Author: Leaman Ralph

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Hey there everybody and welcome to this episode  of the week by week guide to depression treatment   this is part 1 of 14 and i’m  your host dr dawn elise snipes   in this series i’m going to explore one potential  treatment path for somebody with depression  
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depression looks different for each and  every person so no one treatment path   will look exactly the same but this gives you a  general idea of what treatment might look like   this particular video explores what  the initial session will look like
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as a helpful hint over the next few  weeks i will be going over a lot of   stuff for more in-depth information  about particular techniques or issues   in-depth videos can be found on the youtube  channel at doc snipes dot com slash youtube
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the first thing that i do when people come into  treatment is you know get to know them and then   we start talking about what their symptoms are i  typically don’t get too hung up on the dsm or the   diagnostic criteria because depression may look  different for every person and there are a lot  
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of symptoms that occur with depression that are  not in the diagnostic manual so i start by asking   for each symptom the person has when it started  is it something that started a week ago or three   years ago what was different before it started  what do they think causes it what makes it worse  
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and what makes it better even if just a little bit  or for a short period of time this will give us an   idea about potential causes of the symptom about  potential things that the person already does or   skills they already have that we can build on and  about things the person knows already don’t work  
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i also encourage them to watch the video what  causes that symptom on the youtube channel   to learn more about what causes each of the  symptoms that we’re going to start talking about physically when somebody is depressed  they may experience sleep disturbances  
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likewise people who don’t sleep  well often develop depression   many of these symptoms can either cause depression  or be caused by depression and it’s important to   understand that and recognize the reciprocal  nature eating disturbances are another issue  
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that come up sometimes people have no appetite  sometimes all they want to do is eat junk food   and that kind of makes sense because when we  are under stress sometimes our body says you   know what now’s not the time to eat we need to  worry about fighting or fleeing not resting and  
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digesting other times our body is experiencing  imbalances in neurotransmitters and foods we eat   that are high fat high sugar foods tend to  cause the release of dopamine and serotonin   and endorphins which are feel-good chemicals i  always look at what is the behavior telling me  
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another symptom is gi distress some  people may experience constipation when   people get depressed it’s often a  slowing of their whole system including   their gut so we want to look at constipation and  pain pain in the gut can be made worse because of  
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changes in the gut bacteria because of the  depression or because of what they’re eating   and generally pain can be made  worse when people are depressed   because when we’re depressed our pain tolerance  actually often goes down things that may have been  
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not painful or not you know notable before they  were depressed now are are painful to them we want   to recognize that that actually is a legit symptom  of changes in in neurochemicals in the person   when people are depressed they often don’t move a  lot and they often sleep a lot more which can also  
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contribute to muscle imbalances and pain so we’re  going to talk about pain because pain also can   cause depression low energy can be caused by sleep  disturbances poor nutrition or chronic pain or a   lot of other things and we want to recognize that  when we have low energy it’s hard to get motivated  
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it’s hard to feel like you’ve got any  get up and go which can contribute to   feeling depressed you know you just you want to  sit on the sofa all the time different than low   energy which is just not having the energy not  having the gas to go is slowing and that is like  
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moving into a 60 mile an hour wind when people  are depressed it often feels like it takes 10   times more energy to move to walk to take a shower  than it did when they weren’t depressed addiction   also often comes up because when people are  depressed they often try to self-medicate in some  
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way and make it go away this can be behavioral  addictions like shopping or gaming it can gambling   it can be chemical addictions it can you know  and in there we’re also including nicotine   so addictions may get worse addictions also alter  the neuro chemical levels or the brain chemicals  
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which can contribute to mood symptoms impulsive  behaviors some people don’t have enough energy   to even think about it other people occasionally  have these little spurts of energy and they engage   in risk-taking behaviors or impulsive behaviors in  order to feel something you know that’s the brief  
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moment where they have this adrenaline rush and  they’re like oh my gosh that’s incredible and   immunity when your immune system goes haywire  it can contribute to systemic inflammation   people who have autoimmune disorders are well  aware of this but any time your immune system is  
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triggered it can trigger associated inflammation  that inflammation has also been associated   with an increase in depressive symptoms  likewise depression and stress can trigger   an increase in inflammatory cytokines in the  body and an increase in immunity in inflammation  
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all of these symptoms have a back and forth   affectively well of course the person  is presenting for depression so they’re   depressed they may also experience apathy or low  motivation they just they don’t really care about  
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much of anything or what we call anhedonia and  that’s feeling numb not feeling super depressed   not feeling you know super happy super anxious  just not feeling guilt anger and anxiety are also   very prominent symptoms in people with depression  and in treatment if somebody’s experiencing these  
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things we talk about what’s triggering them  and will process some of those issues but right   now we’re just trying to get a picture of what  depression looks like for the person cognitively   or mentally people who are depressed often have  difficulty making decisions and thinking clearly  
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now this can be caused by insufficient sleep poor  nutrition depression itself a variety of things   but these things also make it harder to do  your daily activities which can contribute   to feeling hopeless helpless and depressed  pessimism can cause depression if you’ve  
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always been sort of a negative nelly then that  can contribute to feeling helpless and hopeless   a lot of times when people are depressed  though they can start feeling more pessimistic   because when they’re depressed they notice  more of the negative stuff they notice more  
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of the stuff that’s out of their control and  it can contribute to feelings of depression   ruminations a lot of times  when people are depressed   they have thoughts that bounce around in  their head and you know there’s a lot of  
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reasons for this but what’s important to  recognize is those thoughts are generally   critical negative pessimistic and they tend to  be very overwhelming and loud that negative inner   critic or that those hecklers in your gallery  tend to be a lot louder when when you’re depressed  
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environmentally i found that for a lot of people  they’re outside represents what’s going on on   their inside so if they’re disorganized or  disheveled that gives me a clue that that   that may be how they’re feeling inside because  of all the things that we’ve talked about already  
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people may be experiencing difficulty at school  or work and resulting financial difficulties   difficulty in these areas contributes to stress  and distress and often worsens depression   relationally people who are depressed often  withdraw from others they can’t take the input  
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from other people they don’t have the energy to  deal with their own stuff let alone anybody else’s   stuff they may withdraw from others because other  people may try to cheer them up which makes them   feel rejected or misunderstood or other people  may withdraw from them because they just can’t  
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take being around somebody who’s so depressed  they may experience impatience or irritability   again because they are overwhelmed when people  bring stuff to them when when life happens it   can feel overwhelming and it can trigger that  fight-or-flight response low self-esteem is very  
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common in depression a lot of times because of  the depression the person is not doing the things   they think they should or the way they used to  and it makes them feel bad about themself now   people with low self-esteem from long ago can also  develop depression partly as a result of that so  
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yin and yang toxic relationships  also tend to cause depression and may   flourish when somebody is depressed  because people who are depressed may   tolerate toxic behavior more because they  just don’t have the energy to address it
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once we’ve identified what each symptom looks  like for that person when it’s started what   makes it better what makes it worse etc then  we’re going to identify what recovery from each   symptom looks like and for a lot of things when  we talk about psychology we use what’s called  
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a likert scale and an anchored likert scale has  words that go along with each point on the scale   so for somebody’s mood one may be miserable two  may be okay three is happy four is really excited   and five is unbelievably ecstatic we don’t expect  them to get to five a whole lot but that gives  
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us an idea of where we are starting so people can  rank their moods or rank the behavior on a regular   basis so we can track its progress we will work to  define goals for people’s symptoms that are smart   specific measurable achievable rewarding and time  limited for example i will have more energy as  
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evidenced by being able to work out go to work and  do at least 90 percent of my normal adulting tasks   without getting completely worn out or feeling  weighed down now this is a goal the person is   setting for three months from now not for next  week this is ultimately where they want to be  
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i will sleep better as evidenced by getting at  least seven solid hours of quality sleep each   night i will get motivation back as evidenced  by doing the things that i need and want to do   most days it’s important with goals not to  set extreme goals that are a hundred percent  
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of the time because generally we can’t  do things a hundred percent of the time   so if you set a goal that’s like that then  you’re setting yourself up for failure the next thing i do in this first session  with the person is create a support  
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plan change causes crisis and crisis causes change  it doesn’t matter what the change is it can be a   positive change like getting healthier or bringing  a new baby to the into the family but that causes   changes which can be stressful it may not be like  an overwhelming crisis but it can be stressful  
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change takes a lot of energy and work and i  encourage the people that i work with to recognize   that they’re going to need at least 15 minutes in  the morning 15 minutes of the evening and about   30 sometimes 60 minutes some other time during  the day so when they get up at lunch time and  
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before they go to bed possibly that’s not a huge  time commitment but people who are depressed have   very little energy so this still feels like a  lot we talk about what things can you eliminate   or simplify to free up time and energy for  this change and that may mean things like  
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preparing meals ahead of time or getting  pre-prepared meals for a little while   so you don’t have the dishes and you  don’t have the prep time and all that   stuff so you have more time you can  focus on working your recovery plan  
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how can you alter your environment to stay  motivated and remind you to use your new skills   for change there are a lot of new behaviors  and habits that i ask people to do and those   behaviors and habits can be programmed into your  your mobile device you can get an app that people  
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often use for medication and get push  notifications for things like meditation   then i ask them to think about who in in your  life is supportive and how can they help you and   how will you let them know about plans and what  you need from them don’t expect them to read  
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your mind and know that you need them to do extra  work around the house or help you watch the kids   or something else it’s important to articulate  to other people what they can do to help   it’s also important for the people to identify  what they can do to help themselves feel safe  
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in general feel safe when they’re triggered and  feel safe so they can work on their assignments   so they’re not afraid of becoming overwhelmed or  spiraling and then they’re asked to identify three   strategies they can use to cope when they begin  to spiral when people are experiencing depression  
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you don’t expect them to start treatment and never  have another spiraling episode and i believe it’s   important to create this safety support plan ahead  of time to help people feel empowered so they have   tools at their disposal that can help them endure  what’s going on it’s not going to necessarily make  
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them feel wonderful but it helps them endure it  so they feel safe they don’t feel like they’re   going to be completely overwhelmed the next thing  we do is talk about which two or three symptoms do   you want to focus on changing first because when  you make positive changes in any area of your life  
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it often makes reciprocal positive changes in  other areas and you can really only effectively   focus on two or three things at a time we will  talk about how we’re going to measure that whether   we’re going to measure the frequency how often  each occurs how long particular episodes last or  
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the intensity or quality of each again on one  of those like likert scales and each time the   behavior or or symptom occurs the person  is also going to know what triggered it   what helped stop it if anything and what did  not help so we continue to get information about  
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what is helping what doesn’t work what  triggers it so we can address those in session another thing i ask them to do  is a feelings awareness worksheet   now this is something they’re going to do  between sessions in order to start identifying  
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early warning signs of distress so they may be  able to take action sooner than waiting until   it’s a big crisis you know waiting till  it hits them from quote out of the blue   i ask people to identify what particular feelings  look like for them and what triggers that feeling  
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what thoughts what activities what people  and even what sensations like what sounds   my the ceiling fan over my bed makes an awful  humming sound and it annoys the crap out of me   and that can trigger my irritation so i know that  that’s a sound that will trigger irritability  
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in me and i encourage them to look  at and identify what anger anxiety   depression and happiness look like for  them and what triggers those emotions another thing they’re going to start doing  beginning tomorrow you know beginning the  
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day after this session is morning and evening  mindfulness and this is the 15 minutes in the   morning and 15 minutes in the evening in the  morning they’re asked to inhale for a count of   four envisioning energy and light filling their  body hold it for a count of four and feel that  
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energy spread and then exhale for a count of  four and envision fatigue darkness and brain fog   leaving their body on their breath you know they  can even envision their breath coming out a color   that represents fatigue repeat this four times  in the morning this deep breathing helps increase  
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oxygen and get people get people going  so to speak after they do this they will   do their mindfulness inventory and it seems long  on these slides but it really only takes about 10   minutes they’ll think how do i feel physically  what are my needs physically right now  
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what things might make me more vulnerable to  emotional distress today what physical things do   i have going on that might make me cranky or more  prone to be irritable and how can i cope with them   was it easier hard to fall  asleep how well did i sleep  
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how many hours did i sleep do i feel rested if i  woke up a lot why what will i do beginning today   to address anything that is waking me up  in the night if i did not sleep well how   does that impact my energy concentration  productivity mood and patience with others  
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affectively or emotionally and cognitively or  mentally how do i feel am i happy and clear-headed   or depressed and foggy-headed or something in  between what are my needs what might make me more   vulnerable to distress today if you wake up in the  morning and you’re just in a you know awful mood  
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you know that you know that you’re already kind of  at your precipice and it’s not going to take much   to trigger irritability so what can you do to cope  during your day so when life happens it doesn’t   bring on extra distress and you don’t spiral  environmentally what are three positive things  
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in my environment right now what things might come  into my environment today that cause me distress   and how can i best deal with them planning ahead  for any obstacles that you might have encounter   relationally how do i feel about myself what  relationships do i have that enhance my life  
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and this can include your pets what can  i do to nurture them what relationships   might trigger or make me more vulnerable to  distress today and how can i best cope with them   so if you know you’ve got to interact with  a person at work that typically gets on  
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your very last nerve how can you best cope  with this so it doesn’t cause extra distress   in the evening you’re going to do deep breathing  again but this time inhale for a count of four   envisioning cool blue entering  your body and helping you relax  
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hold for a count of four and feel that soothing  feeling spread then exhale for a count of four   envisioning stress darkness and irritability  leaving your body on your breath if you’ve   got kids in the house this can be a fun activity  to do with them and everybody gets bubble stuff  
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and you try try to see who  can blow the biggest bubble   in order to blow a single big bubble you have  to exhale a lot of breath very very slowly in the evening the questions are a little bit  different again physically how do i feel and  
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what are my needs what things made me more  vulnerable to distress today so you’re doing   a look back how well did i cope with them is  there something i will do differently next time   affectively and cognitively how do i feel you  know emotionally and mentally what are my needs  
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what would make me happy right now how well did  i cope with my feelings today how good was my   concentration and is there something different  i will do tomorrow to improve the moment environmentally what are three positive  things in my environment right now  
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what things came into my environment today that  caused me distress how well did i cope with them   is there something different i will do next time  and finally relationally what are three things   i did well today this plays on your relationship  with self or your self-esteem what relationships  
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do i have that enhance my life remember those  pets again and what can i do to nurture them i also ask people to get a physical because  there are a lot of physiological things   like low testosterone estrogen imbalances  hypothyroid anemia low vitamin d you know there  
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are a lot of things that have relatively simple  fixes that can contribute to depressive symptoms   and no amount of talk therapy is going to address  those things i ask people to schedule their   physical as soon as possible so that we will have  the results including the blood work back by week  
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six i encourage them to make sure that they get  their blood pressure and their oxygen saturation   evaluated vitamin d and b12 levels liver  and kidney functioning their sex hormones   gonadal hormones and thyroid hormones so like  testosterone estrogen and thyroid hormones  
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assess for anemia and if there might be a chance  that they have an undiagnosed autoimmune disorder   to also ask the doctor if it would be  appropriate to look for those autoimmune markers finally i ask people to think about their  housing and their finances when you don’t  
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feel like you’ve got house safe stable housing it  adds stress it adds distress which makes it harder   to recover and con contributes to feeling helpless  and hopeless i encourage people over the next 12   weeks to start thinking about what they need to  do in order to make sure that they feel as safe  
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as possible in their own four walls so they can  relax and what do they need to do if anything to   ensure the stability of their housing so they know  that they’ve got a home i ask them to do the same   thing with their finances because we need to have  enough money to pay the rent to keep the lights on  
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to get medication to get food all those things  and without those things we are at much greater   risk of experiencing distress and depression  so i encourage people over the week to evaluate   their housing and their finances to identify  if there’s anything that needs to be addressed
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in this first session people have identified  their symptoms and the causes they’ve defined   the overall overall what recovery looks like for  them we’ve worked together in session to develop   a support and safety plan now throughout the week  they’re going to use worksheets to gather baseline  
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data on their two or three symptoms that they’re  going to start addressing they’re going to do the   feelings worksheet to identify what feelings look  like for them begin practicing morning and evening   mindfulness and bring those mindfulness worksheets  to session because we’ll process them in session  
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we’ll look for themes we’ll look for trends we’ll  look for triggers and we’ll look for improvement   as you start keeping these mindfulness journals  it will provide a whole lot of information   and then they’re going to schedule a physical  and assess their financial and housing stability  
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so that’s a lot to do in the first  week but when you really look at it   there is the feelings activity assessing  finances and housing and scheduling that physical   so none of those should take too terribly  long beginning practicing morning and evening  
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mindfulness so that’s your 15 minutes in  the morning and 15 minutes in the evening this show was produced by mr charles snipes and  presented by dr donnelly snipes you can learn   more about depression treatment boundaries and  mental health at doc snipes dot com slash youtube  

Hi everyone in today’s video we’re going to be  talking about ways of managing persistent and   pesky worries about health that people often  experience in health anxiety and I’ve talked   in previous videos about how much how we pay too  much attention to physical health symptoms and  
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how by focusing too much on those symptoms it  actually makes the symptoms feel more intense   kind of like a sneaky trap you know the tricky  part is that when those symptoms feel worse it’s   natural to start to worry even more about them  and this triggers even more anxiety and it becomes  
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this self-fulfilling cycle that keeps dragging the  person down into worse and worse health anxiety   the more anxious we become the  more we feel the need to focus   on our health symptoms because we’re  genuinely concerned about them which  
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just makes us feel even more anxious  and it becomes this frustrating spiral   so in today’s video we’re going to be talking  about some strategies that you can use to help   break you out of this health anxiety spiral  and gain some control over your health worries  
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now people who struggle with health anxiety often  find themselves meticulously examining their   bodies for any signs of illness which inevitably  leads to worry about these bodily Sensations   now being aware of bodily changes and potential  health issues is normal that everybody does it  
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to some extent however if you’re spending  excessive time fixating on your physical   symptoms or struggling to break free from the  thoughts about your health or potential illness   it can be helpful to direct your  attention away from those symptoms  
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too much into that I want you to think about what  you tend to focus on when you’re feeling anxious   about your health I often encourage my clients  to make a list of the particular Sensations or   areas of their body that tend to consume their  attention during these health anxiety episodes  
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and once you have this list of Sensations  or health worries this becomes the list   of symptoms or health thoughts that we  want to redirect our attention away from   but why is redirecting attention so important  why is it so critical well as I mentioned earlier  
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fixating on physical symptoms can intensify their  impact and fuel high levels of worry and anxiety   additionally when our attention is fixated on  these physical symptoms it prevents us from   engaging in everyday activities and fulfilling  other important tasks have you ever found it  
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challenging to concentrate on doing your household  chores a work project or simply being present with   your loved ones because your mind is constantly  wandering back to a specific area of your body   or particular Health concern that you’re  focused on this symptom focused attention  
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and health anxiety makes it really difficult  for us to focus on any other aspects of life   so by learning to retain your attention learning  to retain your attention is a critical initial   step in managing and addressing health anxiety  not only does it reduce the amount of focus on  
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the physical Sensations but it also frees up your  attention allowing you to more fully engage in   other activities and experiences that life has to  offer so how do we do this how can we shift our   Focus away from worrying about physical symptoms  and bring our attention back to the present moment  
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one way to approach it is by considering your  attention kind of like a muscle and just like   any muscle if we don’t exercise our attention  regularly it becomes weaker and less effective   so the key is to strengthen our attention and our  ability to focus by giving it a regular workout  
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and one way of doing this is to consciously  sustain your attention during everyday tasks   you see when we’re engaging in mundane  day-to-day activities like washing dishes   folding laundry or driving to pick up the kids  from soccer practice it’s natural for our minds  
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to often wander off we start thinking about  other things like work uh what the weather   is going to be like tomorrow the argument I  had with my wife all sorts of other things   we rarely take the time to fully focus on the  experience of our day-to-day tasks like washing  
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the dishes the activity of folding laundry or  the actual route we take to the soccer field   it’s during these types of activities that  our minds tend to drift we lose touch with the   present moment and we become disconnected from  what we’re actually doing and what’s actually  
