the Baby and Other Scary ThoughtsC02AMM64N1J


Dropping the Baby and Other Scary Thoughts

Course Summary

The birth of a new baby brings joy to many parents, but it can also cause unexpected 

emotions and thoughts. This is particularly true in mothers, who may experience anxiety, 

depression, and/or emotional distress during pregnancy and postpartum. Mental health 

providers can support patients struggling through the perinatal period by helping them to 

understand their “scary thoughts” (a term used to describe the upsetting thinking that can 

interfere with the wellbeing of a new mother), normalizing their experience, and assessing 

the severity of their distress. Dropping the Baby and Other Scary Thoughts, 2nd Edition

provides essential information that both the client and the treating therapist can use when 

dealing with intrusive, negative, and unwanted thoughts. The purpose of this intermediate

level course is to prepare psychologists, social workers, marriage and family therapists, 

and counselor to support perinatal women experiencing “scary thoughts.”

Clinicians can use the information presented in this learning material to identify 

clients experiencing perinatal distress and determine appropriate treatment options that 

reflect the needs of those clients. It also helps providers recognize not only professional 

treatment options, but also self-help strategies that may reduce negative feelings in the 

clients they are supporting. Other topics covered include the role of support systems and 

support considerations for diverse parents and clients from different cultural contexts. 

Upon completion of this course, providers will be able to screen and assess for perinatal 

anxiety and depression as well as recommend and support with interventions intended to 

improve anxiety and depressive symptoms in perinatal women.

Learning Objectives

1) Identify the different presentations of anxiety and depressive disorders in perinatal 


2) Describe the nature, prevalence, and effects of “scary thoughts” in perinatal women.

3) Discuss factors that may increase a woman’s vulnerability to experiencing “scary 

thoughts” during the postpartum period.

4) Recognize the symptoms of anxiety-related and depressive psychiatric disorders that 

may present in perinatal mothers.

5) Explain the cognitive, societal, and symptomatic barriers that may deter a woman from 

disclosing her perinatal distress.

6) Describe screening practices that mental health providers can use when providing 

support to perinatal mothers.

7) Discuss responses, self-help strategies, and nonprofessional interventions that may 

help improve anxiety and depressive symptoms in perinatal women.

8) Identify elements of the cognitive model and strategies that may help perinatal patients 

reduce distressing thoughts and emotions.

9) Discuss the concept of acceptance as a means to reduce suffering among perinatal 

women in distress.

10) Describe psychotherapy and medication interventions available to treat perinatal 

women seeking professional support.

11) Differentiate the mechanisms of practical, emotional, and psychosocial support 

systems beneficial to the physical and psychological health of perinatal women.

12) Recognize how family roles, life experiences, and cultural contexts may influence the 

development and presentation of perinatal anxiety and depression in parents.

13) Identify strategies that are recommended to perinatal women trying to cope with and 

break the cycle of “scary thoughts”.

Chapter 1: A Mother’s Anxiety

1) Anxiety that interferes with normal functioning

is common in all new mothers and will quickly pass.

indicates lack of social support.

requires professional attention. 

is easily identified by healthcare providers.

2) The term “scary thoughts” refers to

persecution delusions.

negative affect.

upsetting thinking that can interfere with the wellbeing of a new mother.

splitting thinking that can cause suicidal ideation in perinatal mothers.

3) The period of pregnancy and the first year following delivery is known as the

post-partum period.

perinatal period.

prenatal period.

antenatal period.

4) The process of repeatedly and excessively thinking about the causes, meaning, and 

consequences of distress is known as





5) Thoughts, preoccupations, images, or impulses that are intrusive, persistent, 

recurrent, and difficult to control are defined as

obsessive thoughts.


depressive thoughts.


6) The factor that determines whether a thought is troublesome or not is the

content of the thought.

frequency of the thought.

individual’s level of distress and meaning attached to the thought.

situation in which the thought occurs and length of the thought.

7) Behaviors that are performed over and over in an attempt to find relief from 

intrusive thoughts are defined as





8) The act of interpreting subtle, harmless physical sensations as a sign of danger or 

impending doom is referred to as

fatalistic determinism.

catastrophic misinterpretation.

histrionic behavior.

cognitive dissonance.

Chapter 2: A Closer Look

9) Which statement regarding “scary thoughts” is accurate?

