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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 to the end of this video and all the way to the
end of this 14 part series on worry management it’s been a lot but i hope it’s been helpful
so thank you and i will see you in the next one
ᵃⁿⁱᵐᵃᵗⁱᵒⁿ ˢᵗᵘᵈⁱᵒ ᴏɴᴇ-ᴛɪᴍᴇ ꜱᴘᴇᴄɪᴀʟ ᴜᴘɢʀᴀᴅᴇ ᴅᴇᴀʟ – ᴍᴀʏ ᴇxᴘɪʀᴇ ᴏɴᴄᴇ ʏᴏᴜ ʟᴇᴀᴠᴇ ᴛʜɪꜱ ᴘᴀɢᴇ. ꜱᴋɪᴘ ᴛʜɪꜱ ᴅᴇᴀʟ ᴀᴛ ʏᴏᴜʀ ᴏᴡɴ ʀɪꜱᴋ ᴀꜱ ᴛʜᴇ ᴘʀɪᴄᴇ ᴍᴀʏ ᴅᴏᴜʙʟᴇ ᴡɪᴛʜᴏᴜᴛ ɴᴏᴛɪᴄᴇ! Animation Studio is a must-have for anyone serious about selling or promoting anything online with video! Damon Nelson. Wow, Paul & Todd, this is a competition killer. “Animation Studio The Animation Creator That You Have Been Waiting For Has Finally Arrived… …..”
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When it comes to anxiety disorders, there is no ‘one type’. Each form of anxiety has its own set of symptoms and treatments It is important to remember that, while some symptoms will overlap. No two anxiety disorders are alike This list aims to bring attention to the five major anxiety disorders, and what they mean for the sufferers We at psych2go hope to bring awareness to the growing number of anxiety sufferers and their needs So, without further ado, here’s five anxiety disorders as well as their symptoms and treatments Number one: obsessive compulsive disorder or OCD Obsessive compulsive disorder technically has two components: the obsessions and the compulsions Obsessions can encompass anything from a severe fear of germs to the placement of things around the home and many things in between The compulsions are what the sufferer does to rid themselves of those obsessive thoughts Someone who has obsessions about germs may ritually wash their hands or carry hand sanitizer everywhere they go Someone who has obsessive thoughts about the placement of objects might arrange and rearrange their belongings until they feel just right These obsessions and compulsions can become very intruisive and disrupted to the sufferers daily life As far as treatments for OCD go, there are a couple: There are selective serotonin reuptake inhibitors such as fluoxetine sertraline These medications are meant to help alleviate the symptoms for the sufferer so that they are at a manageable and less destructive level The other widely used treatment is psychotherapy With this, you might run into cognitive behavioral therapy that will be used to help the sufferer essentially reprogram their response to obsessions and compulsions For the most part, medications and therapies are used in tandem to get the best results Number two: generalized anxiety disorder Generalized anxiety disorder or GED is a bit unlike the other anxiety disorders on this list Those who suffer from GED aren’t always able to give a reason for their symptoms In fact, one of the symptoms is a general feel of restlessness or an ease They may also experience worry as one of the symptoms Everyone worries from time to time, but GED causes the sufferer to eternalize those worries and take them to an entirely new level They may think of them in an obsessive manner which will cause a downward spiral of other symptoms such as a disturbance in sleep patterns The treatments available for GED are similar to those of OCD Medications and therapy.
In this case, the medications may be benzodiazepines and antidepressants rather than the run-of-the-mill SSRIs Cognitive behavioral therapy is used with GED as well as relaxation techniques and mindfulness Number three: social anxiety disorder Those with social anxiety disorder experienced panic attacks related to social situations This can manifest in a fear of public speaking or stage fright and can be so severe that they avoid going into public altogether Social anxiety can also have symptoms of severe self-consciousness and a general fear of being around others Someone with social anxiety might find it hard to speak when other people are present even if they aren’t addressing the crowd as whole Social anxiety is mainly treated with SSRIs and therapy As we stated before, just because a treatment option looks similar from one anxiety to another it isn’t going to be the same Each sufferer presents their own needs that must be taken into account.
Each therapy isn’t going to work the same for each individual Personalization of treatment is key in these situations Number four: panic disorder Unlike the other anxiety disorders on this list, panic disorder rests solely on panic attacks With many other anxiety disorders, panic attacks are just another symptom when it comes to panic disorder those attacks are the symptom Panic disorder is characterized by recurrent panic attacks The sufferer may experience heart palpitations, erasing pulse an intense fear and the feeling that they are hopelessly out of control There isn’t a rhyme or reason to many of these attacks, so the sufferer is essentially lying in wait for the next one to come Panic disorder can be treated in many ways The medications used are some that we’ve heard of such as benzodiazepines and SSRIs We are also introduced to serotonin norepinephrine reuptake inhibitors or SNRIs and beta blockers These medications, as with OCD, are often used in conjunction with therapy to help maximize the usefulness of each Number 5: post-traumatic stress disorder Post-traumatic stress disorder or PTSD can be diagnosed in anyone For the most part you have probably heard it, when someone speaks about veterans or police officers While those careers have a higher rate of PTSD, it is in fact true that anyone can be diagnosed with it PTSD is the result of a very traumatic event or series of events This leaves the sufferer with flashbacks and night terrors where they feel as if they are right back in the event again The sufferer may also suffer from panic attacks as well as phobias associated with people places or even sounds Medications such as fluoxetine venlafaxine may be used in the treatment of PTSD Therapies such as prolonged exposure, cognitive processing therapy, and brief eclectic psychotherapy may be utilized as well Again, this is a situation where the use of medications and therapy together can help give a better outcome than just one alone It is important to note that those with PTSD can lash out in certain situations But there is no need to be afraid of the sufferers There is nothing inherently dangerous about them In fact those with mental illness are exponentially more likely to be the victims of violent crimes than they are to be the perpetrator This is not a complete list of the different anxiety disorders out there by any means, nor is it completely comprehensive in each description There are many kinds of anxiety, these just happen to be the most talked about and diagnosed at this particular moment Regardless of which anxiety disorder the diagnosis is for, it is important to remember that the sufferer is in need of help and acceptance You don’t have to understand anxiety to be able to offer an ear to talk to, or some words to keep them grounded in the moment Remind the sufferer that they are alright, that what they are feeling are just symptoms of their anxiety and that it will pass if given the time Aside from that, just make sure that they know you are there with them and wait it out Do you suffer from one or more of the disorders listed? Share your story in the comments below On a different note, psych2go is now selling t-shirts.
