Introduction: Comprehensive care from preconception to pediatrics, to geriatrics it's conversations with MIT Health. Here's Melanie Cole.

Melanie Cole: Welcome to conversations with MIT Health. I'm Melanie Cole, and today we're exploring cognitive behavioral strategies and how they can be used to help us reduce our stress levels. During these uncertain times, joining me is Dr. Maryam Kkodadoust. She's a Psychologist at MIT Student and Mental Health and Counseling Services. Dr. Khodadoust, it's a pleasure to have you join us again. Tell us a little bit about cognitive behavioral therapy and why it's such a useful therapeutic tool to reduce stress and anxiety?

Dr. Khodadoust: CBT, and as you mentioned, cognitive behavioral therapy is a kind of evidence based targeted counseling, where you're focused on the here and now and on the relationship between your thoughts, feelings, and behaviors and how they influence each other. So the metaphor that comes to my mind to describe this relationship is if you were to imagine three different gears, representing our thoughts, feelings, and behaviors, which are connected to each other in such a way that when you move one, the others move too. So if we overwork, which is a behavior, we're more likely to have stressful thoughts and feel stressed, and this relationship can be mutually reinforcing, but also insight into this. Just what seems like a really simple connection can actually help us navigate our way out of feeling stressed by choosing stress reducing thoughts and activities.

Host: So interesting as we're feeling so much right now in so many different ways, on many levels, how does the way we think about something, change our feelings about it, or the behaviors that we partake in?

Dr. Khodadoust: We don't usually think about our thinking, do we? Right? Cause we tend to think of ourselves as rational human beings, who just sort of look at the environment the way it's meant to be seen and very objectively. But research from cognitive behavioral therapy offers us a lot of information and insight into our thoughts. And I'm going to share two aspects of them today that MIT students might find helpful. So for example, the way we think about something can be impacted by our expectations or by filters we've adopted to help us organize all the information coming at us from the environment being human means that some of our filters are distorted and CBT offers us 12 common distorted filters that are associated with increasing our stress. I invite our students to Google them, but for now, or for this session, I'm going to give you two examples.

So a comment filter, I notice that MIT students use to look at situations which produces a lot of stress, is the all or nothing filter, right? So it's when we see situations in all or nothing terms, I hear it in students' complaints or reactions in our sessions when they say things like, you know, if I don't get an a on this test or this class, the whole thing study session, or even the whole semester has been wasted. Or when they say, if I'm given a critical feedback on a presentation, it means I've failed. Or if someone criticizes anything I say or do it means they don't accept me for who I am. So this is sort of an all or nothing way of looking at something. Another common filter I often come across in counseling session is overgeneralization it's when we come to a general conclusion based on limited evidence.

So an example would be that if I fail a test or a class or even several classes and decide it's proof that my life is a failure, that's generalization. If I have a negative interaction with someone or experience a breakup and decide that no one loves or understand me, that's a generalization it's neither accurate or helpful to generalize something about us and our lives based on a couple of instances. And you can imagine how much more painful a breakup is if you decide that this person represents all of humanity and the breakup is evidence of how lovable or not lovable you are. The second aspect of thinking that CBT teaches us has to do about the process, our thinking, we don't think about that either. We assume that if we think about a problem, we're more likely to solve it. And the more we think the more solution or the more likely we are to come up with a better solution, but that's not always the case.

There are some kinds of thinking that help us find our way out of problematic, stressful situations and other types of thinking that actually make the problem worse, or it increases our stress. So how do we decipher the difference? Well, there's a certain kind of thinking that we do, that's helpful and that's called problem solving, thinking. It involves thinking about a past situation that went wrong and thinking about how to handle it differently. It's like generating solutions or when we're thinking about a future problem, potential problem. And we think about possible solutions or contingency plans in addressing it. I failed my physics test would be a great example. And let me look at my schedule to see how I can increase my time studying physics, or let me reach out to a professor and ask for support, or let me see which commitments I can get rid of for the next few months to make room, to take more time to study physics.

So these are thoughts that are focused on actions we can take, and strategies we can come up with, and that's helpful. But even in those instances, you know, prolonged thinking about a problem, engages our stress response as if we're in it. And certain kinds of thinking are more likely to trigger our stress response. And I'm going to describe two of them right now. Ruminative thinking is thinking that involves going over specifically the event that went wrong as if we're playing a video over and over again, and focusing on how terrible it felt. You know I had that really negative conversation with my advisor and I just play it again and again in my head. And I think about how embarrassing it was or how incompetent he might think I am now because of it or the terrible breakup or how much someone's hurt us.