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going on around us but the thing is these everyday  tasks present a wonderful opportunity to practice   strengthening our attention and the idea is to  gradually train yourself to sustain focus on   these ordinary activities for longer and longer  periods giving your attention a solid workout  
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so what I encourage my clients to do is to think  about those everyday mundane tasks those household   chores that you frequently engage in where your  mind tends to wander it could be anything from   doing the dishes taking a shower ironing gardening  cooking eating walking driving anything you do on  
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a day-to-day basis spend some time and write down  as many of these activities that you can think of   and once you have your list of potential  activities to practice building your attention   muscle the next step is to select one and  plan when and where you’ll intentionally  
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practice focusing your attention with that  task this intentional practice gradually   strengthens your ability to keep your attention  centered which enhances your overall focus and   a presence in the Here and Now so let’s take  the example of washing dishes to illustrate  
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this practice you make a conscious decision to  focus your attention while washing the dishes   initially people are usually quite good at  directing their attention to the task at hand   however after a minute or two their minds  often start wandering off to something else  
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and the Key Practice here is to notice when  your mind has wandered and to gently bring   your attention back to washing the dishes  so in a way the muscle that we’re working   on is more about the bringing the attention  back rather than solely keeping it focused  
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and to assist with bringing your attention back to  the present moment I encourage you to engage your   senses and to be mindful of the sensory experience  you’re having while washing the dishes or whatever   the task is so let’s think about the five  senses the touch science sound smell and taste  
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first pay attention to the sense of touch what  does it actually feel like to wash the dishes   take note of the texture and the temperature  of the water and The Sensation of the soap in   your hands notice which parts of your body  are in contact with the dishwashing process  
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next consider the sense of sight what catches  your eye as you’re washing the dishes observe the   interplay of light and shadows Contours and colors  that unfold before you while you’re washing your   spaghetti meal off the dishes moving on to sound  listen closely to the different sounds associated  
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with washing dishes pay attention to the sound of  water pouring into the sink and the sound of the   sponge scrubbing away the food particles take a  moment to explore the sense of smell notice any   distinct smells that arise do the smells change  as the dishwasher because the dish water becomes  
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dirtier what does the dish soap smell like see  if you can detect multiple scents or changing   scents as you do it and lastly consider taste  now you may not necessarily taste anything if   there’s nothing in your mouth but perhaps you’re  chewing gum while you’re doing the dishes what  
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do you know what do you notice about the act of  chewing gum so you see by bringing your attention   to these sensory aspects you’re anchoring  yourself in the present moment and you’re   cultivating a greater sense of the task at hand  which is washing the dishes it’s through this  
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deliberate practice of engaging your senses  that you strengthen your ability to redirect   your attention back to the present ultimately  enhancing your overall focus and mindfulness   now the nice thing about this type of attention  practice is that you can do it almost any time  
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because it typically involves things that we do  every day anyway so I encourage people to practice   attention on these mundane tasks at least two or  three times a day you’re not doing anything extra   by doing these exercises all you’re really doing  is paying attention to stuff that you do anyway  
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so it’s not like it’s going to take up any more  time in your day now you might be wondering okay   this makes sense I can use this approach to  maintain my focus on mundane tasks such as   folding laundry or mowing the lawn or doing dishes  but how does this help with my health anxiety  
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well the idea is when you notice yourself getting  preoccupied with a physical sensation or a worry   about a particular physical symptom what’s  happening with your attention in that situation   well your attention is focused on the  physical symptom or the physical sensation  
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and your worry and negative interpretation of  what that physical sensation actually means   so when you catch yourself focusing your attention  all these physical Sensations the idea is to work   on redirecting your attention to something else  bringing your attention back in the Here and Now  
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so for example if I notice that while I’m  cooking dinner I notice some numbness in my   fingers and start to worry about what does that  mean if I’ve practiced this mundane task focusing   what it can do is pull my attention away from the  worry about the numbness in my fingers and put my  
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attention more fully into what I’m doing while I’m  cooking dinner it interrupts that negative spiral   that happens in health anxiety where I focus on  the sensation I notice it more intensely it makes   me more anxious so I have to focus on it more by  removing the focus on the physical sensation I’m  
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interrupting this cycle and not getting so anxious  or so worked up by it in that moment and if you’re   interested in learning more ways of interrupting  these worry Spirals and health anxiety or worry   more generally I encourage you to check out this  video so that’s all for today’s video as always  

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Do you worry a lot do you know  somebody who does worry a lot   well this is the ultimate guide for understanding  managing and better controlling worries   hi everyone welcome to the ultimate video guide  for managing worry this video is going to be a  
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long video that puts together a number of  other videos that i’ve previously uploaded   that spell out the best ways to manage and  understand excessive worry but before i get   into that just a couple of disclaimers to  go over i’m a registered psychologist in  
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the province of british columbia canada and  this video is for informational purposes only   it is not intended as a replacement or substitute  for advice from your doctor or mental health   professional now with those two things out  of the way let’s talk about worry management  
00:01:07
so like i mentioned this video is really a  compilation of a 14-part video series that   i’ve previously uploaded about worry  management you can choose to watch   all 14 of those individual videos but i had a  lot of people ask me to put them all together  
00:01:28
into one video that they can use as a reference  and so that’s what this video is all about   i would not recommend watching this video from  beginning to end and expecting to remember   all of it it is pretty dense and has a lot of  material in it but i hope you’ll come back to it  
00:01:47
as you work through some of the worry management  tools that i’m going to be talking about   now one of the things i want to point out is these  worry management skills aren’t things that i just   dreamed up uh these are worry management skills  that are backed by a lot of research and there’s  
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been a lot of scientific work that has been put  into putting together this treatment protocol   it was developed by a brilliant researcher  and psychologist at concordia university named   michelle duga and he has done a lot of research on  these skills and tools that i’ll be presenting and  
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the great part is these skills and tools work and  there’s a lot of research to back that these tools   are highly effective for helping a person  manage and understand their worry so   i hope you’ll find this video helpful and  look forward to any comments or thoughts  
00:02:44
that you have about it so with that being said  let’s start with the first video that discusses   the three features of worry and  two different types of worry have you ever thought about what worry  actually is that’s one of the first questions i  
00:03:05
ask my clients when we get into worry management  is i ask them to provide me with a definition   of worry and usually there’s a bit of a a pause  and a look of confusion because i think most   people know what worry feels like and everybody  knows kind of how it feels to be worried but  
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rarely do people ever stop to think about what  worry actually is and that’s what i want to talk   about today so that people can have a clear  sense and a clear idea of what i’m talking   about when i talk about worry so the first thing  about worry is that worry is a thought process  
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it is something that happens in your head it  is something that you are thinking now worry   tends not to be just a single thought it tends  to be a collection of thoughts now that can be   the same thought looped over and over and  over and over again or it can be one thought  
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leading to another leading to another leading  to another until you get this scenario building   now for example i wake up one morning i’ve got  a really bad headache and i think to myself   what if this is a brain tumor  what if there’s something wrong  
00:04:31
now typically with worry the next thought isn’t  well i wonder what i’m going to have for breakfast   the next thought is either going to be looping  over oh my goodness what if this is a tumor what   if this is cancer what if this is something bad  or spiraling into a negative scenario about what  
00:04:49
might happen if i have to get treatment and what  would happen to my family those types of things   so the first sort of defining feature  of worry is that it is a collection of   thoughts it is a thought process and a  collection of multiple thoughts the second  
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defining characteristic of worry is that worry  tends to be future oriented what that means is   that people don’t worry about things from the  past typically they worry about stuff that’s   going to happen in the future now sometimes people  will stop me and they’ll say hold on a second i  
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worry about things from my past but usually  when people say that they’re worrying about   stuff from their past what they’re actually  talking about is they’re worrying about how   the things from the past are going to affect them  in the future so essentially how the implications  
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of events that have happened in the past and what  impact they’re going to have on a person’s future   so for example if i’m worrying about having been  fired from a job three years ago it’s not so much   that i’m worrying about having been fired from  the job three years ago it’s that i’m worrying  
00:06:07
about how i’m going to be able to explain that  i was fired from that job three years ago in   the upcoming job interview so now another  small but sort of obvious component of this   is that worry tends to be about future negative  events people don’t worry about positive things  
00:06:29
happening right so rarely do people ever worry  oh what if what if this job goes really well or   what if this relationship turns out great what  if my friends are really impressed with me   people don’t worry about those things people  usually only worry about negative things happening  
00:06:49
so that’s the second defining feature of  worry worry is about future negative events   now the third defining feature of worry is  that worry is associated and accompanied by   anxiety anxiety is the emotional result  of the worry process now this is an  
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important concept and important point because  a lot of times people will use the terms worry   and anxiety interchangeably i’m worried and  anxious and that’s probably because people   usually experience worry and anxiety at the same  time but worry and anxiety aren’t the same thing  
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worry is a thought process and anxiety is the  emotion that results from that thought process   so you can’t be worrying without being anxious  but you can be anxious without worrying   so i hope that makes sense that worry is  the thought process anxiety is the emotional  
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result that comes from that thought process so  that’s the definition of worry that i work by   that’s the definition of worry that i use when i’m  working with my clients on worry management worry   is this collection of thoughts or doubts about  future negative events that are accompanied by  
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anxiety so with that definition of worry out  of the way i want to talk about two types of   worry now the first type of worry is what we  call a type one worry now a type one worry   is a worry about a current actual real  problem a problem that’s happening now  
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a problem that i am dealing with in this moment so  for example i get my credit card bill in the mail   and the credit card bill is for three hundred  dollars but i only have twenty dollars in my bank   account and so i start to worry how is it that  i’m going to be able to pay this credit card bill  
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so that worry about being able  to pay the credit card bill   that’s an example of a type 1 worry it’s a worry  about a problem that’s actually occurring now   the other type of worries are called type 2  worries now type 2 worries are worries about  
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future or potential problems problems that haven’t  happened yet problems that may never happen so for   example i get my credit card bill in the mail and  the credit card bill is for three hundred dollars   i have three hundred twenty dollars in my bank  account so i can pay that credit card bill  
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but i start thinking to myself well that was  a close one what if next month i’m not able   to pay my credit card bill and what if that has  a negative effect on my credit rating and what   if that means i’m not going to be able to get a  car loan which means i’m not going to be able to  
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get a good job because i can only get a job that  i can commute to by walking or taking transit   and so i’m not going to be able to sort of have  a very successful career and no one will want   to be with me and because i don’t have a good  job and because i’m not able to afford a house  
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because i won’t be able to get a mortgage and  then i’ll get depressed because no one wants   to be with me and i’ll lose my job and i’ll  become homeless and i’m living under a bridge   none of that stuff has actually happened but i’m  worrying about it happening and that’s that sort  
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of chaining and that spiraling of thoughts that  i talk about yeah when i talked about earlier   in terms of the definition of worry so type one  worries worries about actual current real problems   type two worries are worries  about future or potential problems  
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so you may be wondering okay so what we’ve  got this definition of worrying these two   types of worries what do i do with this how  does this help well the key to understanding   type 1 and type 2 worries isn’t so much in  terms of being able to define the worries  
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but when we talk about worry management tools  we’re going to use slightly different tools   depending on whether or not the worry is a type  1 worry or the worry is a type 2 worry and so   that’s why it’s important early on to get into  the habit of being able to recognize your worries  
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think about your worries and define the worries  as either is this a type one or is it a type two   now sometimes worries can start out as type 1 and  as part of that spiraling they go into becoming   type 2 worries we call those mixed worries so  there’s a component of it that’s a type 1 and a  
00:11:54
component of it that’s a type two so for now the  idea is to just spend some time thinking about   your worry and so this is what i encourage clients  to do is to use this information by just trying to   be more aware and more mindful of your worries and  when you catch yourself worrying to even just try  
00:12:15
and think about is this a type 1 worry is this  a type 2 worry what that can do is it can help   you disengage from the worry even for a moment and  for you to start thinking a bit more analytically   and a bit more critically about the worry  rather than getting caught up in the worry  
00:12:34
experience you’re now kind of observing it  and thinking about it differently even just   by simply being able to say this is a  type 1 worry or this is a type 2 word everybody experiences worry so  when i talk about worry management  
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i’m not really talking about a worry cure what i’m  talking about is helping people who worry a lot   be able to better manage their worries so  they’re not worrying as much because the   reality is everybody worries it’s just a matter  of how much do people worry so you can think of  
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it kind of like falling on a continuum where  one end of the continuum are people who don’t   really worry very much at all they still worry  but just not that much and it’s not particularly   problematic or interfering for them then on the  other end of the continuum are people who worry  
00:13:32
a lot and if a person worries excessively enough  and if their worry is chronic enough they can   meet criteria for what we call generalized anxiety  disorder but regardless of whether or not a person   meets criteria for generalized anxiety disorder  or they are a person who worries excessively or  
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they’re a person who worries a little bit the  same worry management skills that i’m going to   be talking about apply to all different types  of worry and all different intensities of worry   the worry experience for people usually starts  with a trigger some sort of trigger situation  
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leads them to begin worrying now triggers can be  pretty much anything so triggers can be internal   they can be thoughts that i have thinking  about an argument that i had with my wife   they can be physical sensations i wake up in  the morning i’ve got a really bad headache  
00:14:36
triggers can be external my cell phone rings  i check the call display and it’s worth   calling and i think to myself why is work  calling what’s going on is something wrong   so pretty much anything can act as a trigger and  the trigger then leads to what i call the what if  
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question now the what-if question is kind of the  foundation of worry now the thing about worry is   it usually doesn’t just start and stop at one what  if question so for example the trigger is i wake   up in the morning and i’ve got a bad headache and  i think to myself what if this is a brain tumor
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what usually happens is that worry either loops  itself over and over and over again so i worry and   i keep thinking to myself about what if i have a  brain tumor what’s going on what if i have a brain   tumor or it leads to a chaining or spiraling of  additional what-if thoughts that ends up in this  
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negative scenario building of what might happen  and it’s that chaining and spiraling of what if   thoughts that’s what we call worry and so when a  person is worrying think about how that makes you   feel for example so when you’re worrying what’s  the emotion that you associate with the worry  
00:16:03
that emotion is typically anxiety so this  is an important point to note that worry and   anxiety are not the same thing so worry  is this collection of what if thoughts   anxiety is the emotion that results from  the collection of these what-if thoughts  
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so now think about this process and imagine if  you worried a lot and you’re going through this   process day after day after day trigger  what if we’re anxiety trigger what if   we’re anxiety trigger what if we’re anxiety  how are you feeling by the end of the day  
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now most of the time when i ask my clients that  they’ll usually say two things one they feel   exhausted now exhausted on multiple levels  exhausted mentally because their mind will   not shut off right they just keep worrying  they just keep thinking their mind will not  
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stop thinking about something and so mentally that  can be exhausting but it can also be physically   exhausting as well so you’re going through  all of these negative thoughts in your mind   and it’s normal for sort of the muscles to tense  up and to just feel an increased physical tension  
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um it can lead to problems with sleep because it’s  difficult to sleep when you’re worrying so much   and so it’s common for people to feel kind  of exhausted and worn out by their worries   both mentally and physically and the second  outcome of this sort of constant worry process  
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is a feeling or a perception of being demoralized  demoralization and what i mean by that is that   it’s hard to really look forward to anything  when you worry a lot so it’s hard to get really   excited or enthused about something because when  you think about all the positive things that can  
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happen what also happens is that you then begin to  start thinking about all the negative things that   could happen so it’s hard to really look forward  to anything because you’re always thinking about   all of the negative things that can occur and so  the outcome of this worry process is a feeling of  
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being demoralized and exhausted and think about  it the more demoralized and exhausted you feel   what do you think that’s going to do  to the frequency of what-if thoughts   it’s going to increase them and so you get  into this self-feeding cycle of worry where  
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you have a trigger leading to the what-if worry  anxiety feeling demoralized and exhausted which   just means you’re prone to creating more  what-if questions in response to triggers so that’s kind of the the basic engine  of worry this is kind of how worry works  
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and as i’m going as i go along uh with this  video series and talk about other factors that   contribute to worry we’re going to be building on  this model but it’s important to understand this   is kind of the the core engine of worry so with  that understanding in mind it leads to the first  
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key worry management skill that i’m going to  be talking about now this is a foundational   skill it’s hard to do any of the other worry  management skills i’m going to be talking about   if you don’t do this skill and the first worry  management skill is worry awareness training  
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essentially becoming more aware of what it is that  you worry about and having a better understanding   of your worry experience now when i’m working  with my clients and i bring this up a lot of   times people will say hey i already know what  it is that i’m worrying about i don’t need to  
00:19:57
get better at thinking about my worries   but what i find for a lot of my clients is that  they they kind of know what the big worries are   but they don’t really have a great sense of  their entire worry experience and for a lot of my  
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clients they are such highly efficient worriers  that they’re not even aware of everything that   they’re worrying about that they worry almost  automatically to a point that they’re not even   aware they don’t even know what it is that they  worry and so it’s not uncommon for people who  
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come to see me to say i don’t really feel like i’m  worrying but i have a lot of free floating anxiety   now usually when i hear the term free floating  anxiety it’s a cue for me that this is probably   someone who is a highly efficient worrier and that  they’re worrying but just don’t realize it yet  
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and that’s where worry awareness training comes  in so worry awareness training really what it is   at its core is excavating your worries dusting  them off and really beginning to examine them   so that you can have a new understanding  and a better understanding of what your  
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worry experience is actually like getting a  better understanding of that worry fingerprint   your unique worry experience that’s unique to  you so how do you do worry awareness training   key tool i use with my clients is called a worry  diary and what i’m going to be doing is putting a  
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link to a worry diary that you can download in the  description of the video below so please feel free   to download that and take a look at it so the idea  of a worry diary is that you don’t keep track of   every single worry that you have rather what  you’re doing is you’re taking a sampling  
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of your worries so what i get my clients to do  is to complete a worry diary three times a day   for one to two weeks and the idea is to have some  set times every day that you’re going to pull out   your worry diary and write down what it is that  you’re worrying about at that time so i encourage  
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people to set an alarm so an alarm in the morning  in the afternoon and sometime in the evening   when the alarm goes off you pull out the worry  diary and you complete an entry in the worry diary   so with the worry diary the first column is  the time and day so the date time that you’re  
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completing the worry diary the next column  is the situation what’s going on what’s the   context that you’re worrying in this can map  on to the trigger that we talked about before   after that you write down what  is it that you’re worrying about  
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what are the what if thoughts  that you’re having in that moment after you’ve completed the what ifs and  wrote written down what you’re worrying about   you make a rating of your anxiety on a scale  from 0 to 10 where 0 is no anxiety at all  
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10 is extreme anxiety so you make a numerical  rating of how anxious am i in this moment   and then the last column of the worry relates  to what i talked about in a previous video when   i talked about a definition of worry and types of  worry and that relates to is this a type one worry  
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or is this a type 2 worry now type  1 worries are worries about actual   current problems type 2 worries are worries about  future or potential problems and so you take a   look at what it is that you’re worrying about and  you make a rating is this type 1 is this type 2  
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now sometimes a worry can be a bit of a mix  of both so it starts out as a type 1 worry   and it spirals into a type 2 worry if  that’s the case you can write down both so   you complete this worry diary if you do this worry  diary for a week or two what it’s going to give  
00:24:12
you is a rich amount of data about your worry  experience that you may have never had before   are there days or times that you tend to  worry more than other days and times are   there certain situations or triggers  that tend to trigger your worry more  
00:24:31
are there certain worries that come up over and  over and over again kind of like your greatest   hits of worry are there certain worries that  are associated with higher levels of anxiety   so for example it’s not uncommon for people to  be well aware of the worries that are causing  
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them levels eight nine and ten in terms of anxiety  but when they do the worry diet they they realize   wow there’s a whole bunch of worries that  are causing me anxiety about three and   four that i was never actually aware of and those  worries can contribute to just that background  
00:25:07
hum of anxiety and nervousness and those may be  worries that a person’s never thought about before   this worry diary can also help you get a sense  of are my worries more type 1 worries do i have   more type 2 worries do i have kind of an equal  mix of type 1 and type 2 worries this is all  
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information that people typically don’t have  about their worry experience and by getting   this information it provides you with um a lot of  background that you’re gonna be able to use then   when we start talking about other worry management  skills but none of the other worry management  
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skills i’m going to be talking about are effective  if you don’t know what it is that you’re worrying   about and that’s the key and that’s the  foundational skill of worry awareness training and in the last video i talked about  a model for understanding worry  
00:26:10
and i talked about it as the bare bones engine of  worry the the driving force behind worry so if you   think of that as the engine of worry what we’re  talking about today intolerance of uncertainty   that’s the fuel that drives this worry  engine so what is intolerance of uncertainty  
00:26:33
