Chapter 1

What Are Personality Disorders?

Many people struggle with problems that are not as easy to diagnose or treat as
other mental health issues, such as phobias and panic disorder. These other difficult
problems begin early in life, they influence people’s behaviors, they interfere with
relationships and careers, and they alter the way people think about themselves and the
world. Due to the fact that these complex problems cause great distress and affect
nearly every aspect of a person’s life, they are officially referred to as personality
disorders.

In general, personality disorders are characterized by rigid, inflexible patterns

of thinking and behaving that begin as early as childhood or adolescence and cause
continual distress throughout many areas of a person’s life. For example, some people
with personality disorders have an excessive need to complete projects in a lengthy,
step-by-step fashion that interferes with the completion of their work. Others are
extremely afraid of being judged or criticized, so they frequently avoid social
situations. And some people focus on pleasing others more than themselves, and as a
result, they rarely get any of their own needs met.

It’s estimated that almost 15 percent of all adults in the United States, or almost
31 million people, struggle with personality disorders,2 and these types of long-term
problems are often the cause of general unhappiness and disability in a person’s life.3
According to the American Psychiatric Association’s Diagnostic and Statistical
Manual of Mental Disorders (DSM), there are eleven personality disorders that are
common to many people. These are as follows: antisocial, avoidant, borderline,
dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, schizoid,
schizotypal, and personality disorder not otherwise specified (NOS).1 (These are all
defined later, in chapter 2.)

Many people struggle with these problems over the course of their entire lives.
They recognize that their lives are often difficult, but few of them ever seek help for
their problems. In fact, it is likely that few people know there is such a problem called
a personality disorder. When people with these problems do seek help, it’s usually for
the treatment of some other problem, like depression or anxiety, while other people
look for help at the urging of their family members and friends. Whatever your reason
might be, whether you’ve picked up this book for yourself or a loved one, you’ve
probably been suffering with some very difficult problems for a long time and haven’t
known where or how to get the right help. This book will teach you the skills that will
loosen the grip of the personality disorder on your life. It will show you new ways to
think about yourself and the world and will demonstrate new, more effective ways to
meet your goals and interact with others in a more satisfying way.

Before you begin using this workbook, it’s important that you first identify
what type of personality disorder you’re struggling with. As you’ll learn later, it’s
possible that you may be struggling with more than one personality disorder. Or you
might even be struggling with a personality disorder and another psychological
problem, such as depression or anxiety. As with all health issues, it’s important to
identify the specific nature of your problem so that you can find the most effective
treatment. The diagnostic exercise below will help you identify the type of personality
style you’re struggling with; however, if you suspect that you are also struggling with
another mental health problem such as depression, bipolar disorder, generalized
anxiety disorder, panic disorder, or any other mental health issue, you should also seek
help from your medical professional or from a mental health professional, such as a
psychiatrist or psychologist.

Identify Your Problems

In order to help you recognize the personality disorder(s) you’re struggling with
(or in order to confirm a diagnosis that you’ve already been given), read the following
eleven stories. Each one describes a person who’s struggling with a different
personality disorder. At the end of each story, you’ll learn which disorder the person
has. Pay attention to the symptoms of each disorder and to the general nature of the
problem. See if you recognize similar problems in your own life. If you do, record
those similarities in the space provided.

Anthony

People who knew Anthony said that he was always getting into trouble ever
since he was a teenager; sometimes it was serious trouble that involved him getting
arrested and going to jail. In general, Anthony was both impulsive and very
aggressive, which often led him to fights and putting other people’s lives in danger.
For example, he once was arrested for running someone off the road, and another time
he attacked a man in order to steal his wallet.

In addition to being aggressive, Anthony frequently lied to people to get what

he wanted. He regularly deceived others to get money from them. He regularly lied to
his friends and his boss about where he was and what he was doing. Sometimes he
even created fake names for himself in order to cheat people. But in spite of his efforts,
Anthony was often caught because he failed to think through the outcome of his
schemes. Needless to say, he could barely keep a steady job. He was constantly getting
fired for lying to his bosses, stealing from his coworkers, and not coming to work
when he was supposed to.

Unfortunately, Anthony didn’t care much about anyone but himself. He said
that the people he lied to and stole from “deserved to be taken advantage of,”
especially since he thought that he was smarter and more deserving than they were.
Anthony had very few close relationships, and the few he did have were with people
he got into trouble with. Most of the other people in his life, like his parents and ex-
girlfriend, couldn’t tolerate his behavior, so they stopped communicating with him.

Eventually, Anthony was arrested for stealing again, and while in prison he was
assessed by a psychiatrist who diagnosed him with antisocial personality disorder.

Do you struggle with problems similar to Anthony’s? What are they?

Ava

Being around other people made Ava feel very nervous and self-conscious. As
a result, she frequently avoided social situations and group projects where she knew
that she would have to interact with others. People who knew Ava described her as
“very shy,” and many of them thought that she didn’t care about forming relationships
or dating.

However, the truth was that Ava did want to form friendships and romantic
relationships, but she was very afraid of being criticized and rejected. Ava thought that
she wasn’t as smart, as successful, or as good-looking as other people, and she often
worried that others would judge her for her shortcomings or the things that she did
wrong. So rather than face the possibility of humiliation or abandonment, Ava tried to
minimize her contacts with people. For example, whenever colleagues from work
asked her to join them at a social gathering, Ava declined, despite the fact that she
really wanted to go. Her colleagues never understood why she’d refused to join them,
but Ava regularly said no to any activity that might lead to her possible
embarrassment.

Ava could develop a friendship with another person only after she’d been
completely reassured that the person truly liked her. For example, her friend Jennifer
had invited Ava to social events more than two dozen times before Ava finally
accepted an invitation, and she said yes only after she felt 100 percent confident that
Jennifer would not criticize her in any way. However, even after they’d been friends
for some time, Ava still felt insecure because she continually compared herself to
Jennifer. Ava thought that she was neither as smart nor as pretty as Jennifer, so rather
than risk the possibility of being humiliated or criticized by her friend, she often
agreed with Jennifer even when she didn’t want to.

Luckily, one day Jennifer finally convinced Ava to seek help for her
difficulties. When she saw a therapist, Ava was told that she was struggling with
avoidant personality disorder.

Do you struggle with problems similar to Ava’s? What are they?

Britney

People who knew Britney were often worried about her because Britney
engaged in behaviors that were harmful and even self-destructive. She frequently cut
herself on purpose, acted in ways that were impulsive and dangerous (like drinking too
much or having unsafe sex), and twice she’d tried to kill herself by swallowing too
many pills.

Part of Britney’s problem was that her mood often fluctuated. Plus, she
frequently felt as though she was “empty” or “hollow” inside, in addition to feeling
anxious, sad, scared, and angry most of the time. She often found that her emotions
were hard to control or even cope with, especially her anger. As a result, she lashed
out at others or got into arguments and fights. The stress of her intense emotions also
led Britney to occasional experiences when she felt as though she was no longer
connected to her body, and to occurrences when she “blacked out” or “floated away.”
At other times, she became excessively suspicious of other people and their motives.

Many people had tried to befriend Britney, but each new relationship had
followed a similar devastating pattern. At the start of a new friendship, Britney wanted
to spend all of her time with her new friend, and she often said that the person was the
“best friend she’d ever had.” But as soon as the new friend did something that upset
Britney, her emotions drastically changed. She suddenly became angry, accused the
person of betraying her, and stated that the person was the “worst friend she’d ever
had.” Or if Britney became afraid that she was about to be abandoned, she frantically
created a situation to try to prevent that from happening. For example, she might claim
to be terribly sick and ask the person to take care of her, or she might even threaten to
kill herself if the person ever left her.

Britney’s relationships were made even more difficult by the fact that she
suffered with an unstable sense of who she was. She also frequently changed her
thoughts, opinions, and goals in an attempt to redefine herself, but this often led to
confusion for herself and others.

After being hospitalized for cutting herself, Britney was referred to a

psychiatrist who diagnosed her with borderline personality disorder.

Do you struggle with problems similar to Britney’s? What are they?

Dwight

To his friends and coworkers, Dwight appeared unable to take care himself
without asking someone else for help or advice. He consistently relied on others to tell
him what to do and to show him how to do it. For example, Dwight couldn’t decide
what to eat for lunch without calling his girlfriend because he was afraid that he might
eat “the wrong thing.” Also, he frequently sought the help of coworkers on projects
that he was supposed to be doing alone because he was afraid that he might “mess
them up.”

Dwight truly didn’t think he was capable of caring for himself or making
correct decisions. He had very low self-esteem and no self-confidence. He was also
very afraid of offending people because he believed that if he did, he would lose their
support and eventually be abandoned by them. Abandonment was the worst fate that
Dwight could imagine, because he didn’t think that he had the skills and the
knowledge to take care of himself. As a result, he consistently tried to please others
and to maintain his relationships, no matter what the cost was to himself. For example,
he didn’t disagree with others even when he knew they were wrong. And he was
willing to tolerate unsatisfying relationships in order to ensure that he wouldn’t be left
alone. In fact, as soon as one friendship or romantic relationship ended, Dwight
quickly jumped into a new one to take its place.

In order to make people like him and to reduce the chance of being abandoned,
Dwight was also very willing to sacrifice his own needs for the needs of others. For
example, he frequently gave up his lunch break to help his colleagues, and he often
rearranged his weekend plans to help his friends.

After a long string of failed romances, Dwight’s sister finally convinced him to
seek help from a counselor, who diagnosed him with dependent personality disorder.

Do you struggle with problems similar to Dwight’s? What are they?

Hillary

Hillary always wanted to be the center of attention, and whenever other people
were around, she liked to show off. She frequently behaved in very dramatic and
colorful ways, as if she were an actress on stage. Some people found her entertaining,
but others weren’t sure of what to make of her, especially when they noticed that
Hillary’s emotions shifted quickly and often seemed exaggerated.

Hillary also had a strong need to impress people. She often tried to amaze
others with her knowledge of current events, but despite her strong opinions, her true
knowledge of these issues was often limited. So whenever people would ask her
additional questions about what she thought, she would change the subject to distract
them. At other times, she simply changed her opinions and behaviors to match those of
people she admired, like her friends, so that she could appear to be as smart and
impressive as they were.

When her usual methods of getting attention didn’t work, Hillary often flirted
or acted seductively. She even flirted with strangers and treated people she had just
met as if they were her lifelong friends. At other times, she resorted to wearing
provocative clothing to draw attention to the way she looked. To some people this
behavior might have seemed inappropriate, but to Hillary being flirtatious was a highly
successful way to get noticed.

Hillary loved getting attention and being admired. However, when she didn’t
get what she wanted, she often became frustrated. Sometimes she would make a scene
to get others to notice her. At other times, she would simply leave the event when she
wasn’t the center of attention.

Eventually, Hillary became frustrated by her lack of close, genuine friendships

and she sought the help of a psychologist, who diagnosed her with histrionic
personality disorder.

Do you struggle with problems similar to Hillary’s? What are they?

Nathan

Nathan thought very highly of himself. Generally, he thought that he was

smarter, better-looking, and more accomplished than other people; as a result, he also
thought that he deserved more praise and admiration than they did. Nathan frequently
bragged about his special attributes, but very rarely did he receive the praise he
thought he deserved. This surprised him, but he assumed that others were just jealous
of him, just as he was often jealous of others who had succeeded when he had not.

Nathan often fantasized about his future successes. He daydreamed that

someone of great status would recognize his accomplishments and finally award him
the recognition and power he deserved. In fact, Nathan believed that only people of
great wealth, fame, or power could truly understand him, so he chose to associate with
only the most successful and smartest people he could find. In general, Nathan had
little empathy for those who were “less” than he, and he thought his accomplishments
entitled him to take advantage of them for his own purposes. For example, in busy
stores, he often went directly to the front of the line despite how many people were
waiting. While at work, he often gave orders to his coworkers, even to those who were
his equals or superiors.
 Needless to say, Nathan’s need for admiration and his lack of empathy greatly
interfered with his relationships. At the urging of his general practitioner, Nathan
sought help from the best therapist he could find to help him understand why other
people were so unfriendly toward him. After a few weeks of therapy, his therapist
diagnosed him with narcissistic personality disorder.

Do you struggle with problems similar to Nathan’s? What are they?

Olivia

Olivia was a perfectionist who was very concerned with following rules,
making lists, and staying on schedule. Everything she did at home and at work had to
be completed according to her own set of very high standards. This meant that Olivia’s
tasks were completed very slowly—and sometimes not completed at all—since she
frequently rechecked all of the details. This need for perfection greatly upset both her
family and her boss because they were forced to wait for her to complete her tasks.
However, when they offered to help her, Olivia declined.

Olivia found it very difficult to delegate tasks to others because she worried that
they would not follow her procedures and the task would not be completed the way
she wanted it to be. Some called her stubborn or suggested other ways of doing things,
but Olivia strongly resisted any changes, new ideas, and compromises. Instead, to
complete her projects, she worked very long hours. Some described her as a
workaholic because she worked late into the evenings and throughout most weekends.
Olivia rarely took time off, and when she did, she usually brought unfinished work
with her. Not surprisingly, even her vacations were highly organized, structured, and
active. Instead of relaxing during her time off, she preferred vacations that focused on
mastering very difficult tasks, like scuba diving or mountain climbing.

Despite the fact that Olivia did not consider herself to be a religious person, she
still had very rigid moral standards and rules for herself and others. For example,
Olivia expected that everyone in her housing development should strictly abide by all
of the rules, as she did, and she made frequent complaints about those who didn’t.
Similarly, her children had to do their homework perfectly; otherwise, she made them
do it over again.
 Throughout the years, Olivia also engaged in other behaviors that caused her
family to worry about her. First, there was her habit of collecting old magazines,
things she found on the street, and broken items that her family had wanted to throw
away. Over the years, Olivia had filled entire rooms with such things because she said
she might need them some day. Second, she forced her family to live on a very
restricted, small budget and saved the rest of the money for future emergencies,
despite the fact that her family sometimes had to live without basic necessities, like
toilet paper.

Eventually, Olivia’s family convinced her to seek help. After being evaluated
by her social worker, Olivia was diagnosed with obsessive-compulsive personality
disorder.

Do you struggle with problems similar to Olivia’s? What are they?

Patrick

Patrick was always worrying about other people’s intentions. He frequently

thought that someone was trying to hurt him, take advantage of him, or deceive him in
some way. But very seldom could he or anyone else find any evidence that this was
happening. Instead, Patrick merely suspected that it was happening, and as a result, it
was very hard for him to trust people and develop close relationships.

Patrick even doubted the loyalty of his family, longtime friends, and coworkers
he had known for years. His suspicious beliefs prevented him from trusting anyone,
and he was constantly searching for proof of his suspicions, no matter how small that
proof might be. For example, a friend of his at work had once said that he liked
another coworker whom Patrick didn’t care for. But instead of letting the comment go,
Patrick interpreted this harmless remark as meaning that his friend could no longer be
trusted, and Patrick stopped speaking to him.

Behaviors like this made it very difficult to get to know Patrick. In addition, he
rarely confided in other people or shared any details of his life with anyone. If
someone were to ask him a question, Patrick would refuse to answer because he
worried that the person would use that information against him.
 He was so worried about getting hurt that he often misinterpreted harmless
jokes and remarks, which he’d mistakenly thought were made at his expense. For
example, whenever a coworker offered help with a task or project, Patrick thought this
meant that the person was trying to get close to him so that he or she could uncover his
mistakes and use them against him.

Also, Patrick was quick to get angry, and he held on to grudges. Rarely did
Patrick forgive anyone who had done something that he perceived as a threat.

Occasionally, Patrick dated, but his jealousy and desire to control the other
person eventually drove the person away. In fact, he was so jealous of one girlfriend
that he kept a journal of her actions in an effort to catch her in a lie.

After experiencing many difficulties like the ones described, Patrick eventually
sought help from his employees’ assistance program, and a counselor diagnosed him
with paranoid personality disorder.

Do you struggle with problems similar to Patrick’s? What are they?

Scarlett

People who knew Scarlett often described her as a loner because she wasn’t
interested in forming friendships or romantic relationships. However, Scarlett was
neither angry nor jealous of other people; she just preferred to be by herself. She
hardly ever visited her parents and brother, she very rarely dated, and her job as a
computer technician required little interaction with anyone but her supervisor. In
general, Scarlett preferred to be alone, and she didn’t feel the need to seek
companionship. To relax, she preferred solitary pleasurable activities, like reading and
puzzles, and she did little else with her free time since her interests were so limited.

People who knew Scarlett, such as her supervisor and parents, had a very hard
time figuring her out. In addition to not forming close relationships, Scarlett appeared
uninterested in what other people thought of her. Regardless of whether her supervisor
praised or criticized her, Scarlett remained unaffected and indifferent. In fact, people
often said that it was difficult to tell what she was thinking because she rarely
displayed any emotions. Sometimes people would tell her to smile or cheer up, but the
truth was, she didn’t think she had to.
 Scarlett seldom expressed her emotions in a way that other people could see and
recognize.

Her parents wondered if she would ever marry, since she seldom dated.
However, Scarlett didn’t seem to feel the need for close companionship or a sexual
relationship the way other people do. Occasionally, her parents or someone at work
would arrange a blind date for her, but it never worked out. Sometimes Scarlett
worried about her future and the possibility of being alone, but usually she kept her
thoughts and feelings to herself rather than talk to someone about them.

However, at the urging of her mother, Scarlett agreed to seek help from a
psychologist, who diagnosed her with schizoid personality disorder.

Do you struggle with problems similar to Scarlett’s? What are they?

Scott

Scott found it very difficult to connect with people, and he frequently felt odd
and out of place in social situations. Often, he didn’t know what to do or say around
others, and he regularly found himself being stared at as he awkwardly tried to fit in
with one or another social group. For example, Scott sometimes laughed at stories that
no one else found funny, and he often remained quiet while everyone else discussed an
exciting topic. Even Scott’s style of dress regularly made him feel out of place—his
wide-brimmed cowboy hat and purple pants often drew stares and rude remarks from
people on the street.

Many of Scott’s interests and beliefs also got strange reactions when he shared
them with others. For example, Scott was very interested in paranormal experiences,
and he often believed that his thoughts could control or affect other people’s actions.
He also experienced sensing or seeing things that others could not, like the strange
shadows he occasionally saw dancing in the trees. However, sometimes odd things
happened that even Scott wasn’t sure about, like the night he thought the television
newscaster had been speaking directly to him.

In addition to experiences like this, Scott also found it difficult to communicate

with most people. Sometimes his own thoughts were too unclear; at other times,
people told him he was being too vague or that he was taking too long to make his
point.

Regardless of how often Scott tried to connect with others, he generally felt
anxious and was unable to relax in social situations, even after getting to know people
better. The truth was that Scott was suspicious of many people, partly due to the
strange stares and comments he frequently received from strangers, but also partly due
to the fact that he found it hard to trust anyone. As a result, he didn’t have many close
friends. His closest relationship was with his brother, but he seldom spoke to his
brother.

Thankfully, however, his brother convinced Scott that he should see a therapist
for help with his social awkwardness. After a few sessions, Scott’s therapist diagnosed
him with schizotypal personality disorder.

Do you struggle with problems similar to Scott’s? What are they?

Vivian

Vivian also struggled with repetitive, long-term problems that interfered with
her relationships, her job, and her life in general. In fact, she struggled with many of
the same problems described in previous examples, but none of the previous examples
accurately describe Vivian’s own difficulties. For example, like Britney, Vivian was
afraid of being abandoned, but she didn’t engage in selfdestructive behaviors and her
mood didn’t fluctuate as Britney’s did. Like Nathan, Vivian thought very highly of
herself and that she was smarter than most people, but she didn’t always need to be
admired as Nathan did, and neither did she feel entitled to take advantage of others.
And like Patrick, Vivian often worried about other people’s intentions and whether
they could be trusted. But unlike Patrick, Vivian was able to maintain some close
relationships.

In general, Vivian’s problems were similar to all of the other examples cited,
but no one example fully describes her own unique difficulties. In fact, Vivian had one
problem that was very different: she often procrastinated and frequently refused to do
what was asked of her. For example, she often felt unappreciated by her boss, but
rather than talk to him about how she felt, she sometimes refused to do her work and
then blamed her coworkers when it wasn’t completed on time.
 After being reprimanded by her boss, Vivian sought the help of a therapist, who
diagnosed her with a personality disorder, but since Vivian’s symptoms didn’t fit the
criteria for any specific disorder, the therapist labeled her problem personalitydisorder
not otherwise specified (NOS).

Do you struggle with problems similar to Vivian’s? What are they?

In Conclusion

Now that you’ve finished reading each of the descriptions, go back and review
the comments you made after each of them. Is there one particular example whose
problem is similar to yours? Or were there several examples that were similar to
yours? What personality disorders were those individuals struggling with? Note them
for the next chapter. When you’re ready, continue by reading chapter 2, where you’ll
learn more information.
 Chapter 2

The Eleven Personality Disorders

Now that you’ve read the descriptions of the eleven personality disorders in
chapter 1, hopefully you were able to identify the personality disorder you’re
struggling with. Or maybe you recognized that you’re struggling with more than one
disorder or with the characteristics of a few different disorders. If that is the case, now
would be a good time to seek the opinion of a mental health care professional who can
confirm or correct your diagnosis, since only a trained professional, such as a
psychologist or psychiatrist, can accurately diagnosis your problem.

However, assuming that you’ve already sought the help of a professional or that
you are currently working with one, now you’re ready to read more detailed
information about each of the personality disorders. You can choose to read all of the
descriptions or just the ones you’re struggling with. But before you begin reading
about your specific problem, it’s important to note that there are a few characteristics
that apply to all personality disorders:

1. The traits of a personality disorder often begin as early as childhood or

adolescence, but definitely by early adulthood.

2. The traits affect your thoughts, emotions, behaviors, impulses, and

relationships.

3. The traits of all personality disorders are inflexible and difficult to change.

4. Personality disorders affect many areas of your life, such as work, school,
family life, and friendships, and they cause great distress.

