Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

Toggle Menu

Contact Dr. Gots

202-331-1566

2440 M Street, NW
Suite 710
Washington, DC 20037

Email >

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.

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.

  1. 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.
  2. 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.
  3. 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.
  4. *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.
  5. 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.




Leave a comment


Tags: ,
Posted in Anxiety, General, Health Anxiety, Mental Health and the Media, Obsessive Compulsive Disorder |

Read between the Lines in Newspaper Reports about Mental Health

By Lynne Gots, posted on June 5th, 2018.

“Many People Taking Antidepressants Discover They Cannot Quit”

Does this headline concern you? If you read the accompanying article in the New York Times and you’re on medication for anxiety or depression, you might feel alarmed. And if you’ve decided to start a medication regimen, you might even change your mind.

The article reflects a bias many people still harbor towards mental health issues and medication: you should be able to deal with your problems by force of will; if you can’t just get on with it, you’re weak. As the Times article suggests, “Daily pill-popping leaves them doubting their own resilience…” Pill-popping? Seriously?

No medication is completely benign. Yet few would question taking drugs commonly prescribed for high blood pressure, seizures, muscle cramps, and infections, many of which can have discontinuation side effects. Clearly, a double standard applies to the pharmacological treatment of psychiatric conditions..

The writer acknowledges that “many, perhaps most, people stop the medications without significant trouble,” but then goes on to relate the personal anecdotes of a handful of individuals who attributed “all the symptoms of withdrawal,” including increased anxiety and insomnia, to medication discontinuation. He neglects to point out one of the most common reasons for deciding to go back on medications for anxiety and depression after trying to come off them: a resurgence of the symptoms being treated.

It’s true, as the article points out, that primary care physicians write the vast majority of prescriptions for antidepressant and antianxiety medications. Follow-up is not as rigorous as it should be, and office visits are typically too short for an adequate assessment of mood changes and side effects. But it’s very misleading to assume, as the writer does, that “a useless [my emphasis] prescription may be continued for years—or a lifetime” because “improvement…is based on the passage of time or placebo effect.”

I’m not in the pocket of Big Pharma. I can’t prescribe medication. I don’t get a kickback from my psychiatrist colleagues for referring patients to them. When someone in my practice expresses a preference for trying cognitive-behavioral therapy without medication, I’m more than happy to oblige—with the understanding that we’ll revisit the decision at a later date if the therapy yields less-than-optimal results.

I believe in helping people find the maximally effective treatment for them. If that means recommending a trial of medication, I’ll suggest a referral to a psychiatrist who can address their concerns fully, monitor them regularly, and work with me to provide the best care.

Medication isn’t a magic bullet. But it can be a powerful tool. Making any health care decision should involve weighing the costs and benefits–with the help of professional guidance and not anecdotal horror stories–to determine the course of treatment.




Leave a comment


Tags: , , , ,
Posted in Anxiety, Depression, Mental Health and the Media |

Robin Williams Reminds Us Depression is No Laughing Matter

By Lynne Gots, posted on August 13th, 2014.

The suicide of comedian Robin Williams this week has left us reeling. Whenever someone so successful takes his own life, we’re reminded that mental illness doesn’t discriminate. Even celebrities aren’t immune to its ravages. In fact, being rich and famous may even heighten a sense of despair for someone who seems to have it all.

On TV, in the newspapers, and online, commentators, journalists, and the general public are speculating about what led to Williams’ final expression of hopelessness. Almost certainly, they are wrong. Even those of us in the mental health profession can’t always say what pushes a person over the edge. And we definitely can’t draw any conclusions about the inner torment of someone we know only from his public persona.

Even so, ignorance hasn’t stopped many from weighing in with their opinions, as a Facebook post I saw this morning highlighted. It said,”Pharmaceutical companies are evil.”

I don’t even know where to begin. Is the poster suggesting Williams was taking psychotropic meds, which led to his death? Is she alluding to the Black Box warnings on some antidepressants about the potential side-effect of increased suicidal ideation (usually among teens and young adults)? The only thing we know for sure is that whatever treatment Williams was receiving, it failed.

I doubt similar accusations would be lobbed at Big Pharma if someone with uncontrolled hypertension were to die of a heart attack.

Misconceptions about medications used to treat depression unfortunately keep many people who could benefit from psychopharmacology from taking full advantage of the range of options available to them. I don’t know if Robin Williams was on antidepressants. But he was in and out of therapeutic programs over the years, both for depression and for alcohol and drug abuse. He suffered from a mental illness, and it ultimately killed him.

Let’s stop all the commentary by self-proclaimed experts and simply mourn the loss of a beloved entertainer who brought happiness to millions but couldn’t find it for himself.

 

 

 

 

 

 

 

 




Leave a comment


Tags: , , , ,
Posted in Depression, General, Mental Health and the Media |

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

Email >

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.

ADAA Clinical Fellow
Categories
Archives
© 2008-2020 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.