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In this activity…

Students learn about the ABCs of CBT and explore the first strategy for disputing irrational beliefs – the Worst-case/Best-case/Most-likely process. They then use this process to evaluate a present irrational belief or intense worry they are experiencing, come up with a more realistic belief, and create an action plan for dealing with the consequences that may arise from that realistic belief.

And the point is…

Practicing these more intensive cognitive skills is essential for students to be able to use the Real-Time Resilience skills that are introduced at the end of this Unit. Although students might be uncomfortable with writing down their thoughts, fear, and worries, this activity is a building block for future success.
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Materials: Projector, worksheets and writing supplies


Activity

Let students know that, now that everyone is on the same page in terms of their ability to learn to be optimistic, it’s time to actually learn skills to become more optimistic.

Start the activity by reading the following scenario or ask for a student volunteer to read the scenario out loud:

Alexa had a bad day at school. Her best friend walked right past her in the hallway this morning without even saying “hello” and she sat all alone during nutrition break. By the time it came to recess she was already feeling lonely and down, so she stayed inside and read a book. Secretly, Alexa was hoping that one of her friends would notice that she was not outside and would come looking for her. When nobody did, Alexa was disappointed and felt even worse at the end of the nutrition break. The rest of the day was a blur and, by the time the bell rang to go home, Alexa felt lonely and sad.

After reading this scenario, ask students to identify why Alexa is feeling lonely and sad by the end of the day. Encourage each student to only share one point so that as many students as possible have the opportunity to participate. Students will likely identify the following points as contributing to Alexa’s sadness and loneliness:

  • Her best friend walked past her and didn’t say “hello”
  • She ate lunch alone during nutrition break
  • Nobody asked her to come outside (or even noticed that she wasn’t outside)

By identifying these points, students are suggesting that Alexa’s feelings (i.e. Consequences) are the result of events that occurred throughout the day (i.e. Activating event). Use this observation to transition into teaching the ABC Model of CBT. Start by explaining that CBT, or cognitive behavioural therapy, is used to identify distorted or unrealistic thoughts and counter those thoughts with more realistic and healthy ones. Tell students that they can use these CBT strategies to develop a more optimistic explanatory style.

Let students know that one of the foundational elements of CBT is known as the ABC model and explain that the title of this model (ABC) is an acronym that describes the relationship between an adversity or activating event, your beliefs associated with that event, and the emotional or behavioural consequences.

Mention that, in the previous example, students suggested that certain events caused emotional consequences. Now, explain that the ABC model actually suggests that there is an “intermediary player”, or “middleman”, that separates the activating event from the consequence.

Let students know that this intermediary player is their beliefs about the activating event and that their beliefs are more closely related to the consequence than the event itself.

Return to the previous example, but this time, read a description of Alexa’s experience that includes her self-talk, thoughts and beliefs:

Alexa had a bad day at school. Her best friend walked right past her in the hallway this morning without even saying “hello”, which immediately made Alexa think that her friend was mad at her. What did she do wrong? Was her friend purposefully trying to hurt her? At lunch, the table that Alexa normally sits at was full. Now she was convinced that her peers were in on a mission to exclude her, so instead of finding an empty seat at a half-full table, Alexa decided to sit on her own. During the lunch period Alexa somehow managed to forget that it was her choice to sit alone and she became fully convinced that she was destined to be alone for the rest of her life. When she stayed at the table and read instead of going outside during recess, and when nobody asked her to come outside, Alexa told herself that nobody cared about her and that people would be happier without her. The rest of the day was a blur and, by the time the bell rang to go home, Alexa felt lonely and sad.

Now, ask students to once again identify why Alexa is feeling lonely and sad by the end of the day. Help students recognize that Alexa’s feelings are caused by her thoughts and beliefs more than by the objective events that happened that day. Emphasize that the most important thing to understand from the ABC model is the B to C connection and the fact that this connection is in students’ control.