5. The traits and habits of a personality disorder are very different from the
traits and habits that are expected within your culture. For example, if your culture
encourages submissive behavior, this trait should not be considered a symptom of
dependent personality disorder.

6. If your problems are caused by a medical problem, a different mental health

problem (such as depression), or by drug or alcohol addiction, a personality disorder
would not be the correct diagnosis.
 Note: If you don’t meet these six criteria, you probably don’t have a fully
developed personality disorder. You might have only some of the traits of one.
However, the skills in this workbook will still be extremely helpful to you. Now
continue reading about the specific personality disorders you identified as problems.
Do your best to read these descriptions with an open, honest, and accepting state of
mind. Remember, no one wants to struggle with any of these problems, but it’s
important to know what you’re up against. When you’re done, turn to the end of this
chapter and continue reading about the different causes of personality disorders.

Antisocial Personality Disorder

People who have antisocial personality disorder manipulate and abuse others
for their own purposes and show little or no consideration for the needs and safety of
others.

If you have this type of personality disorder, you can often be violent,
impatient, self-centered, and easily agitated. Most likely, you also show little regret
when you hurt others and you pay little attention to rules and the law, which often puts
you at risk of being arrested. A person with an antisocial personality frequently thinks
that other people aren’t as smart as he or she is, and therefore they deserve to be
manipulated. For these reasons, a person with this problem seldom has close friends or
romantic relationships.

According to the American Psychiatric Association, an official diagnosis of

antisocial personality disorder would be made if you met several criteria.1 First, for
this diagnosis to be made, you must be at least eighteen years old, and you must have a
history of harming, disrespecting, or violating the rights of others since you were
fifteen years old; in addition, you must have engaged in similar rebellious behaviors
earlier in your life. Second, at least three of the following types of harmful behavior
should be observed:

1. You repeatedly engage in behaviors that break the law and potentially lead to
getting arrested.

2. You lie or manipulate others for your own pleasure or personal gain.

3. Your behavior is often impulsive or you repeatedly fail to plan ahead.

 4. Your behavior could be described as “violent” or “bad-tempered,” based on
the fact that you’re regularly involved in fights or attacks on others.

5. Your behaviors put your own life or the lives of others in danger.

6. You regularly fail to take responsibility for your work or your financial
obligations.

7. You don’t feel guilt or regret for harming or taking advantage of others.

Obviously, the most frequently observed problem related to this disorder is

breaking the law. In surveys of prison populations, the rate of antisocial personality
disorder has been as high as 60 percent for both men4 and women.

People with antisocial personalities are also at a higher risk of dying from
unnatural causes. In one long-term study, people with this type of personality were
almost four times as likely to die when compared with other people.6 Among the
many reasons for this likelihood are an increased risk for suicide,7 an increased risk
for accidents,8 and an increased risk of experiencing a violent death.

Many people with antisocial personalities also struggle with phobias,

posttraumatic stress disorder, panic disorder, generalized anxiety disorder, depression,
bipolar disorder,10 alcohol and drug problems,11 and gambling addictions.

In a large study of adults in the United States, it was estimated that almost 4
percent of that population, or almost 8 million people, had antisocial personalities,
with men being affected more often than women.

Avoidant Personality Disorder

People who have avoidant personality disorders are very sensitive to criticism
and judgment from others, so they tend to stay away from social interactions.

If you’re struggling with this problem, you probably want to have relationships
with other people, but most likely, you’re also very critical of your own social skills
and self-worth. You might think that you’re defective or somehow substandard in
comparison to others, and so you avoid social and work situations in which you might
be evaluated, criticized, humiliated, or rejected. This avoidance probably prevents you
from meeting or interacting with others unless you can be sure that they will like you.
As a result, others might describe you as shy, a loner, or introverted.
 According to the American Psychiatric Association, an official diagnosis of
avoidant personality disorder would be made if you experienced at least four of the
following symptoms that began by early adulthood and were observable in several
different situations:

1. You avoid work activities that might include significant social interactions
due to your fear of being criticized, shamed, or rejected.

2. You proceed cautiously in romantic and other close relationships due to a

fear of being humiliated or ridiculed.

3. You frequently think about being judged, evaluated, or rejected in social

situations.

4. You’re hesitant to form new relationships unless you’re sure that you’ll be
liked.

5. You proceed cautiously in new relationships and social situations because

you feel defective or incompetent.

6. You think that you lack social skills, are inferior to others, or are unattractive
in some way.

7. You’re cautious about trying new activities or taking personal risks because
you might be embarrassed or humiliated.

In addition to having few close relationships, people who have avoidant

personalities also struggle with problems at work, depression, anxiety, and other
personality disorders.

It’s estimated that approximately 1 percent of the general population has

avoidant personality disorder.

Borderline Personality Disorder

People who have borderline personality disorder suffer frequent, uncontrollable,

and painful mood swings.1 They also experience great difficulty forming and
maintaining relationships, they have problems controlling their own impulsive and
reckless behaviors, and they experience fluctuating ideas about who they are.
 If you struggle with this disorder, you frequently experience rapid and
unpredictable changes in your thoughts, moods, behaviors, relationships, and
beliefs.13 Very often, these rapid changes are caused by recurring fears of being
criticized or abandoned by other people, or by the actions of other people that feel like
criticism, such as disagreements or changes in plans. In response to these types of
situations, you probably experience sudden feelings of sadness, nervousness, or anger.
You might also engage in some type of impulsive selfharming behavior, such as self-
mutilation, unsafe sexual activity, or suicidal acts.

According to the American Psychiatric Association, an official diagnosis of

borderline personality disorder would be made if you experienced at least five of the
following symptoms that began by early adulthood and were observable in several
different situations.

1. You experience unstable emotions that change impulsively and are often
painful.

2. You experience intense anger that is difficult to control and often arises at
times that seem unexpected to others.

3. You experience frequent feelings of worthlessness or emptiness.

4. Your relationships are frequently unstable and intense, and you often
fluctuate between first praising others and then quickly criticizing them.

5. You behave in agitated or frantic ways to avoid being abandoned by others.

6. You behave in ways that are both impulsive and potentially damaging to
yourself, such as engaging in unsafe sex, spending excessive amounts of money, or
using excessive amounts of alcohol.

7. You regularly engage in behaviors related to suicide, such as making threats

or attempts, or you engage in self-mutilating behaviors, such as cutting.

8. You have a very uncertain or unstable sense of self-identity; that is, you’re
not sure “who you are.”

9. During periods of stress you either have powerful thoughts that someone is
trying to harm you or you feel strangely distant or disconnected from your body or
your thoughts—a condition that is called dissociation.
 Of all the problems related to borderline personality, the most severe is suicide.
It’s estimated that as many as 75 percent of the people with this problem will attempt
to kill themselves at some point,15 and as many as 10 percent eventually will take
their own lives.16 In addition, many people with borderline personality disorder suffer
with depression, post-traumatic stress disorder, eating disorders, phobias, panic
disorder, and drug and alcohol problems.17 Males suffering from borderline
personality disorder seem to be more likely to develop drug or alcohol problems than
female sufferers. But female sufferers appear to be more likely to develop bulimia,
anorexia, and other eating disorders.18 People with borderline personality disorder
also frequently suffer with chronic medical conditions such as fibromyalgia, chronic
fatigue syndrome, obesity, diabetes, hypertension, arthritis, and back pain.

Studies have estimated that as much as 5 percent of the general population is

affected by borderline personality disorder.3 Many studies report that almost 75
percent of the people diagnosed with this problem are women.20 However, this
striking outcome isn’t always found,18 and a few researchers have uncovered evidence
that some mental health professionals diagnose women with borderline personality
disorder more frequently than men, even when both sexes have the same symptoms.

Dependent Personality Disorder

People with dependent personality disorder are unable to make decisions

without the constant assistance and approval of others, so they constantly rely on
others to take care of them and to make decisions for them.

If you have this problem, you often find it difficult to make even ordinary,
everyday decisions without the help of others, such as what clothes to wear, what to
eat, and where to go. Most likely, you don’t think that you’re good enough or smart
enough to make those decisions for yourself. In addition, you’re probably afraid that if
you do something wrong, you’ll be abandoned by others. As a result, you’re constantly
trying to please others by seeking approval, volunteering for unpleasant chores, and
not disagreeing.

According to the American Psychiatric Association, an official diagnosis of

dependent personality disorder would be made if you experienced at least five of the
following problems that began by early adulthood and were observable in several
different situations.

1. You frequently struggle with making regular, everyday decisions if you don’t
receive an excessive amount of help and reassurance from other people. 2. You need
other people to take on the responsibility of caring for many of the major areas of your
life, such as your career, friendships, and finances.

3. You avoid disagreeing with other people because you’re afraid that they will
no longer like you or help you in the future.

4. You avoid taking on projects or doing things on your own due to a lack of
confidence in your own ability to make decisions.

5. You go to great lengths to make other people like you and help you, which
includes volunteering to do things that are unpleasant or that you really don’t want to
do.

6. You feel uncomfortable or vulnerable when you’re alone because you don’t
think that you can take care of yourself.

7. You quickly become involved in a new relationship with another person to

help you soon after a previous relationship has ended.

8. You’re often frightened by thoughts about having to care for yourself.

Despite their best efforts to please others, many people with dependent
personality disorder do not have close, satisfying relationships in which their own
needs are met. People with this type of personality are also in danger of experiencing
problems such as depression, bipolar disorder, panic disorder, generalized anxiety
disorder, bulimia, and social phobia. There’s also an increased risk of suicide among
people with dependent personalities. Other studies have found relatively strong
relationships between dependent personality and alcohol and drug problems, especially
for men.

It’s estimated that approximately 1 percent of the general adult population has a
dependent personality, with women developing the problem more often than men.

Histrionic Personality Disorder

 People who have histrionic personality disorders frequently want to be the
center of attention and often act in very dramatic ways in order to be noticed.

If you have this type of personality disorder, you probably spend a lot of time
thinking of ways to get attention and make people like you. For example, you might
dress or act seductively to make people look at you, you might act in a grandiose way
as if you were performing on stage, or you might treat new acquaintances as if they
were the most important people you’ve ever met. Additionally, you most likely
experience emotions that change quickly and appear exaggerated to others. Plus, if
someone doesn’t return the feelings you have for him or her or pay sufficient attention
to what you’re doing, you probably react very dramatically, by acting extremely hurt,
making a scene, or leaving.

According to the American Psychiatric Association, an official diagnosis of

histrionic personality disorder would be made if you experienced at least five of the
following symptoms that began by early adulthood and were observable in several
different situations:

1. You want to be the center of attention in most situations, and you feel upset,
uncomfortable, or angry when you’re not.

2. You behave in ways that are sexually seductive or attention grabbing in order
to make other people notice you.

3. You regularly use your physical appearance to make people notice you.

4. Your emotions change rather quickly and might appear thin or insincere to
others.

5. Your behaviors appear dramatic or showy, as if you’re acting on stage, or

your emotions are more intense than what is necessary.

6. You often voice strong opinions about particular subjects without having
many facts to support your opinions.

7. You treat people as if you know them better than you really do, such as
treating new acquaintances as if they were your best friends.

8. You easily change your opinions and feelings in order to please others,
especially people you respect or admire.
 People with histrionic personality disorder also frequently struggle with
strained relationships, suicidal behaviors, depression, and other personality disorders.

It’s estimated that approximately 3 percent of the general population struggles

with histrionic personality disorder.

Narcissistic Personality Disorder

People who have narcissistic personality disorder believe that they have many
exceptional characteristics and are entitled to the admiration of others; plus, they often
lack sympathy and compassion for others.

If you have a narcissistic personality, you’re often preoccupied with your own
success, intelligence, and attractiveness. It’s very important to you that others see you
as influential, talented, beautiful, intelligent, and persuasive. You might also think that
you’re entitled to special attention from others. Or you might believe that you can be
truly understood only by others like you, so you associate only with people of high
status. People with narcissistic personalities often consider others to be of lesser worth
than they are, so they often criticize others for their faults, act enviously of others’
successes, or take advantage of others to get their own needs met.

In general, there appear to be two different types of people with narcissistic

personality disorder: those who are outgoing in social situations and those who are
not.25 If you’re outgoing, you like to show off and be the focus of attention. You
probably put a lot of time into preparing the way you look and you expect others to
pay you compliments, and if they don’t, you become offended or angry.26 If you’re
not outgoing, you like to keep to yourself and you probably get upset when you’re
criticized, so you put great effort into protecting yourself from disapproval.

According to the American Psychiatric Association, an official diagnosis of

narcissistic personality disorder would be made if you experienced at least five of the
following symptoms that began by early adulthood and were observable in several
different situations:

1. You have a superior opinion of yourself, your abilities, and your

achievements, even though you sometimes overestimate these qualities. 2. You often
fantasize about your own success, power, intelligence, or attractiveness—perhaps
comparing yourself to other successful or famous people—and you often expect to be
recognized or praised for your special traits.

3. You think that you’re exceptional or superior in some way; therefore, you
can be truly understood only by other superior people and you should associate only
with them.

4. You need frequent admiration and compliments from others.

5. You expect to be treated in a special way based upon your exceptional

characteristics.

6. You believe that your needs are more important than the needs of others, so
you take advantage of others for your own benefit.

7. You generally don’t think about or care about other people’s feelings or
needs.

8. You’re frequently jealous of other people, especially their successes, or you

frequently think that other people are jealous of you.

9. Other people describe your behavior or attitude as arrogant, snobbish, or

conceited.

Due to the characteristics of this type of problem, it’s often very hard for
someone with a narcissistic personality to maintain romantic relationships.27 Many
people with narcissistic personality problems also suffer with bipolar disorder,28
depression,1 and anxiety problems.29 There’s also a danger of developing problems
with substance abuse,30 gambling addiction,31 and eating disorders.32 However, the
greatest threat for people with narcissistic personalities is the possibility of suicide.33
It has been observed that suicide attempts can arise very quickly and without warning
in people with this problem,33 possibly resulting from a sudden injury to the person’s
self-esteem.34

It’s estimated that less than 1 percent of the general population has narcissistic
personality disorder,3 with men diagnosed with the problem more often than
women.35

Obsessive-Compulsive Personality Disorder

 People who have obsessive-compulsive personality disorder are very concerned
with maintaining order and control, achieving perfection, and following rules

If you struggle with this problem, it’s probably very difficult for you to
complete tasks because you can’t complete them perfectly. People with obsessive-
compulsive personality disorder might be described as very conscientious students or
workers, but they often have trouble getting projects finished on time because they
must follow their own step-by-step procedures or constantly revise whatever they’re
working on. You also might find it very difficult to delegate work to others unless you
can control the quality of what they do.

Most likely, this need for perfection interferes with your social activities and
relationships, since you put them on hold until you complete unfinished projects. You
also might be equally rigid when it comes to following moral principles and the rules
of law. People with this type of personality believe that others should behave as they
do, and they get very upset or angry when others don’t follow the rules.

In severe cases of obsessive-compulsive personality disorder, you might collect

and hide things because you fear that you might need them in the future. This is called
hoarding. For example, you might collect old, valueless objects like newspapers or
items you find on the street. In other cases, you might hide all of your money and live
a meager lifestyle, fearing that one day you will need the money for a catastrophe.

According to the American Psychiatric Association, an official diagnosis of

obsessive-compulsive personality disorder would be made if you experienced at least
four of the following symptoms that began by early adulthood and were observable in
several different situations:1

1. You’re often fixated on following rules, making lists, maintaining order, or

paying attention to details, which, unfortunately, often becomes more important to you
than the overall activity you’re working on.

2. Your desire to do something perfectly often interferes with your ability to

finish a task.

3. You’re often willing to neglect your family, friends, and personal life in
order to spend more time at work.
 4. You live your life according to a very strict set of morals, rules, and values—
other than your religious or cultural principles—and you often expect others to follow
the same strict standards.

5. You find it very difficult—if not impossible—to assign tasks to others or to

work with others unless you can control how they do things.

6. You collect worthless objects and can’t get rid of them, even if they have no
personal value, because you think that you might need them in the future.

7. You maintain a very meager lifestyle that is far below what you can afford so
that you can save money for future emergencies.

8. Other people would describe your behavior as inflexible or stubborn because

you are unwilling to compromise on how things should be done.

People with obsessive-compulsive personalities also struggle with anxiety

disorders such as generalized anxiety disorder and phobias.1 This type of personality
disorder also shares traits with another anxiety disorder with a similar name,
obsessive-compulsive disorder, but this problem involves intrusive thoughts that a
person tries to neutralize with compulsive behaviors.

It’s estimated that approximately 1 percent of the general population struggles

with obsessive-compulsive personality disorder.

Paranoid Personality Disorder

People who have paranoid personality disorder are very mistrustful of others
and their motives, even when there is little or no evidence to support their suspicions.1

If you have this type of personality disorder, you’re constantly on the lookout
for being attacked, injured, or tricked by other people,36 including friends, family, and
coworkers. You might even suspect that your friends and family members are plotting
to harm you.

People with this problem are always questioning the loyalty of others, and any
deviation from 100 percent loyalty is interpreted as a betrayal. As a result, you
probably have damaged your family relationships and have few close friends or social
interactions. You also might hold grudges, get extremely jealous, react angrily when
you think you’ve been insulted, and try to control other people’s lives.1
 According to the American Psychiatric Association, an official diagnosis of
paranoid personality disorder would be made if you experienced at least four of the
following symptoms that began by early adulthood and were observable in several
different situations:1

1. You think that other people are trying to harm you or take advantage of you,
even if you don’t have reasonable proof to support your suspicions.

2. You often think that your friends, family, or coworkers aren’t loyal and can’t
be trusted.

3. You find it difficult—if not impossible—to trust other people with

information because you suspect that they might use that information to harm you.

4. You often suspect that people are making concealed threats or insults, even
though their words and actions might appear harmless to others.

5. You find it difficult—if not impossible—to forgive others for their

wrongdoings and you often feel resentment toward them.

6. If you suspect that someone is trying to insult or harm you, you become
irritated or quickly fight back.

7. You often suspect that your spouse or romantic partner is betraying you, even
if you don’t have reasonable proof to support your suspicions.

Many people with paranoid personality disorders also suffer with other
problems, such as drug and alcohol addictions,11 depression, bipolar disorder, panic
disorder, phobias, and generalized anxiety disorder.10

It’s estimated that nearly 4 percent of the general adult population struggles
with paranoid personality disorder,2 with women reporting the problem more
frequently than men.2

Schizoid Personality Disorder

People who have schizoid personality disorder aren’tinterested in seeking social

contacts or relationships, and they often prefer to be alone.1 They also aren’t
concerned about receiving either approval or criticism from others and show little
emotional response to other people and events.3
 If you struggle with this problem, others might describe you as very shy,
reclusive, or even unfriendly—despite what you really think and feel. You actually
might like being around other people, but maybe you just don’t know how to interact
with them,38 or maybe you feel extremely uncomfortable when you try to interact.36
Either way, you probably avoid unnecessary contact with others and prefer to have a
job that requires little interaction with people. Also, if you do have relationships,
they’re probably not very intimate.

According to the American Psychiatric Association, an official diagnosis of

schizoid personality disorder would be made if you experienced at least four of the
following symptoms that began by early adulthood and were observable in several
different situations:1

1. You don’t want close relationships with others, nor do you receive pleasure
from having close relationships, even with members of your own family.

2. You frequently—if not always—choose to engage in activities and tasks that

you can do by yourself.

3. You’re not interested in having sexual relationships.

4. You find pleasure in very few pursuits or hobbies—if you have any interests
at all.

5. You have few close friends or people with whom you talk freely, other than
your family members.

6. You’re not interested in receiving compliments from other people, nor do

you care when others evaluate you negatively. Or if you are interested in these
judgments, you don’t allow others to see your reactions to them.

7. Your range of emotional reactions, facial gestures, or social behaviors often

appears very limited to yourself and to others. Others might interpret this as you being
cold or rude, but you might not experience many strong emotions or you might not
know how to act in social situations.

Many people with this type of personality disorder also struggle with bipolar
disorder, depression, panic disorder, generalized anxiety disorder, and social phobia,10
as well as drug and alcohol problems.11 Additionally, there appears to be a strong link
between schizoid personality disorder and the development of problems such as
schizophrenia39 and homelessness.40

In a large study of adults in the United States, it was estimated that 3 percent of
that population had schizoid personalities, with men and women affected equally.2

Schizotypal Personality Disorder

People who have schizotypal personality disorders have difficulties forming

and maintaining relationships, exhibit eccentric behavior that doesn’t fit in with the
rest of society, and will often have unusual or suspicious thoughts.1

If you struggle with this type of personality, you might want close relationships
but lack the necessary social skills to form them or you may feel very uncomfortable
when you try to create them. As a result, you probably have few social contacts.

For some people with schizotypal personalities, the problem of creating close
relationships is related to their eccentric habits. When compared with the rest of
society, people with schizotypal personalities often dress or act in ways that appear
unusual or unconventional. Some people with this type of personality style even claim
to have special powers or psychic abilities. For example, some people believe that they
can cause common events, like making someone call them just by thinking about the
person, while others believe that certain events have a special meaning for them, such
as “Every time the sun comes up, it’s the universe’s way of saying hello to me.”

According to the American Psychiatric Association, an official diagnosis of

schizotypal personality disorder would be made if you experienced at least five of the
following symptoms that began by early adulthood and were observable in several
different situations:1

1. You believe that certain commonplace events have a special meaning for
you, even if you don’t have reasonable proof or they appear unrelated to you in the
opinion of others.

2. You believe that you have magical abilities or supernatural powers, such as
the ability to predict events before they happen, move objects with the power of your
mind, or communicate with the dead. You might also be very superstitious or even
engage in certain rituals to ward off danger.
 3. You have unusual experiences that involve your senses, such as hearing
someone say something when no one’s nearby, seeing things that aren’t there, or
sensing things that aren’t really present, such as another person standing beside you.

4. Compared to other people in your culture or society, you think and speak in
an unusual or eccentric way. For example, you might make up words or phrases, you
might give extremely detailed answers to every question you’re asked, or you might
give vague responses that always require additional explanation.

