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 |

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 |

Social Anxiety: Exposure Exercises to Try at Home

By Lynne Gots, posted on March 8th, 2012.

In a cognitive therapy workshop I once attended, Dr. David Burns, author of the classic, The Feeling Good Handbook, described an exposure session he’d had with a patient he was treating for social anxiety.

They’d walked from his office at the University of Pennsylvania to the food trucks in front of the quad and plopped themselves down on the sidewalk, lying with arms outstretched and eyes closed in the middle of the throngs queuing up to buy lunch.

Such an act of brazen disregard for social convention would be very hard to execute—and not just for the person being treated. As much as I admire Dr. Burns’ chutzpah and creative flair, I could never emulate it.

The closest I’ve come to assisting with an exposure that posed the risk of police intervention occurred shortly after 9/11, when I accompanied a patient with a pigeon phobia to several places in DC where the birds like to roost. They particularly favor the roof of the Air and Space Museum on the National Mall, and thus we ended up there, staring and pointing skyward for long enough to arouse suspicion. Judging from how the guards were eyeing us, I’m guessing we looked liked snipers scoping out sight lines to the Capitol.

A good exposure exercise gets at the heart of a person’s fear.  While the situations will vary for different individuals, the core worry in social anxiety disorder, regardless of the circumstances triggering it, is of being scrutinized unfavorably by others and feeling embarrassed or humiliated.

Creating a public spectacle would be a very advanced exposure skill, and I wouldn’t recommend trying it on your own. But there are many less dramatic ways to challenge social anxiety in the comfort and privacy of your own home.

I’ve compiled a few examples from my clinical files. Hats off to the brave patients who came up with these ideas and were actually willing to try them!

  • Friend a casual acquaintance on Facebook
  • Accept a friend request from someone you don’t know well
  • Email a professor with a question about an assignment
  • “Like” a controversial topic on Facebook
  • Send an email without proofreading it
  • Send an email with an intentional misspelling or grammatical error
  • Post a comment anonymously
  • Post a comment using your real first name

Work your way through these exposures and you may, in time, find yourself standing to the left on a Metro escalator or, better yet, lying down on the platform during rush hour.  Just don’t ask me to join you.

 




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Posted in 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.

Contact Dr. Gots

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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.

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