well intolerance of uncertainty one way to think  about it is it’s kind of like a psychological   allergy and if you think about how an allergy  works suppose i’m allergic to dust and i walk   into a room all it’s going to take is for there  to be just a little bit of dust in that room and  
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it’s going to cause a big allergic reaction on my  part sneezy watery eyes that sort of thing whereas   somebody else who’s not allergic to dust walks  into the exact same room has no reaction at all   so for people who are intolerant of uncertainty  all it takes is for there to be just a little  
00:27:16
bit of uncertainty in a situation and it leads to  a big emotional reaction a big emotional response   so you can think of intolerance of uncertainty  kind of like falling on a continuum where on   one end of the continuum are people  who are highly tolerant of uncertainty  
00:27:38
these are the people who for example can travel  to europe with a one-way ticket and a quarter   in their pocket they have no idea what they’re  going to be doing for work what they’re going to   do for money uh how long they’re going to be gone  where they’re going to go but they just see it as  
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a big adventure they’ll figure it out as they  go whereas on the other end of the continuum   if a person is highly intolerant of uncertainty  and they’re traveling to europe they’re going to   have a clearly laid out itinerary they’re going  to know exactly what they’re doing on every day  
00:28:14
they’re going to have backup plans for if the  weather’s changes they’re going to know exactly   how they’re going to get from point a to point  b everything is going to be highly organized   those people are highly intolerant of uncertainty  now what we know is that for people who worry a  
00:28:34
lot they tend to gravitate more towards the highly  intolerant end of this tolerating uncertainty   spectrum so the way intolerance of uncertainty  works is it’s kind of like a lens through which   a person views the world so you have this person  and they’re faced with an uncertain situation  
00:28:58
and they’re looking at this uncertain situation  through this intolerance of uncertainty lens   what the intolerance of uncertainty lens is  going to do is it’s going to bend the person’s   perception or prediction of what’s going to  happen to be a negative outcome so they’re  
00:29:16
going to think about all of the positive all  of the possible negative things that can occur   when faced with that uncertain situation but you  can probably also recognize on a logical level   that uncertain situations don’t always lead to  negative outcomes that there can be a range of  
00:29:38
potential outcomes that on certain situations can  result in so some are negative but some uncertain   situations can turn out neutral or they’re  neither good nor bad they just kind of are   what they are and then there are some uncertain  situations that turn out really positively  
00:29:55
so they turn out much better than a person  anticipated the situation was going to turn out   i call these happy accidents not expecting them  to happen they happen and they’re really great   so uncertain outcomes can fall anywhere on  this continuum of possible outcomes but the  
00:30:19
intolerance of uncertainty lens prevents a person  from really considering the possible positive or   neutral outcomes and all the person ever focuses  on is the potential negative outcomes so it’s not   so much the uncertainty that is so sort of scary  or anxiety provoking for a person who’s intolerant  
00:30:41
of uncertainty it’s not the uncertainty itself  it’s what they feel that uncertainty represents   which is the negative outcome the negative  potential outcome that they focus on that   this intolerance of uncertainty lends bends their  predictions and their perceptions to be all about
00:31:02
so what do you do with this information how   exactly does this work and how can  you use it to better manage worry well   think about the dilemma that someone who is  intolerant of uncertainty experiences on one hand  
00:31:22
i’m intolerant of uncertainty yet on the other  hand there’s uncertainty in the world around me   and so i have to try to find some way of  reconciling these two things the inherent   uncertainty of the world and my intolerance of  uncertainty and invariably what people do is they  
00:31:44
tend to focus on ways of trying to eliminate  uncertainty in their world trying to control   their world trying to be highly organized try  to seek lots of information avoid things that   they are uncertain about it’s all designed  to try and eliminate uncertainty in the world
00:32:08
but how effective do you think that  is do you think there is any way   to fully eliminate uncertainty in the world   well the answer is no if you think back to the  original model of worry that i talked about  
00:32:25
it starts with a trigger and what i mentioned  and why i pointed out is that anything can be   a trigger so anything can trigger worry  anything can trigger uncertainty any situation   can have uncertainty associated with it so  trying to eliminate uncertainty in the world  
00:32:49
as a way of trying to manage this intolerance  of uncertainty is kind of like a losing battle   it’s sort of like i’m at the bottom of a  pit and i want to get out of the pit and   the approach i use to try and get out of the  pit is to pick up a shovel and to start digging  
00:33:08
now i’m doing lots of work i’m putting lots of  effort and energy into trying to get out of the   pit but is picking up a shovel and digging  actually getting me out of the pit no it’s   just a lot of work that’s not actually getting  me anywhere and that’s what i find for a lot  
00:33:29
of my clients who deal with excessive worry  and struggle with excessive worry they feel   exhausted because everything they’ve tried to  do to manage their worry hasn’t really helped   all of the ways that they try and control their  world all of the ways that they try and gather  
00:33:49
information all of the ways that they try to  avoid or eliminate the uncertainty in their world   isn’t really helping it’s like i’ve got a bucket  and i’m trying to fill that bucket with water but   the bucket’s got a big hole in the bottom of it so  i’m constantly pouring water into the bucket but  
00:34:08
the bucket’s never getting full i will never be  able to fully eliminate uncertainty in the world   so the only way of dealing with this  dilemma the world has uncertainty in it   and i’m intolerant of uncertainty the only way of  really reconciling this dilemma isn’t to focus on  
00:34:30
eliminating uncertainty from the world it’s to  focus on becoming more tolerant of uncertainty it’s not enough to just know you need  to be more tolerant of uncertainty   the idea is you need to behave as if  you’re more tolerant of uncertainty
00:34:55
most everybody knows at a logical level that  uncertainty can lead to a variety of outcomes   they can lead to positive outcomes they can lead  to neutral outcomes they can lead to negative   outcomes that’s not an epiphany to people so  trying to convince yourself that uncertainty  
00:35:12
is going to be okay just based on logic probably  isn’t going to be enough to help you become more   tolerant of uncertainty so the key is to start to  behave as if you’re more tolerant of uncertainty   to do exposure to uncertainty and see what happens  and that’s how we build tolerance for uncertainty  
00:35:38
by essentially having experiences with uncertainty  and seeing whether or not what i’m worrying about   actually happens but before we can we can  get into that you need to know the various   different ways that intolerance of uncertainty  is actually manifesting itself in your life  
00:35:59
in your behavior in the various things that you do  and that’s what i’m going to be focusing on today   what are the various manifestations of  intolerance of uncertainty the various ways   that intolerance of uncertainty kind of sneaks up  on me sneaks into my life sneaks into my behavior  
00:36:21
and is maintaining my worry even if i’m  not aware that that’s what’s going on   so the first three manifestations of intolerance  of uncertainty that i’m going to be talking about   are essentially variants of the same  thing avoiding doing certain things  
00:36:41
finding imaginary obstacles or reasons not  to do certain things and procrastinating   the idea of avoidance finding imaginary obstacles  and procrastinating the idea behind this   is that it gives me a temporary state of  certainty so for example if a friend of  
00:37:04
mine called me up a few weeks ago and i haven’t  returned that phone call and now i’m worrying   about uh whether or not my friend’s going to be  upset with me for not having returned the phone   call as long as i’m not making the phone call  if i avoid making the phone call to my friend  
00:37:22
i have certainty that in this moment my friend  isn’t yelling at me my friend isn’t upset with   me my friend isn’t telling me how disappointed  they are in me that i didn’t return the phone call   so it gives me this temporary state of  certainty that the bad thing that i’m afraid of  
00:37:40
isn’t actually happening and that goes for finding  those imaginary obstacles or reasons not to do   certain things i can come up with all sorts of  explanations and rationale as to why i’m not   going to return that phone call to my friend today  i can just put it off and say i’ll do it tomorrow  
00:38:00
they’re all forms of avoidance they’re  all forms of things i do to give myself   a temporary state of certainty that what  i’m afraid of isn’t happening right now the next manifestation of intolerance of  uncertainty is having to do everything yourself  
00:38:22
not delegating tasks to anybody else the way  this works is that if i do everything myself   i know it’s been done right i know it’s been  done the way i think it should be done i know   it’s been done to my standards to my expectations  the moment i have to bring somebody else in or if  
00:38:46
i have to rely on somebody else to do it well  now that brings up a whole bunch of uncertainty   what if they don’t do it what if they don’t do  it as well as i would have done it what if they   mess it up and it becomes a big mess and they  really screw it up and then i have to go in and  
00:39:04
fix it anyway you know what it’s just a lot easier  if i do it myself so this idea of not delegating   tasks needing to be in control that’s another  manifestation of intolerance of uncertainty another manifestation of intolerance of  uncertainty is not fully committing yourself to  
00:39:27
a relationship a job a project the idea  behind this is that if i fully commit myself   to something if i fully give it a hundred  percent and the thing doesn’t work out   then i’ll be devastated i’ll be really upset i  will have fully invested in it and it doesn’t  
00:39:49
work out and so it’s almost like i’m hedging my  bets kind of having one foot in one foot out not   fully committing to it that way if the negative  thing happens or if the relationship doesn’t work   out or if the project doesn’t work out well i  wasn’t fully committed to it anyway it’s not  
00:40:08
that big of a deal so it’s like i’m hedging my  bets anticipating that it’s not going to work out   now this can be uh really tragic i’ve seen this in  a lot of clients unfortunately especially around   the idea of relationships where they don’t fully  commit to the relationship because they’re not  
00:40:28
sure if the relationship’s gonna turn out and so  they’re kind of in and out of the relationship and   they can never fully commit and they’re not sure  if they can commit and eventually the relationship   falls apart because they were never able to  fully give themselves over to the relationship  
00:40:45
i also see this with students who don’t  fully commit to their studies they don’t   fully put effort into doing their studies into  studying for the test and to doing the paper   that way if they don’t do well  
00:41:04
well the reason why they didn’t do well is they  didn’t really fully commit themselves to it anyway   but if they were to fully commit themselves to it  and they didn’t do well well the only answer is   then is that they’re not good enough so  it’s almost like by not fully committing  
00:41:21
themselves to the project to the assignment to the  studying for the test they’re hedging their bets   that if they if it doesn’t turn out well  then that’ll be okay because they didn’t   really commit to it anyway it’s almost like  a built-in excuse for why it didn’t go right
00:41:42
the next manifestation of intolerance  of uncertainty is spreading yourself out   really thin right wanting to sort  of participate in a whole bunch of   different things keeping yourself really  busy but never fully committing to any  
00:41:59
of those little things that you commit to  or that you’re keeping yourself busy with   the idea behind this is that i don’t want to miss  out on any opportunities so i don’t want to say no   to anything and then later find out that it would  have been a great opportunity so i want to keep  
00:42:16
all of my options open as long as possible but i  won’t commit to any of them i just like to keep   the various options available so it’s like i’m  spreading myself out really thin and keeping   busy doing a whole bunch of different things  but never actually committing to any of them  
00:42:37
now this can lead to feelings of exhaustion  because i’m spreading myself out really thin   all the time because i just don’t want to  say no to something and then regret it later the next manifestation of intolerance  of uncertainty that i want to talk about  
00:42:56
is looking for a lot of information  before proceeding to do something   so for example if i’m going  to buy a digital camera   i’m going to research the heck out of that digital  camera i’m going to read every review that has  
00:43:16
ever been written about that digital camera i’m  going to read every review about every other   digital camera i’m going to watch all the  youtube videos about all the features of the   camera it’s almost like i’m constantly looking  for that little holy grail piece of information  
00:43:35
that’s going to give me certainty that this  is the right decision to make so it’s this   excessive information gathering to try and give  me reassurance and to give me certainty that i’m   making the right choice now think about how  this affects things like efficiency or making  
00:44:00
decisions it just takes so much longer to make  a decision it makes me highly efficient because   i can’t ever just make a decision i have to think  through it over and over and over and look up lots   of information before i can commit to making  a decision about which camera i’m going to buy
00:44:20
and then the next manifestation of  intolerance of uncertainty is that   once i’ve made a decision or i doubt myself and  then i check whether or not i made the right   decision so uh once i’ve bought that camera i  finally made a decision and i bought a camera  
00:44:40
i spend the next six months reading reviews about  all of the new cameras that came out since the   time i bought that camera almost like i’m trying  to convince myself or to prove to myself that i   made the right choice that uh i should have you  know i should have bought the one that i bought  
00:44:59
rather than you know waiting a little  bit longer because a better camera   came out so it’s always like i’m second guessing  decisions that i’ve already made after i make them the next manifestation of intolerance of  uncertainty is seeking reassurance from  
00:45:19
other people this is essentially a variant of the  information gathering manifestation of intolerance   of uncertainty except the way that you’re  gathering information with reassurance seeking   is rather than doing your own research you’re  asking other people for reassurance hey uh i was  
00:45:41
gonna do this this and this what do you think  do you think i should be doing that um i uh   i was going to answer my friend in this way what  do you think do you think that’s what i should do   what do you think i should do this reassurance  seeking is very insidious because what it does  
00:46:05
is it really undermines a person’s confidence  in their ability if you were confident in   what you were doing why would you have to seek  reassurance and have to seek someone else’s input   before you go ahead and do something so the act of  reassurance seeking actually undermines confidence  
00:46:29
and that’s why a lot of people who worry a lot  lack confidence is because they’re really worried   about making the wrong choices or making the wrong  decisions or upsetting someone and so they engage   in this reassurance seeking to try and give  them a sense of certainty that everything’s  
00:46:46
going to be okay but in doing so it just  undermines their confidence and their abilities   and it’s really tragic and it’s really um it’s  really one of the ways that this intolerance of   uncertainty chips away at a person and really  contributes to their worry and their anxiety
00:47:08
the next manifestation of intolerance of  uncertainty uh is one that when i bring it   up with clients they either relate to it or they  don’t relate to it at all um and the idea here is   try and explain everything away rationally or  always trying to imagine everything’s gonna turn  
00:47:28
out well so it’s almost like creating a false  sense of certainty so rather than going into   an uncertain situation and saying look i don’t  really know how it’s going to turn out let’s see this manifestation of intolerance of uncertainty  is is kind of like always thinking the bright  
00:47:48
side is going to happen and always telling  yourself the bright side is going to happen   so it’s not so much i don’t know what’s going  to happen it’s everything’s going to be fine   no no no everything’s going to be fine just  think positively it’s all going to be okay  
00:48:03
well the thing is i i don’t know it’s all going to  be okay so by telling myself that i i kind of know   that i’m sort of trying to pull the wool over  my eyes it doesn’t really give me any sense of   comfort because i know it’s not true i know that i  can’t know for certain that it’s going to be okay  
00:48:28
so this is well like i said this is one that  sometimes people do sometimes they don’t or   they don’t relate to but it is surprising when  people will sometimes look at this manifestation   of intolerance of uncertainty say yeah no i don’t  do that but once they start paying attention to  
00:48:45
their behavior they realize oh wow i actually  do that and i never realized that i was doing it the next manifestation of intolerance of  uncertainty that i wanted to talk about   is double checking things or redoing them  because i’m no longer certain that i did  
00:49:04
them right in the first place so if i’m going  to send an email i double and triple check that   email because i want to make sure there’s no  spelling errors in it i want to make sure that   everything’s clear or there’s no way of  misinterpreting what i’m saying or i don’t want  
00:49:21
to offend someone so i want to make sure that the  tone is is right in that email so i’ll double and   triple check it i i won’t send it  i’ll come back to it and read it over   again this kills efficiency because i can’t  just send an email i have to read it over  
00:49:40
and read it over and read it over and try to  be certain that there’s nothing wrong with it and the final manifestation of intolerance  of uncertainty that i wanted to talk about   today is over protecting others  uh taking care of other people  
00:50:01
this is a big one with parents and this is kind of  like a variant of that earlier one that i talked   about which is not delegating tasks except in  this case the tasks that aren’t being delegated   are allowing the person the other  person to take care of themselves  
00:50:19
so like i said this is a big one for parents who  are overprotective or are over involved in their   children’s lives and their children’s behavior  in their children’s relationships so uh they’re   the ones that are trying to uh fix or coordinate  any sort of arguments or little fights between  
00:50:41
their child and a friend or they do everything  for their child because they want to make sure   that the child is okay or that everything gets  done right for the child so what this does is it   it doesn’t really allow the person who’s being  over protected from doing things on their own  
00:51:02
from learning from their own mistakes so it’s like  trying to cocoon them in this in this protective   bubble wrap but it doesn’t actually protect the  person because ultimately they’re going to have   to learn to do these things on their own and so  it really is about giving this person a giving  
00:51:23
me a false sense of security and certainty that uh  this person that i care about is going to be okay so that’s a lot of manifestations of intolerance  of uncertainty and there’s a lot of different   ways that this intolerance of uncertainty  can kind of weave its way into a person’s  
00:51:45
life and this is one of the reasons why i  really like this concept of intolerance of   uncertainty because you can think of it kind  of like an umbrella concept that helps explain   why all of these various seemingly different  behaviors are all serving or all attempting  
00:52:04
to serve the same purpose so how is me avoiding  returning a phone call to a friend the same as   me spending hours and hours researching a digital  camera well because they’re both designed to try   and eliminate uncertainty in my world and in  doing so they’re both maintaining my worry  
00:52:27
and my anxiety that things are going to turn out  badly or things are going to turn out negatively so may raise the the question of well so what  what do i do with this information so i see   i’ve learned about all these manifestations of  intolerance of uncertainty what now so the idea is  
00:52:50
to spend some time observing your behavior and  looking for personal examples in your life of the   various ways in which intolerance of uncertainty  may have manifested itself in terms of your   behavior once you start looking for it what you  may recognize is that there’s all sorts of ways  
00:53:12
in which you’ve been behaving that are designed  to eliminate or reduce or avoid uncertainty in   your life and it’s that avoidance of uncertainty  or that trying to eliminate uncertainty that may   be one of the big things that’s perpetuating  or maintaining your worry and your anxiety  
00:53:35
so one of the things i often encourage people to  do is you know keep a list of these manifestations   of intolerance of uncertainty and spend a week or  two paying attention to your behavior and seeing   which of these do i do and what are personal  examples of each of these things that i do
00:53:59
so the key to understanding building tolerance  for uncertainty is to understand that when we   talk about worries we’re talking about thoughts  that are predictions of something that’s going to   happen so the idea is to reconceptualize  your worry or think about your worries  
00:54:21
not so much as worries or factual things  that are going to happen but essentially   predictions and hypotheses of what’s going  to happen so the key way we build tolerance   for uncertainty is through behavioral exposure  to uncertainty essentially doing what i call  
00:54:45
tolerating uncertainty experiments so the idea  with these tolerating uncertainty experiments   is to put those predictions to the test and  see how accurate those predictions actually   are so for example if i’m avoiding returning  a phone call to a friend because i’m concerned  
00:55:07
they might be upset with me i might come up with a  tolerating uncertainty experiment that gets me to   call my friend so that’s the behavior  that’s the tolerating uncertainty experiment   behavior that i’m going to do  return the phone call to my friend  
00:55:28
the next thing to think about then is what  is it that i’m worrying about what is my   worry telling me is going to happen  when i return the phone call to a friend   so the idea is you’re setting up the experiment  and you’re thinking about the hypothesis  
00:55:51
the hypothesis or the prediction ahead of time and  so what i’ll often give my clients is a worksheet   to help them organize these tolerating uncertainty  experiments in their mind and i’ll put a link to   the worksheet down below so that you can download  it and see it for yourself so the first two  
00:56:10
the first two parts of the worksheet you do  before you actually engage in the experiment   come up with the chosen behavior and then you  think about what is it that i’m worrying is   going to happen what does my worry predict or  what is my worry telling me is going to happen  
00:56:30
now this is where worry awareness training  becomes really important we talked about   worry awareness training right at the beginning of  this series on worry management you need to know   what it is that you’re worrying about before  you can actually begin to manage the worry  
00:56:46
so the worry becomes central in this  experiment this is what we’re testing   we’re testing whether or not the worry what  we worry about is actually going to happen   so now i’ve come up with my behavior i’ve come  up with my hypothesis the worry prediction  
00:57:05
then i go and do the experiment i actually pick  up the phone and i call my friend this is the data   collection portion of the experiment and i write  down and i record what actually happened i called   my friend and they were really pleased to to hear  from me they were surprised why i hadn’t returned  
00:57:29
their call and uh they had some really exciting  news to tell me and it turned out really well or   i call my friend and they tell me that they’ve got  some bad news they just lost their job and they   were calling me up to get some support or  to get some advice as to what they should do  
00:57:50
or i call my friend and they are really angry with  me and they’re really upset because i keep flaking   out on them and i’m never available for them  when they call whatever the outcome i record it   and then i come up with my conclusion  based on the outcome was my worry accurate  
00:58:14
was my worry prediction did it actually come true   so if you think about this if you do say a hundred  of these tolerating uncertainty experiments   and 95 of the hundred tolerating uncertainty  experiments turn out negatively so they turn  
00:58:34
out badly 95 percent of the time what  does that tell you about uncertainty well what it tells you about  uncertainty is that uncertainty is bad   that uncertainty is something to be afraid of that  most of the time the vast majority of the time  
00:58:55
when i’m uncertain about something bad  things will happen and so what i should   do is get better at avoiding uncertainty get  better at eliminating uncertainty in my life   if 95 of the time these tolerating  uncertainty experiments turn out badly
00:59:17
but what if 95 of the 100 experiments that i  do turn out either neutral or positively what   does that tell me about uncertainty well what it  tells me about uncertainty is 19 times out of 20   the uncertainty is just fine nothing bad happens  and so how do you think that’s going to change  
00:59:44
how i orient myself towards uncertainty how  do you think that’s going to change how i   think about and feel about uncertainty well i’m  probably not going to be as afraid of uncertainty   if through a hundred experiences  with it it’s turned out just fine
01:00:04
so the idea here isn’t to try and convince  yourself through logic or just rational thinking   that uncertainty is okay the idea here is for you  to determine how you should feel about uncertainty   through experiences with uncertainty and  by setting up these tolerating uncertainty  
01:00:27
experiments you’re giving yourself  explicit examples of times where you   did something you were uncertain about you  were worrying that this was going to happen   and what you were worrying  about didn’t actually happen  
01:00:46
and the more you see to the more you sort of  see and the more you observe and the more you   demonstrate to yourself that the things that  you worry about don’t actually happen the less   weight the less uh importance the less  value you’re going to put on your worries  
01:01:10
it’s kind of like if every time the weatherman  said that it was going to rain it was sunny   and every time the weatherman said it was going  to be sunny it rained essentially the weatherman’s   terrible at predicting the weather so the next  time the weatherman says it’s going to rain  
01:01:32
you’re not going to take your umbrella  because you know it’s going to be sunny   if your predictions are not very good  you’re not going to put much weight   or much value in those predictions and  that’s all worry is it is a prediction  
01:01:49
so that’s one way of building tolerance for  uncertainty actually setting up these tolerating   uncertainty experiments using the worksheet that  you can download and fill out you fill out the   first two sections before you do the experiment  what is the experiment and what is your prediction  
01:02:10
then you do it you record the data  and you record your conclusion   so it’s sort of forward thinking pre-planned  tolerating uncertainty experiment   the second way of building tolerance for  uncertainty is taking advantage of naturally  
01:02:30
occurring opportunities in your life to do  things that you’re uncertain about the reality is   we’re faced with uncertainty every day multiple  times a day and the vast majority of the time   that uncertainty is turning out fine we’re  just not even really aware we’re not even  
01:02:48
processing that the uncertainty is turning out  fine so what i often encourage clients to do   to try and take advantage of naturally occurring  opportunities to be more tolerant of uncertainty   is to imagine the following question  tattooed to the frontal lobe of their brain  
01:03:10
so essentially they’re filtering their world  through this question and the question is   if i were more tolerant of uncertainty  what would i do in this situation if i were more tolerant of uncertainty would  i order the same thing i always order in this  
01:03:31
restaurant or would i order something different  if i were more tolerant of uncertainty would i ask   that person out for a date or would i stay in my  seat and not say anything if i were more tolerant   for uncertainty would i answer the call even  though the i don’t recognize the number or would  
01:03:54
i let it go to voicemail if i were more tolerant  of uncertainty would i speak up and express my   opinion in this meeting at work or would i stay  quiet and wait to see what everybody else says you have countless opportunities to tolerate  uncertainty on a daily basis you just have to  
01:04:18
look for those opportunities and take advantage of  those opportunities when they present themselves   i were more tolerant of uncertainty  what would i do in this situation   you don’t have to do all of the tolerating  uncertainties things but just be aware of it  
01:04:39
just keep that question in mind help that orient  you towards uncertainty to look for uncertainty   in your day-to-day life and every once in a  while do the uncertain thing and see what happens because what you do by doing these  tolerating uncertainty experiments either  
01:05:01
the ones that are pre-planned or the ones  that are just taking advantage of naturally   occurring opportunities that come up you  can think of what you’re doing kind of like   putting money in a tolerating uncertainty  bank account what you’re doing is you’re  
01:05:17
having conscious explicit experiences with  uncertainty where you think about what it   is that you are concerned is going to happen  and then compare it to what actually happens   and by being aware of that and seeing that the  uncertainty doesn’t turn out badly all the time  
01:05:38
or rarely turns out badly what you’re doing  is it’s almost like you’re making deposits   in this tolerating uncertainty bank account  each time you do one of these experiments   and so through these ex through these experiences  with uncertainty the more and more of these  
