. This exercise will take you about 20 minutes.

    Dr. Theo De Gagne
    Flora Lung, M.Ed.

    Flora Lung presents Beautiful Beach, a guided imagery relaxation exercise. This exercise is in Cantonese and will take about 20 minutes.

    Flora Lung 提供一個啟導式想像鬆弛練習 ----- 美麗的海灘。練習以粵語進行,需時約20分鐘。

    Flora Lung, M.Ed.
    Poran Poregbal, MA, RSW, RCC

    Poran Poregbal leads you through a body and mind relaxation guide. You will focus on your breathing, heartbeat, mind and sensations. This exercise is in Farsi and will take about 10 minutes.

    پوران پوراقبال راهنمای شما میشود در یک تمرین آرامش یابی‌ بدن - ذهن.  شما تمرکز می‌کنید بر تنفس، ضربان قلب، و هیجانات ذهنی‌. این تمرین به زبان فارسی است و ۱۰ دقیقه به طول می‌انجامد

    Poran Poregbal, RCC
    Andrea Sierralta, MA, RCC

    Andrea presents Safe Place, a guided visualization that promotes feelings of safety and comfort. This visualization is in Spanish and will take about 5 minutes.

    Andrea presenta Lugar Seguro, una visualización guiada que promueve sentir seguridad y comodidad. Esta visualización es en Español y toma aproximadamente 5 minutos.

    Andrea Sierralta, MA, RCC

    Good job! Time to Make Relaxation a Habit

    Download Your Worksheet

    Good job! You've learned how you can use relaxation to give your body a rest. Relaxation is a skill and the more you practice it, the more effective it may become. We have included a worksheet to record your daily practice of relaxation. Download your worksheet and record your practice for the next week. Share your experience with your therapist or healthcare provider.


    Congratulations! You're Learning to Relax

    Keep practicing deep breathing and progressive muscle relaxation. You can revisit this unit to try out different recordings and see which ones you prefer. With practice you will get better at noticing tension in your body. Over time, relaxation will become an important part of your daily self-care.

    I’m using the self-help:
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