Experiencing unwanted, invasive, “scary thoughts” is common among new 


The presence of “scary thoughts” indicates a parent is more likely to harm their 


Ignoring and suppressing “scary thoughts” will assist in making them disappear.

Individuals with no mental health history are unlikely to experience “scary 


10) Which is true of individuals with a history of anxiety, depression, or 


They have a decreased risk of experiencing “scary thoughts.”

They have a risk of experiencing “scary thoughts” equal to those with no mental 

health history.

They have more extreme “scary thoughts” than those with no mental health 


They have an increased risk of experiencing “scary thoughts.”

11) According to Abramowitz and colleagues (2006), what percent of new mothers 

experience obsessive thoughts about their baby at some point following their 

baby’s birth?





12) People who report worrying about things for at least 50% of the time often meet 

the criteria for

obsessive-compulsive disorder.

generalized anxiety disorder.

major depressive disorder.

social anxiety disorder.

13) When a “scary thought” is ego-dystonic, it is

in conflict with one’s belief in who they are and it creates piercing anxiety.

in conflict with one’s belief in who they are and the thoughts are psychotic.

a warning sign that a perinatal women may act on her scary thoughts.

a warning sign that a perinatal women may abandon her baby.

14) When high levels of distress accompany “scary thoughts”, mothers typically

are more responsive to their infant’s cues and as a result experience more stress.

attempt to reduce anxiety and overthinking by overprotecting their baby. 

engage in avoidance behaviors or rituals in an effort to control their thoughts.

have postpartum depression and are likely to withdrawal from their families.

15) There is substantial evidence that “scary thoughts” produce harsh parenting 




Chapter 3: Why Am I Having Scary Thoughts?

16) “Scary thoughts” emerge from a complex system that involves genetics, biology, 

thinking styles, and 

type of birth.

environmental stressors.

marital status.


17) According to Hettema and colleagues (2001) and Levinson (2006), the likelihood 

of inheriting psychiatric disorders like major depression, generalized anxiety 

disorder, and panic disorder is roughly





18) Having a family member with a mental health disorder increases the likelihood of 

an individual developing a disorder by

4–6 times.

10–12 times.

18–20 times.

28–30 times.

19) The likelihood of anxiety and depression increases when receptor sites in the brain 

are damaged or the brain does not have enough of the neurotransmitter





20) The hormone that facilitates maternal attachment to the newborn and increases 

activity in the fear center of the brain is





21) Psychiatric problems and “scary thoughts” are more likely to develop

after first pregnancies.

after successive pregnancies.

during pregnancy.

before pregnancy.

22) Which hormone, known to be elevated during pregnancy, can have downstream 

effects on serotonin and dopamine levels and contribute to the potential to 

experience “scary thoughts”?





23) A thinking style that makes women vulnerable to excessive worry and involves an 

individual second guessing themselves and spending excessive time researching 

answers to their worries is termed

poor problem orientation.

inaccurate beliefs.

intolerance of uncertainty.

verbal what-if process.

24) Although the thinking style of cognitive avoidance may help people avoid 

uncomfortable images of potential catastrophes in the short-term, it also

increases the strength and intensity of distressing worries in the long-term.

decreases the frequency and intensity of distressing worries in the long-term.

makes people resistant to seeking help in managing their anxiety.

provides relief from distressing mental images and intense anxiety.

25) The thinking style associated with especially high levels of distress across the 

postpartum period and that is described as the inability to stop thinking about and 

focusing on a mental state is known as





26) Which client statement indicates the likelihood of anxiety sensitivity and a

vulnerability to catastrophic misinterpretations?

“I’m in so much pain all of the time and distracting myself isn’t helping.”

“My heart pounds when I think about labor so I’ve been practicing breathing

exercises daily.”

“My heart pounds and I sweat when I think about labor. I know I will end up 

having a heart attack.”

“The baby’s cries are so loud they give me headaches. I’m exhausted and 


27) The vulnerability factors listed in a biopsychosocial model that are most likely to

increase a woman’s chances of experiencing “scary thoughts” are

depression, breastfeeding, and perfectionism.

new house, first baby, and hardworking.

anemic, bottle feeding, and religious.

immigrant, twins, and anxious.

Chapter 4: How Do You Know If You Need Help?

28) In which case would professional help be encouraged for a mother experiencing


The person is a first-time mother.

The symptoms have persisted for more than 1 month.

The person is having difficulty performing normal activities.