5. You think that other people are trying to harm you or take advantage of you,
even if you don’t have reasonable proof to support your suspicions.

6. Your range of emotional reactions, facial gestures, or social behaviors often

appears very limited to yourself or others. Others might interpret this as being cold or
rude, but maybe you just don’t know how to act in social situations.

7. Compared to others in your society or culture, your actions or appearance are

considered out of the ordinary or eccentric by yourself or others. For example, during
conversations, you might say things that make other people stop and look at you
strangely, or you might dress in clothes that are drastically different in style from
everyone else’s.

8. You have very few close friends with whom you talk freely, other than your
family members.

9. You’re very nervous when you’re around other people, especially people you
don’t know very well. In addition, you’re often worried about what others are thinking
about you. You may be nervous that they’re trying to harm you, or perhaps you’re
worried because you don’t fit in with them or the rest of society.

Many people with schizotypal personality disorder also struggle with anxiety
and depression, as well as with brief psychotic episodes that are often caused by
stress.1

It’s estimated that schizotypal personality disorder occurs in almost 3 percent of

the general population.1

Personality Disorder Not Otherwise Specified

 People who have a personality disorder not otherwise specified (NOS) do not
meet the criteria for any single type of personality disorder

If you have personality disorder NOS, you might have several traits from one or
more of the personality types described above but not meet the full requirements for
that category. For example, you might struggle with making ordinary decisions
without obtaining an excessive amount of help and reassurance from other people, and
you frequently avoid disagreeing with others, but you don’t meet any of the other
requirements for a diagnosis of dependent personality disorder. Or maybe you
identified symptoms from the categories of borderline, narcissistic, and histrionic
personality disorders, but again, you don’t meet the full requirements of any of them.

In other cases, you might be diagnosed with personality disorder NOS if you
meet the full requirements of the disorders in general; that is, inflexible traits and
behaviors that begin no later than early adulthood and interfere with many areas of
your life, but those traits and behaviors are different than the ones described in the ten
categories above. For example, some researchers have proposed the idea of
recognizing passive-aggressive personality disorder.1 A person with this type of
personality resists doing his or her work or meeting a job’s requirements and
frequently feels resentful of others.

It’s not known how many people struggle with personality disorder NOS or
what types of related problems exist. However, they’re probably very similar to many
of the other personality problems described above.

The Causes of Personality Disorders

If you’re like most people struggling with a personality disorder, you’re

probably wondering why you have these problems in the first place. The truth is there
are many possible reasons.

Personality disorders are most likely caused by a combination of biological,

psychological, and social factors. Some studies have shown that personality disorders
have a strong chance of being passed on in families due to influential genetic traits.41
Other studies have linked the development of various personality disorders to factors
such as brain abnormalities,42 childhood experiences of depression and anxiety,43
parental depression,44 parenting styles,45 childhood temper and activity levels,46 a
history of being abused or neglected,47 having a family member with
schizophrenia,48 poverty,3 and nutritional deficits.49 Certain personality traits can
also be learned by watching the behaviors of parents.50

Unfortunately, you might never know the exact cause of your problem, but that
doesn’t mean you can’t do anything about it. The problems associated with your
personality disorder are very treatable if you’re willing to dedicate some time and
effort to learning new coping skills.

In Conclusion

Personality disorders aren’t fair to the people they affect. There’s often no
known cause, and there are no easy fixes to make them go away. The truth is this:
you’re the only person who can fix your problems, and to your credit, you’ve already
picked up this book and started working. You’ve now completed the first two chapters,
and hopefully you’ve identified your problem and have a better understanding of how
it’s affecting your life.

As you continue reading, remember that the name of your problem isn’t what’s
important. What’s important is that you’ve been struggling with a difficult problem for
a very long time, and now you’re looking to improve your life. Continue reading; the
next chapter will help you to learn how to do this.
 CHAPTER 3

COGNITIVE BEHAVIORAL THERAPY FOR PERSONALITY DISORDERS

This chapter will explain what cognitive behavioral therapy (CBT) is and how it
will help you learn new coping skills. Note that if you already know about CBT or you
just want to begin learning the skills, you can feel free to skip this chapter.

Early Treatment Methods

Prior to the 1950s, the field of psychology was dominated by the theories of
Sigmund Freud and his belief that mental health problems were caused by people’s
unconscious conflicts and their attempts to repress or avoid those conflicts. For
example, imagine that a woman finds out that her husband is having an affair. She
feels very angry and resentful, and secretly she wants to divorce him, but her religious
values won’t allow her to do that. As a result, her thoughts and feelings get pushed
down out of her awareness and become unconscious. Occasionally, however, these
stressful thoughts rise to the surface and cause conflicts in her life, such that every
time her husband comes home from work and pretends that nothing has happened, she
feels angry and resentful.

According to Freud’s theory, the woman might behave in several specific ways
to avoid dealing with this conflict. She might act in the exact opposite way of how you
would expect her to act and be exceptionally kind to her husband. She might
completely block out the memory of her husband’s infidelity. Or she might even vent
her anger on someone other than her husband.

The goal of Freud’s treatment was to make these methods of avoidance known
to the patient, to free him or her from the problem. This process involved letting the
patients talk in a free, open way about anything that was on their mind.
Simultaneously, the therapist’s job was to make interpretations about how the patient
was feeling, the nature and origins of the problem, and the relationship that the patient
had with the therapist. But at no point was the therapist supposed to offer the patient
any direct advice or teach the patient coping skills to deal with the problem.
Unfortunately, this type of treatment often took months or even years to help the
patient. And although many thousands of people did find relief using Freud’s
treatment over the years, some therapists wondered whether there was a more direct
way to help their patients.

Cognitive Therapy

Then in the 1950s and ’60s, a revolution took place in the field of psychology.
Separately, both psychiatrist Aaron Beck and psychologist Albert Ellis discovered that
something other than the repression of unconscious conflicts was causing their
patients’ problems. The cause of their problems was the patients’ own thoughts, and
many patients were fully aware that they were having them— many of their thoughts
weren’t unconscious at all. For example, they found that someone who continually
thought, “I’m no good; I’ll always fail,” often felt sad or anxious. Beck called these
types of thoughts automatic thoughts, and they play a central role in what’s come to be
known as cognitive therapy.

Automatic thoughts are self-critical thoughts that you frequently think and say
to yourself. They influence your mood, affect your behaviors, and sabotage your
success. Other examples of automatic thoughts include those like “I don’t deserve
anything good to happen to me,” and “Why bother trying? I’m just going to fail.”
Much of the work in cognitive therapy involves challenging your automatic thoughts.
A key way to do so is by using the Challenge Your Unhelpful Thinking Styles
worksheet, which you’ll learn about in chapter 5. That worksheet helps you to look for
information that both supports and contradicts these automatic thoughts, and then it
helps you to create a more balanced thought. For example, if you struggle with anxiety
and you habitually think to yourself, “Nothing I do is ever good enough,” you’ll look
for examples of this being true and examples of it not being true from your life. Then,
hopefully, you’ll be able to come up with a more balanced thought that eases your
anxiety, such as “Even though I don’t do everything perfectly, I’m still capable of
doing most things pretty well.”

Beck also identified several common cognitive errors that people often make,
which are equally important in fueling their mental health problems. One example is
called overgeneralizing. When you make this cognitive error, you make broad negative
conclusions about your ability to function in life based on limited situations; for
example, “I got one bad review at work. I’ll probably screw up my relationship with
my wife, too. I can’t do anything right.” You’ll learn more about these cognitive errors
in chapter 5.

Behavior Therapy

Similar to cognitive therapy, behavior therapy was equally revolutionizing to

the field of psychology in the 1950s and ’60s, with the work of psychologist B. F.
Skinner, but the foundation of the treatment began long before that. At the beginning
of the twentieth century, early behavioral theory was largely influenced by the work of
the famous Russian physiologist and Nobel Prize winner Ivan Pavlov. Pavlov
discovered that the dogs used in his research experiments salivated both when they
saw their food and when they heard the ringing of a bell that announced the arrival of
their food. In the dog’s brain, the association of the food and the bell had become the
same, and therefore both elicited the same response. Pavlov’s work became known as
classical conditioning.

In the 1950s, Skinner used techniques that were similar to Pavlov’s and brought
behavior theory to the forefront of psychology. Skinner discovered that he could use
forms of reward and punishment to shape the behavior of animals, and later of
humans, in a technique called operant conditioning. Both Skinner and Pavlov greatly
influenced the learning theories of what later became known as behavior therapy

As its name implies, behavior therapy focuses on the way that dysfunctional
behaviors lead to mental health problems. One of the main beliefs of this treatment is
that your actions and reactions are largely learned. Some behaviors are actively
reinforced and rewarded with things like food and money, while others are learned by
watching and imitating people. Overall, the goal of behavior therapy is to help you
learn new actions that can improve your life.

The methods used in behavior therapy will depend on the nature of your
problem, but often they include relaxation exercises, training in assertive
communication skills, and problem-solving skills. You’ll also be asked to record your
behaviors during the week, in order to observe your progress.

Depending on your problem, you might also need to engage in activities that
often seem challenging. Many people avoid certain activities, which only results in
making their problems more difficult. For example, a person with avoidant personality
disorder who neglects calling friends and then feels lonely will need to overcome this
fear eventually. The process of confronting feared situations in a safe and systematic
way is called exposure. It requires you to make a list of your feared situations and then
confront them, either in real life or in your imagination, beginning with the least
fearful situation and working your way up to the most difficult. The goal of this
treatment is to help you successfully confront your fears in a safe, progressive way
and, by so doing, to help you realize that nothing bad or dangerous will happen to you.
You’ll learn more about this in chapter 11.

Cognitive Behavioral Therapy

As its name implies, cognitive behavioral therapy is a form of treatment that

combines elements of both cognitive and behavior therapies. The components of the
treatment taken from cognitive therapy will help you to examine the way your
thoughts affect your mental health. And the components taken from behavior therapy
will help you to investigate the way that your actions influence your life and your
interactions with others. When used as part of a single treatment for personality
disorders, CBT examines the way you can change both your thoughts and behaviors in
order to improve your life.

Overall, CBT is a very effective treatment for many mental health issues,
including depression, anxiety, phobias, panic disorder, post-traumatic stress disorder,
and obsessive-compulsive disorder.51 And although the number of studies has been
few,52 research also supports the use of CBT to treat personality disorders,53 even
when the treatment is limited to a brief number of sessions.54 However, the majority
of experts will agree that the most effective CBT treatment for your personality
disorder is likely to be more intensive and take longer than the treatment for other
mental health problems like depression.55 Also, its success will depend on your
commitment to the treatment.56

CBT Treatment for Personality Disorders

In general, the CBT skills in this workbook are the same ones that are used to
successfully treat other problems like depression and anxiety. Most of the skills used
in this workbook are based on the recommendations of Aaron Beck, Arthur Freeman,
and their associates, who wrote a CBT treatment manual for therapists called
Cognitive Therapy of Personality Disorders.36 According to this esteemed group of
clinicians, the CBT treatment of personality disorders should help you do the
following:

1. Get reactivated in life.

2. Challenge and correct self-defeating thoughts.

3. Develop healthier core beliefs.

4. Learn stress-reduction and relaxation techniques.

5. Engage in real-life exposure to feared situations.

6. Practice assertive communication skills.

In addition, three other skills have been included in this workbook to make your
treatment even more effective. They will help you do the following:

1. Develop problem-solving skills.

2. Practice coping imagery.

3. Prevent relapse.

In Conclusion

Cognitive behavioral therapy can be a very effective treatment for many people
struggling with personality disorders, if they are willing to make the commitment to
build new habits and learn new coping skills. However, many clients are often looking
for a quick fix. Frequently, they want to know how long the treatment will take to
solve their problems and how much time they need to invest in the process. The
answer, unfortunately, is different for each person.

Remember that you’ve probably been struggling with these problems for many
years, and over that time you’ve developed cognitive and behavioral habits that have
become fairly rigid. Therefore, the treatment might take weeks, months, or even years
to make certain changes. But please don’t let that dissuade you from committing to the
process. The truth is that changing any habit often takes a long time

In order to begin the process of changing your habits, start now by engaging in
new activities in your life using the techniques you will find in chapter 4.
 PART II

SPECIFIC COGNITIVE THERAPY SKILLS

 Chapter 4

Get Reactivated in Life

One of the initial steps of the CBT treatment for personality disorders is to help
you get reactivated. Many people with personality disorders avoid doing necessary and
interesting activities and often isolate themselves from the rest of the world. However,
avoidance only deepens the problem. If you’re already not feeling good about your life
and then you stop doing the activities that you enjoy, you’ll probably feel even worse.

For example, remember Dwight from chapter 1? He struggled with dependent

personality disorder. Very often, Dwight thought to himself, “I’m not capable of doing
anything without my girlfriend’s help.” Not only did this thought cause Dwight to feel
distressed, but it also meant that nothing got done unless his girlfriend was around to
help him. His bills didn’t get paid, his house never got cleaned, and he could never
decide what to eat. As a result, not only did he feel dependent on his girlfriend (and
others), but he also had bill collectors calling him, his house was always messy, and he
frequently felt hungry.

Similarly, Ava, who struggled with avoidant personality disorder, frequently

had the thought “I’m not as smart or as pretty as other people.” Not only did this
thought make her feel lonely and inferior, but she also avoided most situations when
there was the possibility that others would judge or criticize her. She didn’t go out with
colleagues after work, she had few friends, and she frequently avoided going places
where other people would be around, like the shopping mall. As a result, Ava’s actions
made her feel even lonelier, and often she didn’t have the items that she needed or
wanted.

Exercise: Avoidance Identification

Identify some of the chores, tasks, and pleasurable activities that you’ve been
avoiding, putting off, or neglecting recently, and note any effect this has had on your
life:
 As you can see, getting reactivated is one of the most important initial steps in
the treatment of personality disorders. Getting reactivated in life can help you do those
daily activities and chores that you’ve long put off, as well as help you to begin
scheduling pleasurable activities back into your life. There’s no denying that getting
reactivated in your life is probably going to be hard work. If it were easy, you’d
already be doing it. However, it’s a necessary step to take in order to start moving your
life in a new direction. For many people struggling with personality disorders, it’s
often helpful to use a Weekly Activity Schedule, both to keep a record of what you
usually do during the week and to plan new activities that you’d like to accomplish.

Exercise: Weekly Activity Schedule

To begin this exercise, make at least ten photocopies of the following blank
Weekly Activity Schedule. As you’ll see, the columns on the form are divided into the
days of the week, and the rows are divided into several blocks of hours. Over the
following week, do your best to record what you do throughout the day. If you can,
keep a copy of the form with you to record activities after you’ve done them.
However, if this is too difficult, at least record your activities at the end of each day.
Don’t wait until the end of the week because it will be too difficult to recall what you
were doing hour by hour and how your activities made you feel.

Remember, this activity is only for you; it is not for anyone else. No one will
grade or judge you on what you have or haven’t done. The purpose of this first activity
is to be as honest with yourself as possible and to complete an inventory of how you
spend your time throughout the week. Who knows what you’ll discover? For example,
you might find that you spend a lot of time:

 By yourself
 Waiting for other people to do things for you
 Trying to please other people
 Worrying about other people
 Doing tasks that you don’t like to do
 Worrying over the details of a project
 Harming yourself in some way
 You are the only one who will be able to determine if your time is spent doing
the things you need to do to lead a fulfilling life. So do your best to complete the
schedule as accurately as possible. As an extra challenge, for each activity that you
record, note the levels of pleasure and mastery that doing the activities gave to you.
Also, if you can, note whether you were avoiding some other activity.

Pleasure is the sense of enjoyment you experience when doing an activity. You
can rate it from 0 (no pleasure) to 10 (extreme pleasure). Many people with personality
disorders are surprised to discover that their weekly activities provide them with little
or no enjoyment, which makes it important to schedule pleasurable activities back into
your life.

Mastery is the sense that you are accomplishing something that’s important to
you. You can rate it from 0 (no sense of accomplishment) to 10 (extreme sense of
accomplishment). Without activities that give you a sense of accomplishment, life
sometimes feels dull or meaningless. For that reason, it’s important to have these types
of activities as part of your life too; and you may need to schedule them as well.

And, finally, if during the day you become aware that you’re avoiding an
activity, note that in your schedule. For example, if you’re watching television when
you are really avoiding washing the dishes, write that on the form. Again, the purpose
of this exercise is to discover how you spend your time and to learn what you can do
differently. After you’ve spent a week recording your daily activities, move on to the
next exercise.

For more ideas about how to fill out a Weekly Activity Schedule, refer to
Britney’s example, which follows the blank schedule you are to photocopy and use.
(Remember, Britney is struggling with borderline personality disorder.) Note the way
Britney recorded pleasurable activities with a P, mastery activities with an M, and
avoidance activities with an A. After completing this exercise, she noticed that she had
not engaged in many activities that provided her with a sense of either accomplishment
(mastery) or enjoyment (pleasure), and so she needed to schedule some activities into
her life that would do that. She also recognized that she had spent much of her free
time watching television, but that she really hadn’t enjoyed it. Clearly, watching
television was just a way for her to avoid doing her schoolwork and to kill time.
 Weeky Acivity Schedule
Note Pleasure = P, Mastery = M, and Avoidance = A

Time Monday Tuesday Wednesday Thursday Friday Satuday Sunday

Early
Morning
9-10 a.m.

10-11 a.m.

11-12 a.m.

12-1 p.m

2-3 p.m.
Weekly Activity Schedule

3-4 p.m.

5-6 p.m.

6-7 p.m.

7.8 p.m.

Late
Evening
 Weeky Acivity Schedule---Britney’s Example
Note Pleasure = P, Mastery = M, and Avoidance = A
Time Monday Tuesday Wednesday Thursday Friday Satuday Sunday

Early Morning Sleep Sleep Sleep School @ School @ Sleep Sleep

8 a.m. M:2 7:30 a.m. M:3

9-10 a.m. Get to work Get to work M: 4 Get to work M: 4 Economics class Psychology class Walk w/Tracy Sleep
M: 4 P: 5

10-11 a.m. Make calls Make calls @ Make calls @ work Economics class Psychology class Coffee w/Tracy Farmer’s maket
@ work M:3 work M: 3 M: 3 P: 4 P: 7

11-12 a.m. Billing Meeting Billling Economics class Psychology class Bask in bed Cafk
M:6 M: 3 M: 6 M: 6 M: 5 A: Calling Jason

12-1 p.m Lunch w/Tracy Lunch w/Tracy Lunch w/Tracy Walk around Lunch and Bark in bed Cafk
P:6 P:7 P:3 Campus Reading A: Calling Jason P:4
A: Studying P:2 M:3

1-2 p.m. Work with Browse Internet Review week’s sales Library to study Library to study Lunch Television
Margiret on A: billing M: 6 M: 5 M:4 P:5 P: 5
project M:4

2-3 p.m. Talk to Bob Sales meeting Browse Internet English Lit. class Library to study Talked to Jason Television
About accounts M: 5 P: 3 M: 4 P: 8 P: 5
Pâyble. M:3 A: billing

3-4 p.m. With report Talked Browse Internet English Lit. class World History Study Early dinner
M:4 w/Margares P: 3 class M: 6
P: 5 A: calling
customers
4-5 p.m. Review report w/ Reorder suplies Phone customers English Lit. class World History Study Television
Gary M:4 M: 7 M: 5 M: 4 class M: 3 M: 6

5-6 p.m. Drive home Drive home Drive home Bike home Bike home Televison Television
M:2 M: 2 M: 2 P: 5 P: 5

6-7 p.m. Dinner @ home Dinner @ home Dinner w/Jason Dinner alone Dinner Televison Television
w/ Jason alone P:4 P: 3 P: 5

7.8 p.m. Dinner @ home Televison Dinner w/Jason Television Movie @ home Television Television
w/ Jason P: 5 P: 4 alone P: 4 P: 3 P: 3
P: 9 A: workschool A: schoolwork A: schoolwork A: schoolwork

Late Evening Bed at 12 Bed at 11 Dinner w/Jason Bed at 12 Bed at 1a.m. Bed at 11 Bed at 10
P:10
 Weekly Activity Schedule—Results

After recording your activities for a week, look for any noticeable results. Did
you have many pleasurable activities in your life? Did you have any activities that
brought you a sense of accomplishment? Were there many activities you avoided by
doing something else? Would you say that this was an example of a typical week for
you, or does your life look very different from this most of the time?

Remember, life isn’t going to be meaningful and pleasurable all the time. We
all have days and even weeks that seem to be empty of either pleasure or satisfaction.
But if that’s the way your life feels most of the time, it might mean that in some way
your life is out of balance. Perhaps you’re working too much or spending too much
time going over the details of a project that has already been completed. Maybe you’re
spending too much time worrying about what others are going to do instead of making
plans for yourself. Or perhaps you’ve put off making plans because you’re not sure
how they will turn out and you want everything to be perfect; and as a result, you
haven’t done anything.

Whatever the reason, many people with personality disorders get stuck in
habitual patterns of behavior that lead them to do the same things over and over again,
even if those things are unpleasant or unsatisfying. The purpose of this exercise is to
observe your patterns and then to do something differently. If your old behaviors
haven’t been giving you satisfaction, there’s little reason to think that they’ll be any
better in the future.

Exercise: Making Sense of the Results

In the space below, record your thoughts about the Weekly Activity Schedule.
What did you notice? Were there enough pleasurable and satisfying experiences
throughout the week? Was there too much avoidance? What needs to change?
 Pleasurable Activities

Did you observe that you don’t have many pleasurable activities in your weekly
life? If so, you might benefit by making time for such activities. Many people who
lack pleasure in their lives say, “What should I do? I don’t know many pleasurable
things to do.” So the big list of pleasurable activities is provided below to help you
deal with this issue. The list includes over one hundred activities for you to choose
from. Mark the activities that you’d like to schedule into your life, or you can even
create a list of your own. These can be activities that you once enjoyed doing or new
things that you’d like to try.

