Tag: posttreatment

Get to know your trigger thoughts and let them be

It is estimated that the human brain produces thousands of separate thoughts, associations and memories every single day. Most of these thoughts are without significance; they come and go without us noticing. Some thoughts, however, attract our attention. In metacognitive therapy, these thoughts are referred to as ‘trigger thoughts’. If you pay them enough attention, these thoughts can trigger an explosion of bodily sensations and feelings, and a myriad of associations.

Some trigger thoughts can activate warmth and joy about an exciting upcoming project, meeting a friend, or a holiday you’re looking forward to. These kinds of trigger thoughts are, of course, unproblematic. Other trigger thoughts, however, might activate a long series of further thoughts that can develop into worries or ruminations.

Worries typically form around hypothetical scenarios and start with ‘What if…’ statements such as: ‘What if I make the wrong decision?’ ‘What if they won’t like me?’ ‘What if I get ill?’ and so on. Typical rumination, on the other hand, starts with thoughts about what, why and how: ‘What is wrong with me?’ ‘Why am I feeling this way?’ ‘How do I get better?’

You can compare these thoughts to trains at a busy railway station. There are departures all the time to a wide array of different destinations. Each train can represent a thought or a sequence of thoughts. For instance, a thought such as ‘What if they won’t like me?’ could arrive at the mental railway platform.

You could ‘catch’ the thought and you’ll likely soon notice several other thoughts join in: ‘I won’t be able to handle it if they dislike me.’ ‘Perhaps, then, I shouldn’t go.’ Or you could dismiss the thought, similar to letting the train pass by, and turn your attention back to whatever you were doing. When you don’t expend energy on a thought, you’ll find it will either stay on the platform for later or simply pass you by.

So, it’s not the trigger thought in and of itself that will overwhelm you and lead to a variety of unpleasant symptoms; nor is it the amount of trigger thoughts you have (everyone has them). The problems arise if you continuously jump on to each train – that is, if you begin to analyze the thought and engage in extensive worry or rumination – then it’s like you’re adding more and more carriages to the train, one after another; the train gets heavier and slower, and will eventually have trouble passing even the slightest hill. The same goes for your trigger thoughts: the more time you spend engaging in these thoughts, the slower and heavier you will feel.

Recognise what you can and can’t control

If you’re used to boarding most trains rather uncritically – that is, continuously engaging in trigger thoughts and starting to worry and ruminate for long periods of time – then, unfortunately, you’re well on your way to developing an unhealthy pattern. If you repeat this pattern over and over again, it might begin to feel as if it happens automatically. You might, understandably, come to believe that it’s outside your control.

It’s true, the trigger thoughts themselves are completely automatic – you don’t have any say as to what trains will arrive at your mental railway station. However, you do have a choice over which trains to board. You can choose whether or not to engage in a trigger thought. You can control whether you ‘answer’ the thought or follow it up with more questions.

In trying to understand this differently, instead of in terms of trains, you might picture your thoughts as someone calling you on the phone. Of course, you don’t decide whether the phone rings, who calls or when it rings. (Unfortunately, in this case it’s not the kind of phone you can just turn off!) But you do choose whether to answer the phone or just let it ring and turn your attention back to whatever you were doing.

The sound of the phone might be loud, annoying and attract your attention, but what happens if you just leave it be? Eventually it stops ringing. While thoughts and phones are, of course, different things, this metaphor carries a key message in metacognitive therapy: While trigger thoughts are beyond your control, you can control whether you engage with them.

Thoughts are, in principle, ephemeral, although you might not see them this way. Try asking yourself how many of the thoughts you had yesterday you can remember today. To be honest, out of the several thousand I had, I’m not sure I can recall even 10 thoughts. Why is that? Most of the thoughts we have come and go almost instantly because we don’t grant them any special attention but leave them and return to whatever we were doing. Even though you might not be aware of it, you’re already capable of choosing not to engage in a conversation with your thoughts, just as you can ignore the phone that keeps calling.

Postpone and reduce your worries and ruminations

Many chronic overthinkers struggle to change their belief that their thoughts can be brought under control, and perhaps you’re still not convinced. One way of challenging your belief further is to explore whether you’re able to postpone worries and ruminations. I recommend that my clients introduce a so-called ‘worry/rumination time’. It has to be a set time of the day, for instance 7.30pm to 8pm, where you allow yourself to worry and ruminate freely.

That way, when trigger thoughts or feelings occur during the day – for instance, you feel the need to evaluate your health or reflect upon what your friends think of you – try postponing these thoughts to your scheduled worry/rumination time (you might tell yourself: ‘I’ll deal with this later’). This set time is also useful for any planning or reassurance-seeking for which you feel the need. One note of caution: you might want to avoid scheduling your worry time within one or two hours of when you plan to go to bed, especially if you’re prone to insomnia or other sleep difficulties.