Links will be in the description below. As always, don’t forget to subscribe, and thanks for watching.
ᵃⁿⁱᵐᵃᵗⁱᵒⁿ ˢᵗᵘᵈⁱᵒ ᴏɴᴇ-ᴛɪᴍᴇ ꜱᴘᴇᴄɪᴀʟ ᴜᴘɢʀᴀᴅᴇ ᴅᴇᴀʟ – ᴍᴀʏ ᴇxᴘɪʀᴇ ᴏɴᴄᴇ ʏᴏᴜ ʟᴇᴀᴠᴇ ᴛʜɪꜱ ᴘᴀɢᴇ. ꜱᴋɪᴘ ᴛʜɪꜱ ᴅᴇᴀʟ ᴀᴛ ʏᴏᴜʀ ᴏᴡɴ ʀɪꜱᴋ ᴀꜱ ᴛʜᴇ ᴘʀɪᴄᴇ ᴍᴀʏ ᴅᴏᴜʙʟᴇ ᴡɪᴛʜᴏᴜᴛ ɴᴏᴛɪᴄᴇ! Animation Studio is a must-have for anyone serious about selling or promoting anything online with video! Damon Nelson. Wow, Paul & Todd, this is a competition killer. “Animation Studio The Animation Creator That You Have Been Waiting For Has Finally Arrived… …..”
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let’s talk about magnesium’s effect on
mood especially anxiety and depression there are a lot of things that magnesium does in
the body it’s involved in probably actually more than 300 different enzymes involved in biochemical
pathways but I want to emphasize just one area the effect of magnesium on neurotransmitters which are
hormone-like but instead of traveling through the blood they travel through the nervous system now a
magnesium deficiency is extremely common well over 50 of the population is deficient and probably
a lot more that have a subclinical deficiency but it’s very difficult to test magnesium
since only one percent of your whole body’s magnesium is in the blood the rest is in the bone
it’s in the teeth it’s in the muscle and it’s also inside the cell so you kind of have to go by
symptoms and just take some magnesium consume foods with higher magnesium and see if these symptoms
go away so if you’re deficient in magnesium you can get anxiety depression low tolerance to
stress you’re not going to sleep that well you’re going to be irritable and have brain fog other than
that you’re going to be good to go but magnesium has some direct effect on increasing serotonin
serotonin is the hormone that kind of brings you a state of well-being it makes you
feel calm happy and without stress number two magnesium can decrease cortisol so cortisol is a
stress hormone and if it’s too high it puts you in a state of stress so many people have chronic
elevations of cortisol and they’re stressed out and magnesium can help them all right number
three magnesium can lower adrenaline okay so that’s going to help your sleep number four you
can increase GABA which is a neurotransmitter involved in relaxation and feeling calm and even
sleep number five magnesium can increase melatonin it’s going to help you sleep all right number six
it can increase the parasympathetic nervous system which is that that’s part of the nervous
system that’s responsible for rest and digestion so it calms you down it’s an active wave
in your body that’s pushing things down to keep things calm so let’s say for example you ran up
the stairs or you’re exercising and then you stop the parasympathetic kicks in there and bring your
pulse rate down and calms you down without that everything would stay fairly elevated for a long
period and in practice I used to measure the parasympathetic nervous system I had a a test
it’s called heart rate variability which measures the autonomic nervous system and when people would
come in with very low parasympathetic function if they were to exercise their pulse rate
would go high and it just would not come down so they have to do very very light things and
not a lot of exercise all right number seven magnesium decreases the sympathetic nervous
system so this is the opposing nervous system this is the nervous system that keeps things
turned on and it keeps you from sleeping so magnesium can chill that out and another name for
the sympathetic nervous system is flight or fight all right there you have it magnesium’s effects
on your mood before you go if you have a question about a product or you’re new to keto and you want
to know how to begin keto or you’re on keto and you need a debug because it’s not going as smooth
I have a keto consultant standing by to help you this is just for the people in the u.s.
hopefully in
In the future, we’ll be able to answer everyone’s call but I put the number down below
so you can call and get some help.