The person is responsible for caring for multiple family members.

29) The distinguishing feature of generalized anxiety disorder is

prior trauma.

intrusive urges.

excessive worry.

obsessions and compulsions.

30) Many women with generalized anxiety disorder also struggle with



bipolar disorder.

anorexia nervosa.

31) An individual experiencing extreme emotional or behavioral distress or 

impairment in functioning within three months of a recognizable stressor may be 

diagnosed as having

bipolar disorder.

behavioral disorder.

adjustment disorder.

generalized anxiety disorder.

32) Major depressive disorder can be diagnosed when an individual displays a 

depressed mood and experiences emotional distress, the loss of pleasure, 

hopelessness, disturbed sleeping and eating, and suicidal thoughts for at least

1 week.

2 weeks.

1 month.

2 months.

33) Major depressive disorder (MDD) and the “baby blues” are different because

“baby blues” subside on their own and require no intervention, while MDD does 

require intervention.

only MDD often results in poor sleep and exhaustion.

women with “baby blues” have difficulty concentrating but concentration isn’t 

affected by MDD.

only MDD emerges within the first two to three weeks after childbirth.

34) Which statement is true regarding perinatal depression?

Women with perinatal depression are usually unable to care for their babies.

Women with perinatal depression may appear clinically and physically healthy.

Perinatal depression is easily diagnosed by healthcare providers.

Perinatal depression is experienced by all first-time mothers.

35) The category of “scary thought” most closely linked with depression is



intrusive thoughts.

obsessive thinking.

36) Which statement is true regarding obsessive compulsive disorder (OCD) in 

perinatal women?

Both obsessions and compulsions must exist to meet the criteria for a diagnosis of


Counting and hoarding behaviors are most frequently observed in postpartum 


Contamination obsessions and cleaning compulsions are more common in 

postpartum onset OCD.

The majority of obsessive thoughts experienced during the perinatal period

pertain to the new baby.

37) A women's perception that medical staff did not support during labor and that her 

life was put in danger meets the DSM's definition of a traumatic event.



38) A new mother may have agoraphobia if she

avoids the grocery store during popular times because she fears getting sick.

limits her driving because she is fearful about getting into a car accident.

believes that her shortness of breath is due to lung disease.

stays home at all times to avoid having a panic attack in public.

39) The primary difference between suicidal intent and suicidal ideation is that 

someone with suicidal intent

often has a suicide plan.

withdraws from others.

spends more time thinking about dying.

experiences ongoing feelings of hopelessness.

40) Women who experience psychotic thoughts

feel a great deal of alarm and distress.

believe that their thoughts make logical sense.

think and behave like themselves despite the thoughts.

show signs of distress because of the bizarre thinking.

Chapter 5: Barriers to Relief

41) One reason it is sometimes difficult for healthcare professionals to know which 

experiences during the perinatal period are of concern is that

women often have trouble identifying their symptoms during this perinatal period.

women may exaggerate symptoms during the perinatal period due to hormone 


many of the symptoms of anxiety and depression are considered normal 

experiences during the perinatal period.

many healthcare providers are poorly informed about what experiences are 

considered normal during this period.

42) Women report that one reasons they are hesitant to reveal their “scary thoughts” is 

because they

fear others will minimize or dismiss their experience.

do not want to be prescribed antidepressant medication.

believe that their thoughts are typical of what other perinatal women experience.

worry that saying the thought out loud makes it more likely to become a reality.

43) Postpartum women are apprehensive about being diagnosed as mentally ill and

describe being diagnosed with depression as worse than being labeled as a bad 




44) An informal questionnaire at The Postpartum Stress Center found that perinatal 

women first admitted their postpartum distress to their 

partners and/or mothers.

obstetrician and/or pediatrician.

closest friend.

primary care provider.

45) Women are least likely to disclose postpartum distress to the



primary care provider.

lactation consultant.

46) There is a general tendency for women to recoil from social support when they 

feel judged or stigmatized.

are first-time or single mothers.

are criticized by their partners and/or mothers.

feel like other’s problems are bigger than their own.

47) One of the negative consequences of utilizing the internet and social media as 

resources for parental support is the

decreased reliance on face-to-face support.

increased expectation to ignore negative feelings attached to motherhood.

risk of intensifying feelings of isolation.

over-normalizing of symptoms that require professional support.

