Schema therapy is a therapeutic approach developed for treating individuals with longstanding issues, such as personality disorders or chronic depression. The therapy focuses on persistent patterns and incorporates various elements like thoughts, behavior, upbringing, childhood, or attachment. Through this approach, you can learn to better understand yourself and your needs, gaining more control over your life.

What can you expect from the treatment and how can it help you?

You and your therapist will discuss the problems and relevant emotions that frequently arise in your life. During the treatment, you will explore how your childhood experiences have influenced your thoughts, feelings, and reactions in certain situations. You will learn about the basic emotional needs you have as a child and investigate whether they were met during your childhood. Additionally, you will learn to recognize and break free from old patterns or pitfalls. The treatment involves the use of schemas and modes to facilitate this process. The therapy will help you identify and manage your emotional needs and feelings in a healthier way.

Sources

Vereniging voor schematherapie: https://www.schematherapie.nl/schematherapie

Intrusive thoughts are unwanted thoughts or images that seem to repeatedly come out of nowhere. Intrusive thoughts are like uninvited guests, showing up unexpectedly and bringing along a host of emotions—distress, anxiety, tension, embarrassment, shame, and even disgust. It can feel like you have no control over these intrusive thoughts. Common intrusive thoughts range from doubts about relationships to concerns about safety, religion, death, or unsettling aggressive and sexual thoughts. Sometimes, they’re just random thoughts that defy any logic!

This article will focus on understanding intrusive thoughts and typical cognitive distortions that accompany them. 

Understanding intrusive thoughts

Intrusive thoughts are a common symptom in various mental health conditions, such as obsessive-compulsive disorder (OCD), where they are part of the diagnostic criteria (obsessions). Additionally, stress, anxiety, and even physiological factors, like hormonal fluctuations, can trigger these intrusive thoughts. Nonetheless, it is important to understand that everyone experiences peculiar, violent, inappropriate, intrusive thoughts from time to time and that they are a normal part of the human experience. In fact an international study found that 94% of people reported experiencing intrusive thoughts at some point in their lives. You can read more about common intrusive thoughts people have in this article.

Intrusive thoughts can be very explicit and intense which can lead to people feeling guilty or ashamed about them. As a result you can end up worrying about them, and trying to ‘’fight’’, control them or push them away. Unfortunately, it is actually this meaning you attach to the thoughts and the effort you put into controlling and struggling with them which paradoxically makes them stick and keeps them coming back. In reality, your thoughts, even scary or unsettling ones, are just ‘’thoughts’’—they don’t necessarily define you or hold significant meaning. Learning that the content of these thoughts is often irrelevant and unimportant can help you to detach yourself from them and learn to manage them.

Cognitive distortions

Our brains, brilliant as they are, also love to take shortcuts, leading to cognitive distortions. Cognitive distortions are biases, filters or misinterpretations that can result in inaccurate or unrealistic thoughts or beliefs and can contribute to our negative emotions such as those associated with intrusive thoughts. We all have errors or distortions in our thinking from time to time. These distortions can come from past experiences and our beliefs but are also just part of how our brain works.

While we cannot eliminate them entirely, we can educate ourselves about these thinking errors and cognitive distortions so that we can learn to identify them, correct our thinking or detach ourselves from these thoughts. Below you will find some common cognitive distortions typically associated with intrusive thoughts. 

  • Thought-action fusion: This is the belief that having a certain thought can lead us to take action or is the same as taking that action. For example experiencing thoughts about hurting or being aggressive towards another person and believing that you will actually do it as a result.
  • Moral thought-action fusion: This is the belief that choosing not to act on an intrusive thought means you want or implies a subconscious desire for the opposite outcome. For example, if you think about a car crash but don’t do anything about the thought, you might start to believe that deep down, you want the crash to occur.
  • Thought-event fusion: This is the belief that having a thought about an event can influence or cause that event to happen. For example thinking about a potential car accident and believing this influences the likelihood of it to actually happen.
  • Thought-object fusion: This is the idea that an item possesses specific memories, thoughts, emotions, or individual traits. For example, this can also apply to holiday souvenirs or sentimental objects. Some individuals who experience hoarding OCD, do not want to get rid of objects because they represent feelings or thoughts attached to a loved one.
  • Controllability of thoughts: The belief that you should be in control of your thoughts and their content. Holding this belief can lead to increased distress when you experience unwanted thoughts or thoughts that do not match how you view yourself. For example, imagine you see yourself as a kind and caring person, but suddenly, while helping a friend, you have a brief, unwanted thought about hurting them. This thought is intrusive and upsetting because it goes against how you view yourself, and the more you try not to think about it, the more it sticks in your mind.
  • Inflated responsibility: This belief is that if you have the ability to do something to prevent something bad from happening, you should always make the effort. It involves underestimating the role of other factors in the situation and over-emphasising your own control in the situation. Your responsibility isn’t lessened by other factors, like the small chance of the bad thing actually happening. For example, after having the intrusive thought about a break-in, you might excessively check and recheck the door locks multiple times before leaving home, driven by the belief that if you don’t, you will be directly responsible for a break-in, despite the low likelihood of this occurring.
  • Overestimating the chance of danger: This is the belief that a negative outcome is more likely to happen than the evidence or probability actually suggests. This can lead to anxiety or fear. An example would be constantly worrying about a plane crash every time you fly, despite the low statistical risk.