The Big List of Pleasurable Activities

Check the activities you’re willing to do and then add any others you can think
of that you might also like to do:

_____ Talk to a friend on the telephone.

_____ Go out and visit a friend.

_____ Invite a friend to visit you at your home.

_____ Text message your friends.

_____ Spend time with your family.

_____ Organize a party.

_____ Exercise.

_____ Lift weights.

_____ Do yoga, tai chi, or Pilates, or take classes to learn.

_____ Stretch your muscles.

_____ Go for a long walk in a park or somewhere else that’s peaceful.

_____ Go outside and watch the clouds.

_____ Go for a jog.

_____ Ride your bike.

_____ Go for a swim.

 _____ Go hiking.

_____ Do something exciting, like surfing, rock climbing, skiing, skydiving, or

kayaking, or learn how to do one of these sports.

_____ Go to your local playground and join a game being played or watch a
game.

_____ Go play something you can do by yourself if no one else is around, like
basketball, bowling, handball, miniature golf, billiards, or hitting a tennis ball against
the wall.

_____ Get a massage; this can also help to soothe your emotions.

_____ Get out of your house, even if you just sit outside in the fresh air.

_____ Go for a drive in your car or take a ride on public transportation.

_____ Plan a trip to a place you’ve never been before.

_____ Sleep or take a nap.

_____ Eat chocolate (it’s good for you!) or eat something else you really like.

_____ Eat your favorite ice cream.

_____ Cook your favorite dish or meal.

_____ Cook a recipe that you’ve never tried before.

_____ Take a cooking class.

_____ Go out for something to eat.

_____ Go outside and play with your pet.

_____ Borrow a friend’s dog and take it to the park.

_____ Give your pet a bath.

_____ Go outside and watch the birds and other living creatures.

_____ Find something amusing to do, like reading the Sunday comics.

_____ Watch a funny movie. (Start collecting funny movies to watch when
you’re feeling overwhelmed with pain.)

_____ Go to a movie theater and watch whatever’s playing.

 _____ Watch television.

_____ Listen to the radio.

_____ Go to a sporting event, like a baseball or football game.

_____ Play a game with a friend.

_____ Play solitaire.

_____ Play video games.

_____ Go online to chat.

_____ Visit your favorite websites.

_____ Visit crazy websites and start keeping a list of them.

_____ Create your own website.

_____ Create your own online blog.

_____ Join an Internet dating service.

_____ Sell something you don’t want on the Internet.

_____ Buy something on the Internet.

_____ Do a puzzle with a lot of pieces.

_____ Go shopping.

_____ Get a haircut.

_____ Go to a spa.

_____ Go to a library.

_____ Go to a bookstore and read.

_____ Go to your favorite café for coffee or tea.

_____ Visit a museum or local art gallery.

_____ Go to the mall or the park and watch other people; try to imagine what
they’re thinking.

_____ Pray or meditate.

____ Go to your church, synagogue, temple, or other place of worship.

 _____ Join a group at your place of worship.

_____ Write a letter to God.

_____ Call a family member you haven’t spoken to in a long time.

_____ Learn a new language.

_____ Sing or learn how to sing.

_____ Play a musical instrument or learn how to play one.

_____ Write a song.

_____ Listen to some upbeat, happy music. (Start collecting happy songs for
times when you’re feeling overwhelmed.)

_____ Turn on some loud music and dance in your room.

_____ Memorize lines from your favorite movie, play, or song.

_____ Make a movie or video with your camcorder.

_____ Take photographs.

_____ Join a public speaking group and write a speech.

_____ Participate in a local theater group.

_____ Sing in a local choir.

_____ Join a club.

_____ Plant a garden.

_____ Do some outdoor work around the house.

_____ Knit, crochet, or sew—or learn how to.

_____ Make a scrapbook with pictures.

_____ Paint your nails.

_____ Change your hair color.

_____ Take a bubble bath or shower.

_____ Work on your car, truck, motorcycle, or bicycle.

 _____ Sign up for a class that excites you at a local college, adult school, or
online.

_____ Read your favorite book, magazine, paper, or poem.

_____ Read a trashy celebrity magazine.

_____ Write a letter to a friend or family member.

_____ Write a list of the things you like about yourself.

_____ Write a poem, story, movie, or play about your life or someone else’s
life.

_____ Write in your journal or diary about what happened to you today.

_____ Write a loving letter to yourself when you’re feeling good, and keep it
with you to read when you’re feeling upset.

_____ Make a list of ten things you’re good at or that you like about yourself
when you’re feeling good, and keep it with you to read when you’re feeling upset.

_____ Draw a picture.

_____ Paint a picture with a brush or your fingers.

_____ Share intimate experiences with someone you care about.

_____ Make a list of the people you admire and want to be like—they can be
real or fictional people throughout history. Describe what you admire about them.

_____ Write a story about the craziest, funniest, or sexiest thing that ever
happened to you.

_____ Make a list of ten things you would like to do before you die.

_____ Make a list of ten celebrities you would like to be friends with and
describe why.

_____ Write a letter to someone who has made your life better and tell the
person why. (You don’t have to send the letter if you don’t want to.)

_____ Create your own list of pleasurable activities.

_____ Other ideas:

 _____

______

Mastery Activities

Follow the same suggestions for reviewing the mastery activities in your daily
life. Do you engage in many activities during the week that give you a sense of
satisfaction? If not, you might benefit from scheduling some of these activities into
your life. These activities can range from simple chores like doing the dishes to more
complicated activities like completing a big project at work. Some of the suggestions
might repeat ideas from the previous list, but that’s okay. Everyone gets pleasure and
satisfaction from different kinds of activities.

The Big List of Mastery Activities

Check the activities you’re willing to do and then add any others that you can
think of:

_____ Spend uninterrupted time with your family, spouse, children, or friends.

_____ Go shopping for items you need.

_____ Go shopping for items you want.

_____ Go to the bank.

_____ Pay your bills.

_____ Balance your checking account.

_____ Go to work (if you’ve been avoiding it).

_____ Finish a task at work that you’ve been avoiding, delaying, or spending
too much time completing.

_____ Ask for help with a task at work.

_____ Assign a work task to someone else.

_____ Seek guidance from a supervisor at work.

 _____ Challenge yourself by completing a difficult task without asking for help
from anyone else.

_____ Help your child with his or her homework.

_____ Help your child with bedtime activities.

_____ Wash the dishes.

_____ Wash your clothes or take them to the cleaner.

_____ Put away your clothes.

_____ Fix something that’s in need of repair.

_____ Clean something that’s dirty.

_____ Take a shower or a bath.

_____ Clean and organize a messy shelf, desk, or kitchen counter.

_____ Prepare a healthy meal for yourself or someone else.

_____ Write a letter or e-mail to someone you’ve been thinking about or

avoiding.

_____ Investigate your spiritual or religious beliefs and join a group with
similar beliefs if you want to.

_____ Pray, meditate, or just sit still for as long as you can.

_____ Take care of the way you look and feel; get a haircut or a manicure if
necessary.

_____ Engage in some type of creative activity, like painting, drawing, or

writing.

_____ Get needed maintenance and repairs completed on your car or other
vehicle.

_____ Start keeping a personal journal to record your thoughts in.

_____ Plant a garden or work in your garden.

_____ Clean up the interior of your home.

_____ Complete some small repair to your home.

 _____ Organize some area of your home or work.

_____ Redecorate a room in your home or office.

_____ Spend time appreciating nature; go to a park, a lake, or the woods if

necessary.

_____ Visit someplace that is special to you, such as a city or a monument.

_____ Take care of your physical health; visit a medical professional for a
checkup or a needed visit.

_____ Take care of your mental health; visit a mental health care professional
for therapy or assistance.

_____ Get involved with your local community in a way that is meaningful to
you.

_____ Complete work around the outside of your home.

_____ Volunteer to help an organization that you care about.

_____ Make a difficult business call that you’ve been avoiding.

_____ Schedule a difficult business meeting that you’ve been avoiding.

_____ Return a telephone call to someone you’ve been avoiding.

_____ Complete an errand that you’ve been avoiding.

_____ Get dressed up for an appropriate occasion, like going to work or visiting
someone.

_____ Resolve a conflict that’s been bothering you or interfering with your life.

_____ Provide needed care for your pets.

_____ Enroll in a class or for some special training that you need.

_____ Do your best to solve a problem that you’ve been avoiding.

_____ Go for a walk.

_____ Exercise.

_____ Stretch your muscles.

_____ Help someone you care about.

 _____ Other ideas: ___________

Exercise: Schedule Pleasurable and Mastery Activities

Now that you’ve reviewed your weekly activities and identified some
pleasurable and mastery activities that you’d like to engage in, it’s time to schedule
those activities into your week. To begin, look at the Weekly Activity Schedule that
you completed and note the days when you are in need of more pleasure or
accomplishment. Then identify the times when you could schedule some of those
activities into your daily routines.

Be realistic when scheduling your activities. It might be too complicated to

schedule an entire week of activities in advance. Instead schedule them one or two
days in advance. Also, if you work eight or nine hours a day or you attend school, you
probably can’t schedule a pleasurable activity like “go to the movies” into the middle
of your day. However, you might be able to schedule a walk during lunchtime. And in
the beginning, don’t take on more than one mastery activity per day, especially if it is a
new activity. Trying to do more than one might become too challenging. Later on,
after you’ve begun to feel comfortable with the new activity, you can try scheduling
additional mastery activities.

When scheduling activities, be aware that you might be unable to complete a

pleasurable or mastery activity in one hour or even in one day. You might have to
break some activities into smaller tasks to complete them. For example, if one of your
pleasurable goals is to visit Washington, D.C., and you live in Dallas, Texas, you
probably need to do some planning for the trip. Or if your mastery goal is to redecorate
your apartment, most likely you will need to complete it over the course of several
days or weeks; and you may be able to dedicate only one hour a day to the task. That’s
okay. Remember, the goal of this activity is to begin making changes to your life that
will make life feel more satisfying and fulfilling to you.

For an additional challenge, try predicting how much pleasure or sense of

accomplishment each activity will give to you. Many people with personality disorders
anticipate that they will not enjoy an activity very much or take much satisfaction in it.
To see if your anticipations are correct, try making a prediction about each activity.
Then after you’ve completed the activity, record what your actual level of pleasure or
accomplishment was and see whether your prediction was accurate. If you notice that
your new activities make you feel better than you anticipated feeling, this might help
you confront other difficult activities in the future and stand up to the self-critical
thoughts that tell you to give up and not to try anything new.

Try scheduling activities for at least the next four to eight weeks— and you can
continue doing this while you’re learning other skills. It will probably take that long
for you to notice the benefits of making these changes and to begin engaging in these
types of activities in a more natural way, without having to schedule them.

Britney’s Example of Scheduling Pleasurable and Mastery Activities

An example of how Britney scheduled new activities into her week follows.
She started by noting the times in her schedule when she was engaged in activities that
were neither pleasurable nor fulfilling. Next she chose new activities from both Big
Lists. Then she scheduled those activities into her daily life. Finally, she made
predictions about how much pleasure or sense of mastery those activities would
provide her with. (Her predictions are underlined.)
 Weeky Acivity Schedule---Britney’s Example
Note Pleasure = P, Mastery = M, and Avoidance = A
Time Monday Tuesday Wednesday Thursday Friday Satuday Sunday
Early Morning
9-10 a.m. Clean aparment
Predict: M = 3
Actions: M = 8

10-11 a.m.
11-12 a.m. Study for dass
Predict: M = 4
Actions: M = 6

12-1 p.m Study for class Study for class Work in garden
Predict: M = 3 Predict: M = 3 Predict: M = 5
Actions: M = 5 Actions: M = 5 Actions: M = 9

1-2 p.m. Short walk after

lunch
Predict: M = 5
Actions: M = 6

2-3 p.m. Complese billing

Predict: M = 4
Actions: M = 6

3-4 p.m. Phone customers Take a walk in park

Predict: M = 3 Predict: M = 4
Actions: M = 4 Actions: M = 7

4-5 p.m.
5-6 p.m. Dinner w/Tracy Shopping
Predict: P = 5 Predict: P = 6
Actions: P = 7 Actions: P = 7

6-7 p.m. Food shopping Dinner w/Jason

Predict: M = 3 Predict: P = 6
Actions: M = 4 Actions: P = 9

7.8 p.m. Movie w/jason

Predict: P = 9
Actions: P = 8

Late Evening
 Making Time

In the twenty-first century, we all lead busy lives. There’s always something
else that we could (or should) be doing. That’s why it’s important for you to find some
time in your life for the activities that make you feel happy, fulfilled, and satisfied.
When you first start scheduling new activities into your week, you might have to cut
out some unnecessary ones, such as watching television or browsing the Internet, to
make the time for more important activities, such as spending time with your family
and completing necessary chores.

Scheduling activities may also require you to become a researcher. That is, you
may have to try out a number of different activities before you discover which ones
provide you with the most pleasure and sense of accomplishment. That’s okay.
Remember, the point of this exercise is to do something different. By definition,
people who have personality disorders are struggling with longstanding, dysfunctional
habits that interfere with their lives. If anything is going to improve in your life, you’re
going to have to take a leap of faith and try something new. Start with something
small, like completing a task, before you tackle something big, like returning a phone
call to someone you don’t like. Set yourself up for a successful experience and you’ll
be more likely to take on bigger challenges in the future. And remember, write down
your activities on your schedule. Recording them in writing increases the likelihood
that you’ll follow through with your plans

Use Coping Statements

If you’re still having trouble committing yourself to new activities, try using a
coping statement. A coping statement is a little phrase that can help you to:

 Get motivated
 Feel inspired
 Remind yourself of your ability to handle difficult situations
 Remind you of your past successes
 Develop an attitude of acceptance

Whenever you’re in doubt about your ability to take on a new challenge, change
your schedule, or try something new, repeat one of the phrases below either silently or
aloud a few times. Let the positive, self-affirming message sink in, and then try
confronting the challenge again.

Find a phrase below that makes you feel hopeful about your ability to succeed,
or you can create your own coping statement:

“I don’t have to do the activity perfectly; just trying something new is a

success.”

“I can do this; it’s okay to feel scared or anxious, but I won’t let it stop me.”

“This feeling is uncomfortable, but I can do this.”

“I’ve succeeded in the past when I’ve taken on challenges like this.”

“This isn’t dangerous; I’m just trying something new.”

“I need to take a leap of faith and believe that everything will be okay.”

“This is just anxiety (or doubt); I won’t let it stop me.”

“My doubt will eventually pass.”

“I’m just researching activities that might improve my life; I don’t have to
commit to anything I don’t really like to do.”

“Nothing will change unless I’m willing to try something new.”

“I don’t need these negative thoughts; I can choose to think positively.”

Now create your own coping thoughts:

______________________________

______________________________

______________________________

______________________________

In Conclusion

Many people with personality disorders get stuck in habitual patterns of

behavior that often make their lives feel dull and unrewarding. Breaking these habits is
very important. It can be difficult, but it’s not impossible. Sometimes it’s just
necessary to observe how you’re spending your time and then plan new, fulfilling
activities.

Do your best to commit to scheduling these new activities for at least four to
eight weeks, and observe any potential benefits they’ve had in your life. Does your life
feel more fulfilling as a result of doing these new activities? Do you experience more
pleasure in your life? If your answer to either question is yes, then keep scheduling
similar new activities. If your answer is no, don’t give up. Perhaps you’re not engaging
in the best activities for yourself. Maybe you are scheduling activities that you think
you should enjoy or activities that other people like. Be honest with yourself and
choose activities that you think are pleasurable and fulfilling, and you’ll be more likely
to experience a sense of satisfaction.
 Chapter 5

Challenge and Correct Self-Defeating Thoughts

Perhaps the most important step of the cognitive behavioral treatment for
personality disorders is to challenge and correct self-defeating thoughts. These
thoughts are often the cause of many distressing feelings and unhealthy behaviors. At
the heart of CBT is the belief that your thoughts, feelings, and behaviors all interact
and influence each other (and feelings can be either emotional or physical). Take a

Thoughts

Behaviors
Feelings
look at this diagram:

This shows how your thoughts can influence your feelings and behaviors, as
well as how your thoughts can be affected by your feelings and behaviors.

Let’s look at an example. Anthony struggled with antisocial personality

disorder. One day, he lost his favorite watch (a behavior). Anthony felt upset (an
emotional feeling), and then he thought to himself, “I bet my friend Paul stole it” (a
thought). This thought made him feel angry (another emotion) and tight in his chest (a
physical feeling). So he went to Paul’s house and got into an argument with him (a
behavior) and later felt betrayed (an emotion). From this example, do you see how
emotions can be both the result and the cause of your thoughts and behaviors?

This pattern can become a vicious cycle of upsetting emotions, self-defeating

thoughts, and dysfunctional behaviors. However, this cycle also can lead to more
fulfilling emotional experiences if you learn to challenge your self-defeating thoughts.
For example, maybe after Anthony lost his watch (a behavior) and felt upset (an
emotion), he could have challenged the thought that Paul stole it with another thought,
such as, “Paul has never stolen anything from me in the past, I don’t think he would
steal anything from me.” Then he might have been able to figure out how to find his
watch (another thought) and continue his day, feeling more at ease (an emotion). Or
after feeling upset about losing his watch, perhaps he could have gone for a long walk
(a behavior), which would have made him feel soothed (an emotion). There are many
different kinds of coping thoughts and behaviors that Anthony could have used to
prevent getting caught in a cycle of distressing thoughts, emotions, and behaviors, but
he had never learned any of them.

The Goals of This Chapter

This chapter will help you identify the ways in which your thoughts are
affecting your feelings and behaviors, and it will also help you identify the ways in
which your thoughts are contributing to your personality disorder. Most importantly,
however, this chapter will teach you how to challenge and change some of those
thoughts, in order to break free of your habits. Specifically, this chapter will teach you:

 How to recognize your distressing automatic thoughts

 How to record your automatic thoughts in a Thought Journal
 How to recognize and challenge unhelpful thinking styles
 How to challenge your automatic thoughts by examining your past
experiences

The information and skills you learn in this chapter will be crucial to you in
chapter 6, where you will learn how to identify and change your negative core beliefs
about yourself and the world.

This is a long chapter because it is one of the most important in the book. This
one chapter might take you several weeks or even months to work through, but that’s
okay. Take your time and make sure you understand the material. Work through the
exercises in the order that they appear. If you try to skip ahead in this chapter, you can
easily get lost. While you are working with the material in this chapter, also continue
to schedule and engage in pleasurable and mastery activities, as you did in chapter 4.

Automatic Thoughts
 The initial step of challenging the way you think is to observe your automatic
thoughts. Automatic thoughts are self-critical thoughts that people think and say to
themselves that sabotage their attempts at success and happiness. Imagine listening all
day to a radio station that only criticizes you, judges your actions, and tells you what to
do. This is very similar to what many people experience with their automatic thoughts.
Here are some common examples of automatic thoughts:

 I don’t deserve anything good happening to me.

 Why bother trying? I’m just going to fail anyway.
 I’m incapable of doing anything by myself.
 I should always try to please other people.
 I must never make any mistakes.
 Life isn’t fair.
 Nobody likes me.

You can be aware or completely unaware that you’re having thoughts like
these. In either case, they’ll probably make you feel sad, anxious, frustrated, angry, or
hopeless. Or after having a thought like this, you might engage in some kind of
behavior that interferes with your life, such as avoiding necessary chores, getting
angry at others, or physically hurting yourself.

Characteristics of Automatic Thoughts

Automatic thoughts often share common characteristics, which makes them

easier to identify.

1. Automatic thoughts are often repetitive. This means you’ll often have
automatic thoughts throughout the day or week. It also means that your automatic
thoughts will frequently share a common theme, such as criticizing yourself or others.
For example, people struggling with paranoid personalities often have thoughts that
other people are trying to harm them, while people with schizotypal personalities
frequently think that they don’t fit in with the rest of society

2. Automatic thoughts often catastrophize. This means that you’ll exaggerate

the worst-case scenario of anything that goes wrong or could go wrong. For example,
many people struggling with obsessivecompulsive personalities think that if they make
a mistake, no matter how small it is, they’ll be severely punished. Similarly, people
who have histrionic personalities often think that if other people aren’t paying
attention to them, they’ll be abandoned.

3. Automatic thoughts are experienced as strict rules to be followed. This

means that such thoughts frequently use words like “should,” “ought,” “never,”
“always,” or “must.” Often these rules develop early in life and serve some purpose.
But when maintained into adulthood, they can become less helpful or interfere with
your life. For example, people struggling with dependent personalities often have the
thought, “I must rely on other people for help,” while people with narcissistic
personalities think, “Other people should pay me the respect I deserve.”

4. Automatic thoughts can occur very quickly. This means that they can
appear as brief images, a few words, a sense of a situation, or a brief memory of a past
event. For example, people struggling with schizoid personality might have the
thought “I’m alone” or see an image of themselves alone. People with avoidant
personalities might have the thought “I’ll fail” or recall a brief memory of themselves
being criticized.

Examples of Automatic Thoughts

Although each person’s automatic thoughts will be unique, here are some
generalized examples of what your automatic thoughts might be, based on the
personality disorder(s) you’re struggling with:

Antisocial personality disorder: “The rules aren’t meant for me.” “I’m not
responsible for anything.” “Why should I care?” “Other people aren’t as important as I
am.” “Other people get what they deserve.”

Avoidant personality disorder: “Everyone is always judging me.” “Those

people will criticize me.” “I’m no good at making friends.” “Other people are better
than I am.” “There’s something wrong with me.”

Borderline personality disorder: “I don’t want to be left alone.” “No one

understands me.” “I always get hurt by others.” “I’m worthless.” “I’m empty inside.
 Dependent personality disorder: “I can’t take care of myself.” “I always need
help.” “I’m not smart enough.” “If I do anything wrong, I’ll be punished.” “I shouldn’t
disagree with others.”

Histrionic personality disorder: “Other people should like me.” “I need to be

the center of attention.” “I must please others.” “If other people don’t like me, I’ll be
left alone.” “I need to be seductive in order to be liked.”

Narcissistic personality disorder: “I’m better than other people at most

things.” “Other people should compliment me more often.” “I’m entitled to special
privileges.” “Very few people can truly understand me.” “Other people should help me
get what I want.”

