Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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Don’t Let a Fear of Flying Ground You This Summer

By Lynne Gots, posted on July 12th, 2014.

DSC_0390In the last month, several fearful fliers I’ve worked with have successfully bought tickets, boarded planes, and arrived at their destinations without incident. Nobody went crazy, created a scene trying to get off a plane, or even white-knuckled it for the duration of the flight. All of them had avoided flying for years, making excuses for missing weddings and funerals and even turning down promotions if the new position would require travel.

I can’t say they loved their aviation experiences (varying in length from less than two hours to eighteen, involving layovers and connections). In fact, very few people actually enjoy air travel these days. Who would relish standing in long security lines, removing shoes and belts, being scanned by xray machines, cramming toiletries into tiny ziplock baggies, jostling for overhead storage space, and sitting thigh-to-thigh with sweaty strangers?

But we endure these indignities because we want to get places. Not being able to fly can be very limiting.

If you suffer from a flying phobia, you may worry about the plane’s safety even though you know the statistics: the probability of dying in a plane crash is much lower than the odds of suffering a fatal injury in an automobile accident. But the numbers probably don’t reassure you.

Many people who worry about flying aren’t even afraid of the risk. By far the majority of fearful fliers I see in my practice suffer from panic attacks, especially in situations where they feel trapped. So they’re terrified of becoming panicked aboard an aircraft where there’s no escape.

For those who’ve avoided flying for years, I often recommend they get a prescription from their primary care physician or psychiatrist for a short-acting medication for anxiety to take the edge off enough to get them on the plane. But other strategies can also make the flying experience easier.

Here are a few tips my patients have found helpful.

1)    PREP

Learn the facts about air travel and flight safety. Knowing that turbulence isn’t dangerous, for instance, can help ease qualms. You also can view plane interiors and flight videos online to familiarize yourself with the experience without actually having to get on a plane. One of my patients who recently flew all the way to Africa after a five-year hiatus from air travel discovered YouTube videos of the flight she would be taking. Watching it over and over allowed her to visualize the situation, feel the anxiety, and learn to work through it.

2)    PRACTICE

Most people who fear flying can replicate the dreaded physical sensations either by watching flight-related videos or by engaging in other activities they may find anxiety-provoking, such as riding the Metro or taking an elevator to the top of a tall building. Becoming familiar with the feelings and learning to tolerate them are important steps in the process of desentization.

3)    PACK

Avoid the last-minute jitters by packing early. Treat yourself with books you’ve wanted to read, make a playlist of favorite tunes, and download movies and TV shows on your tablet or computer. You might consider adding some guided relaxation audio files  as well. Remember you’ll  have to power off electronic devices during takeoff and landing—times when many people feel most anxious—so make sure you bring some reading material or crossword puzzles you can access nondigitally.

With preparation and practice, you nervous travelers can make it through a flight. But I can’t promise you’ll ever get used to the full body scan.

 

 

 




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Posted in Anxiety, Phobias |

The Power of Paradox: to Change Negative Thinking, Say “Yes” When You Want to Say “No”

By Lynne Gots, posted on March 23rd, 2014.

Much of the advice I dispense daily in my clinical practice involves guiding people beset by negative thoughts and feelings to respond to emotional discomfort in counterintuitive ways.  Anxious? Approach your fears. Depressed? Get moving. Impulsive? Ride out your urges.

It all sounds rather simplistic. Yet changing behaviors in this fashion can improve your mood relatively quickly. Even more important, moving towards what feels scary or hard can help you build a protective core of confidence, making it easier to cope with the difficult times you’ll inevitably have to face in the future.

I won’t ask my patients to do anything I wouldn’t agree to do myself. Some of the “approach behaviors” I work on with them—touching a public toilet seat, say, or limiting themselves to only one glass of wine—don’t present personal challenges. But I certainly generate enough of my own worries to give me ample opportunity to practice what I preach.

Here’s an example: I just signed up for an eight-week course on Mindfulness-Based Stress Reduction (MBSR).

Silly that a program designed to reduce stress should significantly increase mine, right? But just thinking about it makes my mouth dry up and my heart beat faster.

I’d been looking for an opportunity to deepen my meditation practice for some time now. Periodically I’d google “Mindfulness Meditation in DC.” The Insight Meditation Community of Washington (IMCW) always came up. I’d pore over the course offerings and then reject them because the timing wasn’t right or the center’s Buddhist orientation made me uncomfortable.

I had many of the same automatic thoughts and a few new ones yesterday when I found the listing for an MBSR course given through the Insight Meditation Community starting in just two weeks. “Maybe everyone will be a Buddhist. I hope they don’t expect me to practice Buddhism.” “I won’t know what to do.” “Will there be chairs or cushions? Should I bring my own cushion?”  “Seven to nine-thirty on a Thursday night . . . I’ll be so tired after work, I won’t feel like going.” “I won’t have time to eat dinner and I’ll be starving.” “I won’t get home until after 10 and I’ll be so wound up I won’t be able to sleep.” “It might be lame, like that last mindfulness course I took.” “I might not be able to find parking.” “I won’t be able to walk the dogs or exercise on Thursdays.” “I don’t know what to wear. Should I wear yoga pants?” “I’’ll have to bring a change of clothes to work.” And even, embarrassing though it is to admit, “We’ll have to take off our shoes. I hope we can wear socks because I won’t have time to get a pedicure in the next two weeks.”

In the end, I recognized my reservations for what they were—excuses designed to avoid an unfamiliar situation causing me trepidation. I don’t like being a newbie, and this class raises all those old first-day-of-school insecurities (probably dating back to the start of kindergarten, when I wet my pants because I was too shy to ask my scary new teacher where the bathroom was and, humiliated, ran to hide in the coatroom when she asked the class who was responsible for the puddle on the floor).

So I did what I’d tell anyone else to do. I signed up.

To be continued . . .




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Posted in Acceptance and Mindfulness, Anxiety, Behavior Change, Cognitive-behavior Therapy, Depression, Obsessive Compulsive Disorder, Self-help, Techniques |

Seeking Reassurance or Just Being Thorough: How to Tell the Difference

By Lynne Gots, posted on March 10th, 2014.

My last post described the many ways the compulsion of seeking reassurance can interfere with decision-making and overall wellbeing. The differences between compulsively looking for validation and carefully weighing your options are easy to spot if you ask yourself the following questions.

  • Do you always have to ask other people for their opinions before you make a decision?
  • After making a decision, do you frequently second-guess yourself?
  • Do you change your mind often?
  • Does making a choice fill you with anxiety?
  • Do you worry about making mistakes?
  • Is the approval of your friends and family very important to you?
  • Does it take you a long time to make even a small purchase?
  • Do you know what you like when you see it?
  • When you buy an article of clothing, are you likely to return it after trying it on at home?
  • Do you think it’s irresponsible to make a decision without carefully researching it first?
  • In romantic relationships, do you often question whether your partner is right for you?
  • Do you ask for others’ opinions about your partner?
  • Would you call yourself indecisive?
  • Do other people get annoyed with you for asking so many questions?

This isn’t a scientific survey. But if you answered “yes” to many of these questions, you’re probably prone to seeking reassurance. A careful, deliberate person might do research and even ask for other’s opinions before making a decision but anxiety wouldn’t be the dominant emotion. And doubt wouldn’t typically accompany a choice as it often does with chronic reassurance-seekers.

After having read this, you may be tempted to ask the people close to you if they think you use them to provide reassurance. If so, don’t bother to pose the question. You already know the answer.




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Posted in Anxiety, Obsessive Compulsive Disorder, Perfectionism |

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.

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