These are just a few typical cognitive distortions or thinking errors that are typically associated with intrusive thoughts. You might notice that some have overlapping elements or relate to each other. There are many more cognitive distortions and thinking errors and you can read about them in this article about thinking styles and this article about thinking patterns associated with anxiety. 

By understanding these distortions, it can help you to label your intrusions, detach yourself from them, and treat them as though they’re uninteresting distractions. Over time, this approach will help these thoughts fade away and reduce the negative emotions associated with them.

Sources:

  • https://accesscbt.co.uk/thinking-errors-and-cognitive-distortions-in-ocd/
  • https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/unwanted-intrusive-thoughts
  • Richard Moulding, Meredith E. Coles, Jonathan S. Abramowitz, Gillian M. Alcolado, Pino Alonso, Amparo Belloch, Martine Bouvard, David A. Clark, Guy Doron, Héctor Fernández-Álvarez, Gemma García-Soriano, Marta Ghisi, Beatriz Gómez, Mujgan Inozu, Adam S. Radomsky, Giti Shams, Claudio Sica, Gregoris Simos, Wing Wong. Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 2014.
  • Keijsers, G., Van Minnen, A., Verbraak, M., Hoogduin, K., & Emmelkamp, P. (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.

 

Intrusive thoughts are unwanted thoughts or images that seem to repeatedly come out of nowhere. Intrusive thoughts are like uninvited guests, showing up unexpectedly and bringing along a host of emotions—distress, anxiety, tension, embarrassment, shame, and even disgust. It can feel like you have no control over these intrusive thoughts. Common intrusive thoughts range from doubts about relationships to concerns about safety, religion, death, or unsettling aggressive and sexual thoughts. Sometimes, they’re just random thoughts that defy any logic!

This article will focus on understanding intrusive thoughts. By understanding our intrusive thoughts, you’ll gain the tools to detach yourself from them, ultimately reducing the distress they bring.

Understanding intrusive thoughts

Intrusive thoughts are a common symptom in various mental health conditions, such as obsessive-compulsive disorder (OCD), where they are part of the diagnostic criteria (obsessions). Additionally, stress, anxiety, and even physiological factors, like hormonal fluctuations, can trigger intrusive thoughts. Nonetheless, it is important to understand that everyone experiences peculiar, violent, inappropriate, intrusive thoughts from time to time and that they are a normal part of the human experience. In fact an international study found that 94% of people reported experiencing intrusive thoughts at some point in their lives, showing that you are far from alone in experiencing these thoughts. You can read more about common intrusive thoughts people have in this article.

Intrusive thoughts can be very explicit and intense which can lead to feelings of guilt or shame about them. You might even be worried that you will act out on the thoughts you have in your mind or that they say something about you as a person! One common myth is that these thoughts say something about your unconscious desires or intentions. As a result you can end up worrying about them, and trying to ‘’fight’’, control them or push them away. While a completely understandable response it is unfortunately actually this meaning you  attach to these thoughts and the effort you put into controlling and struggling with them which paradoxically makes them stick and keeps them coming back.

Coping with intrusive thoughts

In reality, our thoughts, even scary or unsettling ones, are just ‘’thoughts’’—they don’t necessarily define us or hold significant meaning. Learning that the content of these thoughts is often irrelevant and unimportant and nothing more than words or pictures in our mind can help you to detach yourself from them and learn to manage them. When it comes to managing intrusive thoughts, it’s crucial to label them as intrusive and treat them as though they’re uninteresting distractions. Over time, this approach will help these thoughts fade away.