Obsessive-compulsive personality disorder: “I need to keep everything in

order.” “I should never make a mistake.” “If I mess up, I’ll be punished.” “I should
always follow the rules.” “I must always strive for perfection.”

Paranoid personality disorder: “I can’t trust anyone.” “People are trying to

harm me.” “I often feel threatened by others.” “People will betray me if given the
chance.” “Others don’t deserve my forgiveness.”

Schizoid personality disorder: “I’d rather be alone.” “I don’t know how to act
around other people.” “I’m very awkward in social situations.” “Why bother trying?
I’ll just embarrass myself.” “I don’t need others’ approval.”

Schizotypal personality disorder: “I don’t fit in with the rest of society.” “I

don’t know how to behave in social situations.” “No one understands my special
abilities.” “I don’t want to be alone.” “People often try to take advantage of me.”

Personality disorder not otherwise specified: “Other people get special

privileges that I don’t.” “Other people always have it easier than me.” “Why should I
care? No one helps me.” “I’m never going to feel happy.” “There’s always something
wrong with me.”

Exercise: Your Own Thoughts

Were there any thoughts in the list above that you’ve had in the recent
past? If you answer yes, record those thoughts below. Or you can record any
similar automatic thoughts that you recognize:
 ______________________________

______________________________

______________________________

Recording Your Own Automatic Thoughts

In addition to completing the exercise above, another way to recognize your

automatic thoughts is to keep track of them throughout the day. Listening to your
thoughts is often the first step in learning how to challenge them. This makes sense
because many people aren’t aware that they’re thinking thousands of thoughts every
day.

You’ll probably be able to recognize your automatic thoughts most easily when
they’re connected to a distressing emotion, like anger, sadness, or worry. Remember,
your thoughts, feelings, and behaviors all affect each other, but your thoughts are
especially powerful. Very often, thoughts can make you feel a certain way
instantaneously, such as when you have a memory of a pleasant vacation or of
someone who has harmed you.

The point is that thoughts are powerful, even when they are too fast for you to
recognize in your daily life. Sometimes we all get distressed or excited without
knowing why, until we recognize what we were just thinking about. Some thoughts
come quickly, as pictures or short phrases, while other thoughts resemble constant
commentary and criticism from our “mind radios.”

The Thought Journal

A Thought Journal is a useful tool to help you recognize your own thoughts. As
you’ll see, it’s divided into three columns to help you identify: (1) the situation, (2)
your feelings, and (3) your automatic thoughts. The situation is any event that triggers
a distressing feeling or a critical automatic thought. Note that people frequently notice
the distressing feeling before they notice their thought. So during the next week pay
attention to any unpleasant emotions that you experience, such as sadness, anger, or
worry. Then see if you can identify the situation and the thoughts that accompany it.

SCOTT’S EXAMPLE OF A THOUGHT JOURNAL

 Look at Scott’s Thought Journal. (Remember, Scott struggles with schizotypal
personality disorder.) On Monday he had two experiences that brought up unpleasant
emotions. First, he was late for work, which made him feel very worried. He also
quickly recognized the thoughts that he was thinking: “I messed up again” and “I’ll be
fired.” Later, when he brushed off a friend for lunch, he first identified what he was
thinking, “Why do I keep avoiding people” and “She won’t want to talk to me again,”
before he recognized that he felt guilty about brushing off his friend. In each of these
cases, Scott recorded the experience as soon as possible. Then at least once a day
throughout the week, he continued to record the situations that made him feel
unpleasant, as well as the thoughts that he could identify.

PRACTICE USING THE THOUGHT JOURNAL

Before you begin using the Thought Journal, try a few practice experiences. For
example, think back to a recent event that made you feel distressed or unpleasant. You
might remember only that you felt bad. Do your best to relax, close your eyes, and try
to remember what happened just before you felt that emotion. Also try to remember
what you were thinking. Maybe your thought was only a word, like “alone.” Try to
expand that word into a full thought. Maybe it really indicated “I don’t want to be
alone.” Or if you recognize an image, do your best to connect that image with a
thought.

DIFFICULTIES IDENTIFYING THOUGHTS

Some people find it difficult to identify any thoughts at all. That’s okay,
especially in the beginning. Just do your best. At the very least, you might record each
time you suspect that you had a thought, even if you don’t know what it was. The
more you practice, the easier the process will become.

And remember, no one is going to grade you on your thoughts, so be honest

with yourself. You cannot change anything until you recognize what it is you’re trying
to change. Right now, you’re examining your thoughts. If you start to notice that you
have many critical thoughts about yourself or others, don’t worry, you’re not alone.
Many people have similar critical thoughts. The exercises in this chapter will help you
change some of those thoughts but, first, you must recognize and acknowledge what
they are.
 Exercise: Thought Journal

For the next three to four weeks, do your best to record at least one event in
your Thought Journal every day. It’s important that you write this information on the
form, rather than trying to remember it, because writing it down:

 Will help you identify the situation, feelings, and automatic thoughts
more easily.
 Will help you identify similar repetitious thoughts.
 You will need this information for later exercises.
 The more you practice, the more quickly you’ll develop the ability to
recognize your thoughts on a regular basis.
 Thoight Journal-Scott’s Example
Siuation Feelings Automatic thoughts
When did the situation Describe your feelings What were you thinking
occur? during the situation and trate before you noticed the
Where were you? Who was their intensities from 0 to 10 unpleasant feelings? Or what
involved? What happened? (0 = no internsity, 10 = were you thinking during the
greatest intensity) emotional experience?
Mon., late for work Worrided (8) “I messed up again.”
“I’ll be fired.”
Mon., brushed off Keri’s Guilty (6) “Why do I keep avoiding
invitation for lunch people?”
“She won’t want to talk to me
again.”
Tues., Ted asked me what I Suspicious (7) “What does he care?”
was doing “Why are people always
watching me?”
Wed., no one asked me to go Bothered (8) “I always feel out of place.”
out after work “No one likes me.”
Thurs., the woman at the bus Angry (5) “Why are people always
stop looked at me in a Suspicious (6) looking at me that way?”
strange way “People should mind their
own business.”
Fri., Pete said he didn’t Alone (8) “No one ever understands
understand me when I tried Bothered (9) me.”
to explain what I saw in the
sky last night
Sat., my girlfriend said she Worried (5) “She always brushes me off
didn’t have time for me Suspicious (7) whenever I want to do
today Lonely (9) anything.”
“ She probably wants to break
up with me.”
Sun., sitting in the park with Bothered (6) “I think those people are
other people around Weird (8) looking at me.”
“Why don’t people just leave
me alone.”
Sun., at home alone Annoyed (7) “Why am I home alone
Depressed (5) again?”
“I hate my job and I don’t
want to go to work tomorrow”
 Thoight Journal-Scott’s Example
Situation Feelings Automatic thoughts
When did the situation Describe your feelings What were you thinking
occur? during the situation and trate before you noticed the
Where were you? Who was their intensities from 0 to 10 unpleasant feelings? Or what
involved? What happened? (0 = no internsity, 10 = were you thinking during the
greatest intensity) emotional experience?
Mon., late for work Worrided (8) “I messed up again.”
“I’ll be fired.”
Mon., brushed off Keri’s Guilty (6) “Why do I keep avoiding
invitation for lunch people?”
“She won’t want to talk to me
again.”
Tues., Ted asked me what I Suspicious (7) “What does he care?”
was doing “Why are people always
watching me?”
Wed., no one asked me to go Bothered (8) “I always feel out of place.”
out after work “No one likes me.”
Thurs., the woman at the bus Angry (5) “Why are people always
stop looked at me in a Suspicious (6) looking at me that way?”
strange way “People should mind their
own business.”
Fri., Pete said he didn’t Alone (8) “No one ever understands
understand me when I tried Bothered (9) me.”
to explain what I saw in the
sky last night
Sat., my girlfriend said she Worried (5) “She always brushes me off
didn’t have time for me Suspicious (7) whenever I want to do
today Lonely (9) anything.”
probably wants to break up
with me.”
Sun., sitting in the park with Bothered (6) “I think those people are
other people around Weird (8) looking at me.”
“Why don’t people just leave
me alone.”
Sun., at home alone Annoyed (7) “Why am I home alone
Depressed (5) again?”
“I hate my job and I don’t
want to go to work tomorrow”
Unhelpful Thinking Styles

Now that you’ve identified some of your automatic thoughts, and noticed any
patterns of similar, repetitious thoughts, let’s look at how those automatic thoughts can
contribute to your problems. Psychiatrist Aaron Beck, the founder of cognitive
therapy, identified some common unhelpful thinking styles when he studied people
who were struggling with depression.58 Since then, other thinking styles have been
identified that are associated with anxiety and personality disorders. These unhelpful
thinking styles generate many of the distressing automatic thoughts that support your
personality disorder and make your life more difficult.

In many ways these thinking styles are like mind traps, because you continually
get caught in them. Periodically, we all fall into these traps, despite the fact that the
thought might not be 100 percent accurate. However, people with personality disorders
fall into these traps a lot because it has become their habit to do so.

The Eleven Mind Traps

The following is a list of eleven unhelpful thinking styles that people with
personality disorders get trapped in. 36, 58 Do your best to identify the ones you use.
And despite the examples that are specified for each mind trap, you could be
struggling with any of these styles of thinking, no matter which personality disorder
you’re struggling with. Many of these styles are similar to each other, but don’t worry
about distinguishing between them. What’s important is that you learn to recognize
when you’re caught in one of these mind traps, so that you can learn how to get out of
it.

1. Filtering: You make your conclusions after focusing on the negative details of
a situation and filtering out all of the positive details. As a result, you don’t see the
whole picture or you just choose to ignore it. For example, a person who has paranoid
personality disorder might think, “Everyone is out to get me,” despite the fact that
coworkers or family members often offer their support.
2. Jumping to Conclusions: You draw negative conclusions despite having no
evidence to support them or having evidence that actually contradicts those
conclusions. For example, a man who has schizotypal personality disorder might think,
“My landlord is going to kick me out of my apartment,” despite the fact that the man
always pays his rent on time and the landlord hasn’t said anything to suggest this.
3. Overgeneralizing: You focus on the negative outcomes of one or more limited
situations and use those outcomes to make broad, general rules or conclusions about
many aspects of your life. People who overgeneralize often use broad, absolute terms,
like: every, all, always, none, never, everybody, and nobody. For example, a woman
who has avoidant personality disorder might think, “My best friend didn’t call me
tonight because I must have offended her in some way; now I’ll probably offend all of
my family members too, and then everybody will hate me,” despite the fact that her
friend just forgot to call.
4. Magnifying and Minimizing: When thinking about yourself, others, or a
specific situation, you magnify the negative qualities or minimize the positive
qualities. For example, a person who has narcissistic personality disorder might think,
“My coworkers are complete imbeciles who never do anything right,” despite the fact
that her coworkers are skilled, successful employees.
5. Personalizing: This is the tendency to relate everything that is happening
around you to yourself, especially negative events that you take the blame for, even
when they’re not your fault. For example, a man who struggles with histrionic
personality disorder might think, “Those people sitting across from me are laughing; I
must have done something to embarrass myself,” despite the fact that the people across
the way aren’t paying any attention to him at all.
6. Black-and-White Thinking: You see only two categories for people and
situations; they are either all good or all bad, perfect or defective, a total success or a
complete failure. You neglect looking for compromise or other possibilities. For
example, a woman who struggles with borderline personality might think, “My friends
are the absolute best and never do anything wrong” or “My friends are the worst and
they’re always treating me meanly,” despite the fact that no one is perfect and we all
make mistakes sometimes
7. Catastrophizing: You think that your future will be hopeless and full of
catastrophes, without considering other possible outcomes. For example, a person
struggling with dependent personality disorder might think, “I can never do anything
right by myself, and because of that I’ll probably die alone; helpless and homeless, in
the streets,” despite the fact that the person is sometimes successful at doing things
alone and has a number of supportive friends.
8. Mind Reading: You assume you know what other people are thinking and
feeling, without considering other possibilities. For example, someone with an
antisocial personality disorder might think, “My boss doesn’t look happy today; I bet
he’s thinking about the mistake I made last week on my time sheet,” despite the fact
that his boss could be unhappy due to a completely unrelated person or event.
 9. Rule Making (“Shoulds” and “Musts”): You have a particular, fixed idea
about how things “should” be, and you get upset or angry when your expectations
aren’t met. For example, a person struggling with obsessivecompulsive personality
disorder might think, “I should work harder, because I should never make any
mistakes; if I do make a mistake, it must mean I’m a failure,” despite the fact that
everyone makes mistakes occasionally and nothing is ever perfect.
10. Emotional Thinking: You believe that your feelings are judgments
about who you are or the situation you’re in. For example, a woman who has schizoid
personality disorder might think, “I feel lonely, which means I’m probably not a good
person,” despite the fact that she doesn’t feel lonely all of the time and she actually has
a few friends.
11. Labeling: You attach a negative label or judgment to yourself, others, or
your experiences, without looking at all of the facts. For example, a man with an
unspecified personality disorder might think, “I’m an idiot,” or “My job sucks,”
despite the fact that these statements are not 100 percent true all of the time.

Exercise: Identify Your Own Unhelpful Thinking Styles

What unhelpful thinking styles or mind traps do you use? Record them in the
space below:

______________________________

______________________________

______________________________

Challenge Your Unhelpful Thinking Style

Now that you’re familiar with some of the most common mind traps, you might
be wondering “So what?” And you’re right. Just noticing the way you think doesn’t
help if you don’t do something to change it. Depending on which type of mind trap
you fall into, you can try using some of the suggestions below to get yourself out of it.

Remember, one of the defining symptoms of a personality disorder is a rigid,

inflexible style of thinking. So if you want to improve your life and stop suffering, you
need to try thinking in a different way. You need to take a leap of faith, and use some
of the alternative responses that are listed below. And learning this one skill isn’t
going to be enough to change your entire life, but when used in conjunction with many
of the other skills you’ll learn in this workbook, it just might.

Develop Alternative Responses to Unhelpful Thoughts

If you already recognize the unhelpful thinking style that you use, find it below
and learn how you can challenge it. However, if you haven’t already identified the
style you frequently use, be patient. For the moment, just review the list and become
familiar with the unhelpful thinking styles and their alternative responses. Then in the
next exercise you’ll use this list to explore some new ideas.

1. Filtering versus Expanding Your Focus: When you use filtering, you look
only at the negative details of a situation and you filter out all of the positive details.
Instead, try expanding your focus. Ask yourself, “What am I missing?” or “What am I
not looking at?” If you’re focusing only on what’s going wrong, ask yourself, “What’s
going well?” or “What’s happening that I agree with?” Are you focusing on the
problem instead of a possible solution? What might that solution be? For example, if
you were thinking, “Everyone is out to get me,” as an alternative, look for evidence of
people trying to help you or of your safety right now. Maybe there is some evidence
that people are trying to help you and you’re choosing to ignore it.
2. Jumping to Conclusions versus Sticking to the Facts: When you jump to
conclusions, you make negative assumptions despite having no supportive evidence or
actually having evidence that contradicts your assumptions. Instead, try focusing on
the facts of the situation. Ask yourself two questions: “What facts do I have that my
conclusion is accurate?” and “What facts do I have that my conclusion is not
accurate?” Then compare the facts, to see if your assumption is correct. For example,
if you were thinking, “My landlord is going to kick me out of my apartment,” as an
alternative, look at the facts. If you pay your rent on time and have a valid lease, your
landlord probably can’t kick you out, even if he wanted to. Do your best to stay
focused on the facts rather than get carried away by your imagination.
3. Overgeneralizing versus Being Specific: When you overgeneralize, you focus
on the negative outcomes of one or more limited situations and use those outcomes to
make broad, general rules or conclusions about many aspects of your life. Instead, be
specific about what’s really happening. Ask yourself, “Is this situation really as bad as
I think? Is it really going to negatively affect any other area of my life?” For example,
if you were thinking, “My best friend didn’t call me tonight because I must have
offended her in some way; now I’ll probably offend all of my family members too, and
then everybody will hate me,” as an alternative, be specific about what happened.
There are many possible reasons that could explain the situation and a single bad event
doesn’t mean that your entire life is ruined. Also, do your best to avoid using broad,
absolute terms like “every,” “all,” “always,” “everybody,” and so on. Instead, be
specific. Even if you did offend one person that doesn’t mean that everybody will hate
you.
4. Magnifying and Minimizing versus Thinking in Perspective: When you
magnify and minimize, you enlarge the negative qualities of a situation and minimize
the positive qualities. Instead, think about the situation from a new perspective. When
you use words like “never,” “always,” “forever,” “complete,” and “absolute,” you cut
yourself off from other possibilities. Similarly, when you use strong negative words to
describe people or events, you’re only focusing on a single aspect and you lose sight of
the whole picture. For example, if you were thinking, “My coworkers are complete
imbeciles who never do anything right,” as an alternative, ask yourself if your opinion
is 100 percent accurate. Maybe your coworkers occasionally make mistakes, but it also
is probably true that they’re good people who do some things right some of the time.
5. Personalizing versus Balancing Responsibility: When you use personalizing,
you take the blame for the bad things that happen, even when they’re not your fault.
Instead, take a look at who is really responsible and do your best to balance the
responsibility. Ask yourself, “Am I really 100 percent responsible for this? And if not,
who should share the blame?” Maybe you are partly responsible for what’s happening
around you, but maybe there are other people who are at least partly responsible too.
For example, if you were thinking, “Those people sitting across from me are laughing.
I must have done something to embarrass myself, and they’re probably laughing at
me.” As an alternative, ask yourself if you’re really responsible for their amusement.
Maybe they’re laughing at someone else, maybe one of them just told a joke or
something else that’s completely unrelated to you.
6. Black-and-White Thinking versus Seeing Shades of Gray: When you use
black-and-white thinking, you see only two categories for people and situations; they
are either all good or all bad, perfect or defective, a smashing success or an abject
failure. Instead, look at the situation as a shade of gray, in between black and white.
Most people are not 100 percent good or bad; we all have our faults. Similarly, most
objects have at least small defects, and most events are some combination of success
and failure. There are no absolutes in the world. For example, if you were thinking,
“My friends are the worst and they’re always treating me meanly,” as an alternative,
try to remember the times when your friends treated you well or, at least, treated you
better than they do now. Again, look for evidence that balances or contradicts your
judgments.
7. Catastrophizing versus Considering All Your Possibilities: When you
catastrophize, you think that your future looks hopeless and full of disasters, without
considering any other possible outcomes. You’re one hundred percent certain that the
worst-case scenario will occur. Instead, consider the possibility that the worst disaster
won’t happen. Ask yourself, “If the worst-case scenario doesn’t occur, what else might
happen?” Be fair in your assessment. Be creative; consider even the most remote
possibilities. For example, if you were thinking, “I can never do anything right by
myself, and because of that I’ll probably die alone, helpless and homeless, in the
streets,” as an alternative, consider what else might happen. You might learn how to
help yourself by using the skills in this workbook, you might get help from your
family, or you may end up living in a nice home with a loving family. Chances are that
something better is just as likely to happen as the catastrophe you’re worried about. So
why not hope for the best?
8. Mind Reading versus Asking for Clarification: When you mind read, you
assume that another person is thinking something negative about you, without
considering any other possibilities. Mind reading is one of those things that we all do
sometimes, which just makes us feel worse about ourselves. However, you can’t really
know what other people are thinking unless they tell you. So if you want to know, go
ahead and ask the person what he or she is thinking in a calm, polite way. For
example, if you were thinking, “My boss doesn’t look happy today; I bet he’s thinking
about the mistake I made last week on my time sheet,” as an alternative, ask your boss
what’s wrong. You could say, “I noticed you look upset, may I ask what’s bothering
you?” If the other person does have a problem related to you, asking for clarification
will give you and that person an opportunity to work it out. However, don’t be
surprised if the other person wasn’t thinking about you at all. Remember, your
assumptions aren’t always true
9. Rule Making versus Being Flexible: When you engage in rule making, you
have a particular, fixed idea about how things should be, and you get upset or angry
when your expectations aren’t met. Instead, be flexible in how you judge yourself and
others. And remember, your rules and values aren’t shared by everyone, so don’t judge
them if you wouldn’t want them to judge you. Instead, ask yourself, “How can I be
flexible in this situation so that everyone can be somewhat happier or more satisfied?
How can I make a fair compromise?” For example, if you were thinking, “I should
work harder because I should never make any mistakes; if I do make a mistake it must
mean I’m a failure,” as an alternative, ask yourself if that’s a fair and flexible
statement. Everyone makes mistakes and the only thing that making a mistake really
means is that you’re human, just like the rest of us.
10. Emotional Thinking versus Rational Thinking: When you use
emotional thinking, you believe that your feelings are true judgments about who you
are or the situation you’re in. Instead, use rational thinking and look at the evidence to
determine whether your judgments are 100 percent true. Emotions can be wonderful,
but they’re just temporary electrical and chemical signals within your body. They
aren’t permanent and they aren’t always accurate descriptions of who we are or what
kind of situation we’re in. For example, if you were thinking, “I feel lonely, which
means I’m probably not a good person,” as an alternative, look at the evidence. Ask
yourself, “What good things do I do sometimes? Is it possible that I’m feeling lonely
and I’m a good person at the same time?” Most likely it is.
11. Labeling versus Remaining Nonjudgmental: When you label, you
attach a negative label or judgment to yourself, others, or your experiences without
looking at all the facts. Instead, do your best to remain nonjudgmental of yourself,
others, and the situation. Whenever you use an insulting term to describe yourself, you
cut yourself off from other possibilities; if you’re “dumb,” there are many things you
can’t do. Similarly, when you label and judge others and situations you automatically
place negative expectations on them. Instead, leave yourself open to all possibilities.
For example, if you were thinking, “I’m an idiot,” as an alternative, create a
nonjudgmental coping statement that helps you through your problem, such as “I don’t
feel good, but I’ll do the best I can.” Similarly, if you were thinking, “My job sucks,”
create a coping statement like “I’m not happy with my job right now, but I’ve gotten
through rough times in the past.” Nonjudgmental statements like this make it possible
for you to engage in new behaviors.
 Unhelpful Thinking Styles and Alternative Responses
Unhelpfull Thinking Styles Alternative Responses
These are the mind traps that you use, which These are the new, healthier responses you
generate unhelpful, automatic thoughts. can try whenever you find yourself caught in
one of the unhealthy thinking styles or mind
traps.
1. Filtering: You make conclusions after 1. Expanding Your Focus: Ask yourself,
focusing on the negative details and filtering “What am I not looking at?” If you’re
out all of the positive details. focusing only on what’s going wrong, ask
yourself, “What’s going well?” or “What’s
happening that I agree with?”
2. Jumping to Conclusions: You draw 2. Sticking to the Facts”: Ask yourself,
negative conclusions, despite having no “What facts do I have that my conclusion is
evidence to support them or having evidence accurate?” Then compare the facts to see if
that actually contradicts those conclusions. your assumption is correct.
3. Overgeneralizing: You focus on the 3. Being Specific: Ask yourself, “What are
negative outcomes of one or more limited the facts of this situation? Is it really as bad as
siutuations and use those outcomes to make I think? Is it really going to negatively affect
broad, general rules or conclusions about any other area of my life?” Alsi, avoid using
amny aspects of your life. broad, absolute terms, like: every, all, always,
none, never, everybody, and nobody.
4. Magnifying and Minimizing: When 4. Thinking in Perspective: Ask yourself, “Is
thinking about yourself, others, of a situation, my opinion 100 percent accurate? What are
you magnify the negative qualities or some other aspects of this situation that I’m
minimize the positive qualities. not looking at?”
5. Personalizing: When something bad 5. Blancing Responsibility: Ask yourself,
happenes, you take the blame for it, even “Am I really 100 percent responsible for this?
when it’s not your fault. If not, who should share the responsibility?
Who else is at least parrly reponsible?”
6. Black and White Thinking: You see only 6. Seeing in Shades of Gray: Ask yourself,
two categories for people and situations; they “Am I being fair? Is anything really 100
are either all good or all bad, perfect or percent good or bad? What possiblitities am I
defective, a success or a failure. missing when I choose to see things in black
and white terms?”
7. Catastrophizing: You think that your 7. Considering All Your Possingbilities:
future will be hopeless and full or Ask yourself, “What else might happen? What
catastrophes, without considering other possibilities am I not considering? Can my
possible outcomes. situation improve in any way?”
8. Mind Reading: You assume you know 8. Asking for clarfation: Ask yourself, “Can
what other people are thinking and feeling, I really know what anyone else is thinking,
without considering other possibilities. without the person telling me? Obviously you
can’t. So if you want clarification, go ahead
and ask the person or stop guessing
altogerther.
9. Rule Making: You have a particular, fixed 9. Being Flexible: Ask yourself, “How can I
idea about how things “should” be, and you be flexible in this situations so that everyone
get upser or angry when your expectations can be somewhat happy or satisfied? How can
aren’t met. I make a fair compromise?”
10. Emotional Thinking: You believe that 10. Rational Thinking: Ask yourself.
your feelings are true judgments about who “What’s the evidence that my judgments are
you are. 100 percent true? Is there another explanation
for the way I’m feeling?”.
11. Labeling: You attach a negative label or 11. Remaining Nonjudgmental: Ask
judgment to yourself, others, or your yourself, “Am I being fari to myself, others,
experisences, without looking at all the facts. and the situation? What possibilities am I
cutting myself off from?”
 Create Alternatives to Your Unhelpful Thinking Styles