ᵃⁿⁱᵐᵃᵗⁱᵒⁿ ˢᵗᵘᵈⁱᵒ ᴏɴᴇ-ᴛɪᴍᴇ ꜱᴘᴇᴄɪᴀʟ ᴜᴘɢʀᴀᴅᴇ ᴅᴇᴀʟ – ᴍᴀʏ ᴇxᴘɪʀᴇ ᴏɴᴄᴇ ʏᴏᴜ ʟᴇᴀᴠᴇ ᴛʜɪꜱ ᴘᴀɢᴇ. ꜱᴋɪᴘ ᴛʜɪꜱ ᴅᴇᴀʟ ᴀᴛ ʏᴏᴜʀ ᴏᴡɴ ʀɪꜱᴋ ᴀꜱ ᴛʜᴇ ᴘʀɪᴄᴇ ᴍᴀʏ ᴅᴏᴜʙʟᴇ ᴡɪᴛʜᴏᴜᴛ ɴᴏᴛɪᴄᴇ! Animation Studio is a must-have for anyone serious about selling or promoting anything online with video! Damon Nelson. Wow, Paul & Todd, this is a competition killer. “Animation Studio The Animation Creator That You Have Been Waiting For Has Finally Arrived… …..”
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As a student in college, there are a ton of problems you have to face everyday Problems, you might know how to handle, and others you just simply would like to avoid causing you stress. Stress is a common fact of life, but, being stressed out is not Don’t allow stress to manage your life.
You should manage your stress, So then.
What is stress According to Medical News Today stress is the feeling you have under pressure.
When you are stressed, your body responds as if you’re in danger by raising your heartbeat.
If stress happens too often or too long, you can experience some bad effects like headaches, upset, stomach back pain, or even trouble sleeping As a student, you encounter even more challenges.
Having homework studying for exams, managing deadlines, and struggling with your social life can make.
You feel stress not only affecting your mind but also your body, emotions, and behavior, potentially causing more serious negative effects, including depression, substance, abuse, and even frequent infections.
So here are – some techniques, often used to reduce stress Exercise, Exercise, helps you release stress by taking away the tension in some of your muscles.
Walking is a great way to get started.
Take advantage of the Student Recreation Center, where you can find cardio equipment weights, and even a rock-climbing wall. They also offer fitness classes such as yoga, Zumba, kickboxing and more Giving you tons of options that may fit your schedule.
Writing Using writing.
As an emotional outlet.
Can help express what may be bothering you and allow you to reflect and possibly share with someone you trust, making it easier to deal with your stress.
Do Something You Enjoy If you’re feeling stressed, take some time off to relax your mind and body Watch.
Your favorite TV show listen to music, go for a walk, do anything you want.
Try daily meditation breaks to release a small amount of stress.
The point is to relax.
You can also find some campus resources that can help.
You manage your stress like the University Counseling Center. They offer consultations in Spanish or English and it’s always confidential.
They also provide workshops on how to deal with stress.
All their services are free for students enrolled at UTEP.
Everyone experiences levels of stress, however, when you realize it you can take charge.
Take your mind off things and relax plan and organize your time wisely Manage your stress before it manages you.
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This study investigated the effects of paramedicine training on student wellbeing, comparing the experiences of paramedicine students from the United Kingdom and the Kingdom of Saudi Arabia. The study found that four main themes emerged from the data exposure to potentially traumatic events, relationships and communication programs, atmosphere, and career.
The study also found that the contributors to stress were similar in both countries, suggesting that better preparation and supportive relationships can help reduce the negative impacts of potential trauma and improve student well-being.
Additionally, universities can address both these factors and create a positive learning environment for paramedicine students.
This article was authored by Adnan Alzahrani Chris Keyworth, Caitlin, Wilson, and others.
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(soft instrumental music) – [Amanda] Hey Psych2Go
family, and welcome back. If you’re new to this channel and by the end of the video
you enjoy our content, do consider subscribing and
joining the Psych2Go fam. Now, let’s begin. Narcissistic victim syndrome is a term that collectively
describes specific and often severe side effects
of narcissistic abuse. Many experts acknowledge
narcissistic abuse can have a serious long-lasting
impact on emotional health, although it is not recognized
as a mental health condition. As a result of chronic abuse, victims may struggle with
symptoms of PTSD or complex PTSD. If they had additional trauma such as being abused by
narcissistic parents. (beeping) (upbeat music) With that in mind, here are
10 signs that might suggest you have narcissistic victim syndrome. Number one, you felt like you
had a perfect relationship with that person in the beginning.
When you’re in a romantic relationship, this type of abuse usually begins slowly and it creeps up on you
after you’ve fallen hard and are in love with your partner. In the early stages of the relationship, this is when the love
bombing usually occurs. They may shower you with
gifts and affection and it can feel very intense. Then slowly, manipulative tactics start to invade the relationship and will replace the love bombing. In the case of narcissistic parents, they might also offer
love, adoration, praise, and financial support, until you do something to displease them and lose their favor. They use tactics such as
gaslighting and silent treatment which can leave you
questioning your sanity. And this is something that sticks with you even after you’ve cut
ties with that person. Number two, you feel like
you’re walking on eggshells. A common symptom of trauma
is avoiding anything that might make you relive
that particular trauma. Whether it be people,
places, or activities that pose a threat to you, you may feel like you’re
constantly worrying and being careful about what
you say or do around people because that is how you used to behave when you were around your abuser.