01:05:56
experiences that you have with uncertainty where  uncertainty turns out well or fine or not negative   that tolerating uncertainty bank account gets  bigger and bigger and so when you’re faced with   a bigger uncertainty in life what you can do  is you can draw from this bank account you can  
01:06:18
think about and reflect on all of the various  experiences you’ve had with uncertainty in your   life where it turned out fine and so if all  of those uncertainties turned out fine there’s   a good chance this big uncertainty that i’m  concerned about is going to turn out fine as well
01:06:39
so those are the two main ways of  building tolerance for uncertainty   planning ahead and actually setting up  experiments and taking advantage of the   numerous opportunities you have in your  day-to-day life to tolerate uncertainty  
01:06:58
if i were more tolerant of uncertainty  what would i do in this situation so today we’re going to be talking about  another factor that perpetuates excessive worry   and that relates to this notion of beliefs about  the usefulness of worry one of the things that  
01:07:22
we know about people who tend to worry a lot is  that they tend to hold beliefs that the worry is   actually serving some benefit for them so when  i first bring this up with a lot of my clients   what they tend to do is kind of look at me  a little bit odd and say hold on a second  
01:07:40
um i recognize that my worry is causing me  a lot of problems and now you’re telling me   that i have some underlying beliefs that worry  is actually serving me some benefit or that i   think it’s doing something good for me so the  way i like to sort of introduce this concept  
01:08:02
of beliefs about the usefulness of worry is  to use an example and the example is that   i change the oil in my car every 5 000  kilometers because i believe that changing   the oil in my car every 5 000 kilometers  is good for the long-term maintenance  
01:08:19
of the vehicle it helps with the efficiency it  helps with preventing costly repairs down the line   and it’s just something that’s good to do  because it helps my car run well and problem free   now suppose one day a friend of mine pulls me  aside and this friend knows everything there  
01:08:40
is to know about cars and this friend  says to me hey ramy you know that whole   oil change every 5 000 kilometers thing it’s a bit  of a scam by the oil companies all they’re really   trying to do is to get you to buy more oil nothing  bad is happening to the engine oil it’s perfectly  
01:09:02
fine you don’t need to change it at all now if i  believed what my friend was telling me how would   that change my behavior would i continue to change  the oil in my car every five thousand kilometers   well probably not because the only reason i’m  changing oil in my car every five thousand  
01:09:24
kilometers is because i believe that changing  oil in my car every five thousand kilometers   is serving me some benefit some usefulness the  moment i stop seeing any usefulness or benefit   to changing the oil every 5000 kilometers  then i’m going to stop doing it  
01:09:44
so now relating this to excessive worry what we  know is that for people who tend to worry a lot   they tend to hold beliefs that worry is actually  serving some benefit some usefulness for them so   the first belief is this notion that worry helps  motivate me the idea that uh when i’m worrying  
01:10:11
about something it’s activating me to go and do  something about it it’s activating me to engage   rather than just being really relaxed about it and  if i’m not worrying about it i’m not really going   to be all that motivated to do anything to engage  in an activity to try and change the situation at  
01:10:33
all so the notion here is that worry in and  of itself acts as a motivator to be that sort   of that spark under me or that kick in the pants  that i need to get going and uh and do something the second common belief about the usefulness of  worry is that worry helps with problem solving  
01:10:59
now the idea behind this is that  if i’m worrying about a problem   it’s keeping the problem in my mind it’s helping  me think about the problem a lot and by thinking   about the problem a lot what that’s doing is it’s  helping me potentially come up with solutions  
01:11:19
uh or you know ways of addressing this  problem that i may not otherwise have   if i wasn’t worrying about it as much so  the idea here is that the worry benefits me   because it helps keep a problem in my mind and  helps me figure out ways to solve that problem
01:11:43
the third common worry belief is it’s  got a bit of a superstitious flavor to it   and the idea here is that worry in and of  itself can prevent bad things from happening   another way of thinking about it  is if i don’t worry about something  
01:12:04
then it’s almost like i’m jinxing myself  it’s almost like uh if i don’t worry about   this presentation that i’m going to give then that  will be the time and that will be the presentation   that things go really badly it’s almost like the  universe is giving me a smack on the backside  
01:12:24
for not worrying enough or not being concerned  enough about this presentation so the notion   here is that worry in and of itself can prevent  bad things from happening related to this but   just a little bit differently is this notion that  worry can protect me from future negative emotions  
01:12:53
so if i’m worrying about something bad happening  it’s almost like i’m emotionally preparing myself   just in case that bad thing were to happen so i  won’t be caught off guard i won’t be surprised i   won’t be blindsided by the negative thing because  i’ve been worrying about it and i’ve been thinking  
01:13:16
about it so the notion here is that if the bad  thing were to happen well i’ve already kind of   pre-prepared myself for the negative  thing and i’ve prepared myself emotionally   to deal with it so i’m not caught  off guard and i’m not surprised  
01:13:38
and the final worry belief is this notion  that ruri represents a positive personality   characteristic essentially what kind of person  would i be if i didn’t worry about my children   what kind of person would i be if i didn’t  worry about my relationship what kind of  
01:13:59
person would i be if i didn’t worry about my  performance at work it’s almost like worry   acts as this this measure of how much i care  how conscientious how responsible i am so by   worrying it demonstrates that i care about these  things that i’m responsible that i’m conscientious  
01:14:25
and so that’s actually a really good thing it  demonstrates a really positive aspect or really   positive aspects of my personality so if you  think about these five worry beliefs if worry   actually did serve to motivate me help me solve  problems prevented bad things from happening  
01:14:54
protected me from future negative emotions and  demonstrated a positive personality characteristic   well then that would seem to to be  something that i should be doing   of course i should be worrying if it  actually served all of these purposes
01:15:15
but as you can probably guess worry doesn’t  actually do any of these five things and   i’ll explain why it doesn’t in uh the next  video uh but you may now raise the question   of okay well well so what what do i do with this  information now you’ve you’ve told me about five  
01:15:38
worry beliefs that promote anxiety and promote  worry so what what can i do with this information   well the first thing to do is to use these worry  beliefs and notice them when you catch yourself   worrying the idea here is that for a lot  of people this this concept of part of the  
01:16:01
reason why i worry excessively is because i think  that the worry is doing something positive for me   this is a bit of a foreign concept people often  when i work with my clients they’ve never thought   about any potential benefits that they may have  perceived that worry is giving them and so the  
01:16:21
first step is to just be aware of which of these  worry beliefs actually play a role in my worry now   there may be some of these worry beliefs that  you’re sort of that we’re talking about that   right away you’re saying no that doesn’t that  doesn’t apply to me i don’t believe that at all  
01:16:41
it’s not so much whether or not you believe  the worry belief to be 100 true all the time   but it’s more like you want to ask  yourself the question am i behaving as if   i believe this worry belief to be true and so uh  for a week or two spend some time paying attention  
01:17:03
to a what it is that you’re worrying about and  then when you notice what you’re worrying about   ask yourself are there any of these five worry  beliefs that may be playing a role in this worry   because once you’re aware of the common  worry beliefs that you tend to use  
01:17:24
then you can begin working on challenging those  worry beliefs and evaluating whether or not those   worry beliefs are true but you can’t do that  unless you’re aware of what the worry beliefs   actually are but once you identify the worry  beliefs the question then becomes okay well what  
01:17:50
do i do with that information so if i know that  i’m engaging in this worry in part because i hold   this worry belief how can i go about changing  that and that’s what we’re going to be talking   about today ways of challenging the validity  of these beliefs and assumptions about worry so  
01:18:13
what we’re going to do is go through each of the  five worry beliefs and talk about different ways   and different questions to ask yourself to help  you challenge the validity of the worry belief   because it’s important not only  to recognize that the worry belief  
01:18:30
isn’t true or that the worry belief is a  myth but also to understand why it’s not true   because that results in a much more compelling  challenge to the usefulness of the worry   so the first worry belief that we talked about  is this notion that worry acts as a motivator  
01:18:53
that worry is the kick in the pants that i need  to get going to engage in in doing things that   if i didn’t worry i wouldn’t be particularly  motivated i wouldn’t be particularly successful   here are some questions to think about how you’d  go about challenging that belief so if you believe  
01:19:14
that worry does actually motivate you well have  you ever met anyone or ever known anyone who was   really successful and was really able to motivate  themselves who didn’t seem to worry excessively   well if so then what that means is that  worry isn’t a necessary component for success  
01:19:38
or motivation another question to ask yourself is  does worry dramatically improve your performance   or your ability if so by what percentage it does  it make a big change so when you’re worrying a lot   do you find that you perform even better or do  you find that sometimes when you’re worrying a lot  
01:20:04
it actually interferes with motivation it actually  causes problems that make you less motivated   to engage in activity or to do something  so think about how you feel when you’re   worrying excessively what does that do to  concentration what does that do to energy level  
01:20:26
so if you’re worrying a lot and it’s causing  you to lose focus or lose concentration   how exactly does that help motivate you if your  worrying is so exhausting and wearing you out   so much how does that um how does that help you  get things done if you don’t have as much energy  
01:20:53
when you’re worrying a lot what does that do to  your tendency to want to engage in an activity   when we talked about intolerance of uncertainty  we talked about one of the manifestations of   intolerance of uncertainty is procrastination so  if worrying is causing you to procrastinate a lot  
01:21:13
how exactly can that be something that’s  consistent with something that helps motivate you   so these are some of the questions to ask yourself  to challenge that belief that worry helps motivate   me so the next worry belief that we talked  about is that worry helps with problem solving  
01:21:32
it’s this notion that by worrying a lot about  the problem it keeps the problem in my mind   and it helps me come up with solutions for that  problem so if we want to look at whether or not   this belief is true you want to ask yourself the  question does worry actually solve the problem  
01:21:52
is worrying the same as problem solving well  worrying as we talked about in an earlier video   is essentially looping a feared negative outcome  over and over and over again in your head it is   something that you’re doing cognitively it’s  something that is just a bunch of thoughts  
01:22:12
spinning in your head whereas problem solving  is a much more active behavioral task you’re   defining problems you’re coming up with possible  solutions you’re implementing solutions you’re   doing something about it so what you want to be  clear on is are you worrying or are you problem  
01:22:36
solving and you don’t want to be mixing up the two  because worrying isn’t the same as problem solving   worry doesn’t have any effect on the world worry  is something that you’re doing in your head   it doesn’t actually solve a  problem so being very careful to  
01:22:54
distinguish between worrying  versus active problem solving   another question to ask yourself just like with  the the previous worry belief is do you know   anyone who’s really good at solving problems  who’s able to get things done who’s able to  
01:23:13
figure out solutions to problems who doesn’t worry  excessively well if you’re able to identify at   least one person in your life who doesn’t worry  excessively but is still able to solve problems   what that suggests is maybe you don’t need to  worry excessively to be good at solving problems
01:23:36
and tying back to another question that we  asked earlier think about what worry does to   your anxiety levels and think about when you’re  feeling really anxious what does that do to how   well you’re able to think clearly how well you’re  able to concentrate how well you’re able to  
01:23:56
think creatively well we know that worry  and anxiety interfere in all of these things   so by worrying what you’re doing is you’re making  it more difficult to concentrate you’re making it   more difficult to think clearly through situations  and you’re making it more difficult to think more  
01:24:18
clearly or more creatively so by worrying  what you’re doing is actually interfering in   the cognitive skills and the tools that you need  for effective problem solving so these are some   questions to ask yourself if you believe and if  you think that worry helps you solve your problems
01:24:42
now the third worry belief we talked about has  a bit of a superstitious flavor to it and it’s   this notion that worry can prevent bad things  from happening just the act of worrying can   uh help prevent me from being jinxed uh or  can prevent the bad thing from occurring well  
01:25:06
to challenge this belief you want to ask yourself  some questions based on experience have you ever   worried about something bad happening  and the bad thing actually did happen   well if we were to able to prevent bad things  from happening then every time you worried  
01:25:26
the bad thing shouldn’t happen  think about potentially setting up a   an experiment one thing i i’ll often get people  who hold this worry belief to do is to go out and   buy a lottery ticket and then for one week to  spend five to ten minutes every day worrying  
01:25:49
excessively worrying as hard as they can about  having wasted their money on that lottery ticket think about what should happen then if worry can  prevent bad things from happening what should   happen well they should win the lottery because  by worrying about having wasted their money on  
01:26:14
the ticket if worry can prevent the bad thing from  taking place can prevent the negative outcome then   the person shouldn’t experience a negative outcome  which means that they should win the lottery   not once in all my years of doing this has a  client come back and said hey guess what i won the  
01:26:32
lottery so that’s another way of challenging this  notion that worry can in and of itself have some   impact on the outcome you also want to think about  is it the worry that’s preventing the negative   outcome or is it things that you’re doing that are  preventing the negative outcome so for example if  
01:26:57
i’m worrying about a presentation that i’m going  to give and that presentation turned out fine   after i worried excessively was it the worry  that ensured that the presentation went well   or was it the fact that i prepared really  well for the presentation that ensured that  
01:27:15
the presentation went well is it maybe the fact  that i kind of knew what i was talking about   that ensured that the presentation went well  maybe it has nothing to do with the worry   a fourth common worry belief is this notion  that by worrying about something bad happening  
01:27:38
it almost protects me from future negative  emotions by uh preparing me emotionally just   in case the bad thing were to happen so if the  bad thing were to take place uh by worrying about   it what i’ve done is kind of prepared myself  for that bad thing so i’m not caught off guard  
01:27:58
i’m not surprised and in some ways then that that  can help reduce the impact of the negative emotion   well have you ever worried  about something bad happening   and the bad thing actually happened how did  you feel afterwards did you say to yourself  
01:28:17
yeah you know i don’t feel so bad because i’ve  been worrying about it for the last three weeks   probably not another way i get people to think  about this is it’s a bit abstract and it’s a bit   of a silly math uh puzzle but i like it because  it it helps explain uh how to really get at this  
01:28:38
notion or really challenge this notion that worry  prevents me from feeling bad in case something bad   happens so i want you to think about  sort of negative emotion in terms of   pieces of suck how much it would suck if this  thing happened so suppose one of my big worries  
01:29:00
is that my family is going to be killed in a motor  vehicle accident and i worry about this a lot   well think about what that worry does in  terms of how it makes me feel well it’s   probably going to suck to be worrying about this  all the time and to be thinking about this all  
01:29:24
the time so maybe that’s a hundred pieces of suck  now imagine tragically one day my family is killed   in a motor vehicle accident say that is a thousand  pieces of suck well do you think the moment i   pick up the phone and uh hear the message that my  family’s been killed in a motor vehicle accident  
01:29:54
do you think that moment when i hear that news  that i’m going to be saying to myself wow it’s   a good thing that i’ve been worrying about  this for so long i don’t feel so bad right now   no it’s gonna suck it’s gonna suck that thousand  pieces of sock whether or not i’ve been worrying  
01:30:13
about it or not so if you do the math i worry  excessively about my family being killed   in an accident that’s a hundred pieces of suck  my family is killed in a motor vehicle accident   that adds a thousand pieces of suck to the  equation so what am i left with i’m left with  
01:30:37
1100 pieces of suck well suppose i don’t worry  excessively about it well i have zero pieces   of suck and then if the bad thing were to actually  happen i have a thousand pieces of sock so the net   result is i end up with a thousand pieces of sock  it’s still better than the 1100 pieces of sock  
01:31:01
now suppose my family never gets killed in  a motor vehicle accident well i’m worrying   about it happening so that’s a hundred pieces  of suck it doesn’t happen that’s zero pieces of   sock i’m left with a hundred pieces of sock but  if i don’t worry about it it’s zero pieces of  
01:31:19
sock if it never happens that’s zero pieces  of sock i end up with zero pieces of sock   so um it’s a bit of a a sort of a strange or silly  math puzzle but what i find is that for a lot of   my clients it really resonates with them you know  just do the math how many pieces of suck are you  
01:31:40
actually saving by worrying about this probably  not any and you’re probably actually making   the situation worse so the final worry belief  i want to talk about challenging is this notion   that worry represents a positive personality  characteristic that by worrying excessively  
01:32:01
it demonstrates a sense of caring a sense of  responsibility a sense of conscientiousness   this is a big worry belief for parents especially  moms who who often tell me what kind of person   would i be if what kind of mother would  i be if i didn’t worry about my children  
01:32:24
and so i asked the question well what are some  of the other characteristics that make you a   good mother aside from worrying can you think of  any other characteristics that are important to be   a good mother another way of thinking about it is  does the worry ever interfere in you being able to  
01:32:45
be your best does it ever interfere in terms of  how well you’re able to engage in relationships   how well you’re able to be present in situations  does the worry ever interfere in those things   well if so then how can it be a positive  personality characteristic how can it be  
01:33:07
a positive personality characteristic if  it interferes in your relationships if   none of your friends or people close to you  think that your tendency to worry is a good thing   do you know conscientious responsible caring  loving people who don’t worry excessively  
01:33:28
if so then worry probably isn’t necessary to  be conscientious to be caring to be responsible so these are the five worry beliefs and  these are some questions to help you   challenge each of those worry beliefs  and so you might be thinking now okay  
01:33:52
well so what what can i do with this how do i  actually use this information to help me worry   less so the way you do it is through something  we call cognitive therapy and this is essentially   thinking about your thinking now this is a bit  of a challenging task because we’re not typically  
01:34:13
used to thinking about what we’re thinking and  we’re definitely not used to thinking about   our thoughts about what we’re thinking and that’s  kind of what we’re doing here so you have to be   aware of what your worry is that’s cognitive layer  one then you have to be aware of your worry belief  
01:34:34
that’s cognitive layer two and now we’re  challenging the beliefs about the usefulness   of worry that’s cognitive layer three so this is  a bit of a challenging task if you’re trying to   do it all in your head and so to help uh to help  be better able to challenge these worry beliefs  
01:34:57
i’ve come up with a series of questions  to help you work through this and i   have a worksheet that i give my clients and i’ll  be linking to it in the description down below   so you can download and take a look at this but it  helps you organize your thoughts to help challenge  
01:35:15
the beliefs that you have about the usefulness  of the worry so the way it works is the first   thing you need to do is identify what it is that  you’re worrying about this again goes back to that   foundational skill i talked about in the very  first video which is worry awareness training  
01:35:34
being aware of what it is that you’re  worrying about so you identify your worry   then the next question to ask yourself is what  are the beliefs about the usefulness of this worry   that may be playing a role in this worry  do i think this worry is helping motivate  
01:35:51
me do i think this worry is helping me solve  problems do i think this worry shows that i’m   a caring person do i think that this worry is  going to prevent something bad from happening   do i think this worry is going to protect me  from negative emotions in case something bad  
01:36:06
does happen so you identify which of the worry  beliefs might be playing a role in this worry the   third question then to ask is if i had to prove  to myself that these beliefs may not be true   what are some of the things what is some  of the evidence that i would point out  
01:36:31
so essentially using some of those questions  i talked about earlier and challenging each of   these worry beliefs so if i think that this worry  about my child shows that i’m a caring parent i   may want to start asking myself some questions  of well does does my worry ever interfere with  
01:36:53
me being a good parent does my worry ever make  it more difficult for me to be present in these   situations and moments with my child well if  so then how can that make me a good parent   so you’re using some of those questions  to help challenge the worry belief
01:37:14
then the fourth question you want to ask yourself  is what’s the benefit for me continuing to worry   about this issue right now and it’s not uncommon  for the answer to this question to be none   once you identified the worry belief and you’ve  challenged the validity of the worry belief  
01:37:39
oftentimes it’s easy for a person to see well  there’s there’s no real benefit for me to continue   worrying about it that takes us to the fifth  question which is okay if there’s no benefit   of continuing to worry about it what are the  costs associated with worrying about it so when  
01:38:00
you’re thinking about the costs associated with  worry what you want to think about is things like   how does this worry or your tendency to worry  interfere with your productivity your performance   um how does it make you feel how does it what  is the impact that it has on your relationships  
01:38:21
with other people what are the negative impacts  that worrying excessively about this topic are   having on you and having on uh other people are  there other people who seem to get similar results   as you without the same costs  associated with this worry  
01:38:46
so really thinking about what are the negatives  associated with the worry what are the   negative impacts that this worry is having  on you because you want to think about that   in the context of this equation that we’re looking  at which is asking kind of the ultimate question  
01:39:01
of should i continue to worry about this is  there value in continuing to worry about this   so you’ve gone through these five questions  what’s the worry what’s the benefits associated   with the perceived benefits associated with this  worry what are some of the challenges uh to those  
01:39:21
perceived benefits what is the potential  benefit of continuing to worry about this   what is the cost of continuing to worry about this  and based on all of that information you come up   with a conclusion a conclusion about now that  i’ve thought through all of these things should  
01:39:42
i continue to worry about this topic is there  value in continuing to worry about this topic   and what you end up with is a much more compelling  challenge a much more compelling challenge to   the purpose or the utility of that worry  than what people typically do which is  
01:40:01
just stop worrying about it it’s silly  you shouldn’t be worrying about it well   this goes beyond that it’s not so dismissive of  the worry it’s more about i know i should stop   worrying about it because of this this and this  reason and because of this this and this cost  
01:40:23
so it’s a much more compelling uh more rounded  challenge to the validity of this worry   so this is a challenging skill it’s challenging  because for the most part we’re not used to   thinking about our thinking so it takes a fair bit  of practice and so i hope if you’re interested in  
01:40:48
trying this out or using some of these skills  please download that worksheet that’s in the   description section below and try it out uh don’t  worry if you’re not getting it right off the bat   it is a challenging task but with practice  what i find is that people get a lot better at  
01:41:10
identifying and challenging some of the benefits  they perceive that they’re getting from a worry what we’re going to be focusing on now is  tools and skills specifically to address   type 1 worries so worries about actual problems  so it may not become as much of a surprise that  
01:41:36
the primary way we deal with type 1 worries is to  solve the problem that’s contributing to the worry   and so that leads us to a question about you know  why is it that people who worry a lot tend not to   have very effective or tend not to engage in  very effective problem solving so uh there was  
01:42:00
some studies that were done that looked at  how is it that people who worry a lot how   how good are their problem solving skills  compared to people who don’t worry a lot   and you might be surprised by the findings  and what they found was that there’s actually  
01:42:16
no difference in the problem-solving  abilities of people who worry a lot   versus people who don’t worry a lot but what is  different is that people who tend to worry a lot   tend not to use the problem-solving skills that  they have whereas people who don’t worry a lot  
01:42:35
tend to be able to use their problem-solving  skills more frequently and more effectively   so you can think of this kind of like the way  i like to think of it is it’s kind of like   a garage door where it doesn’t matter if you  have the best problem solving skills in the world  
01:42:54
you can have the ferrari of problem solving skills  but if that garage door is down it doesn’t matter   if you have a ferrari in the garage or if you  have a tricycle in the garage neither of those   problem solving skills are going to be able to  get out of the garage and so this garage door is  
01:43:12
something that we refer to as negative problem  orientation it’s a tendency to view problems   in an overly negative way seeing problems as  threatening as dangerous viewing myself as not   being very good at solving problems or addressing  problems and so if i don’t think i’m very good at  
01:43:35
solving problems if i don’t think that i  should be having problems if i don’t think that   problems are are good or that every time i have  a problem it means that there’s something wrong   i’m not going to be all that motivated to actually  want to engage or do something about a problem  
01:43:56
and so if i’m not actually engaging in a problem  if if i procrastinate or i avoid dealing with   a problem what tends to happen to the problem  well typically problems that you don’t deal with   don’t go away by themselves and they tend to  fester and grow and mushroom until they become  
01:44:18
a crisis and now it’s a crisis that you have  to deal with and so you go into the situation   and now i’m dealing with a crisis situation and i  deal with that crisis situation by spontaneously   coming up with the first thing that comes to  mind to try and deal with this problem that  
01:44:38
is not a very good recipe for effective problem  solving a crisis situation and me spontaneously   coming up with a solution right off the top  of my head to address this crisis situation   and so what that ends up happening is what ends  up happening is i don’t really address the problem  
01:45:00
very well and then that reinforces my negative  beliefs and my negative views about problems   that problems are bad uh problems i shouldn’t have  problems and i’m terrible at dealing with problems   and so as long as i hold those views and i don’t  engage in problem solving that’s just going to  
01:45:19
maintain the problems and it’s just going to  maintain my worry about those problems so if we   want to improve worry management skills if we want  to worry less about problems we need to get better   at solving problems and in order to get better  at solving problems we have to be able to  
01:45:40
use the problem-solving skills we have and  in order to use those problem solving skills   we need to address this negative problem  orientation we need to get the garage door   to move up and then to be able to let our  problem solving skills out of the garage so  
01:46:00