Now that you’re familiar with the common, unhelpful thinking styles and their
alternatives, let’s put this skill into action. To begin, read the following example:

Patrick struggled with paranoid personality disorder. When he filled out his
Thought Journal, he recognized that he often had thoughts like, “I can’t trust anyone,”
“People are trying to harm me,” and “Others don’t deserve my forgiveness.” But after
reading about unhelpful thinking styles and alternative ways of thinking, he was able
to challenge some of those thoughts and to think of alternative ways to respond to his
thoughts. Take a look at his example below of using the worksheet called Challenge
Your Unhelpful Thinking Styles.

Observe that Patrick was able to come up with a number of healthier thoughts
by first identifying the unhelpful thinking styles he was using and then choosing to use
appropriate, alternative responses. But more importantly, notice that after challenging
his thoughts, he rerated his emotions and found some relief, which is the best reason to
challenge your automatic thoughts. Remember, your thoughts and feelings influence
each other. So if you learn how to change your thoughts, you can also soothe your
emotional experiences.

Exercise: Challenge Your Unhelpful Thinking Styles

Use the Challenge Your Unhelpful Thinking Styles worksheet below to

challenge some of the automatic thoughts you recorded in your Thought Journal. Do
your best to identify the unhelpful thinking styles that you were using and then try to
create healthier alternative responses. And remember, the purpose of this exercise is
not to make you an expert at identifying the unhelpful thinking styles by name. The
purpose is to help you learn to think in a healthier, more flexible way. So even if you
can’t identify your specific unhelpful thinking style, still do your best to create an
alternative thought. And if that thought generates some new type of behavior, as in
Patrick’s example (“Some people said hello, maybe I could trying saying hello to
them.”), try doing the new behavior (saying hello to others) and see what happens.

For the next three to four weeks, continue to record your automatic thoughts on
this new worksheet and do your best to create healthier, alternative responses.
 Challenge Your Unhelpful Thinking

Situation Feeling Automatic thoughts Unhelpful Thinkings Alternative Thoight or Rerate

When did the Describe your What where you Style Response Feelings
situation occur? feelings during thinking beforce you Identify the mind trap Challenge your unhelpful After
Where were the situation and noticed the unpleasant you fell into Filtering, thingking style using an considering
you? rate their feelings? Or what Overgeneralizing, alternative thought or
alternatives,
Who was incnsities from were you thinking Personalizing, etc. response.
involved? 0 to 10 (0 = no during the emotional
rerate your
What Intensity, 10 = experience? feelings from
happened? great intensity) 0 to 10
intensity.
On train to work Anixous (8) I can’t trust anyone. Magnifying Thinking in Perspective: “I Anixous (5)
can trust a few people, like
my family and closest
friends.”
Walking to Scared (7) People are trying to Filtering Expanding Your Focus: Scared (3)
work harm me “Some people said hello,
maybe I could trying saying
hello to them.”
Walking home Angery (8) I often feel threatened Emotinal Thinking Rational Thinking: “Maybe I Angery (4)
form work by others felt angry because people
were threatening me.”

Having dinner Worried (6) People will betray me Jumping to Conclusions Sticking to the Facts: “Carl Worried (3)
with Carl if given the chance has not done anything to
hurt me and I was having a
nice dinner with him.”

Talking to my Upset (7) Other don’t deserve Rule Making Being Flexible: “My brother Upset (5)
brother my forgiveness (if does the best he can,
they don’t do what I although he does not always
tell them to do). listen to me. I could try to
suppoert him.”
 Challenge Your Unhelpful Thinking

Situation Feeling Automatic thoughts Unhelpful Thinkings Alternative Thoight or Rerate

When did the Describe your What where you Style Response Feelings
situation occur? feelings during thinking beforce you Identify the mind trap Challenge your unhelpful After
Where were the situation and noticed the unpleasant you fell into Filtering, thingking style using an considering
you? rate their feelings? Or what Overgeneralizing, alternative thought or
alternatives,
Who was incnsities from were you thinking Personalizing, etc. response.
involved? 0 to 10 (0 = no during the emotional
rerate your
What Intensity, 10 = experience? feelings from
happened? great intensity) 0 to 10
intensity.

 Identify your automatic thoughts

So far in this chapter you’ve learned how to:

 Identify unhelpful thinking styles that promote those thoughts

Challenge Your Thoughts by Examining Your Past Experiences
  Challenge those unhelpful styles with alternative thoughts

Ideally, you’ve given yourself at least six to eight weeks to practice these skills
and hopefully you’ve experienced some emotional relief. However, if you’re still
having trouble challenging some of your automatic thoughts, the following technique
might be helpful. In this section, you’ll learn how to examine your past experiences to
find evidence that both strengthens and weakens the validity of your automatic
thought. Then you’ll create a more balanced, alternative thought using that
information. This skill is very helpful, especially if your automatic thought is
preventing you from taking some kind of action. This technique is largely based on the
work of psychologists Dennis Greenberger and Christine Padesky in their book Mind
Over Mood.59

Identify Past Experiences That Strengthen the Validity of Your Automatic

Thought

This first step is usually the easiest. Most people who struggle with selfcritical
automatic thoughts can often think of several experiences from their past that support
or strengthen the validity of those thoughts. For example, Scarlett struggled with
schizoid personality disorder and had great difficulty socializing with other people.
One day at work, some of her colleagues asked her to go bowling with them, but the
thought of spending time with them made her feel scared, embarrassed, and worried.
First, she worked through this difficult situation using the Challenge Your Unhelpful
Thinking Styles worksheet, but she still needed help because she couldn’t decide what
to do. So her next step was to examine her most troublesome automatic thought by
searching for experiences that both strengthened and weakened its validity. The
thought that bothered her the most was “I’ll be very awkward in that situation, so I
shouldn’t go.” When she thought about past experiences that strengthened the validity
of her automatic thought she came up with three examples very easily:

1. Whenever I go out with other people, I never know what to say to them.

2. I don’t know how to bowl and I always embarrass myself.

3. The last time I went out with a friend I didn’t have a good time.

Exercise: Record Experiences That Strengthen Your

 Automatic Thought

This is your chance to act like a defense lawyer during a trial. First identify
your troublesome automatic thought and describe how it makes you feel. Then,
pretend you’ve been asked to provide the facts that strengthen your belief in your
automatic thought. Do your best to remember all of the past experiences that support
your assumption that your thought is true.

My automatic thought is: ___________

This thought makes me feel: ___________

The past experiences that strengthen my automatic thought are: ___________

Identify Past Experiences That Weaken the Validity of Your Automatic Thought

This second step is usually harder than the first one. The goal here is to look for
past experiences that weaken or contradict the validity of your automatic thought.
Often it’s helpful to ask yourself some of the following questions:

1. Have you had any similar past experiences that turned out better than you
thought they would? Scarlett noted, “I’ve gone out with colleagues before and it’s
been okay.”

2. Are you exaggerating the overall accuracy of your automatic thought? For
example, is it true that the situation will lead to the outcome that you’ve predicted or
are there other possibilities? Scarlett wrote, “Sometimes I act pleasantly in those social
situations.”

3. Are there any exceptions to the conclusions that you’ve drawn? Scarlett
noted, “Lately, I’ve been talking with a few coworkers without much fear.

4. Are there other factors that might reduce the negativity of the automatic
thought or the feared situation? Scarlett wrote, “In the past, it has felt good to go out
sometimes, even when it has been difficult for me.”

5. If you were to look at this situation realistically or from someone else’s

perspective, what’s most likely to happen? Scarlett said, “Most likely, nothing very
bad will happen. I might just feel uncomfortable like I have in the past.”
 6. What could you do to cope with the situation in a new, more effective way?
For example, are there certain skills or techniques that you could use? Scarlett noted,
“I could excuse myself and leave if I feel too nervous, like I’ve done in the past.”

7. Do you know someone who could help you or can you think of someone who
would handle this situation in a more effective way? If so, what would that person do?
Scarlett wrote, “I’ll ask [my friend] Ann to stay close by. She’s been a good friend to
me.”

Exercise: Record Experiences That Weaken Your Automatic Thought

Once again, pretend that you’re a lawyer building a big case. But this time
you’re on the other side and your job is to find information and experiences that
weaken the validity of your automatic thought.

The past experiences that weaken my automatic thought are: ___________

______________________________

______________________________

______________________________

______________________________

Create an Alternate, Balanced Thought

After you’ve found experiences that both strengthen and weaken your
automatic thought, it’s very important to create an alternate, balanced thought— which
you believe—and identify how that new thought makes you feel. Read over the
experiences you recorded in the two previous exercises and try to put them together in
a way that is both fair and balanced. It might be as easy as joining a thought from both
exercises, but whatever you do, make sure that your new thought is one you truly
believe, not just a thought that you’ve created for the sake of finishing the exercise.
When you’re done, do your best to identify any new actions you can take and how the
new thought makes you feel. Notice if the emotion is different than the original one
you recorded, even if it has lessened just a little in intensity.

In Scarlett’s example, she was able to create the following balanced thought, “I
might feel very awkward going out with people from work, but this is something that
I’m working on and in the past I’ve been able to get along in some social situations.
Plus, it might be good for me to get out and I might even enjoy myself a little.” She
was also able to identify a new plan of action based on this thought: “I’ll go out with
my colleagues and do the best I can.” Plus, she recognized that she felt less scared,
embarrassed, and worried, and even a little hopeful.

Exercise: Create an Alternate, Balanced Thought

Based on the experiences you discovered that both strengthen and weaken the
validity of your automatic thought, do your best to create an alternate, balanced
thought that is more accurate. Also, identify what new actions you will take and how
you feel.

My alternate, balanced thought is: ___________

______________________________

______________________________

My new plan of action is: ___________

______________________________

______________________________

Based on my new thought and plan of action I now feel: ___________

______________________________

______________________________

In Conclusion

Hopefully, you’ve had some success using the skills in this chapter to:

1. Identify your automatic thoughts

2. Challenge the ones that are causing you distress

3. Improve the way you feel

However, these goals will be met only if you take the time to complete the
Challenge Your Unhelpful Thinking Styles worksheet on a consistent basis and
examine your past experiences, if necessary. With regular practice, you’ll start to
notice some changes. First, you’ll notice that you’re filling out the worksheets more
willingly. Next you’ll notice that you can complete them more easily. And, lastly,
you’ll start to think of alternate, balanced thoughts more automatically, without having
to use the worksheet.

Before you move on to the next chapter, be sure to spend at least six to eight
weeks challenging your automatic thoughts. While you do, search for similar thoughts
that keep showing up. These will be helpful in the next chapter. Also, remember to
continue scheduling both pleasant and mastery activities into your daily life using the
Weekly Activity Schedule.
 Chapter 6

Challenge Your Negative Core Beliefs

While you were identifying and challenging your automatic thoughts using the
Challenge Your Unhelpful Thinking Styles worksheet over the last six to eight weeks,
you might have noticed that some of your distressing thoughts kept repeating or were
very similar to each other in their subject matter. These commonalities often point to
core beliefs. Core beliefs are deep, strongly held thoughts you have about yourself,
others, the world, or your future.58 These thoughts act as the blueprints for your life,
and they frequently influence your behavior, your emotions, and your relationships.

Core beliefs can be either positive or negative in quality. Positive core beliefs
like “I can do anything that I set my mind to” allow you to tackle challenges and help
you to get through difficult times. But negative core beliefs like “I’m a failure” can
make you less likely to succeed, interfere with your relationships, and leave you more
vulnerable to feelings of frustration, loneliness, and sadness. Common negative core
beliefs also include thoughts like “I’m defective,” “I’m worthless,” and “I’m
unlovable.”

Most negative core beliefs develop early in childhood.36 Some children are told
directly by their parents and friends that they aren’t good enough or smart enough,
while other children are treated in ways that makes them feel unlovable or defective.
In addition, some children learn their core beliefs by watching the way people—
especially their parents—interact with others. However, no matter how your own core
beliefs began, over time you started believing that those negative beliefs about you
were true, even if they really weren’t. Then over time, these negative core beliefs
began to influence how you thought, felt, and behaved in the world.

The Goals of This Chapter

Core beliefs are powerful, and changing them might sound difficult, but it’s not
impossible. Developing healthier core beliefs is the most important skill you’ll learn in
this workbook and it deserves your time and effort, even when the work becomes
challenging. Overall, the goals of this chapter are to help you:
 1. Identify your negative core beliefs

2. Identify the rules and predictions of your negative core beliefs

3. Test the rules of your negative core beliefs

4. Create new, healthier core beliefs

Much of the theory and many of the exercises in this chapter are based on the
work of mental health experts like Aaron Beck and Arthur Freeman,36 Jeffrey
Young,60 and Matthew McKay and Patrick Fanning.61

Step 1: Identify Your Negative Core Beliefs

Both positive and negative core beliefs establish the rules by which you live
your life. Most often you’re probably not even aware that you’re thinking about your
core beliefs or using them as rules to live by. They’ve become such a part of your
personality that you simply believe “This is who I am and that’s how I do things.” But
hopefully, by this point in the book, you’ve already seen proof that you can change
your thoughts and create new, healthier experiences

Later, we’ll look at creating new, positive core beliefs, but for now, let’s focus
on identifying your negative core beliefs and seeing how they affect your life. In
essence, negative core beliefs filter your experience and cause you to focus on certain
types of distressing experiences and emotions while ignoring other, more pleasant
experiences and emotions. For example, a man who has the negative core belief “I’m
defective” might think that he is incapable of doing anything correctly, even if he has
had successes in the past. For that reason, it’s likely that (1) he’ll dismiss his past
successes and say they’re insignificant; (2) he won’t take risks; (3) he’ll rely on others
for constant reassurance; and (4) he’ll usually associate with people who confirm his
feelings of being defective.

Similarly, a woman with the negative core belief “I’m unlovable” might believe
that she’ll be lonely and disappointed for her whole life, even if she has had some
healthy relationships in the past. As a result, she might do the following: (1) she’ll
regard the few healthy relationships she had in her past as either being out of the
ordinary or take no credit for having formed them; (2) she’ll stop trying to meet new
people and going on dates; (3) she’ll stop taking care of herself and stop trying to
improve her life; and (4) she’ll continually become involved with others who make her
feel unlovable, such as with people who abuse her or take advantage of her.

It might sound strange that the people in both of these examples take actions
that reinforce their negative core beliefs instead of behaving in ways that change those
beliefs, but more often than not, this is what happens. Too often, negative core beliefs
such as these greatly influence people’s lives, even when those beliefs lead to
suffering.

To help you identify your own negative core beliefs there are two techniques
that you can use: theme analysis and the downward arrow technique. Both of these
techniques will require you to look deep within yourself and to examine how you are
living your life. This can be difficult. Negative core beliefs are always attached to
powerful emotions, and when you identify yours, you should expect to feel some
degree of sadness, fear, or regret. But don’t be discouraged; with some dedicated
work, you can change these negative beliefs as well as these negative emotions.

Theme Analysis

As mentioned at the beginning of this chapter, when you were filling out your
Challenge Your Unhelpful Thinking Styles worksheet over the past several weeks, you
might have observed that certain repetitious thoughts kept coming up or several
problematic situations appeared to be very similar. Perhaps you’ll recognize that many
of your distressing thoughts share the same general theme, such as “I always fail,”
“People are always trying to hurt me,” “I can’t do anything for myself,” or “I’ll always
be alone.” Or maybe you recognize that you feel distressed whenever you are in social
situations. Looking at both your problematic thoughts and situations can help you to
uncover your negative core beliefs.

For example, when Hillary, who struggled with histrionic personality disorder,
reviewed her lists of automatic thoughts, she found that many of her thoughts focused
on attracting attention from other people, expressing her belief that she wasn’t good
enough, and her feelings of loneliness. After reviewing her lists of automatic thoughts,
she summarized them with this statement of a negative core belief: “Unless other
people are paying attention to me, I never feel good enough.” She knew she was on the
right track because this thought made her feel sad. It also sounded very familiar, as if
she had thought it many times.

Exercise: Sum Up Your Automatic Thoughts in a

Single Statement

Right now, go back and review your Thought Journal and Challenge Your
Unhelpful Thinking Styles worksheet and record any of your common themes or
thoughts below. Then try to sum up these thoughts in a single statement.

______________________________

______________________________

______________________________

Downward Arrow Technique

Another way of identifying your negative core beliefs is to use a technique

called the downward arrow. This technique tries to drill below the thoughts that you
normally are aware of, to uncover the hidden negative beliefs that may lie beneath
many of your habitual automatic thoughts.

From your lists of automatic thoughts, find one about yourself that you
frequently think. Then ask yourself, “If that thought is true, what does it mean about
me?” Next, take your answer and ask, “If that’s also true, what does that mean about
me?” And keep going in a similar manner. Keep asking yourself the same question;
that is, “If that thought is true, what does it mean about me?” until you can go no
further. But more importantly, keep going until you find an answer that arouses a
strong emotional response. At that point, you’ll know you’ve found something
important about yourself that deserves to be examined and challenged.

For example, Vivian struggled with personality disorder not otherwise

specified. She recognized that one of her common automatic thoughts was “Other
people should take care of me.” Then she asked herself, “If that’s true, what does it
mean about me?” Her answer was “I need other people’s help.” She then asked, “If
that’s also true, what does that mean about me?” Her response was “I always need lots
of people around who are willing to do things for me.” She continued, “So if that’s
true, what does it mean about me?” Eventually, Vivian arrived at an answer that made
her feel extremely sad, so she knew that she had identified her negative core belief,
which was “It means there’s something wrong with me and that I’m not able to take
care of myself.”

If Vivian had diagrammed her thoughts using downward arrows, they would
have looked like this:

“Other people should take care of me.”

“I need other people’s help.”

“I always need lots of people around who are willing to do things for me.”

“It means there’s something wrong with me and that I’m not able to take care of
myself.” (This is Vivian’s negative core belief.)

Exercise: Using the Downward Arrow Technique

When completing this exercise, be sure to respond to the question “If that’s
true, what does that mean about me?” only with thoughts, not with feelings. For
example, don’t respond to the question with “I feel sad.” Instead, identify the thought
or belief that makes you feel sad.

Use the downward arrow technique below to uncover your negative core belief.
Start by recording one of your common automatic thoughts, and continue until you
arrive at your negative core belief.

First, write down your frequent automatic thought:

______________________________

______________________________
 If that thought is true, what does it mean about you?

______________________________

______________________________

And if that thought is true, what does it mean about you?

______________________________

______________________________

And if that thought is true, what does it mean about you?

______________________________

______________________________

And if that thought is true, what does it mean about you?

