Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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Working With Your Doctor to Manage Your Health Anxiety

By Lynne Gots, posted on October 28th, 2014.

Health, or “illness anxiety disorder,” as it has been newly termed in the latest Diagnostic and Statistical Manual of the American Psychiatric Association, can be a highly disruptive condition. For those who suffer from it, seeking medical attention can be an almost addictive process. Sometimes getting the advice of a medical professional can bring relief. But, more often, it opens the door to unnecessary diagnostic testing, an escalating need for reassurance, over attention to benign physical symptoms, and greater anxiety in the face of uncertainty.

In a post published today on the medical website, KevinMd, I’ve outlined some important guidelines for physicians to follow when treating a patient with health anxiety. Although I usually discourage people with health anxiety from using the Internet to diagnose themselves, I’d recommend you check out my suggestions if you think you might have Illness Anxiety Disorder. (It’s a credible source, unlike many of the ones you may be reading.) And, the next time you see your primary care physician, bring along a copy. With most health matters–and, especially so with health anxiety–collaboration is the best medicine.

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Posted in Anxiety, Cognitive-behavior Therapy, Health Anxiety |

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).


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 |

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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