negative problem orientation tends  to have sort of three components   to it and the first component of negative problem  orientation is this tendency to see problems as   abnormal or that there’s something wrong  with me that i have problems that uh other  
01:46:21
people don’t seem to have the same problems  that i do related to this is the idea that   problems should be solved quickly and easily  and that if i’m not able to solve a problem   really quickly or if i’m not able to solve a  problem the first time i try to solve the problem  
01:46:39
then that means that there’s something wrong  that i should be able to solve a problem quickly   and easily and if i can’t then that just  goes to show that there’s something wrong   with this problem or there’s something wrong  with me for having problems like this so that’s  
01:46:58
one sort of manifestation of this negative problem  orientation second manifestation of this negative   problem orientation is a tendency to focus  entirely on the threat components of the problem   so when faced with a problem all i think  about is all the things that could go wrong  
01:47:21
so if you think about uh if you think about the  possible outcomes of a problem on a continuum   where one end of the continuum is opportunity or  challenge opportunities for things to work out   and the other end of the continuum are uh  i see it as entirely threatening 100 threat  
01:47:42
well what we know is that with people with  this negative problem orientation for with   people who worry a lot they tend to gravitate more  towards focusing on the threat aspect of a problem   and so if all you think about when  you think about solving a problem  
01:47:58
is all the things that could go wrong  and how badly it can turn out that’s not   particularly motivating it’s not particularly  good as a motivator to get me to do something   about that problem so i end up in this paralysis  zone where all i’m really doing is focusing on the  
01:48:18
negative potential outcomes and i’m  paralyzed to do anything about it   so uh what ends up happening is i don’t really  engage in trying to solve the problem or trying   to deal with the problem because i don’t really  see many opportunities for things to work out well  
01:48:39
and that leads to the third component of negative  problem orientation is that sometimes people can   get so good at avoiding problems that they fail  to recognize when a problem’s actually there   they get so good at being avoidant to problems  that they don’t recognize that a problem exists  
01:49:00
until it’s too late until it becomes a crisis  like i talked about before so if i’m not even   aware or if i’m not even recognizing that a  problem’s there i’m not going to be able to engage   in trying to solve the problem so i have these  three components of negative problem orientation  
01:49:21
i see problems as abnormal that there’s something  wrong with me for having problems i focus entirely   on the potential threat or danger associated with  the problem and i get so good at avoiding problems   that i fail to even recognize when problems  exist if i have those three things going on  
01:49:45
i’m not going to be particularly good at actually  engaging or doing anything with regards to problem   solving so the question becomes okay well what  do i do with this if i if i recognize that i’m   i’m i have this negative problem orientation  i don’t deal well with problems what do i do  
01:50:06
so let’s talk about how you challenge each of  these components of negative problem orientation   so if you find that you tend to view problems  as abnormal or is there something wrong with me   for that i have problems or problems should  be solved quickly and easily first thing i  
01:50:28
typically ask my clients is well do you know  anyone who doesn’t have problems or is the   presence of problems indicative  of there’s something being wrong   or is it the case that just everybody has problems  and that there’s nothing really wrong with  
01:50:47
the fact that you actually have problems because  having problems is just a natural state of being   everybody has problems so it’s really about  normalizing the occurrence of problems   beautiful people in hollywood have problems  people who are down and out have problems  
01:51:07
rich or rich and powerful politicians  have problems everybody’s got problems   so the fact that you have a problem or the fact  that you have problems doesn’t necessarily mean   that there’s something wrong with you it  just means that you’re like everybody else  
01:51:24
we all have problems and no one ever said that  problems should be solved quickly and easily   i sort of think of it as kind of like the the  sitcom approach to viewing problems where people   hold this attitude that uh problems should be  resolved just like they are on tv sitcoms where  
01:51:45
a problem arises in the first five minutes of  the show there’s then 20 minutes of zany hijinx   and then everything gets wrapped up nicely in the  last five minutes problem solved everyone goes on   with their life while that works really well  in tv sitcoms no one ever said that real world  
01:52:06
or real life problems are actually like that  so if you’re having problems that you find are   challenging or difficult to overcome well welcome  to the club everybody has those types of problems   and no one ever said that problems should be  solved quickly or easily so really challenging  
01:52:24
this component of negative problem orientation  is really about normalizing the occurrence of   problems and normalizing the fact that some  problems are just really difficult to address the second component of negative problem  orientation this tendency to focus on the threat  
01:52:43
component of the problem well if you think back   if you think about our our continuum and i’m  stuck in the paralysis zone where all i’m   thinking about is all of the potential threat  or danger that is associated with this problem  
01:52:58
all of the things that could go wrong with this  problem well you know part of this has to do with   intolerance of uncertainty and we talked about  that in a prior video intolerance of uncertainty   goes very well and hand in hand with this fear  of addressing problems or this viewing problems  
01:53:20
as threats because problems at their core by  definition are things that we’re uncertain about   the solution to the problem if we knew exactly  what we needed to do to solve a particular problem   then it wouldn’t be a problem it would just  be a series of steps that i need to engage in  
01:53:39
what makes it a problem is the uncertainty and  the unknown of what it is that i need to do to   solve this problem or how i solve this problem  and so this intolerance of uncertainty can get   a person to really focus on all of the the  potential threat or danger associated with  
01:53:58
potentially trying to address this problem  so the idea here is to try and reframe   the problem as an opportunity and try and get  it out of this paralysis zone where all you’re   focusing on is the potential threat so it’s just  a reframe uh thinking about the problem in a bit  
01:54:21
of a different way you don’t have to see the  problem as entirely good or it’s going to be   really wonderful to try and solve this problem but  you just need to get out of this paralysis zone   so you just need to reframe or shift the problem  or shift your perception of the problem just  
01:54:38
a little bit to get out of that paralysis zone  so that you can see a little bit of opportunity   and with that little bit of opportunity now  you might be more motivated to actually engage   in this problem and solving the problem  so so how exactly do you do this well  
01:54:56
let’s think about an example suppose i have a  job interview coming up and one of my things is   that i’m terrible at job interviews um i always  get really nervous and anxious hands get sweaty   and uh and i just my voice tends to tends to quake  and i tend to ramble and all this sort of thing  
01:55:16
and i’m really concerned about this job interview  and i see it as a real problem of how i’m going to   go about dealing with this job interview so  one way of reframing this as an opportunity   is to look at it and say okay yeah i’m i haven’t  had really good experiences at job interviews  
01:55:37
in the past but the opportunity in this is  for me to practice the skill of interviewing   for a job so even if i don’t get this job the  opportunity here is that i get some practice   engaging in a job interview and in doing so i’m  going to potentially get better so that for my  
01:55:58
next job interview i’ll have some experiences  that i can learn from and that will help me   in the next job interview so it’s again it’s  not sort of making it entirely pollyanna   this job interview is going to turn out great i  really love job interviews that’s not realistic  
01:56:16
thinking but it’s more about just reframing it  a little bit to get out of that paralysis zone   and to look for even just a little bit of  opportunity with this problem um if you’re ever   struggling to find an opportunity and a problem a  good default is always this is an opportunity for  
01:56:38
me to tolerate uncertainty like i said problems by  definition are uncertain and so if you’re looking   for an opportunity the opportunity is this gives  me a chance to work on my tolerating uncertainty   which if you’ve seen previous videos you know  that’s a key to cutting off the murray fuel supply  
01:56:59
so to help with this sort of challenging  or reframing problems as opportunities   i have a worksheet that i’ll link to in the  description below you can download the worksheet   and it sort of walks you through how to take a a  type one worry or worry about an actual problem  
01:57:18
and then to reframe it as an opportunity or a  challenge so the third component of this negative   problem orientation this tendency not to recognize  or not to be aware of problems until it’s too late   so there’s a couple ways of addressing this the  first is these problems or problems that a person  
01:57:44
doesn’t deal with very well they tend not to  be one and done types of problems these are   problems that tend to come up again and again  and again they tend to recur for a person   so one way of becoming better at recognizing  problems early on is to actually keep a list of  
01:58:05
what are problems that tend to recur  for me again and again and again   because by keeping this list what it does is  it it keeps your mind or keeps you alert to   potential problems that may come up that you  wouldn’t necessarily recognize unless you were  
01:58:22
looking for them so for example um one of my  recurring problems is that i’m always terrible   at um at school projects that involve a working  in groups and every time that’s happened to me   in the past it’s been a real mess where uh i have  either difficulty trying to take control of the  
01:58:43
situation or i just become incredibly passive  in this situation and it doesn’t work out very   well so that’s something that i can keep track of  that’s a recurring problem that comes up again and   again for me so i just have it on this on my list  of recurring problems just as a way of keeping it  
01:59:01
in the forefront of my mind another way of being  more aware or recognizing problems earlier on   is to use your emotion as a bit of a red flag a  bit of a cue to stop and to look around and to   ask yourself is there a problem here that i’m not  addressing so you notice yourself feeling really  
01:59:23
anxious in a situation that’s a moment to stop and  say okay i’m feeling really anxious what’s going   on here is there a problem that i’m not dealing  with is there a problem that i’m not addressing   i had this uh a good example of this with a client  a few years ago and this client found that he was  
01:59:43
just really really anxious whenever he was at work  and so we got to this part of the worry management   program where we talked about negative problem  orientation and he used his anxiety at work as a   cue and he stopped and asked himself one day okay  what’s going on here why am i always so anxious  
02:00:03
at work and as obvious as this may  sound as simple as this may sound   what he realized by sort of stopping and  asking himself that question was that   he hated his job he hated everything about  it it was going nowhere it wasn’t really that  
02:00:21
reinforcing for him he didn’t like the people that  he was working with and so once he was able to   recognize and identify that the problem was that  he hated his job and that’s why he was so anxious   whenever he was at work he was then able to engage  in some problem solving so what he did is he  
02:00:39
worked on his resume and he submitted his resume  applied for a bunch of jobs and he got a new job   and lo and behold he was no longer anxious  at work so it was using his anxiety at work   as that red flag of that that caused him to stop  and ask is there something that’s going on here  
02:01:01
that’s making me anxious or that’s that i’m  worrying about is there a problem here that   i’m not dealing with and once he did he was then  able to take some steps and deal with the problem   so those are the manifestations of this negative  problem orientation and those are some tips  
02:01:22
to try and improve your orientation towards  problems like i said this is this is the garage   door and until you deal with negative problem  orientation as long as you tend to view problems   in a really negative way as threats and that you  avoid dealing with you’re not going to be able  
02:01:42
to deal with the problems and you’re probably  going to continue worrying about the problems   excessively by addressing this negative problem  orientation by normalizing the occurrence of   problems by reframing problems as opportunity  instead of threat and by recognizing problems  
02:02:00
earlier on what you’re doing is you’re raising  that garage door and you’re allowing yourself to   use your problem solving skills that you already  have and to use them in a really effective way so what we’re going to be talking about is six  steps in problem solving and these six steps  
02:02:26
like i said it’s kind of like a recipe and if you  follow the recipe what you’ll find is that you’re   a lot more effective or it gives you a framework  to be more effective in terms of solving problems   so the very first step in problem solving this  one you probably already know and probably pretty  
02:02:47
obvious to you is that you need to define the  problem and the way i like to think about defining   the problem is to sort of ask yourself three  questions what is the situation that currently is   what would i like the situation to be and what  is the barrier or the obstacle between what is  
02:03:09
and what should be because then you can  reframe the problem is a question about   how you address or remove the barrier to  get the situation to what you want it to be   so the first step is defining what your problem  is so let’s use an example as we go along here  
02:03:31
suppose my problem is that i’m feeling like  i’m overweight that i need to lose some weight   and the barrier i’ve discovered is that i  really just don’t have a very healthy lifestyle   my lifestyle is one that it doesn’t allow me to uh  be particularly healthy with regards to diet with  
02:03:50
regards to exercise and so the problem is that my  lifestyle is preventing me from being more healthy   and helping me lose weight so step one define the  problem step two comes directly from step one and   it’s defining what the goal is so i’ve defined the  problem but what is it that i want what is my goal  
02:04:16
and to try to be as kind of specific and clear and  behavioral as possible with regards to the goal so   in my example the goal may be that i  want to lose 15 pounds so that’s my goal   so that leads us to the third step which is what  i call the brainstorming step coming up with  
02:04:41
alternative possible solutions to address  this problem now i find that with a lot of   the clients i work with this is the part of the  problem solving that they tend to rush through   the idea with brainstorming is you want to try and  generate possible solutions to help you address  
02:05:04
this problem and those possible solutions need  to meet sort of three principles for effective   or good brainstorming the first principle  is what i call the quantity principle   and what that means is you want to generate a  lot of possible solutions what people often do  
02:05:25
when they’re engaging in problem solving  they just come up with the first one or   two uh ideas or solutions that come to mind  and that’s what they go with brainstorming   takes it beyond just those one or two possible  solutions and gets you to think about lots of  
02:05:43
different possible solutions so when you’re  thinking about brainstorming i like to tell people   rough rule of thumb 10 to 15 possible solutions  to this problem so that’s the quantity principle   the second principle of effective brainstorming  is the um the diversity or different types of  
02:06:08
possible solutions so if for example i’m going  through my brainstorming and i’m coming up with   possible solutions like uh my my possible solution  is to go to the gym and run on the treadmill   another possible solution is to go to the gym and  ride the exercise bike another possible solution  
02:06:32
is to go to the gym and go on the elliptical  trainer now these are all different solutions   but they’re all kind of the same solution so you  want uh some diversity in the possible solutions   that you’re coming up with so it’s not just the  same thing over and over again you want some  
02:06:52
uh variety in the possible solutions you’re  coming up with so one of my possible solutions   could be going to the gym and running on the  treadmill or it could be eating more salad or   hiring a personal trainer or taking up hiking  or going on a low carb diet or packing my own  
02:07:13
lunch for lunch rather than getting something at a  restaurant so i’m coming up with lots of different   possible solutions to help solve the problem  or that could potentially solve the problem   the third principle of brainstorming is  one that i find that people really struggle  
02:07:32
with and this principle refers to deferring  judgment in other words when you’re brainstorming   you’re not actually judging the possible solutions  that you’re coming up with you’re just coming   up with the solutions it’s not about evaluating  whether or not the solutions will work the idea is  
02:07:53
you want to be as creative as possible with your  solutions you want to get out of the typical box   that you usually think of when it comes to solving  problems and think a little bit outside of that   box so when you’re doing the brainstorming some of  the solutions you come up with should be a bit out  
02:08:13
there they should be a bit ridiculous and bizarre  because what that means is that you’re allowing   yourself to think outside how you typically think  i once had this experience with a client this was   a mom of two kids she loved her kids dearly but  she just wasn’t getting enough time away from  
02:08:33
the kids where she could do things to recharge her  batteries and so she tried all of the things like   babysitting swaps with other moms or having  her parents look after the kids but she just   wasn’t getting a big enough chunk of time away  from her kids and so one of the things that she  
02:08:50
came up with as she was doing the brainstorming  was putting her kids on a rocket and sending   them to the moon and so she thought well that’s  kind of a ridiculous idea i could never do that   but it got her thinking okay well i can’t send  my kids to the moon but i can send them to summer  
02:09:09
camp and so she got the idea to register them for  a summer camp and they went away to a sleepover   camp she had a week away from them really  recharged her batteries and she felt really great   because it had helped solve the problem of  having some time away from her kids where  
02:09:27
she could really charge her batteries and so she  wouldn’t have got there if she hadn’t allowed her   mind to go into kind of really out there possible  solutions like sending the kids to the moon so   you want to defer your judgment allow yourself to  be creative allow yourself to be a bit out there  
02:09:46
with the possible solutions it’s not about judging  the solutions at this point so after brainstorming   then you want to evaluate the possible solutions  this is where you determine whether or not   those solutions could potentially work so in order  to evaluate the solutions i like to get people to  
02:10:09
think of a few questions so first of all will  this possible solution likely solve my problem   so for example if one of the solutions i came  up with while i was doing my brainstorming   to help me lose weight is to to  go and and do an all donut diet  
02:10:32
well it’s kind of an out there solution but  it’s probably not going to solve my problem   it’s probably not going to help me lose that 15  pounds so right there i can dismiss that solution   as one that’s probably not going to be all that  effective another question i want to ask is how  
02:10:51
much time and effort is going to be involved in  this solution so if i come up with a solution of   going to the gym seven days a week and working  out eight hours a day well chances are that’s   gonna help me get into really good shape but it’s  not really all that realistic and it’s probably  
02:11:10
way more time and way more effort than i’m  willing to do so i’m unlikely to do that solution   i’m going to want to think about what will be the  impact on myself how will i feel about myself for   coming up with the solution or implementing the  solution and what will be the impact on other  
02:11:30
people if i implement this solution so for example  if one of the potential solutions i came up with   is to steal my best friend’s girlfriend who  happens to be a personal trainer so i can get   free personal training lessons well that might  help me get into better shape because she’ll  
02:11:49
give me free personal training lessons but i’m  probably not going to feel very good about myself   for having done that and my friend probably isn’t  going to be too pleased with me for having done   that either so that’s not a very good solution  either so you you have this list of possible  
02:12:10
solutions that you’ve brainstormed so the idea  is to try and evaluate these solutions based on   these questions and to try to come up with the  best possible solution not the perfect solution   there likely will be no perfect solution and  so it’s at this stage where you have to really  
02:12:32
tolerate some uncertainty because you’re not  going to know exactly what the best solution is   you’re just going to have to pick one  that seems like it’s the best solution   and go with it tolerating the uncertainty  of that so once you’ve decided on a solution  
02:12:53
the fifth step is to actually come up  with a plan and implement the solution so   if i come up with uh if one of my solutions  is to eat more salad i need to come up   with a plan for how i’m going to actually  implement solution of eating more salads so  
02:13:13
i’m going to make sure to add salad to my grocery  list i’m going to make an effort to buy the salad   the salad mix so salad dressing all of the  fixings for the salad and i may pick a day   of the week um maybe tuesday or thursday will  be my salad days and so i’ll make a plan to  
02:13:35
implement uh eating more salad on those days so i  come up with a plan and then i implement the plan and then the final step step six is one that  people often don’t think about but it’s actually   pretty critical in terms of problem solving  and step six is to verify whether or not the  
02:14:00
solution has worked so to have sort of a set date  or set time that you’re going to look back and say   okay i’ve been doing the solution i’ve been  implementing my plan has it helped so maybe i   give myself a month of eating salad every tuesday  and thursday and so what i do is i weigh myself at  
02:14:22
the end of the month and see whether or not it’s  worked if it has worked that’s great i can reward   myself give myself a pat on the back for coming  up with the solution and implementing it and   uh and it working so i can feel good about myself  for having taken some steps to solve this problem  
02:14:44
but if it hasn’t worked if i in the solution  verification stage i realize i actually haven’t   lost any weight i’ve actually gained a few  pounds then this is an opportunity for me to   look back on my problem-solving approach and to  ask myself where might things have gone wrong  
02:15:03
well maybe i didn’t define the problem correctly  um maybe when i look back on my brainstorming i   only came up with one or two solutions i didn’t  actually do the brainstorming that well maybe when   it comes to evaluating the possible solutions  i look back on it and realize you know what  
02:15:24
the one that i picked seemed like it was going to  work but it didn’t maybe i should try one of the   other possible solutions that i came up with or i  could look at it and say hey you know what maybe   the solution that i picked would have worked if  i’d actually done it and so looking back on it  
02:15:42
i realized i didn’t actually do a very good job  of implementing the solution that i came up with   so the idea of the solution verification step  is to help you to look back and figure out   where it went wrong if it did go wrong and  then to problem solve or then to try different  
02:16:02
different approaches or different tweaks to your  solution to try to get at a solution that works   so the process is self-correcting if you allow it  to be self-correcting and if you allow yourself   the opportunity to reflect on whether or not it’s  working so those are six steps to a recipe of six  
02:16:25
steps to help you solve problems more efficiently  so you might be wondering okay well that’s all   great and interesting and all but how does that  help me worry less well the idea is with these   type 1 worries if you’re able to more effectively  solve the problem that you’re worrying about  
02:16:47
then you’re not going to be  worrying about it anymore   understanding these problem-solving steps can  also help you recognize what problem-solving is   versus what it isn’t right so when we talked about  worry beliefs one of the common worry beliefs  
02:17:06
is that worry helps me solve problems well by  understanding what problem solving looks like   defining the problem defining a goal brainstorming  evaluating possible solutions implementing a   plan and then verifying whether or not the plan  worked that’s much different than worrying about  
02:17:26
negative things happening from this problem  so understanding these steps to problem   solving also helps you understand a little bit  better what problem solving looks like what   effective active problem solving looks  like versus worrying about a problem  
02:17:44
now obviously these problem-solving steps that  i’m talking about aren’t going to be applicable   to every problem now there are some problems that  are just pretty simple to solve right so if i take   my lunch to work every day and one day i forgot  my lunch at home well i’m not necessarily going  
02:18:05
to have to go through these six steps of problem  solving to figure out what it is that i need to do   i’ll just go down to the food court and buy  myself lunch but these problem-solving steps   can be really helpful for some of those more  difficult problems some of those problems  
02:18:24
that you find that you’re struggling with or  that you’ve been struggling with for a while   and so if you can break down the problems and use  these problem solving this problem-solving recipe   it might be able to help you get to a more  effective solution to the problem and to  
02:18:43
assist with that i’m going to link to a problem  solving worksheet down in the description below   so you can download that worksheet and it  can help you walk through these six steps   of problem solving just as a way of of writing  down how you’re going to approach the problem
02:19:04
type 2 worries are worries about future or  potential problems problems that haven’t happened   problems that may never happen but still a person  worries about them now the thing about these type   2 worries is that they tend to tap into the core  fears that a person often has so these type 2  
02:19:29
worries tend to be about the most scary things  that we fear or that we dread happening worries   about failure failure academically failure  in life more generally worries about losing   a job or a relationship breakup worries about  you or someone you care about becoming very sick  
02:19:54
or a family member dying in a motor vehicle  accident these types of things so these type two   worries tend to be quite scary and quite upsetting  when they come up so if you think about it if uh   if you catch yourself worrying about one of  these really sort of scary core fears what’s  
02:20:18
the most natural thing the most natural reaction  to do with those worries well for a lot of people   who worry a lot and for a lot of people who don’t  worry a lot the most natural thing when these   unpleasant worries these unpleasant thoughts about  future negative events come up the most natural  
02:20:39
thing to do is to try and push those thoughts  out of your mind try not to think about them   and it makes sense if if these thoughts  bring up you know sort of images or or   thoughts about things that are really distressing  or really upsetting to think about it’s natural  
02:20:57
to just want to avoid thinking about that in  general it’s something we call cognitive avoidance   so pushing these thoughts suppressing these  thoughts from my mind so that i don’t have to   think about the thing that’s so upsetting  that obviously i don’t want to think about
02:21:19
now this cognitive avoidance may make sense   on the surface and it’s kind of the most  natural response to these upsetting thoughts   but one experiment one little exercise i do with  my clients to sort of explain how this cognitive  
02:21:37
avoidance works is to get them to for one minute  to think about anything they want to think about   anything at all but in that one minute i get  them to try really hard not to think about   a pink elephant so they can think about anything  they want to think about just not a pink elephant  
02:22:03
and so i start a timer and i get them to  think about whatever they want just not the   pink elephant but if they happen to think  about a pink elephant i ask them to make a   a mark on a piece of paper each time the thought  or image of a pink elephant comes to mind  
02:22:20
and usually what happens is uh in that one  minute i see them really start to struggle   either they start to kind of laugh or they  start to roll their eyes or they but they’re   making marks on that sheet of paper and what  ends up happening at the end of that minute is  
02:22:38
they’ve thought about the pink elephant a lot  and so i often ask them a few follow-up questions   like uh how many times in the past week  have you thought about a pink elephant and   usually the answer to this question is well i  haven’t thought about a pink elephant at all and  
02:23:00
then i asked them okay well in the past week how  much effort did you put into trying not to think   about a pink elephant they tell me well i wasn’t  trying not to think about a pink elephant at all   and so i point out well isn’t it interesting  that in one week of putting no effort into  
02:23:21
trying not to think about a pink elephant  you didn’t think about a pink elephant at all   but in one minute of trying not  to think about a pink elephant   you thought about a pink elephant multiple  multiple times we call this the paradox of thought  
02:23:40
suppression the more you try not to think about  something the more you end up thinking about it   so relating this to type 2 worries if i’m  avoiding thinking about these type 2 worries   because they’re really upsetting to think about  and i don’t want to think about them and so  
02:24:03
