Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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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 |

Self-Help and Change: No Quick Fix

By Lynne Gots, posted on March 26th, 2012.

I’ve alluded in previous posts to the misleadingly reductionist methods promoted by self-transformation gurus. In a recent article on the science website Big Think, Jason Gots (Full Disclosure: he’s my nephew) makes a similar point about the process of personal growth. I hope my recent meditation chronicles have also shown that it takes hard work to eliminate bad habits, adopt better ones, and rewire the brain.

Even the research tested, cognitive-behavioral treatment protocols—which in countless studies have proven to ameliorate complex psychiatric syndromes, such as depression, obsessive-compulsive disorder, social anxiety, insomnia, and attention deficit disorder, to name just a few—have their limitations when it comes to real world applications.

Why? Because the manuals presume an ideal situation in which life and people don’t muddy the pure, scientifically controlled waters.

In reality—that is, in settings like my office where clinicians see real people with complex problems and complicated lives, not carefully screened research subjects who get eliminated from clinical trials if they don’t precisely fit the study criteria, miss appointments or fail to comply with the treatment regimen—change just isn’t as straightforward as the books would have us believe.

One of the challenges I face as a clinician is managing expectations. If, from the outset, I don’t help patients anticipate the difficulties they may encounter with the therapy (and sometimes even when I do), they may get frustrated and end the treatment before they’ve given it a fair chance. I partly blame the self-help movement on causing some people—particularly many of the perfectionists I see, who tend to view the process of change through an all-or-nothing lens—to give up too soon when the results they envision aren’t as immediately forthcoming as they’d hoped.

I don’t mean to sound overly pessimistic about personal growth. If I believed that modifying the ways we think and behave were unreasonable goals, I’d be in the wrong line of work. But expecting an instruction manual to magically transform your life without requiring you to make a long-term investment of time, energy, and honest self-reflection amounts to believing in, well, magic.

 

 




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Posted in Behavior Change, Mental Health and the Media, Perfectionism, Self-help |

Meditation Notebook: Days 6 and 7

By Lynne Gots, posted on March 24th, 2012.

I’ve meditated for five minutes a day, every day, for a week. That’s a total of thirty-five minutes of mindful breathing. Woohoo!

Maybe I should be expressing my pride in this accomplishment in a more restrained fashion, one more befitting the quiet, contemplative nature of the process. But if I’ve learned anything from dipping my toe in the waters of mindfulness, it’s that there is no right or wrong way to go about it.

On some days I felt jumpy and impatient. My mind wanted to review an earlier conversation or plan tomorrow’s dinner instead of attending to my inhalations and exhalations. On other days I felt tired and heavy-lidded. I’d like to say I also had Goldilocks days when it felt “just right,” but that didn’t happen.

Research has shown that regular meditation practice leads to changes in the brain structures associated with self-control, attention, and self-awareness. I’m all for giving my concentration and willpower a boost, so I plan to keep meditating, adding a few minutes to each practice every week, and hope that over time, I’ll improve my mindfulness skills. I’m going to have to wait before I decide whether it’s beneficial for me.

 




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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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