You may present as
anxious and introverted, especially when in the
presence of other people, though you’re simply
acting out of extreme fear. Number three, you may have
experienced smear campaigns once the relationship ended. When breakups happen, it’s
common for people to take sides. This is no different when it
comes to a narcissistic abuser. They will twist your words and tell their version
of the story to others to try and get them to
feel sorry for them. They can often drum up
support from your loved ones by insisting that they only
have the best interest at heart. Then when you try to talk
about the abuse that happened, your loved ones might side
with the abuser over you. This can drop barriers between you and the people
in your support network and leave you feeling isolated. Number four, you feel
isolated and vulnerable.
When no one will listen
to you or your concerns, this can leave you
feeling very much alone. When you feel alone, you’re vulnerable to further
manipulation from your abuser. They may pull you back
in with fake apologies, a hand of kindness, or by brushing their past
abuse under the rock. This tactic, which is called hovering, is the perfect time to pounce when you’re lacking in support since you are more likely
to doubt your perceptions of the abuse when you can’t
talk to anyone about it.
Number five, you’ve developed
a pervasive sense of mistrust. Are you hypervigilant? Do you worry and get anxious
over other people’s intentions? The gaslighting techniques
used by the narcissistic abuser may have contributed to
how you view the world. And you may find that you have
a hard time trusting anyone, including yourself. Number six, you may
engage in self-sabotaging and self-destructive behavior. Victims often find themselves
ruminating over the abuse. This can enhance the frequency
of negative self-talk and the tendency towards self-sabotage. Malignant narcissists
will try and program you, conditioning you for self-destruction. This could potentially lead you to engage in risky
behaviors such as self-harm or even suicidal ideation. You might’ve developed a
knack for punishing yourself because of the toxic shame you carry, put there by the hypercriticism and verbal abuse of your abuser. If you feel like you’re
lacking any motivation to pursue your dreams and goals, then this could be a result
of narcissistic abuse. Number seven, you may experience unexplained physical symptoms.
Narcissistic abuse can trigger
anxious and nervous feelings that can trigger physical symptoms. The stress of chronic abuse may send your stress
levels into overdrive. As a result, your immune
system may take a severe hit leaving you vulnerable to
physical ailments and disease. You may notice symptoms such
as appetite changes, nausea, stomach pain, muscle aches and
pains, insomnia, and fatigue. Number eight, you may have
issues setting boundaries. The experience of narcissistic abuse can often leave you with
little respect for boundaries. This may be because when you tried to set
boundaries in the past, you may have been met with
challenges from the abuser who gave you the silent treatment until you did what they wanted. Once you end the relationship or gain distance from
a narcissistic parent, you promise yourself that
you won’t answer their calls or physically see them at all.
However, even if you’ve tried to cut ties, your abuser is confident that they will eventually wear you down because you’ve set aside
your boundaries with them so many times before. If you’ve experienced narcissistic abuse, you might also have trouble
setting healthy boundaries in your relationships
with others in the future. Nine, you may be questioning
your own identity. When facing abuse, many people
adjust their self-identity to accommodate an abusive partner. You may have stopped
doing things you enjoy or spending time with friends and family to better appease your abuser. These changes can often
lead to a loss of identity during and after the abuse. It’s not uncommon for
victims of narcissistic abuse to experience dissociation and attachment from the physical world.
Dr. van der Kolk writes
in his book titled, “The Body Keeps The Score” that dissociation is the essence of trauma. The overwhelming experience
is split off and fragmented so that the emotions,
sounds, images, thoughts, and physical sensations
take on a life of their own. Oof! Number 10, you may find
it hard to make decisions. When there has been a negative pattern of devaluation and criticism in your life, you might have very little self-esteem and confidence in yourself. Narcissistic abusers can make statements that imply that you are
unable to make good decisions.
Abusive partners may have called
you stupid, or ignorant, or they might’ve insulted you with a false and affectionate tone. They can manipulate you into believing you
imagine parts of reality making it seem less important
than it is. This type of controlling and deceitfulness can affect the way you
make future decisions. So, did you relate to any of the signs? Let us know in the comments below. I wanted to take a second
to say that I… Um, sorry. Hi, it’s Amanda, the voiceover voice. I’m reading the script for the first time and I related to it.
So I wanted to add a point that, in taking the time to learn about narcissistic
victim syndrome, you’re empowering yourself. Once you know you can grow. Acknowledging the effects of being in a narcissistic relationship is the first step to healing from one. As we close out, we want to say that not all
abuse is linked to narcissism, and not all people with a diagnosis of narcissistic
personality disorder will engage in abusive behavior. However, if you feel you might be a victim of this type of abuse, we encourage you to reach out for help. Talk to someone you can trust, like a good friend, a family
member, or a therapist. It’s not easy to leave
an abusive relationship, but with the right support,
you can move on with your life and start to heal from your past hurts. Like and share this video if it helped you and you think it could
help someone else too. The studies and references used are listed in the description below. Don’t forget to hit the Subscribe button for more Psych2Go videos, and thank you for watching. We’ll see you in the next one.