Here are some tips that can help you to effectively manage intrusive thoughts:

  • When you notice an intrusive thought, label the thoughts as ‘’intrusive’’. This will help you to to distance yourself from these thoughts and not take them too seriously. 
  • Remember that the thoughts are automatic and you cannot control them. Understanding that thoughts arise without your control diminishes self-blame and reduces anxiety about having them.
  • Accept the thoughts and any associated feelings and allow them to be there without fighting them or criticising yourself for experiencing them. This will help to reduce their intensity and the distress they cause.
  • Continue with what you are doing prior to the intrusive thought and be persistent in bringing your attention back to activity. Redirecting focus back to your current activity helps in grounding yourself in the present, reducing the thought’s hold over your attention
  • Try not to engage with the thought or push it out of your mind. Fighting or struggling with the thought will amplify its presence and bring it to your attention.
  • Try not to figure out what the thought ‘’means’’ or says about you. Avoiding over-analysis of the thought’s meaning prevents unnecessary self-judgement and reduces the likelihood of spiralling into further negative thoughts
  • Try not to keep checking whether you were able to get rid of the thought and try to focus on the present moment. Focusing on the present instead of monitoring the thought helps in breaking the cycle of rumination and reduces its recurrence.

While these tips can be difficult to apply and take a lot of practice. Persisting with this approach should help the frequency and intensity of your intrusive thoughts to decrease in the long term!

Sources:

Your thoughts, feelings and behaviour all interact and influence one another. It follows then that you can have an effect on the way you feel or behave by changing the way you think or the perspective you take in a situation. This article will focus on how thoughts can influence you and why they play an important role in mental health. 

What are thoughts?

Thoughts are ideas, opinions, assumptions or images that occur in the mind. Your mind is constantly racing with thoughts. You might experience them as that little ‘’voice’’ inside your head that follows you everywhere and talks to you constantly. Sometimes these thoughts are positive, sometimes they are negative, sometimes they help us, sometimes they seem like an obstacle. Research suggests that people typically have more than 6000 thoughts a day! The amount and variation of the thoughts you experience can make it hard to understand how they may be impacting you.

How do your thoughts influence how you feel?

Everyday your brain is tasked with processing information that comes from the world and environment around you: the traffic report on the radio, the recent conversation you had with your colleague at work, the weather outside, the room temperature, your social media feed. Objectively speaking this information is neither inherently good nor bad. Your thoughts and beliefs help you to make sense of this information and give this information meaning so that you can act accordingly. Thus it is the way you interpret – the meaning you give or your thoughts about this information – that determines how you feel about it.  This is why two people can have different feelings or come to different conclusions about the same event. Your thoughts act as the bridge between the information that comes in and your feelings.

See below for an example of how two different people can interpret the same situation differently.

Situation: Receiving constructive feedback about areas of improvement at work

Person A

  • Thought:  ‘’They are generally happy with my work. This feedback is a chance for me to grow and get better at my job.”
  • Feeling: Motivated, inspired.

Person B

  • Thought: “I must be doing a terrible job if they’re saying this. I am never good enough’’
  • Feeling: anxious, stressed, insecure. 

Thoughts and mental health

You can imagine that if a large number of the thoughts you have are unhelpful, inaccurate or if you have a tendency to pay too much attention to negative thoughts this could significantly impact your wellbeing and lead to an increase in negative emotions. But why do we think about things differently from one another? The thought you have in a given situation can depend on a vast number of factors. For example: your past experiences, beliefs, biology, genetics, current mood, the timing, who you are with, etc. An example of this could be someone who grew up with high-achieving parents who placed immense pressure on academic success. As a result, they often experience doubtful thoughts about their ability or competence in professional settings leading to anxiety. Similarly, someone who was bullied in school may have overly cautious and mistrustful thoughts in social situations, or perceive benign comments as potential threats.

Furthermore our brain loves to take short cuts.  You do not always think things through realistically and thoroughly. You often have quick and ‘’automatic’’ thoughts or interpretations and these can be vulnerable to bias and filters. For example many of us fall victim to the negativity bias. This is where you have a tendency to give more importance and attention to negative information compared to positive information. In other words, you are more likely to be influenced by or remember negative information over positive information. Another example is the confirmation bias, which is the tendency to pay attention to and remember information that supports or confirms beliefs you already hold.

You can read more about thinking errors here.

Empowerment through awareness

Luckily this is also a hopeful idea. While you are not always able to control situations or external events, you can become aware of our thinking patterns and influence the way you think about them or the meaning you take from events.

