Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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Why You Should Avoid Avoidance if You Have Anxiety

By Lynne Gots, posted on March 7th, 2023.

If you struggle to cope with anxiety, I guarantee you have developed patterns of avoidance to minimize feelings of distress. The current prevalence of trigger warnings accompanying TV shows, live performances, and social media posts may make avoidance appear to be an appropriate strategy. But protecting yourself from potential triggering content or situations will only heighten your anxiety, make it harder to tolerate in the long run, and seriously affect your enjoyment of life.

I am not suggesting a head-first plunge from the high board into the deep end of the anxiety pool as a means of overcoming trauma or unpleasant feelings. You can start at the shallow end, dip a toe in, and then ease in slowly, if the gradual approach suits you better. Ultimately, though, you have to get wet.

Minimizing avoidance is the rationale behind Exposure and Response-Prevention treatment, the primary evidence-based behavioral treatment for OCD and other anxiety-driven syndromes. There is even a protocol called Prolonged Exposure used to treat PTSD symptoms stemming from serious traumatic events such as combat. Any type of exposure treatment involves seeking out triggers and learning to tolerate the discomfort they provoke (or, in the case of Prolonged Exposure for PTSD, reliving the trauma over and over by visualizing it repeatedly).

For debilitating anxiety or trauma, you should undertake exposure exercises only with the support and guidance of a qualified professional.  But if you see yourself opting out of situations that simply make you uncomfortable, such as social events, driving, or even shopping at a different grocery store, you can find opportunities to push yourself toward the discomfort every day.

Whenever I catch myself finding excuses not to engage in an activity that makes me nervous, I try to practice what I preach and do it anyway. 

In the fall I organized a group of neighbors to play Pickleball. We were all beginners, equally clumsy and clueless, and it was fun. But then an injury sidelined me. I didn’t play again for four months, until a few weeks ago, when I was invited to join a group of regular players. Most of them play daily. They are at a level far above mine, and they are very competitive.

Despite considerable trepidation, I forced myself to go. I was embarrassed by my lack of skill and felt myself transported back to middle school, when I was the last to be picked for the team in whatever sport we were playing. I am not exaggerating when I say I felt close to tears.

I really wanted to make an excuse never to return. Which is exactly why I forced myself to go back the next week, and then again a few days later.

I am still the weakest link but my skills have improved. More important, I am proud I didn’t let my feelings of awkwardness and discomfort get the better of me. I may or may not keep playing with the group, but if I choose to stop or look for other, less intense Pickleball partners, I can be confident I am not letting anxiety drive my decision.

So get out there. Force yourself to do whatever your anxious brain is telling you to avoid. Don’t let it boss you around. You will be glad you pushed back and stopped letting anxiety control you.




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Reframing Emotions

By Lynne Gots, posted on April 12th, 2022.

One of the foundations of Cognitive Behavior Therapy is that our thoughts affect our emotions. And much of what we think, even if we strongly believe our assumptions, may not be true.

Anger is one of many emotions fueled by our thoughts about the behavior of others. The stories we create in our minds may be complete fictions, but we rarely stop to consider alternate interpretations.

If someone cuts you off in traffic, say, how do you react? I doubt the first thing that comes to mind would be: “Oh, she must rushing to the ER because the police just called to say her teenager was hit by a car while crossing the street on the way to school.” More likely, you would be thinking, “ What an inconsiderate !!@**” Neither thought is truer than the other, yet your emotional response to each would likely be completely different.

Considering a possible backstory can be a powerful way to defuse a highly charged, negative emotional reaction. 

I recently had the opportunity to experience such a change in perspective when I learned some new information about my dog Roland, a three-year-old Labrador Retriever we adopted when he was just one. He had spent the first year of his life as an outside dog in rural Louisiana, so kitchen appliances, stairs, and traffic all provoked frenzied barking and mouthing, drawing blood or ripping clothing if an arm or leg was in close proximity. He also came to us with multiple medical problems and partial blindness, all of which contributed to his arousal.

Fast forward two years later, and Roland is much calmer. A model dog, almost. I no longer have bruises and scabs on my arms and legs, and most of the time, I can cook dinner without having to endure an hour of ear-splitting barking. But one behavior I have not been successful in training out of him is food thievery. Even though we try to be careful not to leave food within reach on the kitchen counter, he has managed to snag a bowlful of rising pizza dough (resulting in an expensive trip to the ER), a piece of raisin (a potential toxin to dogs) bread, and hunks of imported Parmigianino Reggiano from the fridge.

I used to get angry and—I am embarrassed to admit this because I consider myself a “positive trainer” who does not believe punishment changes the behavior of animals or people—shout at Roland. But a few weeks ago I learned something that has made it easier for me to remain calm, or at least calmer, when he misbehaves.

Through some Facebook sleuthing, I tracked down the breeder who owns his parents. She told me he was the runt of the litter. His mother rejected him, and he had to be hand-fed to get enough milk. Poor puppy! Any irritation I had felt towards him melted away, replaced by sadness and compassion.

Everyone has a backstory–maybe not as compelling as Roland’s but still deserving of consideration. So, before jumping to conclusions about a person’s character when an interaction upsets you, try stepping back and observing your reactions without judging.  Even if your anger persists, you may avert a response you will later regret.

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Posted in Cognitive-behavior Therapy, Dogs |

News You Can Use: Small Actions Can Boost Your Mood

By Lynne Gots, posted on January 10th, 2015.

If winter is getting you down, consider putting a spring in your step—literally—to feel more energetic and happier.

It’s not hard to recognize people who are sad or depressed from the way they carry themselves: slumped shoulders, lowered gaze, downturned mouth, and shuffling gait. Happy people, in contrast, stand up straighter, make eye contact, smile, swing their arms, and bounce along at a brisk pace.

Short days and post-holiday doldrums can take their emotional toll; temperatures in the single digits may worsen the seasonal blues by limiting our exposure to sunlight and causing us, when we do brave the elements and venture outside, to bow our heads, hunker down against the cold, and pull our arms in tightly against our chests.

Posture, it turns out, can affect mood. The results of some recent research point to a connection between how we walk and how we feel.

In one study, undergraduates (who, due to their ready availability and incentives to participate, are the most commonly tested subjects in psychology experiments) were told to attempt to move a gauge as they walked on a treadmill. For one group, the gauge moved when they bounced along at a fast, “happy” clip; for the other, the gauge responded to a slowed, “depressed” pace.”

After being given a list of 40 words—half negative, such as “ugly” and half positive, such as “happy”—the subjects in the depressed group recalled more of the negative words. Another study by the same research team, which used people actually suffering from depression rather than randomly selected undergraduates, produced similar results when half the participants were told to slump. Subjects instructed to sit upright recalled fewer negative words.

Although more research with larger samples (each of the above studies tested fewer than 40 subjects) would be required to draw any broad conclusions, the results make intuitive sense. They also lend support to the framework underlying cognitive-behavioral therapy: making even small changes in behavior can help alter moods.

If walking isn’t an option–say you’re sitting at your desk and feeling in a funk with a deadline looming–try smiling.  The act of putting on a happy face can activate neural pathways to boost serotonin and dopamine, two of the neurotransmitters targeted by most antidepressant medications.

To be clear, none of these microphysical adjustments will cure a serious case of depression. If you suffer from more severe, intractable mood problems, please seek professional intervention. But for the garden variety blahs so common this time of year, why not try walking happy? It just might help.

 

 

 

 

 

 

 

 

 

 

 




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Posted in Cognitive-behavior Therapy, Depression, 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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