48) The question that best illustrates the ultimate deterrent perinatal women experience 

as they consider disclosure of their “scary thoughts” is

“Will anyone believe what I am telling them?”

“What if something bad happens as a result of my disclosure?”

“Can I overcome these thoughts on my own?”

“Do I deserve to receive help when I am such a bad mother?”

49) Healthcare providers can be a barrier to mothers receiving mental health care when 


ask poorly worded questions about mental health.

conduct routine depression screens on all patients.

refer patients who express significant distress to mental health experts.

ask follow-up questions when women respond tentatively to screening questions.

Chapter 6: Screening for Scary Thoughts

50) It is recommended that the initial intervention for assessing a mother’s mental 

health be conducted

during the phone intake.

via an online questionnaire.

via a mailed paper-based survey.

6 months post-partum.

51) To establish trust with defensive clients during assessment, the provider should

reassure the client and ask yes and no questions.

ask the client complete a questionnaire instead of having a conversation.

ask the client if they would like to come back when they feel more like talking.

reassure the client and explain that full disclosure provides a complete clinical 


52) Universal screenings that ask each perinatal person if she is having thoughts that 

scare her are likely to 

increase the occurrence of suicidal thoughts.

replace the need for specialized mental health screenings.

improve detection of perinatal distress.

yield fewer disclosures than observations made by the clinician during routine 


53) A 31-item questionnaire that can assess for the presence and severity of anxiety 

symptoms in perinatal women is the

Edinburgh Postnatal Depression Scale.

Postpartum Checklist.

Postpartum Depression Screening Scale.

Perinatal Anxiety Screening Scale.

54) The pediatrician is considered the optimal care provider to monitor for perinatal 

distress in women because

pediatricians have more training related to mental health screening.

mothers tend to keep pediatrician appointments but may delay their own care.

pediatricians are able to spend more time with patients than other care providers.

mothers report having a greater level of trust in pediatricians than their other care 


55) If a couple is being treated by a mental health provider together, it is recommended 

that both parents be screened for perinatal anxiety-related and depressive disorders 

because the emergence of significant perinatal distress is possible for both.



56) Which of the following best describes a difficulty most healthcare providers 

experience regarding perinatal screening?

Healthcare providers feel that they have inadequate time and insufficient training 

to screen effectively.

Healthcare providers cannot prioritize the issue of perinatal distress because it is 

not as important as other patient issues.

Healthcare providers struggle to get perinatal woman to participate in the 

screening process.

Healthcare providers avoid screening because they don’t know what to do if 

perinatal distress is detected.

57) When conducting a mental health screen, the healthcare provider should use a tone 


is lighthearted and upbeat.

conveys sympathy and pity.

is warm but unemotional.

is impersonal and cool.

58) After asking perinatal women if they are having thoughts that scare them, the 

healthcare provider should 

avoid clarifying the question so the mother can interpret what she thinks is meant.

let the mother know that it is normal for healthcare professionals to ask questions 

about emotional health.

ask the mother what she thinks she can do to prevent the “scary thoughts”.

validate the common occurrence of “scary thoughts” whether or not the mother 

discloses distress.

59) A universal, 1-question screening question that healthcare providers should ask 

their perinatal woman patients is

“How are you feeling about being a mom?”

“Are you struggling to care for your baby?”

“Are you having thoughts that are scaring you?”

“Do you receive emotional support at home?”

Chapter 7: Things You Can Do to Feel Better

60) Which statement regarding denial is accurate?

Denial is always a maladaptive coping mechanism that is unable to diminish the 

intensity of “scary thoughts”.

Denial provides long-term reprieve from unpleasant thoughts and feelings when 

done deliberately.

Denial is self-sabotaging because it interferes with the management of “scary 


Denial is a useful tool in eliminating “scary thoughts” because it allows 

adjustment time.

61) Redirecting thoughts away from “scary thoughts” or distressing feelings toward 

something else is referred to as





62) The acronym S.E.L.F. represents which elements of self-care?

sex, entertainment, love, fun

spirituality, exercise, love, family

socialize, examine, laugh, facilitate

sleep, exercise, laugh, food

63) Self-care practices such as breathing and relaxation exercises, which research 

shows calm the body and quiet the mind, should be performed

three times per week.

10 to 20 minutes per day.

one hour per day.

5 minutes of every waking hour each day.

64) Which nonprofessional intervention may produce antidepressant effects and is 

considered a favorable option for perinatal women in distress?