Sources:

  • Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond. Guilford Publications.
  • https://www.psychologytools.com/self-help/thoughts-in-cbt/
  • Kahneman, D., & Egan, P. (2011). Thinking, fast and slow (Vol. 1). New York: Farrar, Straus and Giroux 
  • Kanouse, D. E., & Hanson, L. (1972). Negativity in evaluations. In E. E. Jones, D. E. Kanouse, S. Valins, H. H. Kelley, R. E. Nisbett, & B. Weiner (Eds.), Attribution: Perceiving the causes of behavior. Morristown, NJ: General Learning Press.

For your own recovery it is very important to keep track of your progress. This will give you insight into your own thoughts and behavior as well as allowing you to reflect on them. To help you with this, you can regularly fill in short questionnaires, also known as ROM measurements (Routine Outcome Monitoring). With the help of these questions you can keep track of your progress. Additionally, it gives you the opportunity to voice  your opinion about the sessions and the treatment. By doing this you can keep the control over your own treatment process. Your professional has access to the results so that you can discuss them together during your sessions.

What’s the point of these questions?

We use two short, appointment-bound questionnaires consisting of five questions. Not only are they quick to fill in, they give your professional information about how you are doing, and will give you more insight into your own state of mind, how you think the treatment is going and what you think about the sessions.

  1. You fill in the first questionnaire before your appointment. This is about your health and well-being. You can indicate in various domains how you are doing at the moment of filling it in, for example in your social relationships or physical health. The questions are formulated positively and help to monitor your recovery and so that you can check together whether the treatment is still going in the right direction.
  2. You complete the second questionnaire after your appointment and the focus is on your experience of the session you just had. Completing these questions helps to optimize the collaboration with your practitioner. Your opinion about the treatment and the sessions is very important! Therefore you can fill in the list honestly and share your thoughts about it.

Where can I find these questions?

You can find the questions in your Daily Planner on the day your session is scheduled for.

  1. You will see the questions that you fill in before the session as “Questionnaire: how are you?” If you tap on this, you can answer the questions one by one with a slider.
  2. You can fill in the questions that you fill in after the interview by tapping on the scheduled session. These questions are also answered using a slider.

Would you like to see step by step how to fill in the questions? Then watch the instruction video below:


Sources: 

https://www.oplossingsgerichte-therapie.nl/cdoi

https://www.psyq.nl/over-psyq/behandelresultaten/roqua

In a note about your session, you’ll find the most important information from a session, such as things you want to remember or review later. This note can be created by your professional or therapist, and you’re also allowed to create this note yourself.

 

What do you write down about your session?

You can write a note in your own words, giving it your own interpretation.
Consider, for example, the following:

  • What did you discuss today?
  • What were the key points for you today?
  • Did you learn anything new about yourself or gain new insights?
  • What is the homework or exercises for next time?
  • How did you feel during the session?

Why is useful for me to write this down myself?

Writing down the discussed information yourself is useful for the following reasons:

  • Creating the note yourself makes you consciously reflect on what was discussed after a session.
  • You can reflect on how you felt during a session or at specific moments in the session.
  • You may remember information better when you note it in your own words.
  • You can always reread the note.
  • You take a more active role in your treatment.
  •  If you share the note with your therapist, they can see if you understood the discussed information well and what was most important for you.

 

How do I create a note in the NiceDay app?

Click the ‘+’ → Click ‘Session note’

 

Sources:

https://www.apa.org/monitor/jun02/writing

Michael Pilarczyk, Book: Master your mindset, 2017.

 

Social anxiety is a fear of being negatively judged by other people in situations involving social interactions. When you experience social anxiety, you tend to underestimate how well you function socially and overestimate how others perceive you. This is exacerbated by a negative self-image.

Negative Self-Image

Your self-image is activated every time you interact with others and contributes to maintaining social anxiety. If you believe that no one likes you, you are likely to behave accordingly. You project this perception onto your surroundings, and they respond by giving you little attention. These elements reinforce each other because the smaller you make yourself, the less others engage with you.

Positive Self-Image

The opposite of this is a positive self-image. When your self-image becomes more positive, and you are more confident in your good qualities and positive attributes, your social anxiety decreases. It means you believe in yourself more, have a more realistic and therefore positive view of yourself, and behave accordingly. Through interaction with your environment, you will also receive more positive attention.

