Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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202-331-1566

2440 M Street, NW
Suite 710
Washington, DC 20037

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“Do I Need Medication?”

By Lynne Gots, posted on February 18th, 2015.

 

I discuss this question so often in my practice—and have so frequently considered blogging about it—I had to scroll through my archives to see if I’d already written a post on the topic. But, apparently, it only existed in my mind.

I’m prompted finally to address the issue of medication because I attended an interesting discussion the other day about a book titled Does My Dog Need Prozac? Everyone in the group, including me, has a fearful dog (my Australian Shepherd Freddie, as I’ve mentioned before, is tightly wound and “reactive” to other dogs, people unknown to him, and the television). We talked about how to help our sensitive pets be more comfortable in the world while at the same time learning to accept them as they are rather than being disappointed when they don’t behave like TV dogs. Come to think of it, this attitude of acceptance would make it a lot easier to be content with children, spouses, friends, and colleagues who don’t quite meet our expectations, either.

Given the title of the book, the conversation eventually turned to the use of medication to help ease reactive animals’ fears. According to the animal behaviorist who moderated the discussion, people are as reluctant to medicate their anxious canines as they are to consider pharmacological treatments for themselves—although she encounters, as I do, less resistance to so-called “natural” remedies, such as herbal compounds and vitamin supplements. (I’m always puzzled when someone who is adamant about not taking medication will ingest an uncontrolled, unregulated substance, however natural it may be. After all, poisonous mushrooms and hemlock are natural, too. But lethal.)

My position on medication is flexible. I’m more than happy to try a course of CBT sans meds if someone comes to me with that preference. The research suggests that CBT alone can be as effective as a combination of medication and CBT together in treating anxiety. and I’ve certainly seen many people benefit from CBT interventions without the help of a prescription. Medication alone, on the other hand, is not as effective. It may lessen discomfort, but it won’t resolve the patterns of avoidance people develop—and often become consumed by– to cope with their distress.

Here’s the rub. If anxiety is off the charts, a person (or dog) won’t be able to think clearly enough or stay in a triggering situation long enough for tolerance and habituation to take place. So medication can be very helpful in dialing down the arousal enough to facilitate the behavioral practice crucial for success.

I doubt animals feel stigmatized if they need to take Prozac (though their owners certainly might). But many humans I’ve worked with are ashamed, or see themselves as weak, if they can’t white-knuckle it through without the aid of a pill. Despite advances in modern neuroscience, culturally we’re still stuck in the last century when it comes to psychiatry, seeing mental disorders as failures of will or character flaws rather than disturbances of brain chemistry.

I personally have nothing to gain from recommending a course of medication. I can’t even prescribe it. But I believe in doing what works best—for people and for pets. And sometimes that means using all the tools we have at our disposal, including pharmacology, to make the process of coping more manageable.

[For the record, we did try Prozac with my late Golden Retriever Calvin, who suffered from separation anxiety and compulsive licking. Freddie hasn’t been on any medication because we’ve taken great pains to work with him behaviorally, and he’s responded to the training. In the interest of full disclosure, I confess to having been one of those owners who gravitated towards holistic remedies, such as DAP (dog-appeasing pheromone) and lavender spray. Sadly, none of them worked, so we’re back to plain old desensitization. And lots of dog treats.]

 

 

 

 

 

 

 

 

 

 

 

 




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The Best Technique to Manage Anxiety: Start Living!

By Lynne Gots, posted on October 13th, 2014.

DSC_4213When people come to me for help with anxiety, I explain to them why relaxation won’t be part of the treatment plan.  The typical response is often less than enthusiastic: “I don’t like feeling this way. Aren’t there techniques you can teach me so I can feel better?”

It’s understandable why someone with anxiety would want to alleviate the symptoms, which can be extremely uncomfortable–debilitating, even. But when avoidance is used to cope with the distressing feelings, the solution becomes the problem.

Avoidance is a natural response to a threatening situation, even if the threat is only a figment of a hyper-vigilant imagination. So if you’re given to worry or panic, you’re likely to steer clear of the places or events that set you off. Maybe you’ve stopped riding the Metro or declined career-advancing opportunities requiring public speaking or travel. Maybe you’ve stopped meeting friends for happy hour, taking vacations, or exercising (because you don’t want to risk elevating your heart rate). Maybe you’ve even put major life events–changing jobs, committing to a serious relationship, getting married, starting a family–on hold until you feel better.

You know you need to get your life back. But how?

The answer doesn’t involve a technique like relaxation. It requires a seismic mental shift: instead of moving away from anxiety, seek it out.

Scary, I know. And hard to execute, especially when you’ve gotten accustomed to organizing your actions around avoidance. But reclaiming all the activities you’ve relinquished in order not to rock the boat can be exhilarating.