Controlled breathing

Light therapy

Omega-3 fatty acids

Progressive muscle relaxation

Chapter 8: Can You Really Change How You Think?

65) The cognitive model describes how

primitive forces drive humans to grow, change, and develop their personal 


thoughts and perceptions influence the way people feel and behave.

systemic structures and the sociocultural context maintain mental illness.

the unconscious mind, childhood experiences, and interpersonal relationships 

impact behavior.

66) Automatic thoughts are different from beliefs because automatic thoughts

arise in particular situations and are more easily modified than beliefs.

are hardwired in the brain and harder to change than beliefs. 

are understood and processed as core truth or knowledge.

produce appropriate emotional reactions despite the situation.

67) If a patient notices a negative change in their mood during a given situation, the 

first and most central question they can ask themself is,

“What behavior and/or person caused me to feel that way?”

“What evidence supports the way that I felt in that situation?”

“What is it costing me to allow this negative mood to take over?”

“What thought was running through my mind in that situation?”

68) Coping cards are useful in reducing the intensity of negative emotions and can 

serve as an alternative to the “Scary Thought” log when time is tight.



69) An alternative way to enhance cognitive flexibility is to repeat a single word that 

summarizes a “scary thought” over and over again until it loses its original 

meaning, which is a process known as

proactive interference.

internal possession.

cognitive defusion.

cognitive experimentation.

Chapter 9: Working Toward Acceptance

70) Acceptance is the choice to

face reality even if it feels uncomfortable or scary.

abandon hope that change will occur.

be okay with the way things are.

focus only on the positive aspects of a situation.

71) Acceptance is an important step to reduce suffering among perinatal women in 

distress because it

allows for better self-control of “scary thoughts”.

identifies thoughts that need to change to overcome distress.

reduces the amount of “scary thoughts” that occur.

sets in motion appropriate responses to distress.

72) One of the first ways to start developing acceptance is by focusing attention on the 

present moment and rejecting the temptation to critique the past or worry about the 

future, which is otherwise known as practicing

emotionless consciousness.

attentive meditation.



73) One way to implement radical acceptance as a distress tolerance skill is to

mentally picture an ideal reality.

actively work to suppress “scary thoughts.”

ignore feelings of disappointment, sadness, or grief.

relax the body and mind to facilitate a greater openness for acceptance.

74) Willingness is an important part of acceptance because it

involves recognizing the reality of a situation and effectively solving problems.

gives a person the choice to be a spectator on the side-lines when action is needed.

maintains connection with one’s surroundings when action is not an option.

involves watching life more closely and allowing whatever will be to be.

75) Which is one of the Six Points for managing anxiety?

When fear comes on, shift focus to something positive.

When possible, isolate from others until fear passes.

Make a list of activities unable to be completed during periods of fear.

Rate the level of fear on a scale of 0 to 10 when it occurs and see how it varies.

Chapter 10: Professional Treatment Options

76) An active, listening-based therapy that uses approaches such as empathy, praise, 

advice, clarification, confrontation, and interpretation to engage with the client is

acceptance and commitment therapy.

cognitive behavioral therapy.

supportive psychotherapy.

dialectical behavior therapy.

77) Exposure, a cognitive behavioral strategy sometimes used to address “scary 

thoughts”, is believed to work through inhibitory learning—a process by which

habitual subjection to distressing thoughts blocks emotional response.

new information is learned that blocks the original fear.

the mind and body learns to adjust to the source of anxiety.

the mind and body learn how to draw more balanced conclusions.

78) What treatment approach is particularly suitable for addressing perinatal distress

because of its recognition that biological, environmental, affective, and social 

factors interact and may lead to problematic behavior, thoughts, and mood?

Acceptance and commitment therapy

Cognitive behavioral therapy

Supportive psychotherapy

Dialectical behavior therapy.

79) A therapy that reduces depressive symptoms and was found to reduce anxiety 

when delivered during the postpartum period is

interpersonal psychotherapy.

group psychotherapy.

acceptance and commitment therapy.

dialectical behavior therapy.

80) Which statement regarding selective serotonin reuptake inhibitors (SSRIs) is true?

SSRIs have no side effects.

SSRIs recycle neurotransmitters, allowing more time for them to work.

SSRIs are effective for depression but not for anxiety.

SSRIs should be not be used by women who are breastfeeding.

