Relabel, Reframe, Redirect
Decades of cognitive behavior therapy inform us that we usually can’t change automatic emotional reactions, thoughts, and behaviors without feedback. Cognitive restructuring uses the three R’s to help implement cognitive change:
1. Relabel
- Refer to Step 1 of your utility analysis above. Give the trigger a name, e.g., Mr Bossy
- The name should be specific in order to help our minds discriminate between triggers because we will develop specific ways of thinking (Reframe) in response to different triggers.
2. Reframe
- Refer to step 9 of your utility analysis above.
- The alternative thoughts developed through the utility analysis provide us with a thought tool we can choose to use rather than repeating the automatic thinking that has not been serving a useful purpose.
3. Redirect
- Focus attention on a valued activity.
- We generate alternative behaviors that help us redirect and sustain attention so that we are practicing engagement in the thoughts and behaviors that we value, e.g. spending time with people we love, building a spaceship, coloring in a book, going for a run. (Step 7 of the utility analysis can give you insight about finding activities that will help you feel how you want to feel.)
Use of Metaphors as a Technique with Relabel, Reframe, Redirect
Our brains respond well to metaphors. Metaphors can help make things more meaningful and assist in identifying both unhelpful and helpful thinking patterns. If we can add a little dose of humor or fun into the metaphors, it can help keep our fears and worries in perspective. We might even feel better in our moments of anxiety.
The cognitive restructuring portion of this workbook discussed the idea of relabeling worries. The following examples of metaphors used in relabeling and reframing worries can help put a name to thinking patterns that have a unique meaning to the individual, and help redirect thoughts that are more useful and decrease anxiety.
“Fake News” - One client got the idea that his worries were like the recently popularized idea of “fake news,” and his strategy was to imagine a certain politician with a funny look on his face, declaring, “This is fake news.” Worried thoughts meet humor. It’s harder to be upset when we’re laughing inside. This example was funny to him. Someone else might think it’s not funny at all.
“The Big One” - Another client who had health anxiety problems, worrying and checking his blood pressure regularly in response to body sensations, named it after what Fred Sanford would say in the 1970’s show, Sanford and Son, anytime he got upset as if this is “The Big One” (a heart attack that wasn’t really a heart attack.) It was a staple of the show and got a lot of laughs. Health anxiety triggers, combined with the practice of connecting fond memories of watching a funny scene that identified worries as made up and overdramatized, served as a fear-reducing strategy.
“The Dark Side” or “Voldemort” - Star Wars and Harry Potter fans have labeled their thoughts from these movies in order to get into a fantasy world they enjoy, engaging in a battle against evil forces (in this case, their worried thoughts). In response to worried thoughts, they may say, “That’s just the dark side and I’m going to use “the force” to resist evil,” or “I’m not going to be controlled by Voldemort (or he who shall not be named). If a client can imagine themselves as a resistance fighter or Jedi Knight from Star Wars or a Hogwarts student from the Harry Potter series battling the enemy, this strategy can turn an upsetting worry into an adventure in their minds. Again, the metaphor has to have meaning to the individual because the individual needs to buy-in. For big Star Wars and Harry Potter fans, just thinking about the stories can be fun. It’s more difficult to worry and stay upset while having fun in a cool story.
Categorizing Intrusive Thoughts and Worries, and Use of Acronyms
Relabeling unhelpful thoughts helps us see the thought for what it is: obsessive, unhelpful, and/or intrusive. Sorting our unhelpful thoughts into a category is one way to do this. Two major themes of unhelpful thoughts include the Overestimation of Threat and Intolerance of Uncertainty. As unhelpful thoughts and feelings come up, the anxiety sufferer may identify whether they fall into one of these categories.
Overestimation of Threat is the belief that negative events are especially likely, would be especially awful, and will result in negative outcomes that need to be stopped.
For those who enjoy being creative with words, coming up with acronyms can be a fun way to add meaning. Here is an example of relabeling this line of thinking:
THROTTLE
- Tenacious
- Harassing
- Ridiculous
- Overestimation of
- Threats that
- Take away my quality of
- Life and
- Enjoyment
Responses to overestimations (behaviors and thoughts) either throttle up and make things worse or throttle down and make things better. It may feel like there is a real need to do something to throttle down the threat, but that only increases the perceived need to do it over and over, thus throttling up the perceived threat and anxiety over time. The appropriate response to an overestimated threat is to recognize it (name it) and do nothing. Eventually, the feeling and the threat will subside (habituation).