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I’m not suggesting you go full-tilt at first like the hapless character depicted in this classic Far Side cartoon, using “Professor Gallagher’s controversial technique”  to overcome his fear of heights, snakes, and the dark by hanging from a high window in an enclosed chamber crawling with vipers. No need for total immersion (or “flooding,” as it’s called in behavior-therapy parlance). A gentler approach will work just as well–better, even–as long as you allow yourself to feel some discomfort.

If it’s too hard for you to execute such a plan on your own, consider enlisting the help of a cognitive-behavior therapist to help you bolster your resolve.

You have nothing to lose but your fear.

 

 

 

 

 

 

 




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It’s Just Behavior: You Don’t Need to Figure Out “Why” to Change Habits

By Lynne Gots, posted on May 7th, 2012.

On Saturday mornings I volunteer to assist my friend in the dog training classes she teaches. When the alarm goes off at 5:30 am, I always grumble and vow not to sign on for the next session. But in the end, I reenlist time and again, always forgetting how much I hate forgoing the luxury of sleeping in after a workweek of early risings.

Why do I opt for another commitment over sleep? Because it’s so much fun! Especially when we have a class full of puppies like the one we’re currently teaching.

Aside from the obvious too-cute-for-words factor, the puppies are great to work with because they haven’t yet built up a repertoire of annoying bad habits. They’re still very malleable. For the most part, their owners are, too (having already demonstrated their motivation with their willingness to bring their dogs to a 7:30 am class on a Saturday).

Training dogs is a lot like training people, except much simpler. Dogs don’t tend to analyze their actions. If a behavior, such as sitting on command, yields a good payoff, such as a piece of chicken, the dog will repeat it again and again.

Their owners, however, sometimes have trouble buying into this concept despite its scientific grounding in learning theory. We know positive reinforcement increases the frequency of a behavior. But the students in our dog training classes tend to be stingy with food rewards, often arguing that a “Good dog!” or a pat on the head (which animal behaviorists say dogs tolerate, but don’t enjoy) should be sufficient. Come to think of it, the parents of the teenagers I work with often feel the same way about giving their kids tangible rewards for behaviors they’re trying to cultivate.

I also like my dog classes because they give me a forum where I can freely express my opinions about hot-button issues. In my professional life, I try to remain neutral about treatment philosophies I find lacking. But on Saturdays I have free reign to voice my disapproval about theories of canine behavior I deem inappropriate or just plain wrong.

Take the outdated but still wildly popular concept of dominance. Despite its having been discredited by veterinary behaviorists, dominance theory is often invoked by traditional, compulsion-oriented dog trainers like Cesar Millan to justify unnecessarily harsh training methods designed to establish the owner as “alpha.” Even if punishments don’t physically harm a dog (as with the classic “leash pop” for disobedience), they don’t promote optimal conditions for learning. And interpreting an animal’s failure to respond to a command as a sign of insubordination often detracts from the thorough analysis of the problem needed for an effective solution.

If you believe the ultimate goal is to control your dog rather than teach it how to behave, you’ll get frustrated, maybe even angry, if a training exercise isn’t going your way. I saw this happen one day with a neighbor, who was trying to train her recently rescued Golden Retriever to sit squarely at her side when she stopped on their walk. (This position for the “automatic sit” is a requirement in the competitive obedience ring, and old school obedience classes still make it seem like a necessity for pet dogs, too.) Every time they came to a halt, the dog sat a foot in front of her owner, looking back expectantly.

Great, I thought. The Golden had bonded and was checking in, waiting to see what was expected next. But my neighbor was getting increasingly irritated. She kept jerking the leash to “correct” her dog for sitting in the wrong place. Eventually the animal stopped glancing back at her, probably having concluded that turning around was causing the unpleasant tugging sensation on her neck.

By way of explanation, the owner said to me, “She’s dominant. That’s why she’s sitting in front of me.”

Well, no. The dog sat in front because she’d never been taught the rules of the obedience ring. She didn’t know she was supposed to park herself next to her handler’s left leg with her nose in line with the knee. And with the training method my neighbor was using, the hapless dog wouldn’t be figuring out any time soon what she was supposed to be doing.

People often attribute their difficulties to hidden motivations when they’re trying to modify their own habits, too. In my experience, this tendency to search for supposedly unconscious obstacles to change (“I’m lazy,” or “I must really want to fail, deep down”) makes it harder to come up with effective solutions.

So if you’re trying to change your dog’s behavior, or your kid’s, or your own, remember, you’ll make much more progress if you ask “how?” instead of “why?” And, as I constantly remind the puppy owners: Don’t skimp on the rewards!




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This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.

Contact Dr. Gots

202-331-1566

2440 M Street, NW
Suite 710
Washington, DC 20037

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If you don't receive a response to an email from Dr. Gots in 48 hours, please call the office and leave a voicemail message.

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© 2008-2018 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.