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 |

Seeking Reassurance: an Often Unrecognized Compulsion

By Lynne Gots, posted on February 21st, 2014.

If you’re prone to anxiety, you know how shaky it can make you feel—not just physically (that’s why it’s called “the jitters”) but also emotionally. When you’re stuck in a cycle of worrying, you start to question everything.

One common way to respond to doubt is by looking for reassurance. A person with Obsessive Compulsive Disorder (OCD), for instance, may lock the door and then return again and again to check it, or jiggle the knob five, ten, or twenty times to make sure it’s secure. Or she may leave but mentally reenact her departure on her way to work to convince herself she turned the key and heard the latch click.

In the case of repetitive door-checking or any other ritual involving actions you can observe, it’s easy to see how seeking reassurance can become a disruptive compulsion. But other forms of compulsive reassurance-seeking are less obvious, though no less problematic.

Many reassurance rituals take place internally, as with the OCD-sufferer who tries to picture locking the door after she’s left the house. Mental compulsions also occur frequently with the so-called “repugnant” obsessions—fears of being a pedophile or a murderer, say. While such obsessions are an extremely common manifestation of OCD, people who experience them usually feel intensely ashamed and will go to great lengths to keep them hidden.

Incessant questioning is another typical reassurance ritual aimed at minimizing anxiety about uncertainty. It might take the form of constantly polling friends for their opinions about a romantic partner or repeatedly asking a colleague if the boss seemed annoyed when you were five minutes late for the staff meeting. The key words here are “constantly” and “repeatedly.” Asking for others’ opinions and feedback isn’t necessarily an unhealthy practice. But when the need for reassurance is driven by anxiety, getting someone else’s take on a situation is never enough to quell the doubt and the feelings of dread accompanying it.

In our age of infinite information access, it’s especially easy to indulge the urge to question. Have your friends gotten sick of telling you they think your girlfriend is cool? No problem. Just google “How do I know if my partner is right for me?” and you’ll find countless answers*.

[Caution: Don’t read this if you’re prone to relationship anxiety.] *My own search turned up, just for starters: 31 Ways to Know You’re In the Right Relationship,     10 Ways to Know if the Relationship is “Right,” Courage to Know When a Relationship is Not Right for You, Should I Break Up with My Boyfriend Quiz,  How to Determine if You’ve Found Your Soulmate, and I’m Not Sure If I Want to Break Up with My Boyfriend.

For people with health anxiety, looking for reassurance online can be a particularly compelling ritual. Worrying about that suspicious lump? Ask WebMd! There are even sites where you can send photos of whatever ails you to be evaluated by a real doctor. (But, to be clear, I’m not recommending it.)

It’s easy to fool yourself into thinking you’re only being thorough if you’re in the habit of doing endless research before making a major life decision or even just a minor purchase. But anxiety about a wrong choice is often the driving force behind such indecisiveness. For those perfectionistic types, selecting a course of graduate study might involve looking into countless degree programs; taking the GRE, LSAT, and GMAT to cover all the bases; comparing employment statistics for different careers; going on dozens of informational interviews; and asking friends and family for their recommendations and advice.

If you feel you need to know all the options before making a decision, even a low-risk commitment like buying a pair of rain boots might set off the process of exhaustive research and advice-seeking.

I can relate. Even though I usually can decide with only a little hesitation about where to stay on vacations and which kitchen appliances to buy, I’m less confident when it comes to interior decoration. I confess to having recently wasted an entire afternoon searching for an end table after having uncovered the “25 Best” online design sites and looking at all of them. And I still haven’t ordered any furniture.

Seeking reassurance, whether through compulsive checking, mental reviewing, or information gathering clearly can get in the way of decisive action. So how do you know if it’s a problem for you or just an occasional annoyance? I’ll explain in my next post.

 

 

 

 

 




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Posted in Anxiety, Health Anxiety, Obsessive Compulsive Disorder, Perfectionism |

Got Anxiety? News from the ADAA Conference

By Lynne Gots, posted on April 16th, 2012.

My brain hurts. It’s overstuffed with the supersized servings of research data and clinical strategies I devoured during four days at the annual meeting of the Anxiety Disorders Association of America (ADAA). Each day I studied the catalogue of courses to decide which to attend, salivating at the rich array of workshops. It was like surveying the dessert table at a fancy Bar Mitzvah. I ended up sampling as many offerings as I could fit into my schedule until the last day, when just opening the meeting planner made me feel queasy.

And speaking of queasy, I picked up some useful tips on how to make the ultimate fake vomit and supplement it with YouTube vomit videos to provide realistic visual and sound effects when doing exposure therapy for emetophobia (the surprisingly common fear of vomiting). There’s even a site where you can customize the appearance of bodily emissions by typing in different ingested foods, and one where you can weigh in on the relative grossness of a gallery of vomit pictures. Who knew?  And if this is grossing you out, I can also help you with your overactive disgust reaction, having attended a workshop on the topic.

We anxiety specialists have so much fun!

I’ve been thinking about how to distill the volumes of information about anxiety into one pithy sound bite (a recommendation from the ethics workshop I attended on psychology and the media). Here’s what I’ve come up with:

AVOID AVOIDANCE!

It has a nice ring to it, and it’s paradoxical to boot, which fits with the mindfulness training I participated in.

But, in truth, learning how to accept anxiety (rather than fearing it and pushing it away) is a key component of all anxiety treatments across the spectrum of evidence-based practices.

For example, pure behaviorists define avoidance as a negative reinforcer (escaping from the aversive, anxiety-inducing stimulus relieves anxiety, thus making avoidance behaviors more likely to occur). Cognitive therapists emphasize the role of avoidance in perpetuating thinking errors such as catastrophic predictions about the outcome of an anxiety-producing situation. And proponents of the mindfulness and acceptance approaches suggest that experiential avoidance—turning away from negative emotions—promotes an unhelpful, judging state of mind that adds to the pain of anxiety.

So, no matter what mechanism you invoke to explain it, avoidance makes anxiety worse.

This isn’t news to anybody who’s come to me for treatment. But learning about the latest research and clinical applications from the academic experts in the field has made me eager to try out some promising new techniques.

In the meantime, I need something to settle my brain—a mental antacid, so to speak. Catching up on the latest episode of Mad Men should do just fine.

 

 

 

 




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Posted in Acceptance and Mindfulness, Anxiety, Behavior Change, Generalized Anxiety Disorder, Health Anxiety, Obsessive Compulsive Disorder, Phobias, Self-help, Social Anxiety Disorder, 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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