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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The Best Resolution for the Anxiety-Prone

By Lynne Gots, posted on January 20th, 2020.

It’s that time of year. New Year resolutions. Tips on motivation and habit change. Life hacks for cooking healthy meals, fitting in exercise, and taming the clutter.

If you’re looking for such advice, please check out other blogs or previous posts in my archives.  Today I will be talking only about the most important New Year’s goal to set for yourself if you struggle with anxiety.

 Do more exposures!

An essential component of evidence-based practices for OCD, social phobias, generalized anxiety, panic disorder, and even more common anxieties, such as fears of public speaking and flying, is Exposure and Response Prevention (ERP).  In brief, ERP involves putting yourself in a situation that spikes your anxiety while refraining from engaging in “safety behaviors” (eg, carrying a bottle of water or antianxiety medications “just in case”) or compulsions to make yourself less anxious.

Sound scary? Yes! But that’s the point.

Instead of avoiding your triggers, seek them out. Make yourself anxious. You don’t have to jump off the high dive to plunge yourself into the anxiety pool. If slow and steady is more your style, you can dip in just a toe, or a foot. But don’t avoid getting wet.

Here’s the good news. Unlike going to the gym or stocking up on healthy groceries, exposure practice doesn’t require you to carve out extra time in your already over-packed schedule. You can do exposures anywhere or anytime, even while you’re building those new habits, say, going to the gym or stocking up on healthy groceries. Just look for opportunities to get anxious; a little or a lot, it doesn’t matter.

Once you start to move towards these challenging situations, you’ll find it’s not as bad as imagined. You might even start looking for opportunities to face your fears: by approaching, rather than avoiding, your anxiety triggers, your world will open up.

Now wouldn’t that be an incredible way to enter the new year?




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Posted in Anxiety, Behavior Change, Obsessive Compulsive Disorder, Phobias, Social Anxiety Disorder, Techniques |

How to Weather a Setback without Getting Discouraged: Understanding Trigger Stacking

By Lynne Gots, posted on March 9th, 2019.

I learned a new term this week:  “trigger-stacking.” I wasn’t attending a professional conference or catching up on my journals.  I heard the phrase from a veterinary behaviorist.

Six months ago we adopted Clifford, a three-year-old Australian Shepherd who had been a stray in rural New Jersey. Let’s just say the adjustment has been very rough.

During the three-hour drive from New Jersey, he draped himself across my lap, instantly claiming me as his ”person.” But he has what the Aussie rescue groups euphemistically call “a strong guardian instinct,” causing him to be overly protective of his turf, his food, his toys, and…me.  So from the moment he entered our house, he treated my husband as an enemy invader.

Whenever my husband crossed a threshold into a room I was in, Clifford launched a canine air-missile strike.  We began to feel under siege, on constant alert for the next attack.

Fast forward six months. Thankfully, through a combination of medication prescribed by the veterinary behaviorist and lots of counter-conditioning—which derives from the same learning principles underpinning the treatment approaches I use for anxiety—we now have a much more relaxed dog. I’ve stopped my Google searches for “Farms that Take Unadoptable Animals,” and Clifford has gradually been forming a tentative bond with my husband. We’re cautiously optimistic.

But because behavior modification isn’t linear, the aggressive displays we’ve been working so hard to eliminate will occasionally resurface.  And even though I should know better, I was disheartened one day last week to observe a spike in Clifford’s territorial barking along with his refusal to come back into the house after he went out in the yard while I was at work. He stood on the deck for two hours, nervously casting glances at my husband, who tried to lure him back inside with a smorgasbord of tasty treats. Even steak couldn’t entice him.

After reviewing the behavioral log I keep to remind myself of Clifford’s progress (a practice I heartily recommend, by the way, if you’re working on changing your own behavior), the cause of his regression became clear:  trigger-stacking.

I identified three major triggers, each of which individually heightened Clifford’s arousal and, cumulatively, pushed him over the edge: 1) A stressful visit to the vet for a vaccination the previous day; 2) Loud noises overhead while workmen repaired our roof; and 3) Repeated invasion of his territory while my husband walked in and out of his office moving books.

In hindsight, it makes perfect sense. But at the time, I had trouble convincing myself we weren’t back to square one.

When you experience an uptick in the anxiety or compulsive behaviors you’ve been working hard to manage, you might assume a setback means you haven’t made progress. Not so. A bad day at work, a fight with a partner, a sick child, a sleepless night—any one of those triggers might be manageable alone but in combination might just be too much to handle without reverting to the coping behaviors you’ve been trying to change.

So when you suffer a setback, don’t view it as a relapse. Instead, ask yourself if you’ve been facing more triggers than usual. Cut yourself some slack—but don’t make excuses to justify avoidance–by taking on lower intensity challenges, if necessary, to keep yourself from slipping back into old habits.

And, then, start back where you left off, as we did with Clifford. For a week, he continued to balk at coming inside whenever my husband let him out in the yard. But a few days ago, the sight of his leash brought him back in the house. And, for the first time, they walked around the block together.




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Posted in Behavior Change, Dogs |

New Year’s Resolutions: To Resolve or Not?

By Lynne Gots, posted on January 6th, 2019.

 

People have strong opinions about New Year’s resolutions, as I’ve been learning over the past week. In the one camp are the Resolution Deniers, who say that resolutions are stupid, pointless, and scientifically proven to fail. In the other are the diehard Resolution Proponents, who embrace the idea of wiping the slate clean and use the start of another year as a motivation to change their undisciplined ways.

Most Resolution Proponents choose two or three popular areas for improvement: diet, exercise, organization and time management. My own vaguely considered goals for the year—all of which I’ve already failed to meet—include:

  • Start a yoga practice. (Nope, not yet.)
  • Meditate in the morning. (Nope, still putting it off until too late at night to get the full benefits.)
  • Write a blog post at the start of each month. (Nope. It’s already January 6. Or does that count?)

But my modest attempts at self-betterment pale alongside those of a couple I met at a New Year’s Eve party last week. Together they had made 310 resolutions for 2019. How is it even possible to find so many personal habits in need of improvement?

They started off the year—and it wasn’t even midnight yet—quarrelling about how to fulfill one of the items on their list (which they had written down lest they forget any). The host, a potter, invited her guests to choose an item from her studio to take home with them so she could start making progress on one of her own resolutions for the year: to declutter. But despite the generous offer, the super-resolution couple couldn’t decide if they should take her up on it because it conflicted with their own decluttering goal. They finally reached an agreement: they would accept a vase but wouldn’t allow themselves to bring it into their house until they first got rid of something else.

I wholeheartedly endorse efforts to change. Modifying behavior is, after all, my stock in trade. But in the therapy I do, I also stress the importance of acceptance. Accepting yourself at any given point in time—new year or not—means acknowledging the reality of what is and using that as the starting point.

So if you haven’t exercised in the last six months, say, deciding to go to the gym for an hour a day would be a recipe for failure. When reality collides with unrealistic expectations, people who don’t allow for acceptance often just give up instead of modifying their goals to make them more realistic.

So go ahead and make those resolutions. Just try to work on them imperfectly. You know you’ll mess up. But you can start again, January 1st or not. If you practice acceptance, you’ll be giving yourself a better chance at achieving those three—or 310—resolutions you made for 2019.

 

 

 

 

 




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Posted in Acceptance and Mindfulness, Behavior Change, General, Goals |

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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