if i’m trying to deal with these type 2  worries by pushing the worries and by pushing   the thoughts out of my mind it’s essentially  me doing a pink elephant with these worries   i’m trying not to think about it and by trying  not to think about it all that really does is it  
02:24:21
causes the worry to come up over and over and over  and over again and each time it comes up i try and   push it out of my mind which means it’s just going  to come up again and then i’m going to push it out   of my mind and it’s going to come up again so the  reason why these type 2 worries keep coming up  
02:24:42
is often because a person’s trying not to think  about it and the harder you try not to think about   it the more the worry is going to keep coming up  so it’s this uh really kind of self-destructive   uh self-fueling cycle um i liken it to trying to  hold a beach ball underwater the more pressure  
02:25:06
you put to hold that beach ball underwater  the more pressure there is for the beach ball   to keep popping up and then you grab it and you  push it back down again it pops up and you grab it   and you push it back down again but it just keeps  coming up and so while this cognitive avoidance  
02:25:23
on the surface seems like the most natural  thing to do when these type 2 worries come up   it’s actually one of the factors  that’s maintaining the type 2 worries   so that leaves us with the question okay if trying  not to think about the type two worries is what’s  
02:25:44
causing the type two worries to come up over  and over and over again what can i do about it   well the answer to that question is  something we call cognitive exposure   and i’ll be talking about that in the next video
02:26:04
if trying not to think about the type 2 worry  is what’s causing the worry to come up over and   over and over again the solution the tip or the  tool for managing these types of worries may seem   very counter-intuitive and the idea is rather than  trying not to think about the worry rather it’s to  
02:26:31
think about the worry over and over and over and  over and over again until you essentially drain   the emotion out of the worry thought so again  remember that worries are they’re just thoughts   they’re predictions about the future and with  these type two worries what can happen is you have  
02:26:55
this anxiety and this emotion connected with the  worry and the worry thought so every time the   worry thought comes up the anxiety comes up and  if you feel really anxious every time this thought   comes up it makes sense to want to try and get the  thought out of your mind because the anxiety is  
02:27:13
really uncomfortable so the way around this is by  thinking about the worry again and again and again   the the metaphor i like to use to explain  this is to imagine that you’re watching tv and   one day there’s this weird satellite glitch that  happens and whatever it is that you’re watching on  
02:27:38
tv disappears and what ends up happening is this  really grotesque horrible horror film comes on the   tv it’s really upsetting and it’s really gross and  and distressing and so you just turn off the tv   but the next time you turn on your tv lo  and behold the same thing happens the same  
02:27:58
movie interrupts what you’re watching and it gets  really distressing for you and you turn off the tv you do it again and it just keeps happening well  imagine what would happen and how you’d feel   if you watched if you allowed yourself to  watch that horror movie all the way from the  
02:28:19
beginning to the end well you’d probably find it  really distressing you’d probably find it really   uncomfortable and really unpleasant and you feel  really distressed watching that movie but then you   force yourself to watch it a second time well the  second time you watch it you may find it even more  
02:28:39
distressing and even more upsetting because you  kind of know what to expect and you kind of know   the horrors that are that are awaiting but then  you force yourself to watch it a third time and   a fourth time and a fifth time and a sixth time  by the hundredth time you’ve watched the horror  
02:28:58
movie by the thousandth time you’ve watched  the horror movie what do you think is going   to happen to your emotional reaction to it well  you’re you’re probably going to be pretty bored   uh you’re probably going to be like oh yeah  guy jim’s out of the shower with a big knife  
02:29:15
big deal the movie hasn’t changed one bit what’s  changed is your emotional reaction to the movie   essentially it’s drained any emotion out of the  movie and so it’s no longer all that distressing   and so um you’re watching the same movie  it’s the exact same movie that you saw  
02:29:38
the first time you saw it when it was really  upsetting for you but it’s no longer upsetting   it’s the same process with this idea of  cognitive exposure you essentially want to   take these type 2 worries and think about them  over and over and over again to their their  
02:30:00
really horrible hand the most distressing parts  of it that you don’t let yourself think about   with these type two worries what often happens  with people is their their mind will go to a   certain point in the worry and they say okay you  know what it’s too much i i can’t take anymore and  
02:30:16
they they stop thinking about it and so it’s  almost like one of those old-fashioned record   players and it just keeps skipping so it plays  the same part of the song and just keeps skipping   over and over and over again so it’s not playing  the song all the way through that’s what happens  
02:30:33
with these type 2 worries a person doesn’t allow  themselves to think about the type 2 worries   all the way through to the the horrible end  that they imagine but by doing this and by   doing this repeatedly essentially what you’re  doing is you’re giving the worries the air time  
02:30:53
so it’s almost like these worries want their  air time they want you to think about them   and so you give the worries their air time and  you think about them in concentrated ways until   the emotion essentially drains from the worry  and if the emotion drains from the worry it’s  
02:31:11
not going to be so upsetting when it comes up  and if it’s not so upsetting when it comes up   you’re probably not going to try and push the  thoughts out of your mind so it’s a bit of a   strange concept to wrap your head around but  it works and in fact this is the exact same  
02:31:32
treatment approach that we use for people  with post-traumatic stress disorder   the difference with between post-traumatic stress  disorder and this is that in post-traumatic stress   disorder the traumatic event has happened to the  person it’s happened to the person in their past  
02:31:48
whereas in generalized anxiety disorder and  excessive worry the traumatic event is something   that a person imagines happening in the future  but it’s the same process to drain the emotion   out of the thought so how do you go about doing  this cognitive exposure how do you how do you  
02:32:09
do it well cognitive exposure is different than  worrying about the worry with cognitive exposure   the idea is you sit down and you write  out a script imagining your type 2 worry   in all of the graphic horrific upsetting detail  that you can imagine all the way to the end to  
02:32:34
those darkest parts that you don’t even allow  your mind to go to that you don’t let yourself   go to and you take your mind there you write out  this script detailing what you imagine happening   and i encourage person to write out the script  in the first person present tense so like it’s  
02:32:56
actually happening to them because what that can  do is it it puts you in the worry scene it puts   you in that scenario and it allows you to sort of  more closely imagine yourself in that situation   and so you write out the script it should  be anywhere from like one to three or five  
02:33:19
minutes long it doesn’t have to be any longer  than that but you want to include as much   a detail as possible as much sensory  detail as much thought detail as you can   so i’ll give you an example of a script um  now this is a script for someone imagining  
02:33:40
uh that they’re going to die of cancer so  the script may go something like this um   i was diagnosed with or i was diagnosed with my  cancer a few weeks ago and it is spread rapidly   through my body uh the cancer is my fault because  i didn’t take care of myself i had a unhealthy  
02:34:02
lifestyle i ate poorly um i spend too much time  in the sun without sunscreen so it’s all my fault   that this is happening to me i’ve gone through  a series of upsetting and painful procedures   the treatments have caused me to lose my hair  i’ve lost weight i’m fatigued i’m exhausted all  
02:34:29
the time i’m now coughing up blood and it makes  me sick every time i see myself in the mirror   i know now that i’m on my deathbed i can feel  my life draining from me this was all my fault   i did this to myself and now here i am in  this hospital bed having just soiled myself  
02:34:58
and i can smell how awful it smells and i feel  exhausted and weak i can’t even call out for help   i’m in this darkened hospital room in this  darkened ward and i see only shadows in the   background i know my death is coming soon and  it’s going to be a bleak emptiness that i’m  
02:35:22
going to face for eternity so now notice that  that may not be something that you worry about   but that type of script it’s descriptive enough  that it’s like this kick in the gut it it should   make you uncomfortable and so the idea is you  write out this script about this really horrific  
02:35:45
type 2 worry whatever your type 2 worry is  whatever the the worry that you’re struggling with   is you write out a script as detailed as possible  and once you have that script the idea is to take   30 45 minutes an hour a day and read that script  over and over and over again so you read the  
02:36:13
script all the way through and i encourage people  to make a note of how upsetting or distressing it   was on a scale from zero to ten where zero is not  distressing at all ten is uh extremely distressing   extremely upsetting so after every time you read  the script you make a rating from zero to 10. then  
02:36:36
immediately you read it again from 0 to 10 make  a rating and again and again at least 10 or 15   times in that 30 to 45 minutes to an hour chunk  of time that you’re setting aside to do this   you want to do this at a time when you’re not  going to be distracted so turn off your cell phone  
02:37:00
sort of get away so that people aren’t going to  be distracting you now it’s key to understand this   is going to be very distressing it’s going to be  very very difficult to do it’s going to make you   feel very uncomfortable and so if you’re feeling  uncomfortable even at the thought of doing it  
02:37:20
that’s normal this isn’t something that anyone  should look forward to doing because the whole   idea is to bring up the emotion to bring up  the distress and to learn to cope with it and   to let it just go away on its own like watching  that horror movie over and over and over again  
02:37:42
so you do these ratings and  what you should find is that   uh within a session of doing this so from  the beginning where you start with a rating   the first time you read it maybe a 9 out of 10 or  a 10 out of 10. and then you read it over 15 times  
02:38:01
what you should find is that at the end of that  15th time of reading it your rating should be   lower right the first time you do it maybe your  rating at the 15th time is a five or a six out of   ten and then you do it again the next day and  the day after that and i encourage people to  
02:38:20
do this for a week or two and what they find  is that over the course of that week or two   the ratings both within each session tend to  decline and between each session they tend to   decline so after a couple of weeks of doing this  the distress at the you know 10th or you know 15th  
02:38:44
day that you’ve done this those distress scores  are a lot lower than they were in the first day   so this is like i said a very challenging exercise  this isn’t something that you want to do with   every worry because it takes a lot of time and  it’s quite distressing so you want to use this  
02:39:05
on those worries that are particularly problematic  those worries that come up again and again that   you’re really struggling with because this works  it’s it’s not pleasant but it works so i’d liken   it a lot to that buckley’s cough syrup commercial  you know it tastes awful but it works that’s kind  
02:39:27
of what what this cognitive exposure is all about  as well it tastes awful but it does work as we’ve   gone along we’ve talked about lots of different  tools for managing these various uh factors that   maintain worry we’ve talked about worry awareness  training and categorizing worries as type one or  
02:39:51
type 2 worries we’ve talked about the importance  of building tolerance for uncertainty through   behavioral experiments with uncertainty we’ve  talked about ways of challenging worry beliefs   we’ve talked about improving problem orientation  by recognizing problems earlier on by normalizing  
02:40:11
the occurrence of problems and by reframing  problems as opportunities instead of threats   we’ve talked about cognitive exposure and how  that can be used to help address and deal with   type 2 worries so we’ve talked about a  whole bunch of skills a whole bunch of tools  
02:40:33
and for a lot of my clients when we get to  this point of therapy they’ve learned a lot but   there’s a little bit of confusion in terms of like  all of these skills seem a little bit disconnected   and they don’t really understand how they all come  together and how to use all of them to effectively  
02:40:52
manage worry and that’s what i want to talk  about in this video exactly how we put together   these tools and skills the order in which to use  them kind of like a recipe to best manage worry   so the very first step in terms  of this worry management recipe  
02:41:14
goes back to the very first tool we talked about  which is worry awareness training you have to   be aware and you have to know what it is that  you’re worrying about and then you categorize   the worries once you’ve identified the word you  think about it and categorize it is this a type  
02:41:31
1 worry or is this a type 2 worry so let’s start  with type 1 worries what would be the formula or   the recipe for dealing with type 1 worries and  as a review type 1 worries are worries about   actual current real problems problems that  you’re actually experiencing in this moment  
02:41:54
so the first step with type 1 worries is you’ve  identified it as a type one worry well the next   thing to do is to think about are there any ways  in which i’m being intolerant of uncertainty in   this situation are there various things that i’m  doing that may be avoiding or trying to eliminate  
02:42:15
uncertainty with this problem so for example  let’s imagine that i have a problem like i’ve just   gotten into an argument with my friend and uh me  and my friend haven’t spoken in a couple of weeks   so it’s a current problem that i’m dealing with  well what are some of the ways in which i might be  
02:42:39
intolerant of uncertainty in this situation well i  may be avoiding reaching out to my friend because   i’m concerned that they’re still upset with me and  so i’m engaging in avoidance or i may be checking   in with other friends and seeking reassurance  about you know what i did was it was it wrong  
02:43:03
would they be upset with me how would they react  have they heard anything from my friend about it   so thinking about all of the things that i might  be doing that are intolerant of uncertainty   and thinking about what is the opposite that  i could be doing what are things that i can be  
02:43:20
doing to tolerate uncertainty in that situation so  that’s the the step looking for opportunities to   be more tolerant of uncertainty or to be tolerant  of uncertainty with this problem after that after   i’ve worked on tolerating uncertainty the next  thing i want to do is to think about which of the  
02:43:43
worry beliefs might be playing a role in this  worry so i might hold some worry beliefs that   maybe me worrying about you know my relationship  with my friend it demonstrates that i’m caring   it demonstrates that i’m conscientious it  demonstrates that i’m a responsible person  
02:44:03
who cares about his relationships that’s why  i’m worrying about it so once i’ve identified   that worry belief that’s continuing to have me  worry about this i can begin to challenge that   worry belief using some of those challenging  questions i talked about in a previous video  
02:44:23
so i’ve engaged in trying to tolerate uncertainty  i’ve identified and challenged my worry beliefs   the next step is to deal with  that negative problem orientation   so recognizing the problem earlier on well  i’ve identified the worry so that’s good  
02:44:41
now i want to normalize that  problems are normal it’s not um   it’s not that there’s something wrong with me that  i’m having this problem with my friend it’s that   these things kind of happen um and then i want to  try and reframe this problem as an opportunity so  
02:44:58
i can look at this as this is terrible me and my  friend are never going to get back together if i   try to reach out to my friend they’re going to be  really upset with me and it’s going to lead to an   even worse outcome so i’m thinking about all  of the threat associated with this worry but  
02:45:17
the goal here is for me to try to reframe that  as what’s the opportunity or the challenge here   well maybe the opportunity in this is for  me and my friend to be able to work out this   problem and by doing so we actually get closer  because we’ve gone through it we’ve worked out  
02:45:36
our difficulties and now we’re at a at a better  place than we were even before the problem came up   so then i can engage in the problem-solving  steps because i’ve now looked i’ve identified the   the problem i’ve reframed it i’ve normalized  it that negative problem orientation is out  
02:45:58
of the way and now i can actually engage  in some of those problem-solving steps   that we talked about in a previous video so  identifying the problem identifying the goal   brainstorming possible solutions of how i  can fix this relationship with my friend  
02:46:14
evaluating those possible solutions and picking  one developing a plan for what i’m going to do   and actually utilizing the plan or implementing  the plan and then seeing whether or not it’s   helped seeing whether or not me and my  friend have resolved our difficulties  
02:46:34
so that if i do all of those things and if i  solve the problem at the end i’m no longer going   to be worrying about this issue so that’s the  recipe for how you deal with type 1 worries you   identify it and label it as a type one worry you  look for tolerating uncertainty opportunities as  
02:46:56
a type one worry you challenge the worry beliefs  that are contributing to this type one worry you   address the negative problem orientation and you  engage in problem solving so um it’s actually   pretty similar to the order in which i presented  these tools as we were going through the videos  
02:47:17
and that was for a reason because that’s kind of  the order in which you want to use these tools   so that’s a type 1 worry well how do you deal with  type 2 worries well if you remember type 2 worries   are worries about future or potential problems  problems that haven’t happened yet problems that  
02:47:36
may never happen and so what’s the approach  for dealing with these type 2 worries well   the first few steps are actually identical for  dealing with type 1 worries so you’ve identified   the worry you’ve labeled as a type 2 worry the  first thing to do is to look for opportunities to  
02:47:56
tolerate uncertainty so for example if my type  2 worry is i’ve planned my one vacation a year   to be a sunny a warm weather destination  vacation and i’m starting to worry about   the weather and that the weather is going  to be terrible and that it’s going to rain  
02:48:16
the whole time and my vacation is going to  be ruined and this is something that really   sort of bothers me or is really concerning  for me and that i’m worrying about it a lot   well thinking about what are some of the things  that i might be doing to be more what are some  
02:48:33
of the things that i could do to be more  tolerant of uncertainty in this situation   well maybe i shouldn’t be checking the  weather and the weather forecast for my   hot weather destination maybe i shouldn’t  be checking uh the farmer’s almanac to see  
02:48:51
historically what the weather was like at that  destination over the time that i’m gonna be   traveling there maybe i shouldn’t be looking  into all of the possible things i could do   if the weather is not great or if it is raining  the whole time because those are all things that  
02:49:11
are designed to eliminate uncertainty and so  what i want to do is to try to be just more   tolerant of uncertainty in this situation and  not do those intolerant of uncertainty behaviors   so once i’ve worked through the things that  i can do to be more tolerant of uncertainty  
02:49:30
i may want to challenge uh some of the beliefs  about the usefulness of this worry so maybe i’ll   hold i hold a belief that worrying about this  means that i’m kind of preparing myself so that   if i worry about it ahead of time if when i get  to my vacation it is raining i’ll kind of have  
02:49:50
prepared myself emotionally for it and so i won’t  be so upset well identifying that worry belief and   challenging that worry belief as we talked about  in the challenging worry beliefs video so now   i’ve i’ve gone through i’m tolerating uncertainty  i’ve identified and challenged the worry beliefs  
02:50:10
the next step i want to do if i’m still worrying  about this is to engage in that cognitive exposure   exercise that i talked about which is essentially  to write out a script imagining that worst case   scenario imagining that i end up on this  vacation and it’s pouring the whole time  
02:50:29
and imagining how bad it would be to its very end  and then reviewing that script over and over and   over again to essentially drain the emotion out of  it so that’s the process for type 2 worries and if   you notice the first few steps are identical to  the steps in type 1 worries all that differs is  
02:50:51
what you do at the end whether it’s cognitive  exposure or whether or not it’s problem solving   so those are the recipes that’s the order in which  you want to use these tools and that’s how these   tools sort of fit together to work together for  the most effective worry management now one of the  
02:51:11
things that can come up is sometimes my clients  will say okay i understand this and i understand   it makes sense what i do with type 1 where is  it makes sense what i do with type 2 worries   but what if i make a mistake at that very first  step what if i label a type 1 worry as a type 2  
02:51:32
worry so for example it’s a worry about an actual  problem but i mislabel it as a type 2 worry so   i think it’s a worry about a future or potential  problem well whenever clients bring this up i say   okay well let’s walk through what would happen  then well so it’s a type one worry in actuality  
02:51:54
but i imagine it a type two worry so what i’m  gonna do with dealing with the type two worry   is i’m going to be tolerating uncertainty well  i’d be doing that for a type 1 worry anyway   i’d be identifying and challenging worry beliefs  well be doing that for a type 1 worry anyway  
02:52:12
then i’d engage in cognitive exposure so i write  out a script and start working on a script about   the worst case scenario that i can imagine in  this well that wouldn’t really work for a type   one worry because the type one worries about an  actual problem but what will happen and this has  
02:52:35
happened with some of my clients before is they  start working on a worry script and they start   reviewing the worry script and what they find  is that they start to get really frustrated   because they’re reviewing a wordy script  about something they have control over  
02:52:53
and then once they identify that no wait  this is something i have control over   then they can recognize you know what this isn’t  actually a type two worry this is a type one worry   and at that point they then shift to dealing with  it in terms of addressing the negative problem  
02:53:10
orientation and engaging in problem solving so  there’s nothing really wrong with misclassifying   a type 1 worry as a type 2 worry because once  you get to the cognitive exposure part of the   the recipe you’ll recognize that this cognitive  exposure isn’t working because i can do something  
02:53:32
about it and once i recognize i can do something  about it i can then shift over to addressing it   like a type one word so think about what would  happen if it’s actually a type two worry but i   misclassify it as a type one worry so to worry  about a future or potential problem but i deal  
02:53:54
with it like it’s a worry about a current problem  well the first few steps are going to be identical   i’m going to be tolerating uncertainty i’m going  to be identifying and challenging worry beliefs   the only difference is now i’m going to start  to engage in problem solving or i’m going to try  
02:54:12
to engage in problem solving for a problem that  doesn’t exist well as soon as i start to try and   engage in problem solving i’m going to recognize  that the problem doesn’t currently exist and once   i’m aware that the problem doesn’t currently exist  that’s my cue that this is actually a type 2 worry  
02:54:31
and so then i can shift to working on a cognitive  exposure script if i need to so the idea here is   not to worry about or not to get too preoccupied  with having to have it perfectly clear is this a   type 1 worry is this a type 2 worry like i said  from the very beginning just do your best just  
02:54:53
sort of do your best to try and figure out if this  is type 1 or type 2 and just go with it because   the process is self-correcting the first few steps  are going to be identical whether or not it’s type   1 or a type 2 worry and if you misclassify the  worries it’s ok because you’ll recognize that  
02:55:13
as soon as you start doing either the cognitive  exposure or the problem solving and you’ll   recognize that it’s not working which means  that you’ve probably misclassified the worry   and so you just need to shift to whatever tool  you need to use for the other type of work
02:55:35
for some people they find that some of their  worries don’t really fit nicely into this type   1 type 2 categorization that there seems to be  a bit of type 1 component to the worry but also   a type 2 component to the worry so the worry is  is kind of more complex there’s kind of this mix  
02:55:58
of type 1 and type 2 worries so the question  becomes how exactly do i deal with this how do   i deal with these complex worries and so what i  wanted to talk about is kind of a formula recipe   for these type these complex worries that actually  follows quite nicely from the previous video  
02:56:23
so if you think about the very first step in worry  management we identify it as recognizing what it   is that you’re worrying about and labeling  the worry is it type one or is it type two   well in this situation what you’re doing is you’re  recognizing and you’re identifying the worry  
02:56:42
and recognizing that it’s both type one and type  two it’s a mixed worry so i’ll give you an example   of a mixed worry suppose i have a business and  during the busiest time of the year i have a   whole bunch of staff members quit or get sick and  so i don’t have enough staff to be able to fill  
02:57:06
all of the orders that i have and so then i start  to worry well this is going to really upset a lot   of my customers and what if those customers decide  that they’re going to go shop somewhere else and   then this will have a real negative impact on  my business and my business is going to decline  
02:57:26
and maybe shut down in the future because i’m  not going to be able to recover from this setback   so it’s got a bit of a type one component to  it that i’m dealing with a problem right now   of my staff all either quitting or getting sick  and not having enough staff to uh complete all  
02:57:46
of the orders so that’s the type one component of  the worry but the type two component of the worry   is my business suffering in the future because  of this and ultimately me losing my business   because all of my customers have gone somewhere  else that’s the type two component of this worry  
02:58:08
so we’ve got a little bit of a mix our type  one worry has spiraled into a type two worry so   what do you do with this i’ve identified it as a  complex worry i’ve identified it as a mixed worry   what’s what do i do to manage this worry well  very first step as we talked about in the previous  
02:58:29
video is to look for ways in which i can be more  tolerant of uncertainty in this situation how do i   tolerate uncertainty or another way of thinking  about it is what are the ways in which i’m being   intolerant of uncertainty in this situation so  maybe what i’m doing is i’m avoiding notifying my  
02:58:55
customers that their shipment is going to be  delayed because i’m concerned that if i notify   them they’re going to cancel the order well all  that’s really doing is maintaining my worry about   you know what my customers are thinking so  more tolerating uncertainty thing to do in  
02:59:12
that situation is to notify them call them explain  to them what’s going on and see what happens so   thinking about what are the ways in which i can  be more tolerant of uncertainty in this situation   second thing you do like with all worries  is to identify and challenge worry beliefs  
02:59:33
to think about what are the worry  beliefs that might be playing a role   in me worrying about these series of events  and the future series of events do i think   that worrying about this situation worrying about  not having enough staff to fulfill these orders  
02:59:51
is worrying about it going to help me solve that  problem well then i can think about the tools   that i’ve learned to help me challenge that belief  that worry aids in problem solving so i identify   and challenge the worry beliefs that might be  contributing to my worry so i’ve gone through  
03:00:12
those steps and those are the same steps we use  regardless of the worry regardless of whether   it’s a type 1 or a type 2 worry but now what do  i do it’s still there maybe i’m still worrying   about it and it’s this mixed word it’s still got  type 1 and it’s still got type 2 components to it  
03:00:30
well what i recommend for clients in this type  of situation is to focus on it like it’s a type 1   worry so look at the negative problem orientation  that may be contributing to the worry so   uh trying to reframe the problem as an opportunity  what’s the opportunity in this situation for me  
03:00:50
well maybe the opportunity is for me to figure out  ways of becoming more streamlined in how i get my   product out to my customers maybe i can figure out  more efficient ways of fulfilling the orders with   fewer staff which will help me grow my business  in the future so there’s opportunities in this and  
03:01:12
so if i can reframe those offer reframe the the  problem rather than just seeing it as a threat i   reframe it as an opportunity then i’m more likely  to then be able to engage in some problem solving   with this so i then engage in those problem  solving steps to try and address the problem of  
03:01:33
not having enough staff to fulfill these orders so  i engage in those six problem solving steps that   i talked about in an earlier video so now i’ve  engaged in effective problem solving suppose i’ve   i’ve solved the problem so i’ve i figured out ways  of either hiring new temporary staff or being more  
03:01:55
