Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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202-331-1566

2440 M Street, NW
Suite 710
Washington, DC 20037

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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 |

Seeing Anxiety as an Opportunity Instead of a Threat

By Lynne Gots, posted on August 22nd, 2017.

My newly rescued terrier Dewey is, in almost all ways, an excellent dog. He’s energetic, inquisitive, friendly, and affectionate. But when we’re out walking and he spies another dog, he turns into a whirling, barking Tasmanian Devil. Luckily he weighs only eighteen pounds—any bigger and he’d knock me off my feet. Still, the prospect of a surprise canine encounter made me dread our daily outings.

So I signed up for a Distracted Dog class. I already had been working on undoing some of the bad habits Dewey had acquired over the seven years of his life before coming to us. He’s learning how to wait for his food, lie down instead of jumping up and begging, and walk on a leash without pulling. The challenge now is to keep his attention on me in more stressful situations.

Before the first day of class, our instructor asked us to send her a hierarchy of our dog’s top five distractions, much like the hierarchy of anxiety triggers used in CBT for exposure and response prevention. At the top of Dewey’s list was “seeing another dog approach while on a walk.”

In treating anxiety, I help people stop avoiding and start approaching what they most fear. I needed to apply the same mindset to changing my dog’s (and my own) reactions to the stimuli that send him into a frenzied display of doggie frustration.

So, instead of anxiously scanning the environment for other dogs in order to do an about face before Dewey spots them, I’ve started looking for ways to practice building his self-control. As a result, I’ve observed a dramatic change in my own (if not yet Dewey’s) emotional reaction. I’m excited instead of tense when I see neighbors out walking their dogs. I now interpret a potential trigger not as a threat to steer clear of but as an opportunity to seek out.

If I were drawing only from my personal experience, my method wouldn’t carry much weight. But the results of several research studies support my anecdotal evidence. Saying, “I feel excited” instead of attributing physical arousal to anxiety—a technique called “anxious reappraisal”—can improve singing, test-taking, and public speaking performance by putting people in an “opportunity mindset” even though the physiological markers of anxiety such as increased heart rate and cortisol levels remain elevated.

In fact, you don’t even need to tell yourself you’re excited; just believing that anxiety can improve rather than impair performance helped test takers score higher on the GRE. It’s a trick actors often use to cope with stage fright. Those who are successful don’t necessarily feel less nervous. But they’re able to view the fluttering of their hearts and rumbling of their stomachs as feelings that give energy to their performance.

Confronting anxiety is hard. You can’t make progress unless you’re willing to face the situations you fear. But changing the way you think about arousal might make it a little easier to rise to the challenge.




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Posted in Anxiety, Dogs |

Using Mindfulness to Face Your Fears

By Lynne Gots, posted on March 19th, 2016.

One of the most frequent questions I hear from people considering CBT is: “Can you help me get rid of my anxiety?”

I wish I could answer with an unqualified “Yes!” But I’m a psychologist, not a purveyor of snake oil, and professional ethics require me to set reasonable expectations for treatment.

Wiping out anxiety completely isn’t a realistic therapeutic goal. It’s also not in anyone’s best interest to aim for total mental control. Like it or not, anxiety—whether a hard-wired physical response to an objective threat or the product of an over-active imagination—plays an important role in everyone’s emotional repertoire. So we all need to negotiate a peaceful coexistence with it.

A few weeks ago I had the chance to test out my own advice about meeting fears head on. I was at the highest point in LA’s Runyon Canyon enjoying the vista of the city spread out beneath me and the Hollywood sign in the distance on a perfect Southern California day. I sat on a rock soaking up the warmth of the sun and giving the experience my full, mindful attention. Then I started on the descent.

That’s when the panic gripped me.

Heights have always made me nervous, and I’ve never liked hiking downhill. But this time I wasn’t just cautiously inching my way down the slope in my typical fashion. I froze completely. My heart pounded. My mouth dried up. I felt dizzy. I couldn’t figure out how to put one foot in front of the other.

The steep dirt path littered with jagged rocks made my anxious brain conjure up images of slipping and plunging forward and cracking open my head and lying in a pool of blood. Not likely. But it could happen.

Oh, wait! It had happened —just a few months earlier, on a perfectly flat walk only two blocks from my house when I tripped on an uneven patch of sidewalk and landed in the emergency room.

OK, so my fears weren’t entirely irrational (an argument I hear frequently from people with anxiety reluctant to approach triggering situations). But, still, I had to make my way down the mountain.

So I decided to recruit the mindfulness skills I’d just been practicing. I didn’t try to relax. I didn’t tell myself I had nothing to worry about (because, really, how could I possibly reassure myself given the evidence to the contrary?). I didn’t try to push away the gory images. I didn’t attempt to slide down on my butt crab-style, a technique I’ve employed in the past to navigate precipices. I didn’t try to take a calming breath or grab onto my husband’s arm for support (not a viable option anyway because he was focused on his own worries about slipping and dropping his camera).

What did I do? I gave myself permission to be scared. I decided not to care about how slowly I was going and made room for the faster hikers to pass me. I looked down at the path in front of me. I concentrated on finding a place to plant my foot and took a step. Then another. And another. Until I finally reached the bottom.

And the next day, I went back and climbed to the top again. The view was breathtaking

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Posted in Acceptance and Mindfulness, Anxiety |

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

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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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