______________________________

______________________________

Continue for as long as necessary:

______________________________

______________________________

______________________________

______________________________

Common Negative Core Beliefs of Personality Disorders

According to many cognitive behavioral therapists, people with similar

personality disorders often share similar negative core beliefs. Now that you’ve
attempted to identify your own negative core beliefs, check the list of examples below.
Perhaps they will help you to clarify the core belief that you’re struggling to identify.
However, it’s important to remember that these examples are just generalizations and
that your particular negative core belief might be very different.

According to psychiatrist Aaron Beck and his associates, people with

personality disorders often struggle with negative core beliefs like these:36

Antisocial personality disorder: “I have to take care of myself because no one

else will,” “I’m entitled to get what I want no matter what the rules say,” and “Other
people will take advantage of me unless I take advantage of them first.”

Avoidant personality disorder: “I’m defective,” “I’m unlovable,” and “There’s

something wrong with me, so it’s best to stay away from other people so they won’t
discover my faults.”

Borderline personality disorder: “I’m defective (or worthless),” “Other people

will hurt me,” and “I can’t ever be alone, so I need to do whatever it takes to make
others stay with me.”

Dependent personality disorder: “I’m completely incapable of doing anything

by myself,” “If I’m ever alone, I’ll die,” and “I’m completely helpless, so I’ll always
need someone to assist me.”

Histrionic personality disorder: “I’m not valuable (or lovable) unless other
people are admiring me,” “I’m worthless without other people’s attention,” “I need to
entertain people (or be interesting enough) for them to like me.”

Narcissistic personality disorder: “I’m more important than other people and I
deserve special privileges,” “Society’s rules don’t apply to me the way they do to
ordinary people,” and “If other people don’t treat me as special, then they deserve to
be punished.”

Obsessive-compulsive personality disorder: “I’ll fail unless I maintain very

high standards for myself and for everyone else,” “I should do everything perfectly,”
“I must maintain control of all the details, otherwise I’ll be overwhelmed (or things
will fall apart),” and “Everything has to be done perfectly, so I have to be in control of
everything to prevent any errors from occurring.”
 Paranoid personality disorder: “Other people want to hurt me (or take advantage
of me),” “I’m vulnerable to being harmed,” and “I always have to be on guard to
protect myself.”

Schizoid personality disorder: “I don’t need close relationships because they

only interfere with my life,” “I’m better off alone,” “I’m not capable of forming close
relationships,” and “I shouldn’t get close to other people.”

Schizotypal personality disorder: “I don’t fit in with other people,” “Other

people want to hurt me (or take advantage of me),” and “I’m not capable of forming
close relationships.”

Personality disorder not otherwise specified: “I’m unlovable,” “There’s

something wrong with me,” and “I always mess up, so why bother trying?”

Exercise: Record Your Own Negative Core Beliefs

Now that you’ve completed the theme analysis and downward arrow exercises,
as well as having reviewed some common negative core beliefs, it’s time to record
your own negative core belief(s) in the space below. Don’t be surprised if you identify
several that need to be challenged. Many people struggle with more than one negative
core belief, such as “I’m unlovable” and “I need someone to take care of me.”

My negative core beliefs include:

______________________________

______________________________

______________________________

Step 2: Identify the Rules and Predictions of Your Negative Core Beliefs

Now that you’ve identified one or more of your negative core beliefs, it’s time
to challenge them and determine whether they’re really true or not. Of course, you
probably live your life as if these beliefs are true, but have you ever stopped to ask
yourself if your beliefs are absolutely true? That is, would most other people agree
with you that your beliefs about yourself are true? One way to test the truth of your
negative core beliefs is to challenge the rules that support them.
 Each core belief carries with it an unspoken set of rules that determines how
you live your life, what you’re allowed to do and not do, and how you should interact
with other people. Unfortunately, the rules of negative core beliefs are very restrictive
and often prevent people from living fulfilling lives. For example, a man who holds
the belief “I’m unlovable and defective” might live by the following rules: (1) “I
should never seek out healthy, loving relationships” (since he’s unlovable); and (2) “I
should always ask for other people’s help before I do anything” (since he can’t do
anything correctly by himself). Similarly, a woman who has the negative core belief
“I’m going to be abandoned by the people I care about” might live by these rules: (1)
“I should never disagree with other people” (since they might leave her as a result);
and (2) “I should sacrifice my own needs to help others meet their needs” (in order to
please other people)

Identify Your Own Rules

Now, let’s identify how your own negative core beliefs are interfering with
your life. In their book Prisoners of Belief61 Matthew McKay and Patrick Fanning
suggest that you can identify your rules by observing how you react to different
troubling situations that trigger your core beliefs. First, read through the following list
of twenty-one triggering situations, the list of eight questions below the triggering
situations, and the examples that are provided. Then in the exercise that follows,
answer the questions for yourself on several sheets of blank paper.

List of Triggering Situations

1. Coping with other people’s emotions 7. Trusting others

(especially anger, criticism, disapponit- 8. Making friends
ment, and sadness)
9. Having conversations or being social
2. Dealing with other people’s love and
10. Coping with romantic or sexual
sipport for you
relationships
3. Handling your own emotions
11. Dealing with work or career issuses
4. Coping with mistakes (yours or those of and problems
others)

5. Asking for help or suppoer from others

6. Being alone or with others

12. Relating to your family or children 17. Handling your own health issues or
someone else’s
13. Handling success (yours or others)
18. Coping with your spiritual beliefs and
14. Deadling with stressful or problematic
activities
situtations
19. Engaging in fun and recreational
15. Handling new or challenging
activities
situaations
20. Taking care of yourself
16. Expressing your own feelings, opin-
ions, or limits 21. Taking care of others
 Now ask yourself how your negative core belief causes you to behave in each of
the triggering situations listed above. Every answer that you come up with is a rule that
you follow—for better or for worse. If you need help identifying how you react in each
of the triggering situations, answer as many of the following questions as you can for
each situation.

1. How does your negative core belief cause you to react in this situation?

2. What do you do to avoid distressing feelings that are caused by your belief
and the situation?

3. What do you do to avoid the situation or the people associated with it?

4. What do you do to avoid problems created by the situation instead of dealing

with them directly?

5. What do you do to protect yourself in the situation?

6. Do you limit yourself in some way as a result of your belief and the
situation?

7. Do you do something that reinforces or confirms your belief about yourself?

8. Do you do anything else in this situation as a result of your belief?

an example of how using the list of triggering situations and answering the
questions can help you to discover some of the rules that may govern your life.

Nathan was struggling with narcissistic personality disorder. After working

through many Thought Journal and Challenge Your Unhelpful Thinking Styles
worksheets, he had realized that he held the following core belief: “I’m undesirable to
others.” Then he used both the list of triggering situations and the eight questions to
uncover the rules of his core belief.

To begin, he took the first situation—coping with other people’s emotions—

and he answered as many of the questions as he was able to. Here are his responses:

 Answer to question 1: “Because I believe that I’m undesirable to others, I

ignore them when they express any emotion whatsoever.”
  Answer to question 2: “Because I believe that I’m undesirable to others,
when people express emotion it makes me feel anxious and I usually avoid
feeling that way by criticizing the other people.”
 Answer to question 5: “Because I believe that I’m undesirable to others,
when people express emotion I protect myself by acting superior to them.”

Then he moved onto the next situation—dealing with other people’s love and
support—and again he answered as many of the questions as he could. He continued
until he had reviewed the entire list of twenty-one triggering situations and had
answered as many questions as possible. Here are his responses to the last situation—
taking care of others:

 Answer to question 3: “Because I believe that I’m undesirable to others, I

avoid taking care of others by not doing anything at all and by not getting
close to anyone.”
 Answer to question 7: “Because I believe that I’m undesirable to others, I
don’t take care of anyone, which makes me feel like a selfish jerk, which
then makes me feel even more undesirable.

When Nathan finished reviewing the list of triggering situations and had
answered as many questions as possible, he realized he had recorded sixty-one
answers. Each answer represented an unhealthy rule that he followed as a result of his
negative core belief. When Nathan attempted to summarize all of his rules he
discovered that four of them were very dominant in his life: (1) “I find it very difficult
—if not impossible—to ask anyone for help”; (2) “When other people express
emotions, I ignore them or belittle them”; (3) “I never volunteer for challenging
situations at work”; and (4) “I never help others.”

Exercise: Discover Your Own Rules

Now do your best to discover your own rules. On a sheet of paper, record the
core belief that you’re exploring, as well as the ways you react to the triggering
situations as a result of that belief. Use the eight questions if you need help. Be as
honest and as specific as you can when you record your answers. If you have trouble
recognizing your own rules, go through the list of triggering situations in a slower,
more thorough way.
 When you’ve completed the exercise, record the dominant rules you discovered
in the space below:

My core negative belief is:

______________________________

______________________________

My rules are:

______________________________

______________________________

______________________________

______________________________

Identify Your Negative Predictions

Now that you’ve recognized several rules that result from your negative core
belief, you can next identify what you think will happen if you don’t follow those
rules. The consequences that you imagine are probably very powerful negative
predictions that prevent you from challenging your rules. Let’s continue looking at
Nathan’s example. Here are his negative predictions based on his core belief and its
rules.

Rules and Negative Predictions—Nathan’s Example

Core belief: “I’m undesirable to others.”

1. Rule: Don’t ask anyone for help.

Negative prediction: People will get annoyed with me and then will abandon
me.

2. Rule: Don’t react when others express emotions.

Negative prediction: I’ll do something wrong and the person will feel insulted.

3. Rule: Don’t volunteer for anything difficult at work.

Negative prediction: I’ll probably mess it up; I might cause a huge problem, and
then I’ll be fired.
 4. Rule: Don’t bother helping others.

Negative prediction: If I do something wrong, they’ll get angry with me.

Exercise: Identify Your Own Negative Predictions

Now identify the negative predictions that are attached to each of your own
rules. Use the space provided below and a blank sheet of paper if necessary. If you
have trouble identifying your negative predictions, ask yourself the following
questions. If you don’t follow your rules:

 What awful event will take place?

 What are you afraid will happen?
 What’s the worst that could happen?
 Will someone get hurt?

Rules and Negative Predictions

Core belief: ___________

1. Rule: ____________

Negative predictions:

________________

________________

2. Rule: ____________

Negative predictions:

________________

________________

3. Rule: ____________

Negative predictions:

________________

________________

4. Rule: ____________

Negative predictions:
 ________________

________________

5. Rule: ____________

Negative predictions:

________________

________________

Step 3: Test the Rules of Your Negative Core Beliefs

This third step in the process of challenging your core beliefs is often the
hardest for many people. In order to challenge your negative core beliefs, you must
test your rules and your negative predictions to see whether they’re true or not. Often
this means doing the exact opposite of what the rule requires or finding another way to
challenge the rule. By doing this, you’ll generally find that although your negative
predictions may sound very powerful, in truth they are usually inaccurate.

For example, one of Nathan’s rules was “Don’t ask anyone for help” because
his negative prediction said, “People will get annoyed with me and then abandon me.”
He decided to test this rule by asking some neighbors to help him move some furniture
in his apartment. To his surprise, he discovered that his neighbors were happy to help
him and that no one got annoyed. Clearly, his prediction was very inaccurate. This not
only caused Nathan to question the accuracy of his rule, but it also changed the way he
thought about himself and others. He had learned that people were sometimes happy
and more than willing to help him.

How to Test Your Rules

Testing the rules of your core belief will take some courage. For a very long
time you’ve strengthened your rules by following them. Now you’re being asked to
break them. Generally, this requires you to do the exact opposite of what the rule says
to do, to see if your negative predictions come true. For this reason, you need to make
a commitment to yourself to test your rules in a specific way. Throughout the process,
follow these guidelines:
 1. To begin, test a rule that’s fairly low on a difficulty or fear scale. On a
scale of 0 to 10, with 10 being extremely difficult or frightening, start by picking a rule
that’s a 2 or a 3. Then, as you gain confidence with early successes, you can start
challenging harder rules that feel more intimidating.

2. Pick a rule that’s easy to set up in a situation that you can initiate. For
example, it was far more effective for Nathan to create a situation in which he could
ask his neighbors for help, rather than waiting for a random situation to occur when he
might ask a stranger for help.

3. Make a plan to test your rule. When are you going to test it? Where? What
are you going to do? What might get in the way of testing your rule, and what could
you do about that? For example, Nathan knew that his neighbors were usually home
on Saturday around noon, so he planned to do it then. And if his neighbors weren’t at
home, he knew that he could try again the following day around the same time.

4. Create a situation in which you can observe immediate outcomes. For

example, if Nathan decided to test his rule of expressing his opinions to someone else,
it would be more effective to do so when he was with other people rather than
expressing his thoughts in a letter or an e-mail, because he would then have to wait for
the person’s response.

5. Test your rule in such a way that you can observe other people’s
behavioral responses. You want to be able to see if your negative predictions come
true. You don’t want to rely on reading someone else’s mind or guessing about other
people’s feelings to determine their responses. For example, Nathan volunteered to do
a small project at work, which he completed and gave to his supervisor. But rather
than guess at his supervisor’s reactions, Nathan went to her office so he could directly
observe her responses, which were positive.

6. Prepare to test your rule. There are many strategies you can use. You can
write down what you’re going to say or do in the situation, much like creating a movie
script. Then you can use an audio or video device to record what you plan to say and
how you will say it. This will allow you to determine if your words, tone of voice, and
body language are appropriate for the situation. You can also practice what you plan to
do in front of a mirror, or you can rehearse the situation with someone you trust, much
like rehearsing a scene for a play. Another way to prepare is to use your imagination.
That is, you can visualize the details of the situation and imagine yourself completing
the test successfully.

7. Record the outcome of your test. Did it go better or worse than you feared?
Did your negative prediction take place, or did something else happen? Did something
get in the way of testing your rule? If things went differently than you thought they
would, why do you think they went differently? Was the rule as difficult to test as you
thought it would be? And, most importantly, what did you learn from this experience?
Be as specific as possible about what happened as a result of your test. Even if
something trivial occurred, it might help you build a body of evidence that contradicts
your negative core belief. And remember, you should be engaging in tests where you
can observe how the test affects other people (if others are involved); so if you’re not
sure how it affected them, then ask. Say something like, “Was it okay with you that I
asked you to do that?” or “Was it okay with you that I did that?” Do your best to get
honest feedback about your actions, rather than trying to guess about their
effectiveness.

If challenging the rules of your core belief still feels too intimidating, use a
stress-reduction technique from chapter 7, like progressive muscle relaxation or
mindful breathing, to help you relax both before and after you challenge the rule. In
addition, you can consult chapter 10, Learn Coping Imagery, or chapter 11, Use
Exposure to Confront Feared Situations and Emotions, to learn additional techniques
that will help you test your rules.

Use the following Test Your Rules worksheet to challenge the rules of your
negative core beliefs. (Make additional photocopies as needed.) After you successfully
challenge less intimidating rules, begin challenging more difficult ones. And most
importantly, remember to record your progress and save the forms that you complete.
Many people fail to write down the results of their tests, and so they forget their
successes.

Over the course of the next several weeks or months, do your best to challenge
as many of your rules as possible. Do this before moving on to Step 4: Create New,
Healthier Core Beliefs. While you are challenging your rules, continue to schedule
pleasurable and mastery activities into your life.
 Test Your Rules
Before Testing
Negative core belief:
Rule of the belief:

Negative predictions

How will you test the rule?

Will there be immediate obserable result? (if you answer is no, revise your plan)
When will you test the rule?
Where?
…Page 114…
Step 4: Create New, Healthier Core Beliefs

Now that you’ve had several weeks or months to challenge the rules of your
negative core beliefs, you’ve probably encountered some successes. Hopefully you’ve
had new, unexpected experiences that contradict your rules and negative predictions.
It’s likely that you now realize your worst fears don’t always come true, despite how
intimidating or scary they might have seemed to you.

Perhaps you’ve also started to think about yourself, others, and the world in a
different, healthier, more balanced way. For example, if your original core belief was
“I’m unlovable,” maybe now you think, “Sometimes I still feel unlovable, but I often
have experiences with others when I know they like me or even love me.” Or if your
core belief was “I’m defective,” maybe now you think, “Sure, sometimes I don’t do
things perfectly; nevertheless, I often do a very good job.” Do you see the difference?
It’s subtle, but it’s important. Your negative core beliefs aren’t going to change
permanently overnight. In fact, you might continue to think about yourself in your old
way from time to time for the rest of your life, but hopefully testing your rules has
helped you develop the psychological flexibility to think about yourself in a healthier,
more positive way sometimes.

Now that you’ve tested your old rules, it’s time to reprogram the way you think
about yourself, your future, and others, so that you can start living according to
positive core beliefs and new, healthier rules. The exercises below will help you to
develop a new positive core belief and a related set of rules. Then, after you’ve had
some success developing one positive belief, you should consider working through this
process again to develop additional positive core beliefs for yourself.

State Your New Belief

To begin, you first need to state a healthier, positive core belief about yourself
and the way you want to interact with other people. Usually, this positive core belief
will come from the work you’ve done testing your old rules. For example, Dwight,
who has dependent personality disorder, had the negative core belief “I’m completely
incapable of doing anything by myself.” However, after testing the rules of this belief,
he realized that he was capable of completing many tasks successfully without the
constant support of others. As a result of his tests’ positive outcomes, he rewrote his
positive core belief as, “I’m a capable person who can do many things without the help
of others.” Similarly, Hillary, who has histrionic personality disorder, had the negative
core belief “I’m worthless without other people’s attention.” When she tested her
rules, she discovered that other people liked her even when she wasn’t the center of
attention. As a result, she created a new core belief that said, “I’m a likable, worthy
person who doesn’t have to try so hard.”

What Is Your New Core Belief?

Based on the work of testing your old rules that you’ve completed, record the
new core belief you’d like to have about yourself, even if you don’t believe it
completely right now:

______________________________

______________________________

______________________________

______________________________

State Your New Rules

Next, you need to create the new set of rules that you intend to live by, based on
your new, positive core belief. But instead of creating rigid “If...then” rules (that is, if
someone does this, then I’ll do that), consider developing rules that highlight your
overall positive qualities and reinforce your positive core belief. A good test for your
new rule is to ask yourself whether it’s fair to both you and the people you interact
with. For example, based on her new core belief that said, “I’m a likable, worthy
person who doesn’t have to try so hard,” Hillary developed the following new rules:
(1) “I can relax, even when I feel anxious”; (2) “I’ll do my best to be friendly, but it’s
still okay if I’m not liked by everyone”; and (3) “I can be quiet and reserved
sometimes and people will still want to be my friends.”

Write Your New Rules

When you first write down these new rules for yourself, don’t be surprised if
they sound very strange, as if someone else had written them. You shouldn’t expect
that these new rules will magically feel comfortable or that they will automatically be
easy to set in motion. These new rules will be challenging but, hopefully, you’re
willing to experiment with them and to test the hypothesis that they will improve your
life.

Based on your new, positive core belief, record at least three new rules you
intend to follow:

1. ___________

2. ___________

3. ___________

Record Your Progress with New Belief and Rules

Now that you’ve created a healthier core belief and a new set of rules to live by,
it’s time to put them into action and record your progress. You should look for
frequent opportunities every day to test your new belief and rules, and then you should
record the evidence of your progress. Remember, these rules aren’t going to change
quickly; it’s going to take an honest effort on your part to change your life. This
process might take months or even years, but it’s certainly worth the effort to achieve a
happier, healthier life and better, happier relationships with other people.

Use the following Positive Core Belief Evidence Log to record your new
beliefs, your new rules, and the experiences that reinforce them. Be sure to record
what happened during the new experience and what you learned about yourself and
others. Do your best to add at least one experience to the form every day. Either keep a
copy of the form with you to record experiences as they happen, or make a point of
recording at least one event before going to sleep each night.

As you begin testing your new rules, keep in mind that some situations may be
easier than others. You might need to start testing your new rules in less intimidating
situations before you test them in more challenging situations later, just as you did
when you tested your old rules. And again, if you need additional help, use a stress-
reduction technique from chapter 7, like progressive muscle relaxation or mindful
breathing, or consult chapter 10, Learn Coping Imagery, or chapter 11, Use Exposure
to Confront Feared Situations and Emotions, to learn additional techniques that will
help you test your new rules.
Page 118

Examples of Using the Positive Core Belief Evidence Log

Refer to the following examples of positive core beliefs and rules that are
provided below for each of the personality disorders. But remember, these are just
examples, and your own new beliefs and rules may be very different.

ANTHONY: ANTISOCIAL PERSONALITY DISORDER

 Original negative core belief: “Other people will take advantage of me unless
I take advantage of them first.”
 New positive core belief: “People are generally nice to me if I try to be nice
to them.”
 New positive rule: “I’ll help someone at work every day.”
 How did you test the new rule? “I helped Tanya put the heavy water bottle
into the watercooler.”
 What happened? “She thanked me.”
 What did you learn from this experience? “I don’t have to keep my guard up
all the time. I can be nice to people sometimes and they’ll appreciate it.”

AVA: AVOIDANT PERSONALITY DISORDER

 Original negative core belief: “I’m defective.”

 New positive core belief: “I might not be an expert at everything, but I
do lots of things well enough.”
  New positive rule: “I’ll take on new challenges whenever possible.”
 How did you test the new rule? “I sorted through the stack of mail that
has been sitting on my desk for the last two months.”
 What happened? “It was difficult, but I got through it and now it’s
done.”
 What did you learn from this experience? “I’m stronger than I often
think I am.”

BRITNEY: BORDERLINE PERSONALITY DISORDER

 Original negative core belief: “I can’t ever be alone, so I need to do

whatever it takes to make others stay with me.”
 New positive core belief: “I’m a strong, confident woman who is capable
of being alone sometimes.
 New positive rule: “When opportunities arise to be alone, I’ll welcome
them.”
 How did you test the new rule? “I stayed home on Saturday night and
read a book.”
 What happened? “I enjoyed the book and my time by myself. It was very
peaceful.”
 What did you learn from this experience? “Sometimes I actually enjoy
being alone, and I can cope with it.”