efficient and being able to fulfill these orders  with the staff that i have so i’ve solved that   problem well there’s a good chance that by solving  the problem i’ve now eliminated the type 2 worry   part of this worry as well so i’ve eliminated  the type 1 because i’ve addressed the problem  
03:02:15
but now that i’ve addressed the problem maybe i’m  not going to worry about losing all my customers   anymore and maybe i’m not going to worry  about becoming bankrupt and losing my company   so by addressing it as a type one worry i  may fully solve the type two worry part of  
03:02:34
this and fully address the complex worry by  just treating it like it’s a type one worry   but suppose that i solved the problem i’ve  addressed the type one worry part of it   but there’s still this mingling worry that i have  about yeah that was close what if in the future  
03:02:54
my business falls apart and i start to keep  worrying about that type two part of the worry   well if i’m still worrying about the type two part  of the worry then i can engage in the cognitive   exposure we’ve talked about so write out a script  imagining that worst case scenario and then  
03:03:14
reviewing that script over and over and over again  to essentially drain the emotion out of that worry   so these complex worries even though they  seem more complex they’re actually pretty   straightforward in terms of the steps you  need to use in the order you need to use them  
03:03:37
and they’re very similar to how we deal with  be it a type 1 worry or be it a type 2 worry   so you essentially treat it like it’s a type 1  worry you identify the worry tolerate uncertainty   challenge worry beliefs address the negative  problem orientation and engage in problem solving  
03:03:58
at that point if there’s any type  2 part of the worry left over   then you engage in the cognitive exposure so what  i like about this is that it flows nicely with   what we talked about in the previous video about  our recipe for managing worries and that complex  
03:04:21
worries are actually not all that complex in  terms of what you need to do to address the worry so what we’ve done over the last 14 videos  is talk about a number of worry management   skills and tools we started out with our basic  engine of worry we talked about the role that  
03:04:49
intolerance of uncertainty plays as the fuel  that drives the worry engine we’ve talked about   the role of beliefs about the usefulness of  worry and how that those beliefs can maintain   excessive difficult to control worry we’ve talked  about the role of negative problem orientation  
03:05:08
and ineffective problem solving in keeping  worry about current problems going we’ve talked   about how cognitive avoidance can maintain  worries about future or potential problems   we’ve also talked about a flow chart for  and recipe for how you go about managing  
03:05:30
different types of worries including type 1  worries type 2 worries and mix or complex worries   so we have talked about a lot of tools we’ve  talked about a lot of skills and you may have   learned a lot by watching all of these videos so  the question becomes okay well what do i do with  
03:05:51
this now moving forward now one of the things i  want to point out is that this isn’t this model   of worry that i’m talking about here isn’t just  something that i’ve imagined it’s actually based   in a lot of scientific research that has backed  this model of worry and back this treatment  
03:06:10
protocol that i’ve been walking you through this  treatment protocol is based on the research and   work of a really brilliant psychologist named  michelle duga who’s at concordia university   in montreal and what duga and his colleagues did  was they developed this protocol and then they  
03:06:32
administered it to a number of people who worried  excessively people with generalized anxiety   disorder and what they found was that at the end  of treatment not surprisingly the vast majority of   people who went through this treatment showed  significant improvements in their worry levels  
03:06:54
in terms of their anxiety levels so it showed that  at the end of treatment the treatment had actually   worked it actually been really effective in  terms of helping people better manage their worry   but what they did was they took the research  even a step further and they followed up  
03:07:12
the people two years later and  what they found was actually quite   encouraging they found that the majority of  people who went through this treatment protocol   at two years later we’re still showing the  same gains and the same improvement that  
03:07:30
they had demonstrated at the end of treatment  and so what that means is that the treatment   wasn’t just effective as long as the person was  in the treatment or was receiving the therapy   but that they maintained the progress two years  later and so there are lasting improvements and  
03:07:48
lasting gains from this treatment but what they  also found was that there was a subset of people   who actually showed even further improvements  at the two-year mark that they demonstrated   even lower levels of worry and even lower levels  of anxiety two years later than they did when they  
03:08:10
stopped the therapy so what this demonstrates is  that for the most of the people the vast majority   of people who go through this treatment  and who go through the treatment protocol   actually maintain their gains or show even further  improvement two years later and that’s great to  
03:08:29
know so what it means is that this treatment isn’t  just something that you do and then the benefits   go away it’s something in which the benefits are  maintained for at least two years likely beyond   but in the research what they also found  was that there was a small subset of people  
03:08:50
who experienced a recurrence of symptoms so at two  years later they are actually demonstrating higher   levels of worry and higher levels of anxiety  than they were when they stopped treatment   and so what dugon his colleagues looked at was  what was the difference between these groups  
03:09:08
of people what was it about the people who  showed a recurrence of symptoms who showed   a deterioration in their  level of worry and anxiety   at two years compared to the people who maintained  their gains for who even got better at two years  
03:09:27
and not surprisingly what they found was that the  people who maintained their gains or who continued   to get better at two years those were the people  who were still using the worry management skills   whereas the people who showed a worsening in  their symptoms at two years they were people who  
03:09:48
at the end of treatment had felt better and  then they were just happy to be done with   excessive worry they were happy to be over  it and they just wanted to move on with their   lives and so they stopped using the skills and  this is one of the things about this type of  
03:10:07
treatment or this approach for worry management  it’s a skills-based form of treatment it is not   a worry cure it’s worry management  because the reality is everyone worries   and everyone will always worry but this  treatment isn’t about preventing worry  
03:10:28
it’s about helping a person control and manage  the worry so it’s not so excessive or interfering   in a person’s life and so if you stop using the  tools then they’re going to stop being of benefit   and you’re likely going to fall back into old  habits of excessive worry and high anxiety  
03:10:51
and so it really is about what can you do to make  sure that you’re continuing to use your tools what   can you do to ensure that you’re maintaining the  gains and using these worry management skills on   an ongoing basis and i want to give a few tips  about how to do that uh in this video so the  
03:11:14
first thing to realize and the first thing that’s  really important to understand is that there will   be times when you will experience a resurgence  in worry there will be times in your life moving   forward where you will experience higher levels  of worry because life stressors will come up  
03:11:32
things will come up and we know that life stress  tends to exacerbate and increase worry for people   now there’s a difference between a temporary  increase in worry and a full relapse of worry   so what you want to do is to  take these life stressors and  
03:11:53
to take these uh the increase in worry  that comes with these life stressors   and really apply the worry management tools to  address the worries as they come up and help you   get through those life stressors and get through  the worries associated with those life stressors  
03:12:12
now sometimes life stressors are unexpected  they come out of the blue i suddenly lose my job   someone in my family suddenly gets sick and i  didn’t anticipate it there was no way i could   have anticipated it it’s not really much you can  do about those types of stressors however there  
03:12:34
are some life stressors that are predictable and  so what you want to do one of the first things you   can do and to ensure that you’re maintaining  uh your use of these worry management skills   is to plan ahead for future stressors so for  example some predictable life stressors are  
03:12:55
the holiday season christmas and new year’s  a lot of people find that time of year to be   extremely stressful well that’s an example of  a predictable stressor so if you know that the   holiday season’s coming up the idea is to plan  ahead for what it is that you’re going to do  
03:13:13
to better manage your worry or to manage your  worry that comes up with that stress so it may   be that you plan to do more formal tolerating  uncertainty experiments during that time it may   be that you’re more hyper aware and hyper tuned to  those problems that tend to come up for you over  
03:13:36
and over again and so you can identify those  problems earlier on during the holiday season   and then be able to kick into your reframing and  problem solving so you want to plan ahead and if   you can plan ahead for foreseeable futures and to  develop a plan for what you’re going to be doing  
03:13:56
to manage your worry during that time that can go  a long way in preventing you from spiraling into   excessive worry and high levels of anxiety during  those stressful times second thing you can do to   maintain your worry is to think about what are  some early warning signs that you may want to  
03:14:18
pay attention to that would indicate to you that  you’re starting to slip back into old excessive   worry habits now the thing is people don’t  just tend to start worrying excessively one day   it’s for a lot of people it’s something that  they’ve done their whole life so you may have  
03:14:40
gone through these worry management videos you’ve  learned a lot of skills and you’re using them and   you’re able to really manage your worry quite  well but it’s important to remember that you’ve   only been managing your worry quite well for a  few weeks now compared to maybe a lifetime of  
03:15:00
excessive worry so that lifetime of excessive  worry is kind of like an old habit and so   it’s really easy to fall back and slip back  into those old worry excessive worry habits   so the idea is to think about what are some clear  signs for me that are going to be like early  
03:15:23
warning signs that tell me that i’m starting to  slide down an old familiar path of excessive worry   you want to try to make these as specific as  possible so that they can be your early alarm   or your early warning sign that something bad or  something wrong is going on in terms of worrying  
03:15:43
excessively so things like noticing that you’ve  been having trouble sleeping for the last four   nights in a row things like noticing that you  haven’t been doing any tolerating uncertainty   experiments for a couple of weeks noticing  that maybe you’ve been avoiding some social  
03:16:04
interactions because you’ve been a little bit more  uncomfortable or or experiencing a bit more stress   those behavioral indicators those behavioral  signs that maybe you’re sliding back into old   habits because once you recognize that maybe  you’re starting that slide back into old habits  
03:16:24
you can then kick into using your worry management  skills again and really focusing on those worry   management skills to get back on track and to  ensure that that little lapse doesn’t lead to   a full relapse in terms of high levels of worry  high levels of anxiety because it’s a lot easier  
03:16:44
to make a course correction earlier on than it is  when you find yourself worrying excessively again and the third tip for ensuring that you’re  maintaining your progress is to have a plan for   what you would do if you ever did find yourself  worrying excessively again now i know for a lot  
03:17:08
of people they don’t like to think about this  they want to to be positive and optimistic about   being able to manage their worry moving forward  and that it’s not going to be a problem for them   again but i like to think of this  more like an insurance policy  
03:17:26
so the idea is to sit down and spend some  time writing out a recipe or a formula for   exactly what it is that you would  do what are the various steps   that you would need you would go through if you  noticed yourself worrying excessively again so it  
03:17:45
may be uh bookmarking or uh or highlighting some  of these videos and going back to watching some   of these videos it may be that you’ve taken some  notes from these videos so it’s about reviewing   your notes and having a plan for what is it what  it is that i’m going to do if i catch myself  
03:18:05
worrying excessively again and you can have this  this instruction manual and you can fold it up put   it in an envelope and then right on the outside  of the envelope open in case of worry emergency   because if you ever catch yourself worrying  excessively again at some point in the future  
03:18:26
it’s really difficult in that moment to remember  exactly what it is that you need to do to better   manage or better control your worry so what you  can do if you ever find yourself in that situation   is you go to this envelope you open it up and then  you just read the instructions that you have come  
03:18:45
up with for you and so it can be a nice insurance  policy and hopefully you never need it because   you’ve been planning for stressors you’ve been  catching yourself in those early warning signs   that you might be falling back into old habits  and you’re continuing to use the worry management  
03:19:05
skills that you’ve learned on an ongoing  basis maybe you never need to open that letter   but it’s there for you just in case you need it so  those are some tips for maintaining the progress   that you’ve made uh through using these worry  management tools that i’ve been talking about  
03:19:26
and that’s the end of our 14-part series on worry  management you’ve learned a lot if you’ve watched   all of the videos you’ve learned a lot about  worry you’ve learned a lot about the factors   that maintain worry and all of the tools  that you can use to manage worry this is not  
03:19:49
five simple steps to overcome worry i’ve never  believed in that sort of approach because   i think it tends to invalidate and minimize  worry if it was as easy as five simple steps   nobody would be worrying excessively worry  management is a lot of work that’s a lot  
03:20:10
of hard work but if you understand the skills  and you understand the tools and you use them   these skills and tools work and you can better  control and better manage your worry so i would   love to hear your thoughts and comments about  this so please leave me some comments down below  
03:20:33
uh if you like this video if you found  it helpful please hit the like button   and if you’d like to see more of my videos please  hit the subscribe button and the notification bell   and you’ll be alerted every thursday when i post  a new video so thank you for making it all the way  

CEUs are available at AllCEUs.com/Trauma-CEU i’d like to welcome everybody today’s  presentation on the neurobiological  impact of psychological trauma and the hpa axis or our threat response system   now what we’re talking about is not necessarily  ptsd we’re talking about the impact of trauma  
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on our hpa axis and if we have excessive  stimulation of that hpa axis it can contribute   to traumatic injury but not every trauma  causes traumatic injury and we do want to   remember that there are things that we go through  that or you may have gone through which may have  
00:00:40
not been caused traumatic injury it was traumatic  but you had enough resources and resilience and   all that kind of stuff that it didn’t cause injury  or long-lasting effects and there are other things   or or somebody else may have gone through a  similar situation and not had those resources  
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and experienced traumatic injury from it so we  do want to recognize that every trauma impacts   every person differently at every point in  time what was stressful for you five years ago   may not be stressful now or vice versa maybe  five years ago you were just kind of walking  
00:01:18
on sunshine and right now you’ve got a lot of  stress and you’re already worn down so we’re going   to start by defining and explaining the hpa axis  identifying the impact of trauma on the hpa axis   and the impact of chronic stress and cumulative  stress on the hpa axis finally we’ll identify  
00:01:38
symptoms of hpa axis dysfunction and interventions  that are useful for people who are experiencing   hpa axis dysfunction i’m going to say that a lot  hpa axis stands for hypothalamic pituitary adrenal   axis i call it our threat response system for  short just because i get tired of saying hpa axis
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this presentation is based in part on the  article post traumatic stress disorder the   neurobiological impact of psychological  trauma that was published in 2011.   attention therapists all ceus is grateful to  our new sponsor the diversion center they offer  
00:02:20
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00:02:37
you have the option to add or remove  content insert your name as the author   and reprint and resell the workbooks to your  clients go to privatelabelworkbooks.com and take   advantage of their buy one get one free bundle  offers remember that’s privatelabelworkbooks.com
00:02:55
neurobiological abnormalities in ptsd or trauma   overlap with the features found in traumatic  brain injury imagine that we actually see   physiological changes shrinkage of the hippocampus  and other physiological changes as the result of
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environmental situational emotional trauma   not just actual traumatic brain  injury like from a concussion   the response of an individual to trauma depends  not only on the stressor characteristics you know  
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let’s look at what’s what actually happened  but also on factors specific to the person   such as the perception of their stressor how close  did this occur to the person’s safe zone we have   places where we feel safe you feel safe in your  home hopefully you feel safe at work hopefully  
00:03:50
if this whatever this trauma is occurs somewhere  where you thought you were safe suddenly you don’t   feel safe anymore it’s going to have a stronger  impact than for example if you experienced a   traumatic incident when you were on vacation  a thousand miles away from your house your  
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similarity to the victim if you are the victim  then obviously you’re very similar to the victim   if you are interacting with people and maybe you  are the parent of the victim or the great aunt of   the victim um or even you are a therapist working  with the victim or the survivor and you feel a  
00:04:36
great deal of similarities with that person then  it may impact you more one of the things i see   in emergency service personnel is we have some  uh first responders that go out to say a child   drowning and it impacts them don’t get me wrong it  impacts everybody but the ones that tend to have  
00:04:58
a stronger reaction also tend to have or have had  similarly aged children at home at some point so   it’s very similar they can almost see their child  in that position and the degree of helplessness   how powerless that person felt which kind  of goes along with what joseph pointed out  
00:05:21
trump trauma definitely is affected by or our  ability to handle trauma is affected by our age   children need to have those social supports  they need to have their parents their primary   attachment figures there to help them feel safe  children need to have a lot of other resources  
00:05:42
because they don’t have as many experiences so  something that may not seem like a big deal to us   may seem like a really big deal to a 10 or a 12  or heaven forbid a five-year-old and they don’t   understand things the same way that we do they  are also very egocentric a lot of times they feel  
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they think that something they did caused  the problem or something they didn’t do   may have caused the problem or in the in  the case of say a hurricane they may over   generalize and start having fears whenever any  thunderstorm comes along because they were in that  
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hurricane so they think that every storm is going  to be a hurricane we do need to make sure that we   work with children after stressful  incidents to make sure that they understand   what happened to the best of their ability they  may not get death they may not get addiction  
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and we need to help them depersonalize it so they  understand it wasn’t something they did or didn’t   do we need to present them the information  in a way that they will understand and keep   reiterating to them that they’re safe and help  them feel safe recognize that a lot of children’s  
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behaviors when they are experiencing trauma  are often reactions that are designed to elicit control or structure or comfort from those  primary caregivers regression acting out   those sorts of behaviors we want to look and  say what is this behavior communicating to us  
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people who’ve had prior traumas tend to have  a stronger reaction to successive traumas   they’ve found that people who are in a state  of hypocortisol ism um and we’re going to talk   about that in a little while but people who’ve  experienced prior traumas and it’s impacted their  
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physiology actually are at a greater risk for  developing ptsd from future traumatic events it   is they’re already primed so to speak or  whatever you wanna however you wanna call it   the amount of stress in the preceding months also  contributes to our reaction if you’ve had a great  
00:08:08
six eight twelve months leading up to  whatever this trauma was then you’re probably   stocked up on emotional cognitive social resources  your energies built up however if you have had a   hell of a year and a lot of times they say  that bad things come in threes usually by  
00:08:29
the time you get to that third thing you’re done  you’re exhausted um but if you’ve had stressors   and challenges even small ones they add up and  they can wear down your recovery resources your   recovery capital so you may not be in the place  to have the resilience that you you might have had  
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should you have not had such a hard time in the  past few months current mental health or addiction   issues obviously if you’ve got something currently  going on then you’re starting 20 yards back and   we need to take that into consideration  people who are currently symptomatic for  
00:09:14
some sort of mental health issue are  probably going to have more difficulty   dealing with the traumatic stress because their  neurotransmitters are already out of whack   and the availability of social support and  i’m going to talk about this multiple times  
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but there are critical windows here social  support in the first 24 hours is the most critical   if somebody gets social support in the first  24 hours it helps them process what’s going   on before they start compartmentalizing it we can  only experience crisis oriented stress for so long  
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before we start having to kind of try to pack it  up and do something with it after about 24 hours   24 to 48 hours it’s still there it’s still raw  but people have caught their breath a little bit   and they’ve started to push it back and social  support is still helpful here because it’s still  
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easily accessible to process after about 72  hours people have had to pack it up and put it   on that back burner for a little while because  it is too overwhelming to continue to feel that   level of distress and it makes it harder  sometimes to access it after about 72 hours  
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some people may start saying you know what  i’ve got it it’s not that big of a deal   and in reality it probably is they have just  put it away in a box somewhere that is going to   require energy at some point in time  the vast majority of the population  
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has experienced trauma but their reaction is  limited to an acute transient disturbance it   may be a few days a couple of weeks something  like that the signs and symptoms of ptsd reflect   persistent adaptations of the body systems the  neurobiological systems to the experience trauma  
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and you notice i crossed out the word abnormal  adaptations it is a very normal adaptation the   stuff that happens because when we’re under  stress that hpa axis kicks off and i’m fond   of it when it’s working well because it helps us  survive it tells us fight or flee let me give you  
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the energy so you can fight or flee but when  it stays active for too long it starts causing   lots of problems such as you know destruction  of neurons and all that kind of stuff one of the   things that the body does is try to dampen that a  little bit um so we’re not running so hot so often  
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and but that reaction you know our body’s  reaction to try to balance out that persistent   high level of cortisol glutamate norepinephrine  results in changes in our neurochemical system the hypothalamic pituitary adrenal access the  hpa axis or our threat response system controls  
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reactions to stress and regulates many body  processes i want you to think about why why   does the hpa axis control these things digestion  well when we’ve got a fight or flea it is not   time to be resting and digesting it’s time to get  that food out of the system to speed things up and  
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focus the energy on you know protecting ourselves  the immune system when people are fighting or   fleeing you know cortisol actually suppresses the  immune system suppresses initially suppresses and   inflammation in order to divert all that energy  to the current crisis so people’s immune system  
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goes down mood and emotions are altered when that  hpa axis is activated norepinephrine glutamate   adrenaline those are coursing through your system  some dopamine those are your go get them those are   your excitatory neurochemicals which means it is  turning down your body’s turning down if you will  
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the dial on serotonin which is more of a calming  and gaba which is sort of our natural value   and our endogenous opioids those are going you  know now is not the time to worry about pleasure   now is not the time to worry about reproduction  so estrogen progesterone and testosterone  
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all get altered in their levels and the  receptors that are being activated so   our sexuality and our libido goes down so you can  see somebody who has a persistently activated hpa   axis may have digestive problems reduced  immunity mood issues because that serotonin  
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and gaba is not helping to help the person feel  calm and happy and relaxed and all those things   additionally that low serotonin also reduces  pain threshold so people tend to feel more pain   energy storage and expenditure is also all over  the place so people with for example diabetes  
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have a hard harder time controlling their blood  sugar cortisol one of the things it does is tell   your body dump glucose dump glucose we need that  fast energy so if cortisol is constantly surging   through your body then you’ve constantly got  glucose surging through your body so that glucose  
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insulin balance it ain’t there and it’s important  for people to remember that that they may feel   hypoglycemic faster they may get a little bit  edgier faster these are all things that we need to   recognize when people are experiencing stress help  them understand why they’re having these different  
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systems or symptoms and why it makes sense from  a survival point of view and to a certain extent   that’s awesome i am glad your body is focusing  to try to help protect you the ultimate result   of hpa axis activation is to increase levels  of cortisol in the blood during times of stress  
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we call cortisol our our stress hormone  and it’s there to help us get motivated but   when the hpa axis kicks off cortisol goes really  high and it can eventually cause some problems   cortisol’s main role is in releasing glucose into  the bloodstream to facilitate the fight-or-flight  
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response it also suppresses and modulates the  immune system digestive system and reproductive   system cortisol plays a big role now when we  think about people who experience chronic stress   what hormone do they have that is generally very  high i’ll give you a hint it’s cortisol we’re  
00:16:17
not necessarily just talking about some trauma we  can be talking about chronic ongoing stress they   found that there are a lot of lifestyle factors  that contribute to hpa axis hyperactivation the body reduces its hpa axis activation  when it appears that further fight or flight  
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may not be beneficial remember think about a  a bath you know you’re running a bath you turn   that hot water you know wide open that is your  hpa axis that’s your fight or flight that is the   heat the get up and go but it starts getting  a little too hot and you want to turn on the  
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cold so you don’t burn yourself well your  body does the same sort of thing it wants   to protect those neurons wants to protect  your body from running too hot so to speak   but eventually what happens that hot water you  only have so much well unless you have limitless  
00:17:15
hot water but most of us still have a hot water  tank and eventually that hot water runs out   and then it starts running cold if you want to  think about it that way the body’s trying to   balance against the excessive heat of  the hpa axis but the hot water runs out  
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the body doesn’t cue into the fact that that’s  happened yet so it continues to try to protect you   from that excessive stimulation which can lead  to feelings of depression it also can create   a situation called hypocortisolism  where the body is actually blocking  