ROOT
- Ridiculous
- Overestimation
- Of
- Threat
Thoughts and behaviors in response to anxiety either keep you rooted in illogical thoughts and unhelpful behaviors that perpetuate the anxiety or provide roots for progress and helpful thoughts and behaviors that diminish the anxiety. This metaphor may help one stop and make a decision on where to take root.
Intolerance of Uncertainty is the perceived need to be 100% certain that negative outcomes will not occur. This includes the perceptions that uncertainty cannot be tolerated and one must do something to ensure certainty, and that one must search for proof or non-proof.
An “IOU” references something that is “owed.” Our worried thoughts may tell us that we are “owed” certainty, leading us to actions that try to guarantee certainty. When we recognize the reality that there is no certainty, we can see that attempts at certainty ultimately increase anxiety, not decrease it.
Acceptance of uncertainty ultimately decreases anxiety. The person experiencing difficulty with uncertainty can redirect thoughts to more helpful ones such as, “That’s just an IOU (relabel). There is no such thing as certainty; I can practice tolerating uncertainty,” or “There really is no proof to be found; I can only rely on my best guesses, and I need to accept some uncertainty.” (reframed rational thoughts).
Reframed Thoughts That Lead To Acceptance
Reframing our unhelpful thoughts, revaluing the helpful ones and devaluing the unhelpful ones, can help us move toward acceptance of reality. Acceptance is an essential piece of reframing and a crucial part of therapy. There are several things that need to be accepted in this process:
- Recognizing that OCD or an anxiety disorder is a biological condition that transmits erroneous alarms to your brain
- That there is no real explanation for why you have the particular thoughts you have
- That there are no real answers to your questions and doubts and that attempts to figure it out in your head, find answers on the Internet, or worry about it only lead to more anxiety
- That the solutions you have previously come up with haven’t worked, aren’t working now, and will not work in the future, and therefore must be abandoned
- That you can have thoughts of the type you experience, that they will not simply go away on their own, and that they can be managed and redirected
- That your anxiety and uncertainty can ultimately be overcome but only by confronting them and building up your tolerance to them without safety behaviors
- That it will take hard work, time, and practice to overcome your fears and the habits you have built up
Examples of Reframing Thoughts Through Self Talk Alternatives
As therapists, we want to help our clients develop positive emotional states through helpful self-talk, recognizing and challenging false messages, revaluing thoughts and urges as they arise, and devaluing unwanted, obsessive thoughts. Here are some examples.
Self Talk Alternatives
- That thought isn’t helpful right now.
- Now is not the time to think about this.
- I can think about it later.
- This is irrational.
- I’m going to let it go.
- I won’t argue with an irrational thought.
- This is not an emergency.
- I can tolerate the discomfort.
- I can slow down and think clearly about what I need.
- This feels threatening and urgent, but it really isn’t.
- I don’t have to be perfect to be OK.
- I don’t have to figure this out in my head or research it.
- The best thing to do is just drop it. It’s OK to make mistakes.
- I already know from my past experiences that these fears are irrational.
- I have to take risks in order to be free.
- I’m willing to take this risk.
- It’s OK that I just had that thought/image, and it doesn’t mean anything.
- I don’t have to pay attention to it.
- I’m ready to move on now; I can handle being wrong.
- I don’t deserve to suffer like this.
- I can’t control someone else’s response to me.
- That’s not my responsibility.
- That’s not my problem.
- I’ve done the best I can.
- It’s good practice to let go of this worry.
- I want to practice.
- I can accept the uncertainty of this.
- I can accept imperfection in others.
- I don’t have to know in order to be OK.
Redirect and Practice
Now that unhelpful thoughts and reframed helpful alternatives have been identified, the next step is to practice, practice, practice. You don’t need any practice thinking the unhelpful thoughts, they just pop up. You do need daily practice using relabeling, acceptance, and productive self-talk to recognize and challenge the false messages by redirecting your aim toward valued behaviors such as learning, developing a career direction, and relationships while practicing tolerating the negative feelings. It’s like a U-turn. In the case of redirecting worried thoughts, U-turns are not only legal, they are also encouraged!
Example: “This is not logical; it’s an anxious thought; I can handle the discomfort.” Instead of avoiding, make a U-turn and face a fear or situation that creates discomfort (i.e., social situation, touching a feared object, resisting a compulsion, or taking an emotional risk) and then go about your day.
End of Part 3
Part 4, “Keeping Your Fears at Bay,” closes the manuscript. It is not in the web edition yet.