Lynne S. Gots, Ph.D.
Licensed Psychologist
Why You Should Avoid Avoidance if You Have Anxiety
By Lynne Gots, posted on March 7th, 2023.
If you struggle to cope with anxiety, I guarantee you have developed patterns of avoidance to minimize feelings of distress. The current prevalence of trigger warnings accompanying TV shows, live performances, and social media posts may make avoidance appear to be an appropriate strategy. But protecting yourself from potential triggering content or situations will only heighten your anxiety, make it harder to tolerate in the long run, and seriously affect your enjoyment of life.
I am not suggesting a head-first plunge from the high board into the deep end of the anxiety pool as a means of overcoming trauma or unpleasant feelings. You can start at the shallow end, dip a toe in, and then ease in slowly, if the gradual approach suits you better. Ultimately, though, you have to get wet.
Minimizing avoidance is the rationale behind Exposure and Response-Prevention treatment, the primary evidence-based behavioral treatment for OCD and other anxiety-driven syndromes. There is even a protocol called Prolonged Exposure used to treat PTSD symptoms stemming from serious traumatic events such as combat. Any type of exposure treatment involves seeking out triggers and learning to tolerate the discomfort they provoke (or, in the case of Prolonged Exposure for PTSD, reliving the trauma over and over by visualizing it repeatedly).
For debilitating anxiety or trauma, you should undertake exposure exercises only with the support and guidance of a qualified professional. But if you see yourself opting out of situations that simply make you uncomfortable, such as social events, driving, or even shopping at a different grocery store, you can find opportunities to push yourself toward the discomfort every day.
Whenever I catch myself finding excuses not to engage in an activity that makes me nervous, I try to practice what I preach and do it anyway.
In the fall I organized a group of neighbors to play Pickleball. We were all beginners, equally clumsy and clueless, and it was fun. But then an injury sidelined me. I didn’t play again for four months, until a few weeks ago, when I was invited to join a group of regular players. Most of them play daily. They are at a level far above mine, and they are very competitive.
Despite considerable trepidation, I forced myself to go. I was embarrassed by my lack of skill and felt myself transported back to middle school, when I was the last to be picked for the team in whatever sport we were playing. I am not exaggerating when I say I felt close to tears.
I really wanted to make an excuse never to return. Which is exactly why I forced myself to go back the next week, and then again a few days later.
I am still the weakest link but my skills have improved. More important, I am proud I didn’t let my feelings of awkwardness and discomfort get the better of me. I may or may not keep playing with the group, but if I choose to stop or look for other, less intense Pickleball partners, I can be confident I am not letting anxiety drive my decision.
So get out there. Force yourself to do whatever your anxious brain is telling you to avoid. Don’t let it boss you around. You will be glad you pushed back and stopped letting anxiety control you.
Tags: anxiety, behavior change, OCD
Posted in General |
How to Keep Your Anxiety from Spreading Like a Virus in the Face of COVID-19 [Updated]
By Lynne Gots, posted on March 7th, 2020.
The new Coronavirus outbreak has infiltrated our public consciousness, and it is exhausting. When the media are constantly bombarding us with updates about fatality counts and quarantines, even the most unflappable are finding it hard to stay calm. Everyone seems to be running to the nearest supermarket to stockpile disinfectant wipes, bottled water, and canned goods. So how are people with health anxiety and OCD—who are already prone to excessive worry about uncertainty, contamination, and illness— supposed to cope?
In treating anxiety, I use the evidence-based approach called Exposure/Response Prevention to help people tackle their fears and limit the compulsive behaviors, such as excessive washing, designed to make them feel less anxious about risk. But some of the practices my colleagues and I would typically recommend for someone with contamination worries, such as limiting hand-washing and avoiding the use of hand-sanitizer, fly in the face of current public health recommendations. Even so, if you keep in mind the rationale for exposure-based approaches to anxiety, which is to learn to tolerate discomfort and uncertainty, you can still come up with a personal plan allowing you to follow reasonable disease- prevention guidelines without letting your anxiety skyrocket and control your behavior.
- Take reasonable precautions.
Use only one source, such as the CDC, to create your “response-prevention plan,” or rules for practicing sensible health habits without giving into compulsions. Follow the plan you’ve made in advance so you don’t let anxiety dictate your behavior in the moment. - Less is better than more if you have OCD. For example, the CDC says “clean frequently…wash your hands often…for at least 20 seconds.” The words “frequently,” “often,” and, “at least” are ambiguous—and potential landmines for the OCD brain. Accepting uncertainty is a vital component of OCD treatment but, in this case, vague guidelines are not helpful. Decide you’ll wash your hands for 20 seconds, not 40 or 60 “just to be safe.” Don’t let anxiety make you doubt, second- guess, or modify the plan.
- Limit your consumption of the news and social media. You will be informed enough without knowing every detail about the outbreak. Decide which news outlets you will follow, how long you will spend reading them, and put yourself on a predetermined schedule for checking your sources. Don’t go down a rabbit hole seeking information. Unless you are on the frontline of the public health effort, you don’t need to know as much as the experts. And don’t look to random internet sources for preventative measures. According to a recent Washington Post column, Craig’s List is selling DIY Coronavirus vaccines. Which don’t exist.yet.
- *Don’t modify your activities just because you’re anxious. Unless your employer has implemented a mandatory telework policy, continue to go to work. Take your kids to the playground. Eat out if you normally enjoy going to restaurants. Spend time with friends. Shop at the supermarket. Get haircuts and manicures (sadly, many of my Chinese manicurist’s clients have been cancelling appointments out of misplaced fear). Of course, you should follow your response-prevention plan for washing when you are in public places where you are coming into contact with a lot of people. *See update below.
- Practice mindfulness and acceptance techniques. Whether you use meditation, yoga, prayer, or exercise, focusing your attention on the present moment, rather than ruminating about a catastrophic, uncertain future, can help you cope.
This is a challenging time for all of us. But we don’t need to make it worse than it already is by fueling our anxiety. If we practice responding to the uncertainty with reason and thoughtfulness rather than reacting out of panic, everyone will benefit.
Update: When I wrote this post only ten days ago, the coronavirus situation was very different from how it is now. The current national emergency mandates strict social-distancing practices, which make my advice to carry on normal activities no longer medically sound. or feasible.
I will be writing another post in the coming days with tips for staying sane while stuck in the house.
Tags: coronavirus anxiety, OCD
Posted in Anxiety, COVID-19 Mental Health, General, Health Anxiety, Mental Health and the Media, Obsessive Compulsive Disorder |
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.
Tags: acceptance, New Year's resolutions
Posted in Acceptance and Mindfulness, Behavior Change, General, Goals |
