Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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The Best Resolution for the Anxiety-Prone

By Lynne Gots, posted on January 20th, 2020.

It’s that time of year. New Year resolutions. Tips on motivation and habit change. Life hacks for cooking healthy meals, fitting in exercise, and taming the clutter.

If you’re looking for such advice, please check out other blogs or previous posts in my archives.  Today I will be talking only about the most important New Year’s goal to set for yourself if you struggle with anxiety.

 Do more exposures!

An essential component of evidence-based practices for OCD, social phobias, generalized anxiety, panic disorder, and even more common anxieties, such as fears of public speaking and flying, is Exposure and Response Prevention (ERP).  In brief, ERP involves putting yourself in a situation that spikes your anxiety while refraining from engaging in “safety behaviors” (eg, carrying a bottle of water or antianxiety medications “just in case”) or compulsions to make yourself less anxious.

Sound scary? Yes! But that’s the point.

Instead of avoiding your triggers, seek them out. Make yourself anxious. You don’t have to jump off the high dive to plunge yourself into the anxiety pool. If slow and steady is more your style, you can dip in just a toe, or a foot. But don’t avoid getting wet.

Here’s the good news. Unlike going to the gym or stocking up on healthy groceries, exposure practice doesn’t require you to carve out extra time in your already over-packed schedule. You can do exposures anywhere or anytime, even while you’re building those new habits, say, going to the gym or stocking up on healthy groceries. Just look for opportunities to get anxious; a little or a lot, it doesn’t matter.

Once you start to move towards these challenging situations, you’ll find it’s not as bad as imagined. You might even start looking for opportunities to face your fears: by approaching, rather than avoiding, your anxiety triggers, your world will open up.

Now wouldn’t that be an incredible way to enter the new year?

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Posted in Anxiety, Behavior Change, Obsessive Compulsive Disorder, Phobias, Social Anxiety Disorder, Techniques |

Don’t Let a Fear of Flying Ground You This Summer

By Lynne Gots, posted on July 12th, 2014.

DSC_0390In the last month, several fearful fliers I’ve worked with have successfully bought tickets, boarded planes, and arrived at their destinations without incident. Nobody went crazy, created a scene trying to get off a plane, or even white-knuckled it for the duration of the flight. All of them had avoided flying for years, making excuses for missing weddings and funerals and even turning down promotions if the new position would require travel.

I can’t say they loved their aviation experiences (varying in length from less than two hours to eighteen, involving layovers and connections). In fact, very few people actually enjoy air travel these days. Who would relish standing in long security lines, removing shoes and belts, being scanned by xray machines, cramming toiletries into tiny ziplock baggies, jostling for overhead storage space, and sitting thigh-to-thigh with sweaty strangers?

But we endure these indignities because we want to get places. Not being able to fly can be very limiting.

If you suffer from a flying phobia, you may worry about the plane’s safety even though you know the statistics: the probability of dying in a plane crash is much lower than the odds of suffering a fatal injury in an automobile accident. But the numbers probably don’t reassure you.

Many people who worry about flying aren’t even afraid of the risk. By far the majority of fearful fliers I see in my practice suffer from panic attacks, especially in situations where they feel trapped. So they’re terrified of becoming panicked aboard an aircraft where there’s no escape.

For those who’ve avoided flying for years, I often recommend they get a prescription from their primary care physician or psychiatrist for a short-acting medication for anxiety to take the edge off enough to get them on the plane. But other strategies can also make the flying experience easier.

Here are a few tips my patients have found helpful.

1)    PREP

Learn the facts about air travel and flight safety. Knowing that turbulence isn’t dangerous, for instance, can help ease qualms. You also can view plane interiors and flight videos online to familiarize yourself with the experience without actually having to get on a plane. One of my patients who recently flew all the way to Africa after a five-year hiatus from air travel discovered YouTube videos of the flight she would be taking. Watching it over and over allowed her to visualize the situation, feel the anxiety, and learn to work through it.


Most people who fear flying can replicate the dreaded physical sensations either by watching flight-related videos or by engaging in other activities they may find anxiety-provoking, such as riding the Metro or taking an elevator to the top of a tall building. Becoming familiar with the feelings and learning to tolerate them are important steps in the process of desentization.

3)    PACK

Avoid the last-minute jitters by packing early. Treat yourself with books you’ve wanted to read, make a playlist of favorite tunes, and download movies and TV shows on your tablet or computer. You might consider adding some guided relaxation audio files  as well. Remember you’ll  have to power off electronic devices during takeoff and landing—times when many people feel most anxious—so make sure you bring some reading material or crossword puzzles you can access nondigitally.

With preparation and practice, you nervous travelers can make it through a flight. But I can’t promise you’ll ever get used to the full body scan.




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Posted in Anxiety, Phobias |

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:


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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© 2008-2024 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.