Overview

Brain Battles

100

What are intrusive thoughts?

These unwanted thoughts often involve violence, sex, religion, or fear of harming yourself or others. They are common, do not reflect your values, and having them does not mean you will act on them.

• Nearly everyone experiences intrusive thoughts.
• People with OCD often give these thoughts more importance and may fear they mean something about who they are.
• Thoughts are not actions or intentions.
• Trying to "get rid" of the thought often makes it come back stronger (the "white bear effect").

Intervention:
Notice the thought without judging it.

            "I'm having the thought that..."

Label it as an intrusive thought.

           Allow it to pass instead of arguing with it.

Return attention to the present moment. 

200

Question: What is emotional regulation?

This skill means recognizing emotions, understanding what triggered them, and responding intentionally instead of reacting impulsively.

Emotional regulation does NOT mean: Never crying,

Never feeling angry, Always being happy

It DOES mean:

• Feeling emotions without letting them control your behavior and Choosing how to respond rather than reacting automatically.

Instead of...

• Yelling when angry
• Leaving work after receiving criticism
• Self-harming after feeling rejected
• Drinking to numb sadness

Emotional regulation looks like...

• Taking several deep breaths before responding.
• Asking for a break during an argument.
• Talking with a trusted friend.
• Going for a walk before making a decision.
• Using coping skills until the emotion decreases.

Interventions

• STOP skill (Stop, Take a step back, Observe, Proceed mindfully)
• Deep breathing
• Grounding (5-4-3-2-1)
• Journaling
• Naming the emotion ("I notice I'm feeling frustrated.")
• Opposite Action (DBT)
• Taking care of basic needs (sleep, food, hydration) 

300

Replaying the same negative thoughts or situations repeatedly without finding a solution is called this.

Question: What is rumination?

Rumination is different from problem-solving.

Problem-solving asks:

• "What can I do?"

Rumination asks:

• "Why am I like this?"
• "Why did that happen?"
• "What if..."
• "I should have..."
• "I can't stop thinking about..."

Rumination often:

• Increases depression
• Increases anxiety
• Makes problems seem bigger
• Keeps people stuck

Examples

• Replaying an awkward conversation for hours.
• Thinking about an ex every day without taking action.
• Constantly wondering if you made the wrong decision.
• Obsessing over mistakes from years ago.

Interventions

• Ask: "Is this problem-solving or rumination?"
• Set a 10-minute "worry time."
• Redirect attention to a meaningful activity.
• Practice mindfulness.
• Write thoughts down, then move on.
• Behavioral activation (do something despite the thoughts).
• Challenge whether the thought is helpful. 

400

Question: What is catastrophizing?

Answer:
When your brain automatically assumes the worst outcome without evidence

Examples:

• "If I make one mistake, I'll lose my job."
• "My friend didn't text back—they must hate me."

Intervention
Ask yourself:

• What evidence supports this?
• What's another possible explanation?
• What's the most likely outcome?

500

What is cognitive restructuring (or cognitive reframing)?

This CBT skill helps you identify unhelpful thoughts, examine the evidence, and replace them with more balanced and realistic thoughts.

Examples:

• ❌ "I'm a failure." → ✅ "I made a mistake, but that doesn't define me."
• ❌ "Nobody likes me." → ✅ "I don't have evidence that nobody likes me."
• ❌ "I'll never get better." → ✅ "Recovery takes time, and I've made progress before."

Substances & Mental Health

100

Some people use this substance because it seems to reduce anxiety in the moment, but frequent or high-THC use can actually increase anxiety, panic attacks, and avoidance over time.

What is marijuana (cannabis)?

• Temporary relief does not always mean long-term improvement.
• THC can make anxiety worse, especially in high doses.

Short-term relief by temporarily changing brain chemicals, but over time the brain adapts, leading to tolerance, withdrawal, and worsening symptoms.

200

Although this substance may help you fall asleep faster, it often causes fragmented sleep, early morning awakening, and less restorative sleep.