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Unlimited CEUs for $59 are available at AllCEUs.com/Trauma-CEU this episode was pre-recorded
as part of a live continuing education webinar. CEUs are
still available at AllCEUs.com/Trauma-CEU welcome to today’s presentation on the
neurobiological impact of psychological trauma on the HPA axis we’re going to define and explain
the HPA axis which we’ve talked about before is a response system so it’s not
anything to get to you know overly concerned about that it’s going to be super dry well identify the
impact of trauma on this axis and on basically your whole nervous system in your brain identify
the impact of chronic stress and cumulative trauma on the HPA axis because a lot of times when
we talk about PTSD we think only about some particular acute event and that’s not necessarily
true there are a lot of people with PTSD who have basically what I call cumulative trauma and they
were exposed to extensive child neglect they were in domestically violent relationships they were
in a situation where they were exposed to trauma over and above what a normal person would think lawfully think of law enforcement military personnel think first responders I mean
they see stuff that no human should have to see and they see it not only once but you know once
a week or once a month depending on kind of where you are so it’s important to understand well
one thing may not be so traumatic to create post-traumatic stress we’re going to look at some
of the reasons that PTSD symptoms may develop as a cumulative sort of thing which I found this
to be interesting anyway we’ll identify symptoms of dysfunction and we’ll talk about some
interventions that are useful for this population now my guess is none of you are prescribing
physicians so when we’re going through this you’re going to be going yeah that’s all well and good
what’s the exact point of thinking about exactly what this information is telling
me on each slide show used to be the hat to help my clients who have been annoyed by trauma and
have not yet developed any sort of PTSD symptoms or who have PTSD symptoms and how can I use this
information to better tailor my treatment plan to help them become more effective in managing their
symptoms this is kind of a unique presentation because it was based on only one article this
was a meta-analysis so it’s a long article and it’s a really good article that I would
strongly suggest looking at it in your resources section in the class it lays out the many changes
and/or conditions that are seamed in the brain and nervous system of people with PTSD so they really
looked at a lot of research longitudinally to see what we know and what we don’t know as clinicians
awareness that these changes can help us educate patients about their symptoms why do you feel this
way and find ways of adapting to improve quality of life so neurobiological abnormalities in PTSD
overlap with features found in traumatic brain injury so that started making a lot of researchers
go hmm you know traumatic brain injury there is something or again of course hurting part of
the brain so why are the symptoms similar in PTSD you’re going to find out pretty
soon is that PTSD does cause damage actual physical damage in the brain the response
of an individual to trauma depends not only on the stressor characteristics but also on factors
specific to the individual so somebody can see a trauma and not be as traumatized if you will as
someone else and part of these factors and there was a study done by Pi Newson Nader back
I believe the early 80s looked at triage factors for PTSD and some of the factors that
they found why certain traumas may be more traumatic than certain people versus others have to do
with this particular trauma, you’re experiencing it close to one of your safe zones where you
live where you work somewhere where you’re not where you’re supposed to be feel safe and if
so then it’s probably going to be perceived as more traumatic now again think about the survival
capacity or the survival function of this behavior when your brain says this is supposed to be a safe
zone and it’s not so I need to respond in kind you’re trying to protect yourself make sense the
similarity to the victim if it could happen to her if it could happen to him they’re like me it could
happen to me that makes me feel scared because we like to categorize the world in terms of using them
bad things happen to those people not to us people but if you’re looking at a victim who’s liked you
and you say well I am and us people then you’re going to have more difficulty separating it and
feeling safe and going well that couldn’t happen to me and the degree of helplessness you know if
you saw something and you were just like there was nothing I could do there’s a greater sense of
helplessness and horror then if you didn’t have that necessarily that same experience so those
are a couple of things as far as the prestress or perception that we want to consider when we’re
talking to our patients even if you’re not a therapist that works with the trauma specifically
some people refer out for that some people are working with an EMDR therapist and you know cool
but as important to understand and if you happen to go down this road with your clients help them
understand why they perceived that particular stressor so intensely versus some other stressor
that they think may have good English there oh well sorry they think should have stretched
them out more so their perception of the stressor prior traumatic experiences and we’re going to
learn that prior traumas do cause changes in the brain to prepare you basically
Therese bond more quickly when there’s a threat so prior traumatic experiences can send you from
zero to 100 a lot faster which means it’s going to be or could be more traumatic the amount of
stress in the preceding months if you’re already worn down and your body has already said I can’t
fight anymore it’s not doing any good then when it encounters PTSD and when it encounters a
trauma the body might be going I just can’t take another thing please just I can’t do it which
is why we see in people with PTSD chronic stress burnout and chronic fatigue this inability to
tolerate stress because the body’s just already waived them that white flag going I can’t do it
current mental health or addiction issues again that’s your body’s way of saying something in
the neurotransmitter something in the system is a little bit wonky and that means I’m not
going to be able to respond a hundred percent healthy and functionally to whatever’s going
on and the availability of social support now a lot of the research especially with emergency
service personnel points to the availability of social support within 24 hours of the trauma
so when there’s an officer-involved shooting when there’s something that they encounter on
the duty that’s trauma the ability to have social support within that first 24 hours preferably first
two-hour period to at least touch base with a social positive social support is vital to
helping somebody process the memories instead of just kind of them disappearing into never-never
land and getting solidified in an unhelpful way for the vast majority of the population though