The Vicious Cycle

If you see yourself as someone who can’t tell an interesting story, you are unlikely to start one. This creates a vicious cycle: if you never initiate to tell a story, you will also never discover whether you can tell something interesting. To break this vicious cycle, it is important to determine whether your self-image is accurate. A good self-image means it is realistic, not overly positive, but also not overly negative. You are aware of your shortcomings, but you also give sufficient attention and appreciation to your strengths. It means that you not only know everything about yourself as facts but also feel and behave accordingly.

Source:

Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.

In mindfulness, you work a lot with your body. When you’re focused on your body, you can’t be lost in thoughts. Moreover, your body is always available, no matter where you are or what you’re doing. Your body sends signals about how you’re feeling and serves as an anchor, always present and always accessible. But the most important thing is that your body exists in the here and now. Everything you experience is happening in that moment, not in the past or the future. By connecting with your body, you connect with the present moment. A good way to practice being in the present moment with your body is by performing the body scan.

 

How do I do that?

During this exercise, you get to know your body with attention, without expectations, striving, or judgments. Just notice what’s there. Do this with a gentle and open attitude. Don’t wonder if you’re doing it right; instead, wonder how it is at every moment.

 

Quote

“Mindfulness is: being consciously present at this moment and without judgment.”

Sources

https://centrumvoormindfulness.nl

https://www.happywithyoga.com/mindfulness/mindfulness-explanation/

https://www.radboudcentrumvoormindfulness.nl/media/1366/

https://www.happywithyoga.com/mindfulness/scientifically-proven-benefits-of-mindfulness/

Segal, V.S., Williams, J.M.G. & Teasdale, J.D. (2004). Mindfulness-Based Cognitive Therapy for Depression.

 

 

 

 

By practicing your attention, you quickly notice how often your actions are influenced by certain ideas you have. An image, phrase, or sound can immediately trigger your autopilot. Your mind is always in motion and constantly distracted by automatic responses: emotions, opinions, thoughts, judgments, desires, memories, and so on! By practicing directing your attention, you learn more about your way of perceiving and thinking, as well as how that influences your actions and reactions.

Exercise

Your breath is a handy tool to bring you into the present moment and guide your attention. Your breath is always present, which is why you can use it anytime and anywhere. It’s a safe point to return to. At such a moment, you can ask yourself: how am I feeling right now, in this moment, and how is my breathing?

An exercise that can help you with this is the ‘three-minute breathing space.’ It’s best to do this exercise standing or sitting in a quiet place with your eyes closed. It consists of three steps:

  1. Direct your attention to your experiences in this moment: what are you experiencing now, what thoughts do you have, how do you feel at this moment, how does your body feel? You’re only observing, not changing anything.
  2. Direct your attention to your breath: follow each inhalation and exhalation, and continue using your breath as a central point.
  3. Gradually expand your attention: direct your attention to feeling and experiencing your body as a whole, to your posture and facial expression. Then open your eyes again and notice what the exercise has done for you. What do you observe?

You can go through these steps on your own with your eyes closed or use audio guidance for the three-minute breathing space exercise. Choose what suits you.

 

“Breath is the link between mind and body”

– Dan Brule

Sources

https://centrumvoormindfulness.nl

https://www.happywithyoga.com/mindfulness/mindfulness-explanation/

https://www.radboudcentrumvoormindfulness.nl/media/1366/

https://www.happywithyoga.com/mindfulness/scientifically-proven-benefits-of-mindfulness/

 

 

 

 

 

 

When you start with symptom reduction, it’s important to gain insight into your symptoms and keep track of them. Since stress is central to burnout, this will be the symptom you’ll be recording. If you find it difficult to concretely define stress, you can also choose to track a stress-related symptom, such as energy or concentration problems.

You can track your symptoms using the app’s Trackers feature. Go to Track and add a new tracker. Then choose what you want to track, for example, stress using the “Stressed” tracker.

Now that you’ve added the tracker, you can easily add a new entry and indicate its intensity. You can optionally add a diary entry if you want to write something about it. This way, both you and your therapist will have more information about your moments of stress.

Try to track your symptoms as often as possible and discuss with your therapist what is feasible.

After returning to work

As you gradually engage in returning to work, it’s important to continue monitoring stress related to specific events or tasks. Try to record your stress for each specific event or task. You can think of specific tasks like a meeting, administrative work, or an important phone call. For events, you can think of a heated discussion, a difficult colleague, or accidentally being late.

Source:

Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocol treatments for adults with psychological symptoms.