To reinforce the significance of the B to C connection, ask students to consider how Alexa’s experiences would have been different if she had different beliefs about what happened that day:

This morning, Alexa’s best friend walked right past her in the hallway without even saying “hello”. Alexa was puzzled at first but told herself that her friend was probably in a rush to get to her next class and she even didn’t notice her. At lunch, the table that Alexa normally sits at was full, so she told herself that this was a great opportunity to either meet new people or to catch-up on some personal quiet time. She decided on the quiet time and found a table where she could sit on her own and read. When recess came, Alexa stayed inside but was truthfully hoping that one of her friends would finally notice her and ask her to join in. When nobody asked Alexa to come outside with them, she could feel herself slipping into negative thoughts and worries. What if all of her friends were mad at her? Fortunately, Alexa noticed these thoughts creep in and was able to catch and redirect her irrational beliefs. Alexa decided that her friends were not intending to exclude her and that her own behaviours of withdrawing might have even prevented them from reaching out to her. Who knows, maybe her friends were even planning a surprise birthday party for her next week? In this scenario, Alexa feels relaxed, balanced and thoughtful by the time the bell rings to go home.

Point out that the only thing that is different about these two descriptions is the beliefs that Alexa has about the events that are occurring. In other words, the difference between the two descriptions is Alexa’s explanatory style. Review the diagram of the ABC model with students and relate this back to Alexa’s story: In the first example, Alexa’s thoughts lead her to believe that her friends were mad at her and didn’t like spending time with her, which spiraled into the idea that she will be alone for the rest of her life. Note that this seems pretty extreme and that it’s a very unlikely outcome when you only consider the facts.

In the second example, Alexa’s thoughts were much more balanced. She was able to take a broader perspective and, when she did start having unhelpful thoughts, she was able to catch herself, evaluate the situation, and choose a healthier, more realistic response. Help students become more comfortable with this model by collectively working through a number of different examples included in the slide deck and give students 5 minutes to complete the ABCs worksheet.

ABCs Worksheet available in downloads section.

Now that students recognize the power of their beliefs, introduce the next two letters – D and E – of the expanded model. Let students know that, after they have identified their irrational belief, they need to dispute (or counter) it and come up with more realistically optimistic belief that leads to more effective emotional and/or behavioural consequences. Tell students that there are two strategies for disputing irrational beliefs, one of which they will learn today (the Worst-case/Best-case/Most-likely process). Let students know that the Worst-case/Best-case/Most-likely process is best for disputing intense worries or for countering catastrophic thinking.

Then, share the steps of the process, as presented in the ‘READY’ section:

  1. Identify the adversity or trigger that caused, or is causing, the worst-case scenario thinking and intense worry.
  2. Make a list of things that will happen if the worst-case scenario is true, letting yourself spiral into the deepest and darkest “hole”. Create this list by starting with the most automatic, negative thought and asking yourself, “Then what happens?”. It’s normal for the list to become progressively more depressing and unrealistic.
  3. Identify the percentage likelihood of each scenario, given the adversity identified in step 1. If you did it correctly, then the percentage likelihood will become increasingly smaller as you go down the list.
  4. At the opposite extreme, identify the best-case scenario. Make a list of progressively more positive scenarios by asking yourself “Then what happens?”. By the end of this list, it’s normal to think that it’d be more likely to live in a world with rainbows and unicorns than for the best-case scenario to occur (given the adversity).
  5. Identify the percentage likelihood of each scenario, given the adversity identified in step 1. If you did it correctly, then the percentage likelihood will also become increasingly smaller as you go down the list.
  6. Use the worst-case and best-case scenarios to develop a more balanced, healthy and realistic perspective. With this perspective, create a list of the most-likely scenarios.
  7. Identify the percentage likelihood of the most likely outcomes, given the adversity.
  8. Given the most likely scenario, create an action plan for how you can cope with the outcome.

After talking through the steps, use a personal example to demonstrate this tool’s application. Then, give students the Worst-case/Best-case/Most-likely worksheet and the next 10 minutes to use this tool for a worry or irrational belief that they are currently experiencing.

WC/BC/ML Worksheet available in downloads section.