What is alcohol?
Alcohol suppresses REM sleep early in the night. As the alcohol wears off, REM "rebounds," leading to lighter sleep, frequent awakenings, and vivid dreams.

• Falling asleep quickly but waking at 3 a.m.
• Feeling exhausted despite sleeping 8 hours.
• Waking with increased anxiety after drinking. 

300

Many people believe this substance calms anxiety, but it often creates a cycle of temporary relief followed by increased anxiety and cravings.

Question: What is nicotine?

Nicotine briefly releases dopamine, making you feel better for a short time. As nicotine levels drop, withdrawal begins, causing: Anxiety, Irritability, Restlessness, Difficulty concentratingSmoking or vaping relieves the withdrawal—not necessarily the original anxiety.

400

Why might someone feel calmer after vaping if nicotine actually increases anxiety over time?

Nicotine can briefly make someone feel calmer because it quickly stimulates dopamine release and temporarily relieves nicotine withdrawal. As nicotine levels drop, withdrawal symptoms return, often causing more anxiety and cravings, leading the person to vape again. Nicotine creates a cycle:

Stress or anxiety → Vape → Temporary relief → Nicotine wears off → Withdrawal symptoms (anxiety, irritability, restlessness) → Vape again

Many people think the vape is treating their anxiety, but it is often relieving nicotine withdrawal that developed between uses.

Imagine someone vapes every hour at work. Before the next vape, they start feeling restless, tense, and irritable. After vaping, they feel calm again. It may seem like vaping "helps anxiety," but in reality it is mostly relieving withdrawal from the previous vape.

500

This brain chemical is released by many addictive substances and is involved in reward, motivation, and reinforcement.

What is dopamine? Dopamine helps reinforce behaviors, making the brain want to repeat activities that feel rewarding.

Pot Luck

100

Regular marijuana use—especially high-THC products—can increase the risk of this condition, particularly in people with bipolar disorder, schizophrenia, schizoaffective disorder, or a family history of psychosis.

What is psychosis? Psychosis may include: Hearing voices, Seeing things others don't, Delusions (fixed false beliefs), Paranoia, Confused thinking

200

Stopping this substance after regular use may cause irritability, insomnia, vivid dreams, decreased appetite, anxiety, and strong cravings—even though many people don't realize it has withdrawal symptoms.

Cannabis Withdrawal

Cannabis withdrawal usually begins within 1–3 days, peaks during the first week, and generally improves over 2–4 weeks, although cravings may last longer.

Examples:Feeling unusually irritable after quitting, Difficulty falling asleep for several nights, Vivid or intense dreams, Feeling more anxious before symptoms improve.

300

Vaping is completely harmless because it doesn't produce cigarette smoke.

Question: What is false?

Vaping may expose users to fewer toxic combustion products than cigarettes, but it is not harmless. It can:

• Increase nicotine dependence
• Raise heart rate and blood pressure
• Worsen anxiety
• Irritate the lungs
• Expose users to chemicals whose long-term effects are still being studied

400

This thinking pattern involves assuming you know what others are thinking without evidence.

What is mind reading? Example:
"My friend didn't text back, so they must be mad at me."

500

This DBT skill helps you pause before reacting when emotions are intense. (STOP)

What is the STOP skill?

S = Stop

Don't react right away. Pause.

Example:
Your friend sends a text that hurts your feelings. Instead of immediately sending an angry reply, you pause.

T = Take a Step Back

Give yourself a moment before acting.

Examples:

• Take 3 deep breaths.
• Count to 10.
• Walk into another room.
• Get a glass of water.

O = Observe

Notice what is happening inside and around you.

Ask yourself:

• What am I feeling?
• What am I thinking?
• What happened?
• What are the facts?

Example:
"I'm feeling angry because I think my coworker ignored me, but I don't know if that was intentional."

P = Proceed Mindfully

Choose the response that helps you reach your goals—not just what feels good in the moment.

Examples:

• Speak calmly instead of yelling.
• Walk away instead of slamming the door.
• Use a coping skill instead of self-harming.
• Wait until you've calmed down before sending a text.