00:17:56
cortisol from going through because it’s  saying okay we can’t have this much cortisol   going into the system because it’s overdoing  it kind of like flooding a garden with water   you know that would be if the if the farmer put  on a nozzle so he wasn’t putting so much water out  
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into the garden hypocortisolism is seen in stress  related disorders such as chronic chronic fatigue   syndrome burnout and ptsd and it’s actually a  protective mechanism designed to conserve energy   during threats that are beyond the organism’s  ability to cope so this other reason for  
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feelings of flatness and apathy after persistent  or ongoing hpa axis dysfunction is the body going   i’ve only got so much energy left and i’m going to  conserve that right now so when there is a problem   i can spring into action oh but there’s a  problem with that when they spring into action  
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then the hpa axis goes from apathetic and  kind of flat and the person is you know blah   feels blah to emotional dysregulation there is  no middle ground when the hpa axis has gone into   this um hypocortisol or glutathio glucocorticoid  resistant state so we see a lot more emotional  
00:19:24
dysregulation until we can get that hpa axis  re-regulated and we need to look at all the causes   for dysregulation including sleep disturbances  excess caffeine pain mood issues cognitions   lack of social support you know  there’s a whole list of biopsychosocial  
00:19:45
triggers for stress and stress activates that  hpa axis dysfunctional hpa axis activation will   result in abnormal immune system responses which  generally suppressed immune system for a while   but the interesting thing is initially the  hpa axis suppresses inflammation but after  
00:20:11
a stress response the way the system’s supposed to  work the cortisol subsides and inflam inflammatory   cytokines are released into the body why because  they circulate around and find any places of   injury cause inflammation cause blood to go to the  area for repair and rejuvenation so it makes sense  
00:20:35
but if that hpa axis stays activated and  never kind of calms down then you have this   weird situation where you’ve got cortisol in the  system but you’ve also got circulating systemic   inflammation what do we know about suppressed  immune system and increased inflammation  
00:20:54
a lot of times that’s related to the  development or exacerbation of autoimmune issues   there can be increased inflammation and  allergic reactions irritable bowel syndrome   such as constipation and diarrhea reduced  tolerance to physical and mental stresses  
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including pain you know it could be the person is  just edgy and irritable i say just and they also   may have difficulty tolerating pain tolerating  hunger tolerating blood sugar alterations and   there are altered levels of sex hormones because  the body is still getting this message that  
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it’s not safe to procreate our our little you  know ankle biters aren’t going to be safe yet fatigue interestingly enough when we  experience extended hpa axis activation   one of the symptoms is fatigue and fatigue  is actually an emotion generated in the brain  
00:21:51
which prevents damage to the body when the brain  perceives that further exertion could be harmful   so i was at the gym today and i was doing  a lactic acid threshold workout which   you know those suck i’ll just tell you and  after about 30 minutes of working at 98 to 102  
00:22:09
of my max heart rate i was starting to feel really  fatigued i was like i don’t know if i can finish   this segment here that was my brain going okay  you done pushed the envelope it’s time to back off   because you’re getting to the point where you  could start hurting yourself fatigue in sports  
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is largely independent of the state of the muscles  themselves and is more related to core temperature   glycogen levels i was fasting before i worked  out so my blood sugar i had run through it by   that point my blood sugar was really low my core  temperature was high oxygen levels in the brain  
00:22:49
thirst sleep deprivation and level of muscle  soreness and fatigue so thankfully i only   had two of those things working against me so i  was able to complete my workout but fatigue can   be cumulative and we want people to recognize that  and this is true during daily living too not just  
00:23:10
in sports if people’s blood sugar levels are not  adequate if they’re there’s not getting enough   oxygen to the brain they’re breathing shallowly  if they’re dehydrated sleep deprived and have   muscle fatigue for whatever reason and sometimes  people who are depressed report feeling a lot of  
00:23:29
heaviness and muscle fatigue then you know you  can see that they may be experiencing ongoing   fatigue that may be unrelated to sports it’s more  related to that hpa axis activation because the   body is still acting as if it is being stimulated  by something like running from a lion or sports
00:23:56
psychological factors that can be involved in  reducing fatigue including your emotional state   if you are enthusiastic about it which most  of us are not enthusiastic about trauma   but if you’re enthusiastic about it it can reduce  fatigue which is why athletes tend to see that
00:24:15
finish line and they start to get enthusiastic  and they can push past that fatigue we want to   help people see the finish line we want to help  people feel efficacious we want to help people   see the progress that they’ve made and see that  their destination is not unreachable knowledge of  
00:24:35
an endpoint you know if you’re just you keep going  and it’s like eventually maybe you’ll feel better   you know it’s hard to keep going but if you  know that okay this is 10 weeks of therapy or   you know this is a mile run or  whatever it is or you know that  
00:24:53
this pain you know you had surgery and the doctor  says you know in three to six weeks you should be   feeling significantly less pain that i know  shoulder surgery is a huge hugely painful surgery   and but people who go through it they know okay  this is really hideous right now but i know  
00:25:14
hopefully after this recovery period  i will feel better other competitors   or motivators can reduce fatigue so if we have  good social support for people who are around us when people are going through trauma that  can be seen as motivators not competitors  
00:25:36
necessarily when we’re talking about trauma  but they are people that are there to motivate   us to cheer us on from the stands so to  speak if we want to keep with this analogy   and visual feedback can help reduce fatigue  use baseline charts use journals use logs to  
00:25:54
help people see that they are gradually improving  fatigue is one sign that the body is getting ready   to down regulate the hpa access to start holding  on to those energy reserves in counseling practice   we need to figure out how we can reduce fatigue  and help clients restore hpa axis functioning and  
00:26:17
a lot of it comes back to incur having them have a  survivor mentality and a positive emotional state   helping them devise an end point so that they  can see getting social support and motivation and   making sure that they are rested  nourished and all those other things  
00:26:41
low cortisol has been found  to relate to more severe ptsd   or hyperarousal symptoms sensitized negative  feedback loop in veterans diagnosed with ptsd   showed that they had greater  glucocorticoid responsiveness  
00:26:57
so what does that mean that means that people  who’ve experienced extended hpa axis activation   they go into that period of hypocortisolism and  then when there is a threat there is a greater   cortisol response so when there  is a stressor instead of having  
00:27:17
you know a little bit of cortisol dumped into  the system it is wide open generally low cortisol   is seen in people who have experienced extended  stress as a result of trauma or or chronic stress   but when a threat is perceived  there’s an exaggerated stress response  
00:27:41
and i call this flat or furious so they either  feel kind of flat or they are super agitated   evidence points toward a role of trauma experience  in sensitizing the hpa axis independent of ptsd   development so hpa access can dysregulate we can  have problems with it even if the person doesn’t  
00:28:04
develop diagnosable ptsd which is why i always  say we want to look for traumatic injury we   don’t necessarily want to just hold it out there  for only people who meet the criteria of ptsd   as i mentioned earlier those with prior  trauma histories are often more at risk  
00:28:24
of ptsd from later traumas so we can help them  hopefully prevent the development of ptsd if we   notice that they have had a history  of trauma or chronic stress they do   have an hpa axis that is dysregulated or  dysregulating we can help them start to  
00:28:48
take positive holistic steps  to re-regulate that hpa axis   so if there is another trauma which in life  there’s going to be occasional um if there is   another trauma they are at less risk of developing  ptsd because they’re not hypocortisol-ish
00:29:13
core endocrine features of trauma include abnormal  regulation of cortisol and thyroid hormones okay hypocortisolism in ptsd occurs due to increased   negative feedback sensitivity of the hpa axis  we’ve already talked about that studies suggest  
00:29:40
that low cortisol levels at the time of exposure  to trauma often predict the development of ptsd   glucocorticoids your cortisol interferes  with the retrieval of traumatic memories   and an effect that may independently independently  prevent or reduce ptsd symptoms cortisol that  
00:30:00
fight or flight stress hormone interestingly says  you know what you really don’t want to remember   that so it prevents some of our traumatic  memories from being solidified if you will   which is another reason that when people are  experiencing stress when they’re experiencing  
00:30:20
hpa axis dysregulation they have a harder  time with concentration and learning because   that cortisol circulating through their system is  inhibiting the formation of memories and learning core neurochemical fact features of trauma or  ptsd include abnormal regulation of catecholamine  
00:30:44
serotonin amino acids peptides and opioid  neurotransmitters each of which is found   in brain circuits that regulate and integrate  stress and fear responses the take-home message   from that is there are core actual changes in  dozens not just not just these but dozens of  
00:31:06
hormones and chemicals in our body as a result  of hpa axis activation and extended hpa axis   activation or hypocortisolism glucocorticoid  resistance results in a whole different set of   hormone and chemical changes it’s important for  us to recognize this it doesn’t mean it can’t be
00:31:32
rebalanced i don’t want to say fixed i want to  say rebalanced we can help people give their hpa   access a break but eating better getting good  sleep practicing good cognitions those things   aren’t going to fix it overnight it’s kind of like  gaining weight think about if you gain a hundred  
00:31:53
pounds you’re not gonna lose a hundred pounds  in two three weeks what they’re carrying is a   hundred pounds of stress if you want to look at  it that way and it’s going to take time of living   right reducing their stress practicing some of the  tools that they learn in counseling and dealing  
00:32:12
with any remaining traumatic memories that  they’ve got in those boxes in order to help them   re-regulate that hpa axis the catecholamine family  of neurotransmitters includes dopamine are let’s   keep doing that again and again neurochemical  norepinephrine which is our focus and let’s go  
00:32:35
get it neurochemical and both of those are derived  from the amino acid tyrosine so we got to eat   foods that have tyrosine it’s not hard anything  with protein in it in order to let our body   make those neurotransmitters when a stressor  is perceived the hpa axis releases cortico  
00:32:58
crh which interacts with norepinephrine to  increase fear conditioning and encoding of   emotional memories enhancing arousal and vigilance  and increa in integrating endocrine and autonomic   responses to stress so when that fear response  takes over that fight-or-flight reaction takes  
00:33:17
over the body actually secretes chemicals that  make us hyper vigilant that make us more aware   of what’s going on and alert to threats which is  great from a survival perspective in the short   term in the long term it really sucks there’s  an abundance of evidence that norepinephrine  
00:33:37
accounts for certain classic aspects of  trauma symptomatology including hyperarousal   heightened startle responses and increased  encoding of fear memories so remember that   cortisol initially blocks the encoding  of those memories but in an extended  
00:33:56
exposure the norepinephrine is going to  counterbalance that because remember in   an extended exposure the body starts turning  down or blocking the cortisol from going through   for a lack of a more clinical explanation  right now which means norepinephrine surges and  
00:34:15
takes over it becomes can become more powerful  and is able to start encoding those fear memories   poor serotonin transmission in trauma may cause  impulsivity hostility aggression depression and   suicidality too little serotonin is associated  with depression too much serotonin is associated  
00:34:38
with anxiety too little serotonin is also  associated with impulsivity and low pain tolerance now you don’t need to memorize these  but i think it’s important and i try   to teach this as much as possible there are  multiple types of serotonin receptors and  
00:34:59
serotonin is responsible for or integrated in  just about every body system and reaction there   is out there from appetite and blood pressure to  heart rate impulsivity memory mood respiration   sexuality sleep sociability and it goes  on interestingly certain ssri selective  
00:35:20
serotonin reuptake inhibitors most of  them focus on this 5-ht-1a receptor   but look at all the other receptors that are  out there and they’re throughout our body and   some of those can get a little bit wonky and  if you’re taking something that acts on 5ht1a  
00:35:39
to help with your mood and your cognition and  your appetite and your sleep because you’re having   those symptoms of depression but it’s actually  your 5-ht 2a receptor that’s wonky guess what   you’re not going to feel much response from that  particular ssri so we do want to educate patients  
00:36:01
that there are multiple serotonin receptors there  are multiple different medications that target   different serotonin receptors but it’s not always  about the serotonin norepinephrine dopamine and   some of our other thyroid and gonadal hormones are  also involved in the functioning of the receptors  
00:36:25
for all of our neurotransmitters  and mood depression can be caused by   imbalance of any of our neurotransmitters not  just serotonin gaba has a profound anxiolytic   effect in part by inhibiting the norepinephrine  circuits when gaba is released gaba is created  
00:36:45
from glutamate so it reduces glutamate levels but  it also inhibits inhibits the norepinephrine so   gaba turns down it’s the cold water if you want  to think of it that way to the hpa axis hot water   patients with ptsd have decreased peripheral  benzodiazepine binding sites gaba is our one  
00:37:06
of our natural benzodiazepines so patients with  b ptsd don’t have as many receptors for gaba as   patients who haven’t experienced trauma which is  kind of interesting so it’s harder for that gaba   system to work if there are fewer receptors  in the body it may indicate the usefulness  
00:37:28
of emotion regulation and distress tolerance  skills due to potential emotional dysregulation   one of the things we need to do is help reduce  excitotoxicity which is the fancy word for too   much glutamate and norepinephrine in order  to reduce distress improve stress tolerance  
00:37:47
in and enable acquisition of new skills harder to  learn new skills when that cortisol level is high   we need to help people develop those distress  tolerance skills so they can get into their   wise mind which is partly turning down the  adrenaline turning down the norepinephrine  
00:38:04
turning down the cortisol so they can  focus and think and learn and remember our glutamate receptors or nmda receptors  are implicated in synaptic plasticity or our   brain synapses ability to function and adapt as  well as learning and memory glutamate binds to  
00:38:30
our nmda receptors and high levels of glutamate  are secreted during high levels of stress so   when glutamate is going through our body there’s  fighter flea let’s get that energy let’s you know   get to it those nmda receptors are um super  activated you know they are on fire if you will  
00:38:53
which can lead people to feel anxious  hyper vigilant all those other things   one of the things that they found with the  ketamine is that it actually blocks the nmda   receptors one of the interesting side  effects and too much to go into right now  
00:39:09
except for to hit the highlights you can read the  article by clicking on the hyperlink but ketamine   actually blocks those receptors so it blocks  the glutamate but it doesn’t lead people to feel   depressed it actually leads to more focus and  more controlled energy so it redirects that system  
00:39:31
instead of turning it off completely what it’s  doing is helping the body redirect that energy   to more task oriented goals overexposure of  neurons to glutamate so too much glutamate   in our brain is excito toxic which means it  actually starts causing brain cells to die  
00:39:50
and results in loss of volume of the hippocampus  in people who’ve experienced trauma elevated   glucocorticoids or cortisol increases sensitivity  of the nmda receptors so the more cortisol we   have the more sensitive those glutamate receptors  are so when the glutamate comes comes in they are  
00:40:13
super excited rendering the brain more vulnerable  to excitotoxic insults so instead of being   you know turning on the heat a little bit when  that glutamate hits those nmda receptors that have   been sensitized all of a sudden you know it’s like  charcoal that’s been primed with lighter fluid
00:40:35
things we need to remember it may take  clients who’ve experienced trauma who   have high levels of cortisol more time to master  new skills because it’s harder for them to focus   that norepinephrine is focused on fight or  flea not learning memory and concentration  
00:40:51
if the brain becomes excitotoxic during stress it  inhibits learning and memory so exposure therapies   for these particular clients may or may not be  super helpful if it’s increasing the excitotoxic   environment in their brain too much can be  dangerous which is why exposure therapies  
00:41:13
need to be taken uh very seriously and not just  done by somebody who hasn’t been well trained   endogenous opioids or our natural opioids that  we have act on the same nervous system receptors   as morphine and heroin opioids even the endogenous  ones are system depressants they slow things down  
00:41:38
and ex in exert inhibitory influences on the  hpa axis so the opioids along with gaba and   serotonin help turn things down a little  bit alterations in our endogenous opioids   may be involved in certain ptsd symptoms such as  numbing stress-induced analgesia and dissociation  
00:42:01
recognizing that again these symptoms are merely  outward manifestations of changes in the neurobio   biology of the patient now trexon we all know that  as the anti-overdose drug basically appears to be   effective in treating symptoms of dissociation and  flashbacks in traumatized persons the naltrexone  
00:42:24
basically goes in and blocks those opioid  receptors so the person is not experiencing   the emotional numbing and the stress-induced  analgesia which they may not be real keen on   highlights um one of the things that this  does point out is the risk for opioid abuse  
00:42:44
for people with ptsd they may be self-medicating  because they figured out they may not consciously   have put two and two together but they figured  out when they use opioids they get some relief a hallmark feature of ptsd  is reduced hippocampal volume  
00:43:04
the hippocampus is a part in the brain  that is implicated in the control of stress   memory and context contextual aspects of  fear conditioning so the hippocampus tells us   let’s look around and identify all the triggers or  signs that there is a threat prolonged exposure to  
00:43:22
stress and high levels of cortisol damages the  hippocampus this reduction in hippocampal volume   may reflect the accumulated toxic effects of  repeated exposure to glutamate and increased   glucocorticoids or that whole flat fat sorry  flat and furious sort of situation which if  
00:43:46
you’re working with somebody for example who  has borderline personality disorder symptoms   there’s a lot of flat to furious and emotional  dysregulation in people with those symptoms   so we do want to recognize that they may be  experiencing trauma on a regular basis what  
00:44:06
not necessarily what we perceive as traumatic but  for them they are going from flat to furious and   that’s exhausting and from a neurochemical  standpoint it is reflective of trauma decreased hippocampal volumes might also  be a pre-existing vulnerability factor  
00:44:26
for developing ptsd we’ve already talked about  how hypocortisolism or glucocorticoid resistance   makes people more prone to develop ptsd well  they’ve said well maybe it’s that or maybe   it’s only people who’ve had that for so long  that it’s reduced the volume of their hippocampus  
00:44:48
they’re not really sure but we do know that  prior trauma prior alterations of the hpa axis do   prime people for being more at risk for  later development of ptsd the amygdala   is a limbic structure involved in emotional  processing and is critical for the acquisition  
00:45:07
of fear responses it is a very primitive area  of our brain but it is there to protect us   functional imaging studies have revealed hyper  responsiveness in ptsd patients during the pres   presentation of stressful scripts cues and  trauma reminders so again looking at the  
00:45:28
hpa axis goes from flat to furious there’s a  dump of cortisol whenever some somebody who is   experiencing hypocortisolism is exposed to future  stressors ptsd patients further show increased   amygdala responses to general emotional stimuli  even the ones that are not trauma associated  
00:45:49
such as emotional faces so they tend to be more  emotionally raw emotionally responsive sensitive   whatever you want to say so things that are  totally not related to the trauma can trigger a   much stronger response in them than in someone who  didn’t have that pre-existing hpa axis dysfunction
00:46:14
early adverse experiences  including prenatal stress   even you know when it’s the baby’s still cooking  and stress throughout childhood has profound and   long-lasting effects on the development of our  neurobiological systems thereby programming  
00:46:31
subsequent stress reactivity and vulnerability  to develop ptsd kids who’ve experienced a bunch   of adverse childhood experiences everything  from environmental stress to poor nutrition   to exposure in utero to drugs and alcohol you  know there’s a lot of different insults that the  
00:46:52
pediatric brain can experience may set them  up without any overt traumatic experience   may set them up to be at risk for emotional  dysregulation and potentially even eventually ptsd   later in life so it’s really important that  we get in there with early prevention programs
00:47:17
a variety of changes take place in the brains  and nervous systems of people with ptsd   pre-existing issues causing  hypocortisolism the brain has   already down regulated it started blocking  the cortisol receptors so to speak so  
00:47:33
there is not as much glutamate and norepinephrine  and stuff released if cortisol can’t get through   then it can’t trigger the release of all of  those excitotoxic chemicals like glutamate and   norepinephrine so if the body’s already down  regulated the person may experience more ptsd  
00:47:54
remember if that cortisol can’t get through  then when norepinephrine is released   there is more fear in coding cortisol is the one  that blocks that fear in coding this points to the   importance of prevention and early intervention  of adverse childhood experiences remember that  
00:48:14
people with hypocortisolism may or may not have  ptsd i recently wrote an article about lifestyle   factors that contribute to hpa axis dysfunction  and they found that or i found in the research   that exposure to noise for example people who  live near wind farms or airports tend to have much  
00:48:38
higher rates of use of antidepressant medications  and symptoms of hypocortisolism and symptoms of   hyperactivated hpa axes than people who aren’t  exposed to that chronic noise for example   hypocortisolism sets the stage for the flat  and the furious leading to toxic levels of  
00:48:59
glutamate upon exposure to stressors reduction of  hippocampal volume and persistent negative brain   changes now once that hippocampal volume has been  reduced a lot of times there’s no building it back   up the good thing is most humans only use a very  small proportion of our brain so there is a lot  
00:49:19
of room for workarounds if you will so i don’t  want people to think that oh i’ve already shrunk   my brain so there’s nothing i can do totally  not not it in most cases there are a lot of   workarounds think about people who’ve experienced  massive strokes um or massive brain injury  
00:49:38
a lot of them regain their abilities to walk  to talk to write to do whatever they did before   sometimes not a hundred percent but a lot  of times the brain is very um receptive   to functioning it wants to help people do what  they need to do and it develops its own little  
00:50:02
workarounds which i think is really cool people with ptsd are more  reactive to emotional stimuli   even stimuli unrelated to  trauma this is so important for
00:50:17
our clients to understand as well as their  loved ones and us as clinicians because it   highlights the need for really good self-care and  really good distress tolerance skills and coping   skills and awareness mindfulness  of trauma so they become more aware  
00:50:36
of okay this is going on it’s stressing me out and they can intervene early before they become   super dysregulated you know sometimes they can  notice that oh this is going to be stressful and  
00:50:52
they can prepare ahead of time they may be able  to mitigate stressors so they mitigate or at least   reduce the impact on that hpa axis because  they can start developing a certain level of   control over their reactions through biofeedback  and the use of a lot of other skills that they  
00:51:19
can learn purposeful action acceptance and  commitment therapy uh cognitive processing therapy   um dialectical behavior therapy those are the  big you know buzzwords if you will for hpa axis   resolution or rebalancing in addition  to healthy healthy nutrition exercise  
00:51:44
circadian rhythm balancing making sure that  people are maintaining their circadian rhythms and nutrition sleep exercise and circadian rhythms all  of those if they are out of whack if they are poor   then they can contribute to hpa axis activation  that includes the use of caffeine and nicotine  
00:52:07
i know i i loved my caffeine before i  had to give it up but it’s important to   help people recognize that  there are things that they’re   doing in their daily life which may be  contributing to them continuing to feel
00:52:24
flat or have the experience  of emotional dysregulation feelings of fatigue set in when the brain  perceives that continued effort is futile   and or the brain says can’t run keep running this  hot you know i’m going to have to turn on some  
00:52:44
some cold water because we can’t keep keep  sitting in this hot bath reducing fatigue can   be accomplished in part with psychological factors  including motivation and knowledge of competitors   knowing what is what you’re dealing with can  help people feel a sense of personal control  
00:53:04
feedback about frequent successes encouragement   helping them know that endpoint remember  all those fatigue things that we looked at   there are a lot of things that we can take from  sports and translate to hpa axis activation  
00:53:20
because when that hpa access is activated it’s  telling us to fight or flee so fight or run if you   will both of those are sort of sport type things  when that hpa axis is activated what happens our   heart rate goes up our breathing increases it’s as  if our body is doing something physiolog physical  
00:53:40
but sometimes we’re still sitting still so we  can take some lessons from that and help people identify ways to feel empowered hopeful and  less fatigued 46 of people in the u.s are   exposed to adverse childhood experiences so  there is a lot of room for early intervention  
00:54:03
we also can provide everyone not just people  with traumatic injury but everyone instruction   and skills to handle emotional dysregulation  including mindfulness being aware of triggers   preventing them when possible having a plan  to mitigate them if you couldn’t prevent them  
00:54:22
vulnerability prevention and awareness what makes  you more likely to respond strongly to something   you know for me too much um too much  sugar not enough food low blood sugar   or not enough sleep tends to make me more  vulnerable i tend to get really cranky  
00:54:43
emotion regulation skills distress tolerance  skills and problem solving skills of those exposed   to trauma education about and normalization of  their heightened emotional reactivity it’s your   brain’s way of trying to protect you totally makes  sense it may really tick you off right now but if  
00:55:03
you look at it from you know have a little bit  of a cognitive restructuring and look at it as a   survival mechanism then we can look at ways  to help your brain calm down recognize it safe   and develop new strategies  for dealing with the stress
00:55:23
okay so i went through a  lot of stuff in 55 minutes   um and there’s if you want to download  that article that um this is based on which oops
00:55:42
post-traumatic stress disorder the neurobiological  impact of psychological trauma it is a tough read   i will tell you it takes you have to sit down you  can’t have the tv going and really focus on it and   maybe take it in chunks it’s a longer article  but it has so much wonderful information in it  
00:56:01
that i strongly recommend if you work with people  who’ve experienced trauma even adverse childhood   experiences you take a look at it remember  that not every trauma causes traumatic injury   so one of the adverse childhood experiences  for example is divorce well not every person  
00:56:22
experiences divorce as and gets traumatic injury  from it it may actually be an improvement of a   situation so we do want to not necessarily tell  people that they’re wrong if they don’t think   they were injured by it but we want to take into  consideration the fact that they may have been  
00:56:42
injured by it and every experience we go  through impacts our phenomenological reality   so the divorce that your parents went through when  you were six the experiences you had at school   the experiences you had last week all impact the  way you react to every situation henceforth and  
00:57:04
forevermore now you can choose you can become  aware of how the past is impacting you now   and choose how it impacts you now but that is sort  of one of those advanced skills after people start   being able to get that hpa access to recalibrate  and respond a little bit more mildly to distress