DWIGHT: DEPENDENT PERSONALITY DISORDER

 Original negative core belief: “I’m completely incapable of doing

anything by myself.”
 New positive core belief: “I’m a capable person who can do many things
without the help of others.”
 New positive rule: “I’ll look for opportunities to complete tasks by
myself.”
 How did you test the new rule? “I volunteered for a project at work and
asked to do it alone.”
  What happened? “I completed the project and my manager gave me
some feedback about how I could improve my performance next time,
although he was generally satisfied with what I did.”
 What did you learn from this experience?“I’m sometimes more skilled
than I think I am.”

HILLARY: HISTRIONIC PERSONALITY DISORDER

 Original negative core belief: “I’m worthless without other people’s

attention.”
 New positive core belief: “I’m a likable, worthy person who doesn’t
have to try so hard.”
 New positive rule: “I can be quiet and reserved sometimes and people
will still want to be my friends.”
 How did you test the new rule? “I went out with friends from work and
behaved modestly, without showing off.”
 What happened? “Friends and colleagues came over to talk to me
anyway.”
 What did you learn from this experience?“I don’t need to be the center of
attention in order to connect with my peers.”

NATHAN: NARCISSISTIC PERSONALITY DISORDER

Original negative core belief: “I’m more important than other people and I
deserve special privileges.”

New positive core belief: “I can play by the same rules as everyone else and
still get my own needs met.”

New positive rule: “I’ll ask for what I need rather than demand that other people
just give it to me.”

How did you test the new rule? “I asked my coworker Beth if she could help me
organize a luncheon (rather than giving her an order to do so).”

What happened? “She looked surprised. Then she said she was busy at the
moment and would talk to me about it later. When she did, she said she’d be happy to
help.
 What did you learn from this experience? “I don’t have to give orders to get
what I want. I can act like other people and still get my needs met.”

OLIVIA: OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

 Original negative core belief: “I should do everything perfectly.”

 New positive core belief: “I don’t have to do everything perfectly; I’ll
still keep my job and maintain my family.”
 New positive rule: “I’ll leave work on time, even if my tasks aren’t
completed.”
 How did you test the new rule? “I left work at 5 p.m. and went home to
have dinner with my family.”
 What happened? “My boss didn’t reprimand me, and my family was
happy to have me home for dinner.”
 What did you learn from this experience? “I can satisfy my boss, my
family, and myself.”

PATRICK: PARANOID PERSONALITY DISORDER

 Original negative core belief: “I always have to be on guard to protect

myself.”
 New positive core belief: “I can be safe and still let my guard down
sometimes.”
 New positive rule: “I will let my guard down around the people I know.”
 How did you test the new rule? “I went to a family party and told them
about what I’d been doing lately.”
 What happened? “Nothing. No one tried to take advantage of me or use
the information to harm me.”
 What did you learn from this experience? “It’s safe to be around certain
members of my family.”

SCARLETT: SCHIZOID PERSONALITY DISORDER

 Original negative core belief: “I’m not capable of forming close

relationships.”
 New positive core belief: “Maybe I lack relationship experience, but I
can still try to form friendships with people.”
  New positive rule: “I’ll make opportunities to form new relationships
whenever possible.”
 How did you test the new rule? “I went to lunch with some colleagues
from work.”
 What happened? “We chatted about our lives and gossiped about what
was happening in the office. My colleagues were very friendly and said I
should come out with them more often.”
 What did you learn from this experience? “I don’t have to form perfect
friendships immediately. My colleagues were patient and friendly.”

SCOTT: SCHIZOTYPAL PERSONALITY DISORDER

 Original negative core belief: “I don’t fit in with other people.”

 New positive core belief: “I don’t fit in with everybody, but there are lots
of people with whom I do fit in.”
 New positive rule: “I’m going to find groups of people with whom I
share common interests.”
 How did you test the new rule? “I went to a party and looked for people
who were wearing interesting clothes and tried talking to them.”
 What happened? “Some of them said they felt awkward at parties too.
One of them invited me to a get-together at her house next weekend.”
 What did you learn from this experience? “Other people often feel out of
place, too. I’m not the only one. I can connect with others pretty easily.”

VIVIAN: PERSONALITY DISORDER NOT OTHERWISE SPECIFIED

 Original negative core belief: “I always mess up, so why bother trying?”
 New positive core belief: “I sometimes do things successfully, and no
one is perfect.”
 New positive rule: “I’ll challenge myself with tasks, even when I’m not
sure that I’ll succeed.”
 How did you test the new rule? “I offered to help my son paint a room in
his house, even though I’ve never done that before.”
 What happened? “He said my painting looked like it was done by a
professional.”
  What did you learn from this experience? “I’m capable of handling
challenges, including things I’ve never done before.

In Conclusion

Hopefully, this chapter has showed you how to challenge your negative core
beliefs and helped you develop new positive core beliefs. As you continue to work on
these skills, remember to be patient with yourself and with the process. Most people
with personality disorders have been struggling with their negative core beliefs for
many years, so these habits of thought will take a good amount of time and effort to
modify. But remember, developing positive core beliefs is definitely the most
important skill you will learn in this workbook. So keep working hard to create them
and your new rules as you continue to develop the other skills that are explained in the
following chapters.
 Chapter 7

Practice Stress-Reduction and Relaxation Techniques

Remember the following diagram from chapter 5? It shows how your thoughts,
feelings, and behaviors all interact and influence each other:

Thoughts

Behaviors
Feelings

So far, the previous chapters have shown you how to think and behave in
healthier, more helpful ways. In this chapter, you’ll learn how to soothe both your
physical and emotional feelings using a variety of stress-reduction and relaxation
techniques.

Why These Techniques Are Important

For most people, changing the habits associated with their personality disorders
is very challenging, and therefore the process can cause both physical and mental
strain. Stress-reduction and relaxation techniques can help to reverse some of these
effects, and they can also help you to confront those challenges in a more successful
way.

Let’s look at an example. Ava struggled with avoidant personality disorder. She
regularly avoided dealing with big problems, and she also avoided making common,
everyday decisions, like what to have for dinner. As a result, many of her relationships
became strained, and she frequently suffered with mental anxiety and physical
symptoms of stress, such as tight muscles and headaches. Ava achieved great success
when she challenged her distressing thoughts and engaged in new activities using a
Weekly Activity Schedule, but she also realized that she needed additional help to
soothe her body and mind. So she started using many of the relaxation techniques you
will find in this chapter— especially before engaging in an activity that she’d been
avoiding—and soon she recognized that it was easier to make tough decisions and
confront stressful situations when she felt more relaxed.

Goals of This Chapter

Like Ava, you may find making changes in your life difficult. Often, your own
anxious thoughts and stressful physical sensations make matters worse. For this
reason, stress-reduction and relaxation techniques are very important when you are in
the process of changing the habits associated with your personality disorder. As you
read this chapter, practice all of the techniques discussed and then choose the ones that
work best for you. Then, as you continue the work of challenging your behavioral and
cognitive habits, you can use these techniques when you:

 Feel physical or mental strain

 Plan a difficult task in your Weekly Activity Schedule
 Challenge your distressing thoughts
 Restructure your core beliefs
 Engage in other techniques that change your habits, such as problem
solving, coping imagery, and stress inoculation.

But, remember, each of these skills requires practice in order to be effective.

Mastering some techniques might require a few days, and others might need several
weeks. Don’t give up. Remember, you’ve spent many years making yourself feel
anxious and tense; now you’ll need an adequate amount of time to practice feeling
relaxed.

Many of the exercises described in this chapter were adapted from The
Relaxation and Stress Reduction Workbook62and The Dialectical Behavior Therapy
Skills Workbook,63 and you should consult those books to learn additional similar
skills.

The Body Scan Exercise

Typically, relaxation exercises begin with building body awareness. This

exercise will help you learn how to scan your body for signs of muscle tension so that
you can learn to release that tension and to relax. This exercise should take only about
ten or fifteen minutes. Practice the body scan exercise at least once a day for one week
before trying the next exercise, which is called progressive muscle relaxation.

Read the instructions before beginning the exercise in order to become familiar
with the process. Then you can refer to them again or you can record the instructions
and listen to them while observing the sensations in your body.

Don’t be surprised if your focus begins to wander while you’re doing this
exercise. When you recognize that your attention is drifting, gently return your focus
to the exercise, and do your best not to criticize or judge yourself.

Exercise: The Body Scan

To begin, find a comfortable place to sit in a room where you won’t be disturbed for at
least ten minutes. Turn off any distracting sounds. Take a few slow, long breaths, and
then close your eyes. When you begin the exercise, observe any sensations you notice
in your body, especially muscle tension. For now, don’t try to release the tension. Just
do your best to notice it, continue to breathe, and try to stay focused on the activity.
Make sure to spend enough time on each section of your body to notice all of the
sensations there, before you move on to the next area of your body.

First, focus on your feet. Notice any sensations in your toes, the soles of your feet,
your ankles, and the tops of your feet. You might notice tingling or tension. For now,
just notice it and continue to breathe. (Pause here.)

Now notice your lower legs, including your calf muscles, shins, and knees. Observe
any sensations there and continue to breathe. (Pause here.)

Next focus on your upper legs and your hamstrings, thigh muscles, buttocks, and
genital area. Notice the weight of your body supported by the chair you’re sitting in.
Notice any other sensations and continue to breathe. (Pause here.)

Then notice the front of your torso, including your stomach and chest area. Observe
any sensations and continue to breathe. (Pause here.)

Now notice your lower and upper back. Pay attention to any muscular sensations or
tension as you scan this area. Notice any other sensations and continue to breathe.
(Pause here.)
Next focus on your shoulders, upper arms, and elbows. Observe any sensations there
and continue to breathe. (Pause here.)

Then notice any sensations in your forearms, hands, and fingers. Slowly scan both the
tops and bottoms of your hands. Observe any sensations there and continue to breathe.
(Pause here.)

Now focus on the front and back of your neck. Observe any sensations there and
continue to breathe. (Pause here.)

Next notice any sensations in your face, especially around your jaw, mouth, nose,
eyes, and forehead. Notice any signs of tension there, including a tight jaw and
forehead. Observe any other sensations in your face and continue to breathe.

And, finally, notice any sensation around the rest of your head, especially near your
ears and the top of your skull. Observe any other sensations there and continue to
breathe. (Pause here.)

When you’ve finished the exercise, open your eyes and take another minute to sit
quietly before returning your focus to the room.

Progressive Muscle Relaxation

Hopefully, you’ve been practicing the body scan exercise and now feel comfortable
locating and observing the tension in your body. Progressive muscle relaxation is the
next step in helping you learn to release muscle tension, reduce anxiety, and relax.
This exercise is based on the work of physician Edmund Jacobson. In his book
Progressive Relaxation, Jacobson observed that anxiety frequently caused muscle
tension, and therefore, if you can learn to release that tension, you can also soothe your
feelings of anxiety.64

In a safe and systematic way, progressive muscle relaxation will guide you
through tensing and relaxing different muscle groups throughout your whole body. As
you do this, pay attention to the feeling of relaxation that occurs after you release the
tension. If you experience any pain while doing these exercises, stop immediately. In
addition, if you already are experiencing any chronic pain issues, such as arthritis,
back pain, or joint pain, consult your medical professional before conducting this
exercise. Otherwise, proceed with caution. You can gently tense any of these muscle
groups without experiencing pain and still benefit from the exercise.

Remember, the purpose of this exercise is not to tense your muscles to the point
of exertion or strain; it is to help you identify what relaxed muscles feel like in
comparison to tight muscles. Many people habitually tense their muscles, especially in
the neck and shoulder area, without noticing it. Over time, these habits can lead to
chronic back pain, shoulder pain, and headaches. The goal of progressive muscle
relaxation is to help you notice any muscle tension that you’re carrying and quickly
release it, and by doing so, hopefully you’ll relieve some anxiety as well.

As with all of the exercises in this book, the more you practice progressive
muscle relaxation, the faster you will experience its benefits. It’s recommended that
you practice this skill at least once a day for a few weeks, or twice a day if you
frequently feel tense or anxious. While doing this exercise you might find it easier to
wear loose, comfortable clothing that allows you to bend and stretch. Also, when you
release the tension from each group of muscles, you might obtain additional benefit by
using a suggestive word or phrase to help you relax, like “Peace,” “Relax,” or “Let go
of the tension.” And, lastly, when releasing your muscle tension, do your best to
release it quickly and completely, rather than slowly. This will help to emphasize the
difference between the tight feeling and the relaxed feeling.

Read through the exercise before beginning. Then you can either refer to the
script again, or you can record the instructions and listen to them while observing the
sensations in your body.

Exercise: Progressive Muscle Relaxation

To begin, find a comfortable place to sit in a room where you won’t be disturbed for
fifteen minutes. Turn off any distracting sounds or lights. Take a few slow, long
breaths, and then close your eyes. As you breathe, remember that the point of this
exercise is to notice the difference between muscle tension and muscle relaxation.
Don’t overstrain your muscles during this exercise. Tighten each muscle group only
until you feel a gentle tension, and then release it. This is especially important when
you’re tightening and releasing your feet, back, and neck muscles. If you experience
any pain during the exercise, stop immediately.
When you’re ready to begin, gently inhale and hold your breath while you curl your
toes under, on both feet. Notice how the muscle tension feels. Hold the tension for
approximately five seconds. (Count, “One, two, three, four, five.”) Then exhale while
you quickly and completely release the tension in your feet. (If you want to use a
helpful word like “relax,” say it each time when you release the tension.) Now notice
the released feeling in your toes and feet. Notice how different it feels. Then, again
gently curl your toes under, without exerting too much pressure on them, while you
inhale and hold your breath. Notice how the muscle tension feels. Hold the tension for
five seconds, and then quickly and completely release it while you exhale. Again,
notice the released feeling in your toes and feet and note how different it feels
compared to the tense feeling.

Next gently inhale and hold your breath while straightening your legs and pointing the
toes of both of your feet. Notice the tension in your legs and feet. Hold your breath and
the tension for approximately five seconds. Then exhale and release the tension
quickly. Notice the sensation in your muscles as the tension is released. Feel the
relaxed sensation in your muscles and notice how different it feels from the tensed
feeling. Then, when you’re ready, repeat this exercise for this muscle group one more
time.

Now gently inhale and hold your breath while you bend your arms at the elbows and
tighten both of your hands into fists—like a bodybuilder posing. Notice the tension in
your upper arms, forearms, hands, and fingers. Hold your breath and the tension for
five seconds. Then exhale and release the tension quickly. Notice the sensation in your
muscles as the tension is released. Feel the relaxed sensation in your muscles and
notice how different it feels from the tensed feeling. Then, when you’re ready, repeat
this exercise for this muscle group one more time.

Next gently inhale and hold your breath while you tighten your stomach and chest
muscles. Imagine that you’re hugging a large beach ball as you bend forward and curl
around it. Notice the tension in your stomach, chest, and back. Hold your breath and
the tension for five seconds. Then exhale and release the tension quickly as you sit up
straight. Notice the sensation in your muscles as the tension is released. Feel the
relaxed sensation in your muscles and notice how different it feels from the tensed
feeling. Then, when you’re ready, repeat this exercise for this muscle group one more
time.

Now gently inhale and hold your breath while you straighten your arms with your
fingers pointing toward the ground and raise up your shoulders toward your ears.
Notice the tension in your upper back, neck, and shoulders. Hold your breath and the
tension for five seconds. Then exhale and release the tension quickly. Let your
shoulders drop. Notice the sensation in your muscles as the tension is released. Feel
the relaxed sensation in your muscles and notice how different it feels from the tensed
feeling. Then, when you’re ready, repeat this exercise for this muscle group one more
time.

Finally, gently inhale and hold your breath while you tighten the muscles of your face.
Tighten the muscles around your mouth, eyes, and forehead and notice the tension.
Hold your breath and the tension for approximately five seconds. Then exhale and
release the tension quickly. Notice the sensation in your facial muscles as the tension
is released. Feel the relaxed sensation in your muscles and notice how different it feels
from the tensed feeling. Then, when you’re ready, repeat this exercise for this muscle
group one more time.

When you’ve finished the exercise, take another minute to sit quietly before returning
your focus to the room in which you are sitting.

Release-Only Relaxation

After you’ve had success practicing progressive muscle relaxation, try releasing your
tension by mentally focusing on each group of muscles. Do not tense up your muscles
first; just let them release. Use the same order of muscles as you did in the last exercise
(for example, first your feet, then your legs, and so forth). But this time, just use your
memory of what your muscles feel like when they’re relaxed to let go of any tension.
Each time you notice tension, do your best to let your muscles release, lengthen, and
let go. Breathe normally throughout this exercise without holding your breath. Or if
it’s helpful, imagine releasing your muscle tension each time you exhale. Spend as
much time as you need focusing on each group of muscles and releasing any tension
you find. With daily practice, this technique can help you relax your whole body in
just a few minutes.

Exercise: Cue-Controlled Relaxation

A cue is a signal that reminds you to do something. This technique will teach
you to relax by using a word or phrase to remind yourself to do so.

To begin, use the release-only relaxation technique to help you fully relax. Take
a few minutes. Then, after you’re feeling peaceful, shift your focus to your breath. As
you inhale, think of the words “Breathe in,” and as you exhale, use a word or phrase
like “Relax,” “Peace,” or “Let go,” as you might have done with progressive muscle
relaxation. Continue to breathe and use your cue word to create a deeper sense of
relaxation: “Breathe in…” then “Relax…” Practice this technique once or twice a day
for at least two weeks (and be sure to remember to use the release-only technique
first).

After you’ve had several sessions of successful practice, see if you can induce a
state of relaxation just by thinking of your cue word. For an added challenge, try doing
this before you do something difficult, like talking to someone you’ve been avoiding
or trying something new.

Mindfulness Skills

Mindfulness is the ability to be aware of your thoughts, feelings, and actions in

the present moment. Have you ever heard the expression “Be in the moment”? This is
another way of saying, “Be mindful of what’s happening to you right now.”
Developing your mindfulness skills is one of the most important things you can do to
overcome your personality disorder. By definition, people struggling with personality
disorders are stuck in rigid patterns of thinking and behaving that interfere with their
lives. In order to get out of that pattern, you first have to become aware of what it is
you’re doing. Awareness is the first step for changing anything. You need to start
asking yourself, “What’s happening right now? What am I thinking? What am I doing?
What’s the other person doing? How am I reacting to it all?” Then, after you’ve
become aware of what’s happening, you can begin reacting in newer, healthier, and
less stressful ways.
 Let’s look at an example. Britney struggled with borderline personality
disorder. Part of her problem was making quick, critical judgments about herself and
others, which then led to upset feelings and anger. One day at work, Britney saw her
friend Joan across the room but Joan didn’t see her, so Joan left the room. Very
quickly, Britney had these thoughts: “She’s ignoring me. Why doesn’t she like me
anymore?” Then Britney started to feel very hurt and angry. To deal with her anger
and to relieve the stress she felt, she went to the ladies’ room and began chewing her
fingernails until her cuticles were bleeding.

In this example, Britney’s reactions were so quick and unmindful that she
reacted automatically without being aware of what was happening. If she’d been more
mindful of what she was thinking and she’d challenged some of her thoughts, the
situation might have developed like this: “She’s ignoring me. Why doesn’t she like me
anymore? Wait. That’s a very negative thought. Maybe she’s not ignoring me. Maybe
Joan just didn’t see me. Or maybe she’s in a bad mood today. Joan has been a good
friend to me. I’ll check with her later.”

If Britney had been more mindful of her emotions, she might have done the
mindful breathing exercise (see below) to help herself relax after she felt angry. If she
had been more mindful of her actions, she might have gone somewhere private to do
some progressive muscle relaxation to release the tension from her body instead of
hurting herself.

Mindful Breathing

Mindful breathing is an important skill that uses long, slow breaths—in through
the nose and out through the mouth—to help you relax and focus your concentration.
This is a very important skill, especially for people who frequently feel anxious or
stressed out. When you feel anxious, it’s natural to breathe more quickly and more
shallowly. Unfortunately, this style of breathing naturally increases your feelings of
anxiety. To counteract this, you’ll need to learn how to do mindful breathing

This type of breathing activates the diaphragm muscle at the bottom of your
lungs and helps you take slower, longer breaths, and as a result, it naturally helps you
feel more relaxed and focused. To recognize whether you’re properly using your
diaphragm muscle, place one hand on your stomach as you breathe. If you’re breathing
correctly, you should feel your stomach gently rise as you inhale, as if you were filling
a balloon with air. Then as you exhale, you should feel your stomach gently fall, as if
the balloon were deflating.

Note that some people find it difficult to breathe this way because their
abdominal muscles are generally tight and releasing them to breathe is difficult. When
people are anxious or stressed, they naturally tense their abdominal muscles, which
causes them to take short, shallow breaths using the muscles of their upper chest and
shoulders. This can easily be detected by placing one hand on your stomach and the
other hand on your upper chest as you inhale. Ideally, you should feel little movement
under the hand resting on your chest. If you do feel greater movement there and little
movement in the abdominal muscles of your stomach, you’ll need to practice releasing
your abdominal muscles as you breathe. Again, imagine your stomach as a balloon
that gently inflates while you inhale and gently deflates while you exhale.

When first practicing this form of breathing, some people find it easier to lie
down, rather than sit in a chair. Lying down often makes it easier to notice the rising
and falling of your stomach. If this is true for you, feel free to begin your practice this
way. Eventually, however, you should transition to practicing in a seated position
since this is the position in which most people spend much of their time, such as while
driving or at work. Then later on, you can even practice while standing and walking.

Ideally, mindful breathing should be performed by breathing in through your

nose and out through your mouth. However, some people might find it difficult to
breathe in through their nose. If this is true for you, feel free to inhale through your
mouth, but do so slowly, as if you were breathing in through a straw, rather than taking
quick gulps of air.

Be aware that some people might become light-headed or experience tingling in

their lips or fingertips when practicing mindful breathing. This usually means that
you’re breathing too fast or too deeply. If you experience any symptoms like this, stop
doing the exercise and return your breathing to its normal state. Then, when you’re
feeling better, try breathing more slowly and less deeply.