Mental Health and Symptoms

100

What is overthinking?

Answer: Overthinking is when your brain keeps going over the same thoughts without solving the problem.
Overthinking feels productive, but it usually keeps you stuck. It increases anxiety instead of leading to action.
"I've replayed that conversation 20 times, but I still don't know what they meant."

One way to stop overthinking is to ask yourself this question.  "Is there anything I can do about this right now?"

• If yes → Take one small action.
• If no → Practice letting the thought go and refocus on the present.

200

If you've been thinking about the same problem for an hour and haven't taken action, you're probably doing this.

What is ruminating?

Taking one small, realistic step is a simple strategy that  helps move from rumination to action.

Example:
Instead of worrying about cleaning the whole house, wash one sink of dishes.

Rumination usually makes a person feel more anxious, more depressed, or more stuck?

300

One evidence-based treatment for emotional numbness is this depression strategy.

What is behavioral activation?

You don't wait to feel motivated—you act first, and motivation often follows.

400

Someone keeps asking friends, "Do you think everything is okay?" Their anxiety decreases briefly, but returns within an hour. What is happening?

What is the reassurance cycle?

Reassurance works temporarily but teaches the brain to depend on others instead of building confidence.

500

Answer: When an intrusive thought appears, what should you do instead of trying to prove it false?

Question: What is acknowledge it without engaging with it?

Instead of arguing with the thought, trying to figure it out, or seeking reassurance:

• Notice it: "I'm having an intrusive thought."
• Label it: "This is my OCD/anxiety talking."
• Allow it to be there: Don't try to force it away.
• Refocus on what you were doing: Return your attention to the present task.
• Accept uncertainty: "Maybe it's true, maybe it isn't. I don't need to solve it right now."

Example:

Intrusive thought: "What if I accidentally hurt someone?"

❌ Unhelpful response:

• "I would never do that."
• Replaying memories to prove you're a good person.
• Asking others, "Do you think I'm dangerous?"

✅ Helpful response:

• "That's an intrusive thought."
• "I don't have to figure it out."
• Continue making dinner or talking with a friend without trying to get certainty.

The goal is not to make the thought disappear. The goal is to change your relationship with the thought so it no longer controls your behavior. Over time, when you stop feeding the thought with attention and compulsions, it usually becomes less distressing and less frequent.

Neurotransmitters

100

This neurotransmitter is most closely linked to mood, anxiety, and OCD. Most antidepressants work by increasing its activity.

Question: What is serotonin?
Low serotonin may contribute to depression, anxiety, OCD, and irritability. SSRIs don't create serotonin—they help the brain use more of the serotonin it already has.

200

Question: What is dopamine?

Answer: This neurotransmitter is involved in motivation, pleasure, reward, and attention. Too little may contribute to low motivation, while too much in certain brain pathways can contribute to psychosis.

Low dopamine → low motivation, fatigue, difficulty concentrating

High dopamine (in certain pathways) → hallucinations or delusions

ADHD medications generally increase dopamine availability.

Most antipsychotics reduce dopamine activity in specific brain pathways.

300

Which medication class primarily works by blocking dopamine receptors to reduce hallucinations, delusions, and mania?

Question: What are antipsychotics?

• Zyprexa (olanzapine)
• Seroquel (quetiapine)
• Risperdal (risperidone)
• Latuda (lurasidone)
• Vraylar (cariprazine)
• Caplyta (lumateperone)

Antipsychotics do more than treat psychosis. Many are also used for bipolar disorder, depression, irritability, and mood stabilization.

400

Which neurotransmitter is associated with alertness, energy, and the body's "fight-or-flight" response?

What is norepinephrine? Too little may contribute to fatigue and poor concentration. Too much can contribute to anxiety, racing heart, and feeling "keyed up."

500

This neurotransmitter helps regulate mood, sleep, appetite, and OCD symptoms.

What is serotonin? Think of serotonin as helping with emotional stability, not happiness.

(Blank)

300

its