Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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Why I Don’t Teach Relaxation Anymore

By Lynne Gots, posted on October 6th, 2014.

If you’re a worrier, you’ve probably heard more times than you can count, “You need to relax.”  And you’ve probably given yourself a mental smack on the forehead and thought, “Duh.”

Relaxation exercises in which you alternately tense and relax each muscle group in the body or breathe from the diaphragm to create a calming response used to be standard components of my clinical repertoire. But these days I almost never recommend them except to manage chronic pain (which is aggravated by muscle tension) or, on rare occasions, hyperventilation (which can be controlled with belly breathing).

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Although using relaxation to counteract anxiety and stress may seem intuitively to make sense, it almost always backfires. You can’t force yourself to relax, no matter how hard you try. In fact, trying to relax makes most people—especially those prone to tension—more stressed when they can’t achieve the mental calmness they’re seeking.  Not only is it hard to summon relaxation on demand; it’s also a particular challenge for tightly wound people to let go because the sensations of relaxation can feel alien and even unpleasant to someone who values feeling in control.

And there’s another reason I don’t teach relaxation.  Learning to tolerate negative emotions like anxiety is much more beneficial in the long run than trying to eliminate them.

So the next time some well-meaning friend or family member advises you to relax, you can respond with an enigmatic smile and say, “Actually, I’m trying to get more anxious.”

In my next post, I’ll tell you how.

 

 




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Posted in Anxiety, Behavior Change, Cognitive-behavior Therapy, Techniques |

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 |

Using a Competing Response to Break a Habit

By Lynne Gots, posted on March 18th, 2014.

Entertaining can be stressful for me—not because I worry about cooking an excellent meal or making the house look spotless but because our Australian Shepherd Freddie is a handful when strangers are on his turf. And to him, everyone except the very immediate family is a stranger with dubious intentions.

Recently our neighbors were over for dinner. As usual, Freddie barked. A lot. I gave him a bone to chew and sent him to his crate to quiet him. After awhile, he’d settled enough for me to let him out to lie by my feet at the table.

Dogs are very put off by direct eye contact. They find it threatening, especially if they’re fearful, like Freddie. So I always instruct visitors not to look at him.

But telling someone not to do something often has a paradoxical effect. Just think about the last time you told yourself not to eat dessert, or not to check your email, or not to send a text to someone you desperately want to hear from.

So of course as soon as I told my neighbor, “Don’t look at him!” he immediately turned and locked eyes with Freddie.

After the frenzied barking had subsided and Freddie had gone back to his bone, I was able to think clearly enough to realize my approach had been all wrong. Instead of saying, “Don’t look at Freddie” I should have said, “Look out the window” or even, “Close your eyes!”

The idea of replacing one action with another is a behaviorial strategy used to break habits. Substituting an undesired behavior (such as nail-biting, smoking, hair-pulling, or skin-picking) with a benign one is using a competing response to short-circuit the habit.

An effective competing response should be: 1) readily available, 2) inconspicuous, and 3) incompatible with the undesired behavior. For example, someone with trichotillomania (hair-pulling) might keep a fidget toy on the desk to use while working at the computer at home but might prefer to clench her fists to ride out the urge to pull at work. Or a smoker trying to quit might chew gum instead.

Trainers use competing behaviors all the time to stop dogs from barking and jumping up. When Freddie and I are out for a walk and see another dog across the street, I tell him to “Heel” and “Watch me” to divert his attention and keep him from going into overdrive. When he and Baxter greet me on my return from a day at the office, I throw toys for them to fetch so they won’t get muddy paw prints on my work clothes.

Come to think of it, I should try the “Watch me” command the next time we have company for dinner. Unaware I’m talking to the dog, the guests will look at me instead of making eye contact with Freddie. Problem solved.




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Posted in Dogs, Techniques |

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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