psychological trauma is limited to an acute transient disturbance you see something that’s
traumatic you’re like oh my gosh Wow it is devastating and yeah is going to affect you for
a little while but in a week or two you’re kind of feeling like you got your land legs again so
there’s this subpopulation of the population there’s a small group that ends up developing
PTSD the signs and symptoms of PTSD reflect a persistent adaptation of the neurobiological
symptoms to witnessed trauma and I crossed out abnormal in the article it says abnormal and
I look at it as a perfectly normal adaptation because the body is either going with the reserves
I have right now I can’t deal or you know whatever it’s doing it’s trying to protect itself now it
may not be helpful but from a survival perspective it generally makes sense so I try
when I’m working with clients to help them see the functional nature of their symptoms
given the knowledge they had or the state they were in at the time so now to the HPA axis the
The hypothalamic-pituitary-adrenal axis aka your threat response system controls reactions
to stress and regulates many body processes including digestion the immune system mood and
emotions sexuality energy storage and expenditure so let’s think about this real quick when you’re
under stress, your body feels threatened I needs to survive so it sends out excitatory
neurotransmitters that get you wired up which kind of makes your digestion speed up
it can cause some cramping in the abdominal area your immune system is not really important
right now threat we’re not worried about the flu mood and emotions you tend to
be hyper-vigilant and more easily startled threat means fight or flee which means anger or anxiety
so you’ve got some stress emotions and I don’t want to say dysfunctional because they’re very
functional your body perceives a threat and it’s saying you need to do something sexually well if
there’s a threat this is no time to procreate so your body says let’s turn off those sex hormones
right now, because we need to use us for fighting and fleeing not procreating which is all well
and good but when we have reduced sex hormones it also reduces our serotonin availability which
serotonin is one of those calming chemicals which help us calm down the excitatory neurons
so without them, you stay revved up which brings us to energy storage and expenditure you’re
revved up you’re on high alert you’re staying up here and your body says you know what if
I’m going to survive this fight or flight I need fuel which means you need to eat preferably
high-fat high-sugar foods that give us instant energy and sustained energy we want calorie defense
stuff now thinking about it from that perspective you can see how when you’re under chronic stress
or a big stressor you know some of your symptoms make sense why do you want to go eat chocolate
or do whatever you do that’s my go-to pizza and chocolate when I’m stressed is generally what I
crave not what I need but what I crave so we want to help people understand that there’s a reason
it makes sense now we just have to figure out how to deal with it differently the ultimate
result of HPA axis activation is to increase levels of cortisol in the blood during times of
stress now cortisol is the hormone that goes out and sets off kind of this whole well there are
a couple before it but it sets off this whole event cortisol is your stress hormone cortisol
is the one who says no sex hormones right now you know and it monkeys with all your different
hormones to make sure and your energy storage to make sure that you’re ready for this fight or
flee its main role is to release glucose into the bloodstream in order to facilitate the fight
or flight now glucose is sugar is raising your blood sugar so you’ve got energy now we’re going
to talk regularly about glucocorticoids which are glucose hormones that make your body release
glucose which is mainly cortisol and that term is going to become important later I’m just
kind of throwing it out there right now cortisol also suppresses and modulates the immune system
digestive system and reproductive system so again cortisol is saying we’ve got this energy we’ve got
this threat let me figure out how to sort of dole out our resources right now for survival in the
now it’s cortisol is very present focused it’s not looking at you know the long-term and
going well this will pass cortisol is very right now HPA axis dysfunction the body reduces HPA axis
activation when it appears further fight-or-flight may not be beneficial and they call this hypo
cortisol ism so basically a threat response system is you know warning the alarm in
my dorm when I was in college used to have these really annoying blinking lights I because why I do
this all the time sorry the hypercritical ism is your body’s response to going if I keep fighting I
am just throwing good energy after bad there is no sense in surrendering so it turns down the system
and it stops producing as much cortisol that way it has cortisol your stress hormone for when there
is a bigger more threatening threat well what does that mean well we need cortisol is what
helps us get up in the morning our cortisol goes up and down throughout the day which helps us
have the energy to get up go to work do those sorts of things it’s a normal hormone when it’s
in the right balance hypo cortical cortisol ISM seen in stress-related disorders such as chronic
fatigue syndrome burnout and PTSD is actually a protective mechanism designed to conserve energy
during threats that are beyond the organism with us ability to cope so dysfunction in the axis
causes abnormal immune system activation so you have increased inflammation and allergic
reactions cortisol is also related to cortisone your body does not release its
natural antihistamines when you are pardon me under stress which is why your allergies seem to
bother you more which when your allergies bother you more you’re probably not sleeping as well at
night and we know that not sleeping as well at night keeps your HPA axis activated so you’re
fighting this battle you’re trying to squeeze blood out of a turnip basically because your body
said we’re not releasing any more cortisol I don’t care what you say but everything else you’re not
sleeping as well you’re still kind of revved up you’re fatigued and your body is going but there’s
a threat and back in your brain they’re going yep but it’s not a big enough threat yet so you can
see where this cascade you’re fighting inside your own body and all your systems are kind of arguing
irritable bowel syndrome such as constipation and diarrhea because cortisol speeds things up and if
you don’t have enough cortisol you know what might happen reduce tolerance to physical and mental
stresses including pain remember I said that sex hormones go down which means that the availability of
serotonin goes down we know that serotonin is not only involved somehow in mood it’s involved
with some level of anxiety reduction but we also know it’s involved in pain perception
so when serotonin goes down we perceive pain more acutely and altered levels of sex hormones
