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?

7min
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.
0:51

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.
0:51

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.

Thoughts

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.

0:32
Dr. Margaret Drewlo
Emotional

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.

0:26
Dr. Margaret Drewlo
Physical

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).

0:24
Dr. Margaret Drewlo
Behavioral

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.

1:26
Dr. Francois Botha
Audio Tip
Dr. Heather Fulton discusses the core principles of psychotherapy for substance use problems.
1:02

Treatments

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

Physchotherapy

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.

Medications

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

20min
Working on goals that endorse your values will help you stay committed to change.
Committed Action Unit Guide

Cutting down on your substance use can be a significant life change. Sticking to it is tough. It can be hard to stay committed to your goals long term. Looking inside yourself and discovering your values can help. When your goals align with what’s important to you, it can be easier to stick it out.

  • Commitment
  • Your Values
  • Your Goals
  • Obstacles
Audio Tip
Dr. Heather Fulton explains the importance of taking action for learning and making changes.
0:55

Committed Action

You may have spent a lot of time thinking about how you’d like to change your substance use. You may want to use less often or stop altogether. But for a shift to really happen, you need to move past thinking and into action. There’s no way around it — you need to do something to see real change!

Committed Action is about finding what’s most important to you and then taking steps in that direction. You need to think about what’s meaningful to you, what’s practical, and then make a plan of action. It’s a big undertaking and may feel overwhelming. A great place to start is by thinking about your values.

Audio Tip
Dr. Heather Fulton discusses values which help clients change.
0:32

Identifying Your Values

It’s easiest to find meaning in life through our values. They can give us direction in how we want to spend our time. Determining the values that are most important to you can help you gain clarity about your goals and what you want your life to stand for.

Identify the 5 values that are most important to you:

75 characters remaining
75 characters remaining
75 characters remaining
75 characters remaining
75 characters remaining
Feeling Stuck?
BeautyContributionDignityHopeLearningNurturePlaySelf Expression
CommunityConnectionFamilyHumourLoyaltyParentingPleasureSelf Respect
CompassionCreativityHomeIntegrityNaturePartnershipRelationshipTrust

Edit

Pick a Value

Making goals based on your values can help you sustain a change in your substance use. For the rest of this exercise, let’s focus on the value you feel is most important. It can be the value that seems the most urgent, the most lacking, or the most meaningful. It’s up to you.

Here are your top 5 values:

Which value do you want to build goals towards today?

75 characters remaining

Done

Edit
Audio Tip
Dr. Francois Botha highlights the importance of internal goals for sustained change.
0:55

Choose a New Goal

Finding a new goal might take some time. You want it to be realistic, achievable, and time-framed. It could be something small or something to work towards over months. For example, a goal motivated by “learning” could be tiny, like reading a news article each day. On the other hand, it could be as big as starting a new university degree. To start, you might want to pick something small and more easily achieved. But the most important thing is that your goal feeds your values.

Create a goal that is guided by your value:

What's something you could do that would bring more of this value into your life?

500 characters remaining

Done

Edit

Daily Action

To give yourself the best chance of achieving your goal, you want to break it down into little steps. These activities should be things you can do over the next few days. The sooner you take action, the better. This way, other stuff is less likely to get in your way.

Your actions should be small and manageable. Ideally, an action can be completed within a single day. Let’s say your goal is to start volunteering. Some steps could be to research volunteer centers, prepare a CV, and send in an application. If your goal is to spend more time with your kids, your actions could be to read a bedtime story, do an art project, or help with homework.

Here's your goal:

What actions could you do to work on your goal?

500 characters remaining
500 characters remaining
500 characters remaining
500 characters remaining

Done

Edit
Audio Tip
Dr. Heather Fulton discusses common obstacles when people work on substance use.
0:48

Dealing with Obstacles

Obstacles are bound to come up when you’re trying to cut down or stop using. It’s guaranteed. Think about what you can do when faced with a challenging situation. Planning now will help you to cope better in the future.

Consider your goal and daily actions. What obstacles can you see getting in your way?

500 characters remaining
500 characters remaining
500 characters remaining

Done

Edit

Thinking Ahead

Take a moment to think about how you could get around each of the obstacles you listed. How could you cope and still work towards your goals?