Wrap-up the lesson with a short, 5-minute conversation about students’ initial thoughts about this tool. To get the conversation started, consider using the following prompts:

  • In the future, do you think that you will be more aware of your beliefs?
  • What might get in the way of identifying irrational beliefs? How can you reduce that barrier?
  • Did you find this tool helpful for addressing worries? Why or why not?
  • Do you anticipate using this tool (or at least the principles behind this tool) to counter future worries or irrational beliefs? Why or why not?
  • Were you able to come up with a more realistic and likely outcome? If so, how might focusing on this new outcome change the way you approach the situation?
FAQ's
Beecuz

Why are we learning therapy strategies if we do not have a mental illness?

It’s important to learn these strategies proactively to promote mental health and prevent the onset of mental illness. You’re right, CBT has been traditionally used as a reactive approach to mental health care, where therapists respond to someone who is in the middle of a mental health crisis, or who’s already struggling with the signs and symptoms of a mental illness. However, learning about these skills now can help you more effectively cope with negative thoughts and overcame adversities. This is known as resilience, or the ability to bounce back from challenges. Building your resilience can help buffer against the emotional, cognitive and physical consequences of negative events and decrease the risk of developing a mental illness. Consider the following question: If you didn’t know how to swim, would you rather have a lifesaver thrown into you after you’re already drowning, or be given a lifejacket to prevent you from drowning? In this scenario, it seems obvious that the lifejacket is a better option. Learning about CBT strategies before you are even struggling with a mental illness is like being given a lifejacket to protect you from drowning.

Is there proof that this is effective?

Yes, CBT is actually one of the most researched, and evidence-based psychotherapies and there’s good news: It works! Studies with people from all different ages, ethnicities, backgrounds, and statuses have repeatedly found that practicing CBT enhances people’s quality of life and helps them feel more in control of their thoughts, emotions and behaviours. The best way to test this is to try it out for yourself!

How long does it take before this starts helping?

What you get out of this depends on how much you put into it. In order to see the best results, you need to practice these skills consistently, by interrupting, disputing and redirecting every irrational belief that you have. Think about it like trying to learn any other skill or like trying to break a bad habit. Let’s pretend that, instead of trying to stop unhelpful, distorted thoughts, you were trying to stop biting your fingernails. In order to effectively stop biting your fingernails, you need to interrupt the behaviour every time. If you only stopped yourself once every twenty times, then you wouldn’t have much luck. Similarly, you need to catch and dispute every irrational thought you have. You will learn even more strategies to catch and correct your thoughts in the next lesson. Apart from being consistent, you also need to practice these skills with an open mind. If you are going through the motions with the belief that “this is not going to work” then it’s not going to work. In this case, you might have to start by disputing and redirecting that belief before you try disputing any other beliefs.

People who are fully committed to practicing these skills have seen dramatic benefits within a matter of weeks!

Can this help me with my past problems?

One of the core principles of CBT strategies is that they are used in the “here-and-now”. You can’t change the past, but you can change the way you think about the past. Although changing the way you think about the past won’t change your experiences, it might help you reflect on, process, and move on from what happened. Using CBT strategies to better understand past experiences will help you learn from your mistakes so that you either don’t have to go through these experiences in the future or, if you do go through similar experiences, then you will be able to manage the situation better.

How am I supposed to use this skill in real-time? You aren’t expecting me to carry this worksheet around and ask for a 10-minute break to fill it out when I’m in the middle of something, are you?

No, I am not asking you to do that. I understand how that would be incredibly uncomfortable and unrealistic. Think of this as a tool that you can use to practice these skills. For now, it might be necessary to go through all of these steps and to sit down and really think things through. However, as you practice this and become more comfortable using these skills, you will be able to more naturally dispute worries by going through the steps in your head, in real-time. As a class, we are working towards establishing this real-time resilience. The last lesson in this unit addresses real-time resilience and will help you learn more specific phrases or things that you can do quickly, without any tangible tools. But, keep in mind that working through this lengthy process and understanding all of the steps to disputing irrational beliefs is important for you to be able to effectively use real-time resilience skills. Think about how you learn math: You need to understand long division before you can learn short-hand division.