so fatigue and you’re like where did that come from well the HPA axis is activated see how
many times I can say that without tripping on my tongue when it’s activated it sends out these you
know excitatory neurotransmitters when you’re excited for too long you get fatigued
well interesting little caveat or thing here fatigue is actually an emotion generated in the
brain you know we’ve learned to label it which prevents damage to the body when the brain perceives
that further exertion could be harmful sounds similar to hypo cortisol ISM it is so what do
we know from athletes we know that fatigue and sports is largely independent of the state of
the muscles themselves so fatigued you know your muscles usually only work up to about 60% of
their ability to work and then fatigue starts to set in so there was still a big margin that you
could work before your muscles finally gave out and said hold no more I’ve got jelly legs but
your muscles quit you start feeling tired you start feeling exhausted so this is a protective
mechanism the body’s gone we need to conserve a little bit of energy because you have to get home
and shower and you know prepare to run in case the tiger chases you but what factors is your body
paying attention to but tells it OK whoa we need to stop so we’ve got enough reserve in the event
of a problem core temperature, you’re working out your core temperature goes up at a certain point
it goes that’s high enough your glycogen your blood sugar levels your oxygen levels in the brain
how thirsty you are whether you’re sleep-deprived, to begin with, it’s going to mean that you fatigue
a lot easier and the level of muscle soreness and fatigue going into that exercise session the
brain kind of takes all these factors into effect and goes okay I can unless you work out
this much and then I’m going to shut you down I’m wrong it’s off what they have found though
is we can override this so when clients come into our office, they’re fatigued they are they’re off
they’re just like I’m exhausted I’m agitated I’m irritable I’m not sleeping well I just uh okay so
with athletes, we know that psychological factors can be used to reduce fatigue such as their
emotional state if they go in in a positive emotional state or a hyped up energized emotional
state if they’re listening to really energizing music it can help them push past that fatigue
point a little bit if they know the endpoint maybe they know they’re doing three sets of ten
reps they’re going to push through faster or more effectively than if they’re working with the coach
and they have no idea how many sets they’ve got or how many reps they’ve got to do they’re just like
are you going to make a stop to other competitors that service motivation they’re looking around they’re
seeing other people doing it they’re going okay I got this and in the case of athletes visual
feedback you know they’re seeing growth in their muscles they’re seeing positive changes so they
can push through that fatigue a little bit more they’re like okay this is worth it so fatigue
is one sign that the body is getting ready to down-regulate that HPA axis and go conservation
in practice and counseling practice how can we help reduce mental fatigue and help clients
restore their age PA access functioning and one of the things I would challenge you to think
about is how can we increase their self-efficacy and their high ductless if you will in their
the emotional state that a can-do attitude increases their hardiness and resilience you know we talk
about those, a lot man make sure they know their endpoint where are they going what does their
what do their symptoms look like what is it going to look like in three weeks in three months
and what can we reasonably think will change you know let’s give them some tangible goals that
they can look at other competitors or motivational group therapy can be very helpful in dealing
with some of this stuff obviously, you’re not going to do a lot of trauma work in the group most of the
time but having other people around knowing that there are other people who are dealing with
PTSD and having support groups can be really helpful because they can cheer each other on and
go come on John you got this you just need to push I know this is a really tough week for you and
that can help people push through that fatigue and feedback now in the case of psychological
issues we’re not talking about visual feedback but we’re talking about looking at that treatment
plan or looking at their symptoms and being able to say you know what I have made progress I’m not
having nightmares as much as I actually slept through the night last night who knew and finding those
things that they can latch on to and go things are getting better you know they’re not going to get
exponentially better overnight likely but they are getting better and I can see this incremental
progress and in doing that we can help people get a sense increase that those dopamine levels
increase that learning and go okay I can do this we want to make sure that we are considering
their fatigue level though and not putting too much on them at once let’s look at really
small steps and then solidifying those steps not taking one step after another but taking one step
and then taking a breather for some of our clients helping them identify how they’re feeling and
be aware of their own fatigue level low cortisol has been found to relate to more severe PTSD
hyperarousal symptoms and you’re like yeah it took me quite a while to wrap my head around this
whole concept but it makes sense now so when you have low cortisol your body is conserving all
its energy can in case it needs to respond to an extreme threat the sensitized negative
feedback loop in veterans diagnosed with PTSD have they’ve shown that they’ve got greater ludic
corticoid responsiveness now remember I talked about cortisol being a glue to co-corticoids and
there’s just no nice way to talk about this without using really obnoxiously clinical
terms anyhow which means that the body is holding on and it’s going you’re not going to have cortisol
to just get irritable or happy or excited about just anything but if there’s a threat I’ll let you
have it unfortunately in patients with cortisol ISM when there’s a threat they have an exaggerated
response thank hyper-vigilance and I call it the flatter the Furious so their mood is either kind
of flat and they’re not really responsive too much but when there is something that startles them or
their body perceives as a threat all of a sudden their body dumps cortisol and dumps glucose into
the system which floods the system and if you’ve ever flooded your engine you know what happens
doesn’t respond quite as well but there are even more problems with this so evidence says that the
role of trauma experienced in sensitizing the HPA axis regulation is independent of PTSD development
okay so what does that mean that means even if somebody doesn’t develop PTSD clinical diagnosis
if they’ve had trauma HPA access is going to sensitize them a little bit and hold them back a little bit
more cortisol and be a little bit more reactive when there is trauma which means successive
traumas could produce success successively significant reactions in those with prior trauma