You know, when you're really just sort of getting stuck perseverating on the emotional pain of it, all you're rehearsing is the stress part. You're not actually generating solutions to a problem. And another way that students can actually do thinking that's harmful is what we call worry hopping. You know, students say, you know, I I'm, I get stuck trying to sort of figure out problems. I have a lot of problems I need to figure out, but when you ask them to give you details about it, it seems like they're going from worrying about one thing to worrying about another thing to another thing, and another thing. Not really generating solutions, but just reviewing all the things there is to worry about or worry hopping. And this kind of thinking also actually increases our stress and adds or fuels to the stressful situations we may already be facing.

Host: That's fascinating. And boy, did I see myself in some of what you were describing, Dr. Khodadoust. So you've really drawn this clear picture for us, between how our thoughts impact our feelings and how we, we do these things and we have these thoughts, but how do our feelings impact our thoughts and behaviors? How does that make us do whatever we do if we're worry hopping, or if we're very stressed out, how is that related?

Dr. Khodadoust: So Melanie, there's a lot of wonderful research. That's come out about how our feeling States actually then impact our thoughts and behaviors. And one sort of restrict piece of research I'm going to talk about is state dependent cognition and memory. It's basically this, that whatever mood state you're in is what you have most readily access to in terms of your thought process and your memory. And I'll give you example. So when I'm really angry with my partner, what I remember most readily in that moment, or all the things that he's done to irritate me over the past couple of years. And when I think about what possible things could happen in the future, I have access to all the things, all the ways that my partner could irritate me in the future, you know, and it's real. And it's true, except what it is, is it's lopsided, right? Because it takes more effort for me to remember all the things that I love about my partner and which happens when I'm in a better mood.

You know, when I'm in a better mood, I remember all of the things that are wonderful about my partner. And so this happens in counseling all the time. Students come in telling me that it's when they're really upset that they're thinking, Oh, I'm coming to the truth of my existence is that I am, you know, I'm a failure. My life is a failure, to hear all the evidences of things that have gone wrong in my life. And I feel like this is the moment I need to fix myself. And I have to remind them that in those times, that's not when they have access to all the information because their access is limited to whatever their mood state is. So when you're the most anguished and the most depressed, or the most angry is not the time to be thinking rationally or to expect yourself, it's okay to stop and say, I am too upset to solve this problem right now. And to instead use some coping mechanisms or skills to sort of reduce your stress, give yourself permission to walk away from a situation. And that's why they say don't make decisions when you're in strong feeling states, because you don't have access to all the information.

Host: That is really interesting and really great advice on the way we sometimes need to take a step back from that. So now we're left with our behaviors. Give us your best advice about how those behaviors impact our thoughts and feelings and what we can do about it to change some of that?

Dr. Khodadoust: We tend to associate doing feel good activities for when we're feeling good. And we often wait to feel good before we do them, right? So research shows that it actually works the other way around as well. Remember those gears they're all related. So how many times has it happened that you were in a bad mood? You didn't feel like doing anything and a friend dragged you out, took you for a walk or, you know, how to zoom conversation with you and out of obligation or, you know, because you didn't want to let your friend down, you did the thing you didn't feel like doing. And how many times have you afterwards felt better? You thought, Oh, actually I'm glad I went. I ended up enjoying, or it took you out of that bad space that you were in. So we often overlook the ways that our behaviors also impact our mood. We tend to think that it's one directional where it's, it's multidirectional, what you do impacts also what you think and how you feel. So using that to your advantage can be really helpful.

Host: Well, it certainly can. And do you have any final thoughts for us on how these cognitive behavioral strategies can help the MIT Health community in these uncertain times and stressful times, and really your best advice on how to deal with them and when we should seek professional help.

Dr. Khodadoust: So, Melanie, there are plenty of external sources of stress. We don't have control over, COVID-19 pandemic, our society struggled with economic, social, racial injustice, or just some of the broader, stressful backdrops against which we have to navigate our own stressors, right? Our own health, financial family, academic relationship stressors. What we do have control over is the condition with which we show up to these stressors, how well we take care of our physical, mental, and emotional health. So becoming aware of our standards, our expectations, and adjusting them, according to the environmental stress. Becoming aware of our filters, respecting our feelings and the role they may be playing and how we view situations, can sometimes make all the difference in how successfully we navigate the external stressors and sort of the level of our resiliency towards them.

And I want MIT students to know that you don't have to navigate this by yourself and you don't have to have, you know, a mental, a diagnosable mental illness to come reach out to us. Stress is an incredible force that impacts every aspect of our wellbeing. So please don't hesitate to come to us for resources. We can be reached at our regular number (617) 253-2916. And students can also reach us through the website and look out for workshops that we have on CBT and self compassion. We also have a variety of workshops to help you manage sort of relationship stress and academic stress. So use the resources that are there to help you navigate these difficult times.

Host: Thank you so much, Dr. Khodadoust, what great information. Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.