500 characters remaining

500 characters remaining

500 characters remaining

Done

Edit
Audio Tip
Dr. Heather Fulton talks about the importance of rewarding yourself.
0:52

Recognize Your Work

Making a change in substance use is a big undertaking. You need to acknowledge the vital work you are doing. Despite the stigma, you are seeking and accepting support. How can you reward yourself without using a substance? Finding a way to celebrate your success will help you to keep going. Recognize your work and pat yourself on the back. You deserve it.

Jordan's Story

Jordan had been using alcohol and cannabis since high school. While he started using only with friends on weekends, things had slowly changed. Alcohol and marijuana were now a part of his daily routine. Jordan didn't think he had a problem until his boss fired him for being late and hung-over too often. Jordan felt ashamed and embarrassed. He started to feel like his life had lost direction.

Jordan worked with a therapist to start turning things around. To make an action plan, his therapist suggested that Jordan think about his values. After a bit of thought, Jordan realized that contribution and family were particularly meaningful to him. He decided that he'd like to start helping his brother with the family business.

As a first step, Jordan called his brother to talk about what days and times are busiest at the shop. He started to plan his schedule around helping his brother. He felt good knowing that he was contributing to his family and spending more time with his sibling.

Making changes was not easy 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.

Well done! You've Started to Set Up Some Goals

Download Your Worksheet

Sticking to changes in substance use is hard. Having goals that feed your values will help you stay on track.

Download

Well Done! You're Moving Towards Your Values

Keep working to accomplish your goals. Think about your other 4 values and make goals for them too. As you rethink your values, your goals might change. That’s alright. Keep working towards what’s meaningful to you.

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

Coping with Cravings

20min
Strong urges to use substances can get in the way of your goals.
Coping with Cravings Unit Guide

It’s common to have cravings when you reduce your substance use. It might feel like using is the only way to make them stop. But urges can be handled in other ways too. Learning new skills to cope with cravings will help you resist the urge to use.

  • Understanding Triggers
  • The Craving Cycle
  • Working with Cravings
  • Urge Surfing
Audio Tip
Dr. Heather Fulton highlights common triggers for substance use.
0:42

Types of Triggers

You may have noticed that certain situations, thoughts, or feelings can set off a craving. Your mind has made associations between these things and substance use. We call these events internal or external triggers.

External triggers usually involve people, places, or things that remind us of substance use. A friend you always drank with or a dealer in your area could be a trigger. Hearing them talk about using could be enough to bring on a craving. Places, where you used to use or buy substances, could also start an urge. Even objects can be a trigger. Things like empty beer bottles, a vape pen, or even cash can make you think about using substances. You may have noticed that using other drugs can start an urge. “I always want a drink when I smoke a cigarette.” Sometimes even events like sports or anniversaries can act as a trigger.

Internal triggers include your emotions, physical sensations, and thoughts. You may feel an urge to use when you’re feeling depressed, lonely, or tense. On the other hand, you might want to use substances when you’re happy and feeling good. A thought like “I want to have some fun!” could be the start of a craving.

Your Triggers

When you understand your triggers, you can start taking steps to reduce them. Noticing what brings on a craving is essential. Your triggers are unique to you. You may even find that different drugs have different triggers.

Take a moment to list some of your triggers. What kinds of things bring about a craving?

For external triggers, think of people, places and things.
For internal triggers, think of thoughts, feelings and sensations.

150 characters remaining
150 characters remaining
150 characters remaining
150 characters remaining
150 characters remaining
Feeling Stuck?
DealersUsing other substancesGetting moneyPartiesFeeling hungryLoneliness
Friends who useSeeings ads for cigarettesWeekendsSports eventsArgumentsAnxiety / Stress
Ex-partnerPainBeer in the fridgeTaking transitBoredom / Free timeFeeling excited

Edit
Audio Tip
Dr. Heather Fulton discusses how clients can avoid triggers.
1:09

Avoiding Triggers

The simplest way of dealing with triggers for substance use is to avoid them. If you can, don’t go to the places or meet up with the people who remind you of drug use. You may need to change your routes or ways you get around town. At home, it can be useful to get rid of all the tools associated with use. Don’t keep beer in the fridge or a vape pen at home. Make it harder for yourself to get the substance you are trying to cut down or quit.