81) A patient must follow strict dietary restrictions and be aware of multiple drug-drug

interactions when taking


tricyclic antidepressants.

monoamine oxidase inhibitors (MAOIs).

selective serotonin reuptake inhibitors (SSRIs).

82) Which statement regarding benzodiazepines is accurate?

Benzodiazepines have no risk of tolerance or dependence.

Benzodiazepines take four to six weeks to exert a full effect.

Benzodiazepines may cause drowsiness and short-term memory impairment.

Benzodiazepines may be purchased over-the-counter.

83) A noninvasive procedure that uses magnetic fields to stimulate nerve cells in the 

brain to improve symptoms of depression is called

electroconvulsive therapy.

neural implantation.

transcranial magnetic stimulation.

lobotomy treatment.

Chapter 11: How Others Can Help

84) Information, programs, or groups that help promote healthy attitudes and skills are

examples of

emotional support.

psychosocial support.

practical support.

affirmational support.

85) The two skills associated with high-functioning marriages are

intimacy and self-awareness.

communication and conflict resolution.

financial management and organization.

humility and accommodation.

86) The greatest act of support a friend or family member can give to someone 

struggling with “scary thoughts” is

accepting how the person in distress is feeling and what they may say.

avoiding discussing the “scary thoughts” with the person in distress.

helping the person in distress find professional support immediately.

reassuring the person in distress that everything will work out.

87) Which statement most indicates an increased risk of suicidal behavior and the need 

for professional support?

“I just want to run away.”

“I want to go to sleep and not wake up.”

“I’m tired of crying all the time.”

“Motherhood is not at all what I expected.”

88) When therapists treat perinatal women struggling with “scary thoughts”, some of 

the ways they can maximize a woman’s connection to the therapeutic process are 

by being clear about their expertise in this area, responding with confidence in 

their ability to provide help, and 

being firm with clients about their need for treatment.

praising clients for all the things they are doing right.

encouraging clients to not talk specifically about their “scary thoughts”.

informing clients that they likely will feel better by talking about the “scary 


Chapter 12: Recognizing the Needs of Diverse Parents

89) Which of the following statements is a flag that a nongestational parent is 

experiencing disentitlement?

“I don't know what to do about my wife being anxious and depressed.”

“I go to the gym a lot because it helps me better handle being a new parent.”

“I should not feel depressed and anxious about the baby, but I do.”

“I am frustrated that my wife is depressed because I am helping her so much.”

90) Approximately what percentage of adoptive mothers have reported clinically 

significant depressive symptoms at some point during the first postadoption year?





91) Which statement is true regarding the presentation of anxiety and depression in 

men experiencing paternal postnatal depression?

Men are less likely than women to engage in alcohol and substance use and abuse.

Men tend to experience more anger, avoidance, and impulsive behavior than 


Men are more likely than women to seek professional intervention for depressive 


Men are less likely than women to feel abandoned by current medical and social 


92) Some of the factors that contribute to the increased risk of postpartum depressive 

symptoms among Black, Latina, and Hispanic women (as compared to White 

women) include increased incidence of domestic violence, history of trauma, high 

rates of poverty, and living 

without the baby’s father.

with unsupportive family members.

in unsafe neighborhoods.

far away from treatment providers.

93) New mothers who participate in non-Western collectivist cultural practices, such 

as resting and avoiding their usual housework duties for extended periods of time

after childbirth, experience perinatal distress at significantly reduced rates as 

compared to mothers in Western culture.



Chapter 13: Your Personal Treatment Plan

94) Once upsetting thoughts are recognized, the next step in breaking the cycle of 

“scary thoughts” is 

listing and categorizing the thoughts. 

identifying who is to blame for the thoughts.

using cognitive strategies to respond differently to thoughts.

starting a “scary thought” log to help with acceptance of the thoughts.

95) In the eight steps to breaking the cycle of “scary thoughts,” after acknowledging 

the thoughts, identifying the thoughts, and identifying vulnerabilities, the next step 


letting go of distressing thoughts and letting in positivity.

selecting appropriate self-help interventions and treatments.

identifying barriers to disclosing the thoughts to others.

determining whether professional help would be of value.

96) Rating the level of distress, taking several breaths, and noticing fluctuations in 

distress level are all strategies for

identifying barriers to normalcy.

practicing acceptance of distressing thoughts.

augmenting a self-care regime.

avoiding pitfalls of distressing thought