Introducing a set worry/rumination time serves several functions. First, it’s an experiment that challenges the belief that worries and ruminations are uncontrollable. When dedicating themselves to this experiment, most of my clients find that it is indeed possible to postpone worries or ruminations. While this might seem a hard goal, in fact it’s something you already do on a daily basis without realizing.

For instance, any time you notice an alarming newspaper headline on your way to work and start worrying, but then remember that you’re in a hurry and so turn your attention back to getting to work – that’s you controlling your thoughts. Or maybe you’re sitting in a café with a friend and you overhear a conversation at another table that triggers unpleasant memories, but instead of dwelling on them, you decide to redirect your attention back to the conversation with your friend.

Again, that’s you controlling your thoughts. In the same way, you can learn to consciously ignore your own internal trigger thoughts, thereby experiencing that you really do have a choice in whether you choose to engage in them or not.

A second function of setting worry/rumination time is that it’s a way of discovering that trigger thoughts are ephemeral and ever-changing. For instance, the thoughts that seemed highly relevant and important in the morning will often seem less important when you arrive at your worry/rumination time later in the day. You might even discover that you’re not able to recall some of the thoughts that triggered you.

All feelings, whether positive or negative, are usually ephemeral if we tolerate them and let them be. Of course, not all thoughts disappear forever when you postpone processing them – some thoughts might be about important issues that you really need to address. Regardless, as most of my clients find, it’s much more constructive to deal with these issues within a defined time of the day instead of endlessly problem-solving while you’re trying to go about your daily responsibilities.

Finally, while this might seem obvious, the worry/rumination time is a way of reducing and containing the amount of time you spend worrying and ruminating. As I explained earlier, it’s not the trigger thought in and of itself that causes unpleasant symptoms, nor is it the amount of trigger thoughts. It’s the time spent engaging in these thoughts, ruminating and worrying, that weighs us down. By allocating a set period of time for worry and rumination, you’re more likely to feel in control and prevent yourself becoming overwhelmed.

Avoid avoidance and train your attention

For people struggling under the burden of overthinking, it’s all too easy to develop a fear of one’s own trigger thoughts. After all, if you feel at their mercy, you might be tempted to avoid them occurring in the first place. Unfortunately, not only is this largely futile, it’s also counterproductive – avoidance of triggering situations will hamper your life and, moreover, to the extent that you’re at all successful in avoiding situations that prompt trigger thoughts, you won’t get the chance to practice letting go of these thoughts. After all, you can’t learn to ride a bike without a bike.

Inspired by the above, and if you feel ready, I recommend that you give yourself daily challenges that involve trigger thoughts, and that you practice instructing yourself to leave them alone until a designated worry-time. This will help you become more adept at leaving your trigger thoughts alone and to realize that you’re in control of your worries and ruminations. You won’t succeed every time but, just like learning to ride a bike, you need to get up again every time you fall and keep biking until you get the hang of it.

Some people struggle to develop this skill. In that case, in metacognitive therapy we use attention training to help clients realize that they can shift their attention regardless of inner inputs, such as trigger thoughts, and outer input, such as external stressors. I usually ask my clients to do the following 10-minute exercise. Maybe reading this will inspire you to try it out yourself:

• Tune in to three or more environmental sounds, such as: traffic; birdsong; chatter from a nearby radio or TV; children playing; building work, or whatever. You need to find somewhere where these ambient sounds are going on. It’s helpful if some of the noises you select are nearer and louder, while others are further away and quieter.
• Of the three or more sounds you’ve selected, practise tuning in to just one at a time for approximately 10 seconds each (you could use a digital timer to help you) and let the others fade into the background. After the 10 seconds is up, switch your focus to another of your chosen sounds.
• After two minutes, repeat the exercise, but switching more quickly between the sounds – now focusing on each one for just two to four seconds each.
• The aim of the exercise is to become familiar with, and adept at, shifting your attention. When you’re feeling more confident you could introduce a recording of a trigger thought into the exercise, and practise switching your attention away from and back to the sound of that thought.

Another exercise you could try that I use in my clinic is the windowpane exercise – this will further illustrate that your attention is under your control, independent of the existence of trigger thoughts in your head. I write one or two trigger thoughts in washable ink on a window (such as: ‘What if I fail my driving test?’ or ‘What if she finds me boring?’), then I ask my client to practise looking through the words to notice the scene beyond – the trees, the sky, the buildings, whatever the view is from the window.

Then I ask them to switch their attention back to the words again, now back to the details of the view. The purpose here is to familiarise clients with the sensation that we can control our attention. If you give it a try, you’ll find that, while the written thoughts remain in view, you can control whether you focus on them or whether you let them fade and enjoy the world outside instead. Please note, if you find this exercise at all difficult, I recommend that you wait and try it with a professional metacognitive clinician (see the ‘Learn More’ section to find out how)…..