Avoiding internal triggers is a bit trickier. You can’t escape your thoughts or emotions! But you can work on avoiding extremes. If hunger is a trigger, make sure you carry snacks with you and eat 3 meals a day. If pain causes cravings, do what you can to take care of your body to avoid flare-ups.

Think about your triggers. Can any of them be avoided? How?

500 characters remaining
Audio Tip
Dr. Francois Botha considers common misunderstandings about cravings.
1:07

The Craving Wave

Some triggers, like vivid dreams, can’t be avoided, and cravings happen. When faced with an urge to use, it can be helpful to understand how they work.

A craving affects your mind and body. Your memory might shift, so you only remember the good side to using in the past. It may be hard to focus on anything aside from how terrible the urge to use makes your body feel. Or you might find it challenging to pull your attention away from the dealer you just saw at the bus stop.

It may feel like a craving will go on forever until you give in. But these urges aren’t infinite. Instead, they move in a wave. They come up, they reach a peak, and they fade away. As a craving builds, you may fear that you’re going to get overwhelmed. Using may seem like the only way out. Knowing that the craving will fade can give you the strength to hold on. It might surprise you, but these urges rarely last longer than an hour. There are different ways to “ride out the wave” and resist the desire to use.

Audio Tip
Dr. Margaret Drewlo explains how people can use distractions to cope with cravings.
0:30

Distraction

One way to cope with a craving is by distracting yourself. Don’t forget, the urge you feel is time-limited. Sometimes you can wait it out by focusing your attention on something else.

To distract yourself, you need to zone in on something — the more engaging, the better. You could focus on doing a puzzle or trying a relaxation exercise. If you need any tools for distraction, make sure to keep them with you. For example, you can download some games on your phone or keep a Sudoku puzzle in your wallet.

It can be especially powerful to focus on completing one of your goals for the day. This way, the activity will feel more meaningful. You can also ask yourself what need the craving is looking to fulfill. For example, you might be bored and want to have some fun. In that case, you could find a different way to enjoy yourself without using substances. Replacing substance use with other fulfilling activities is a great long-term goal.

How can you distract yourself when a craving hits?

150 characters remaining
150 characters remaining
150 characters remaining
Feeling Stuck?
Play video gamesFocus on a goalListen to musicBrowse a storeSmell some perfumePet an animal
Deep breathingWord searchLook at nature around youFocus on soundsDoodleHave some dessert
Play cardsRead the paperWalk in the parkHum a tuneSuck on a candyUse a stress ball

Done

Edit

Urge Surfing

A third way to cope with cravings is with a mindfulness exercise called urge surfing. This technique encourages you to focus on your present experience without judgment. The idea is not to try and change what’s happening, but just be aware of it, even if it’s not enjoyable. Using urge surfing during a craving can help you “ride the wave” until the peak of the urge has passed.

With regular practice, urge surfing can help you become more tolerant of cravings. When you feel less overwhelmed, you’ll be able to remind yourself that an urge is temporary and will pass. As you get better at this, you’ll suffer less during a craving. Urges will reappear, but their intensity will likely decrease with time.

Try Urge Surfing now and when you have a craving. The more you practice, the more helpful the exercise will become.

Urge Surfing Practice

Dr. Margaret Drewlo guides you through a mindfulness practice of urge surfing. Try to stick with the exercise for at least 20 minutes during the beginning of a craving. The longer you can hold out, the less likely you'll be to resort to using substances.

9:11
Dr. Margaret Drewlo

Louise’s Story

Louise tried cocaine for the first time at a sorority party. She'd struggled with depression and loved how the drug boosted her low mood. Although Louise started to use more and more, she didn't think she had a problem. That all changed in her third year of university. Louise's grades were suffering, and she was put on academic probation.

Over the summer break, Louise went to rehab. She wanted to stop using cocaine altogether, but her cravings kept leading to lapses. With the help of her counselor, Louise started to notice triggers for her urges. Things like campus bars, her sorority sisters, low mood, and boredom all made her think about cocaine. Louise realized that she could avoid some triggers. She decided to move out of the sorority and live with a supportive friend.

Out of rehab, Louise also made sure she had trustworthy social supports. She joined Cocaine Anonymous and worked with a sponsor. He had a way of helping Louise remember her goals when a craving hit. Her new housemate was also a good person to talk to when things were tough. Although she tried Urge Surfing, Louise found distraction was a better fit for her.

A month out of rehab, and Louise was still doing well. So far, she has managed to cope with her cravings. She joined a basketball team and found practicing helped her avoid boredom. It also led to new social groups. She continued to feel supported by her sponsor. There were still hard times, but she was proud of the progress she'd made so far.

Good Job! You’re Learning to Cope with Cravings

Download Your Worksheet

Keep looking for new ways to cope with cravings. Focus on what works for you. If a lapse occurs, come right back to these tools. Add new techniques or make adjustments as needed. Download your worksheet and start trying different ways to cope with your cravings.

Download

Well Done! You're Starting to Manage Your Cravings

Continue practicing the 3 techniques to cope with cravings. Figure out which ones work well for you and which do not. Keep experimenting and adding new tools.

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

Thinking about Substance Use

15min
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?

150 characters remaining
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

Edit
Audio Tip
Dr. Heather Fulton discusses dealing with excitatory thoughts.
1:58

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?

250 characters remaining

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

250 characters remaining

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

250 characters remaining

Done

Edit

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?

150 characters remaining
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

Done

Edit
Audio Tip
Dr. Francois Botha considers how people may deal with anticipatory thoughts.
1:08

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?

250 characters remaining

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

250 characters remaining

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

250 characters remaining

Done

Edit

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?

150 characters remaining
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

Done

Edit
Audio Tip
Dr. Francois Botha explains how to identify and respond to permission-giving thoughts.
1:15

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?

250 characters remaining

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

250 characters remaining

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

250 characters remaining

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

250 characters remaining

Done

Edit

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?

150 characters remaining
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

Done

Edit
Audio Tip
Dr. Heather Fulton discusses how to deal with effectively with lapses.
1:37

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?

250 characters remaining

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

250 characters remaining

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?

500 characters remaining

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

250 characters remaining

Done

Edit

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.

Download

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

20min
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
1:10

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
1:02

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
1:25

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.

1:27
Audio Tip
Evidence

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.

0:50
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
1:28

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
1:07

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
1:20

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.

Download

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

10min
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
0:42

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'
1:02

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
0:56

Brainstorm

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:

450 characters remaining
450 characters remaining
450 characters remaining

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
0:26

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.

Download

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

16min
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.
1:02

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.
2:47

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.
1:24

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.
2:03

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?

300 characters remaining

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

300 characters remaining

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

300 characters remaining
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

Done

Edit
Audio Tip
Dr. Margaret Drewlo explains how to identify evidence that a core belief is not entirely true.
0:42

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:

positive_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.
0:58

Your Balanced Core Belief

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

text-5

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.
1:36

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.
0:50

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.

Download

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:

Relaxation

15min
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
0:49

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
0:43

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
0:56

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

Forehead

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.

Eyes

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.

Jaw

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

Shoulders

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.

Chest

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.

Stomach

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.

Calves

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.

Shins

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.

1:15
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.

0:51
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.

1:26
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.

1:44
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.

39:54
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.

19:11
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。

18:53
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

10:03
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.

5:30
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.

Download

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:
I’ve got an online therapist:
I’m working on my own:
Useful Tools

 

Keep practicing. Download reusable worksheets and audio guides for Substance Use Problems.

Dr. Margaret Drewlo - Urge Surfing Exercise
9:11
Dr. Lori Brotto - Mindful Body Scan
36:26
Dr. Theo DeGagne - Quietude (music by George Blondheim)
19:11
Flora Lung, M.Ed. - 美麗的海灘
18:53
Poran Poregbal, MA, RSW, RCC - یک تمرین آرامش یابی‌ بدن
10:03
Andrea Sierralta, MA, RCC - Lugar Seguro
5:30
X

We use cookies and similar technologies to operate this site and help us understand how you use it. By continuing to browse this website, you are agreeing to our use of cookies and confirming your review of our privacy policy.

Accept Cookie