maybe more at risk of PTSD for later traumas so again as a clinician what does this mean for
me this means that if I’m working with a client who comes from a troubled childhood there were
adverse childhood events or you know whatever you want to label it they had chronic stress they
had trauma in their childhood even in the prenatal period they found I wanted to educate them about the
the fact that they are at a greater risk of developing PTSD if they’re exposed to more trauma so they
can learn how to keep their stress levels under control because it’s more important for
them according to this research because of some persistent brain changes that we’re going to see
core endocrine factors of PTSD include abnormal regulation of cortisol and thyroid hormones okay
so we’ve already talked about cortisol our stress hormone and you’re probably familiar with thyroid
hormones being sort of your metabolism hormone but what happens when cortisol goes down in the body
starting to rein in the energy thyroid hormones also go down hypo cortisol ism and PTSD occurs
due to increased negative feedback sensitivity of the HPA axis okay studies suggest that low
cortisol levels at the time of exposure to trauma may predict the development of PTSD so if their
cortisol levels were already low they were already suffering if you will from hypercortisolism and
remember we’ve seen hypercortisolism in burnout and you know regular old burnout chronic fatigue
syndrome as well as PTSD so we’re not just talking about veterans here if the cortisol levels are
already abnormally low and the body’s already started conserving cortisol when they’re
exposed to a trauma we can with more certainty predict which people are going to develop PTSD
symptoms back to those gluteal corticoids they interfere with the retrieval of traumatic memories
an effect that may independently prevent or reduce symptoms of PTSD so when cortisol is in
the system and it’s causing all the blood sugar to develop we’re not forming lots of
memories right now we’re just surviving which they hypothesize could prevent or reduce the symptoms
if those memories aren’t consolidated and they go away, or it could contribute to difficulty
in treating PTSD why well let’s think about it if people who’ve been exposed to trauma you
know hypercortisolism they respond to threats by increasing the amount of cortisol and political
corticoids exponentially have an exaggerated response than when they’re in our off and
we’re talking to them about their trauma, and they start to get upset they start to get excited there
the body’s going to start dumping all these gluten coke or turquoise and guess what it’s going to make it
more difficult for them to retrieve those memories potentially so it’s kind of an interesting thing
to look at because a lot of clients that I worked with PTSD have been like I can’t
remember why can I not remember and my very general response because they don’t want to know
about all this stuff generally is it’s your brain’s way of protecting you it’s your brain’s way of
saying there’s a threat right now and you need to protect yourself from the threat we don’t need
to be worrying about all those memories back there so we do some you know relaxation activities and
those sorts of things to help them you know get back down to baseline so we’re not continuing to
fight against those gluten Co corticoids and thus cortisol because when you fight with that what
happens the client generally gets progressively frustrated progressively upset and progressively
unable to think clearly and access those memories neurochemical factors corner or chemical
factors of PTSD include abnormal regulation of catecholamines serotonin amino acid peptide and
opioid neurotransmitters each of which is found in brain circuits that regulate and integrate the
stress and fear response now again if you’re thinking I’m never going to remember this for the
quiz don’t get too stressed out about it because I want you to take home the overarching concepts
I’m not going to ask you really nitpicky questions about stuff that you have absolutely no control
over or at least that’s what I tried to do that being said I want I think it’s important that you
know that all of these neurochemicals including opioids are involved in the regulation and
integration of stress and fear responses it’s not just serotonin or two dopamine the catecholamine
family including dopamine and norepinephrine are derived from the amino acid tyrosine now it’s
not really all that important but an interesting little aside is that norepinephrine is made from
the breakdown of dopamine so your focus and get up and go chemical is made from your pleasure
chemical interesting little concept there when a stressor is perceived the HPA axis releases
corticotropin-releasing hormone which interacts with norepinephrine to increase fear conditioning
and encoding of emotional memories enhance arousal and vigilant vigilance and increase endocrine
and autonomic responses to stress so when the threat response system is turned on it releases
cortisol which interacts with norepinephrine the stress hormone and they get up and go hormone
say there’s some really bad mojo brewing here which increases fear conditioning because the
heart rates go in and everything and the response is stress there’s an abundance of evidence
that norepinephrine accounts for certain classic aspects of PTSD including hyperarousal heightened
startle and increased encoding of fear memories so what about serotonin you know that’s supposed to
be one of our calming chemicals it where did it go poor serotonin transmission and PTSD
maybe may cause impulsivity hostility aggression depression and suicidality remember you’ve got
the downregulation of the sex hormones so less availability of serotonin and there are other
things that cause the serotonin to not be as available but they found that serotonin binding
to 5h t1a receptors and this is just a little soapbox I’m going to go on don’t differ between
patients with PTSD and controls so what does that tell us that’s the only way we can really
To figure out what’s going on in the brain in a live subject look at PET scans what we have figured
out or they’ve hypothesized is the fact that the serotonin may not transmit as effectively as it may
be a really weak connection it’s connecting but it’s you know it’s kind of like having a rabbit
ears you got to twist it to get the signal to come in correctly all right this is another one
just a concept I want you to think about all they’re looking at in the research is the 5-hit
1a receptor there are a ton of 5-ht serotonin 5-ht receptors and each one of these receptors is
involved in some aspect of addiction anxiety mood sexual behavior mood sleep so when we’re talking
about why SSRIs don’t work well SSRIs only bind to certain receptors and if we’re not picking
the right receptor if it is the serotonin at all then we’re probably barking up the wrong tree
I educate my patients about this if they decide they need to go on antidepressants just so they
don’t get frustrated as easily I mean it’s still frustrating but so they don’t feel hopeless if
the first medication they start taking doesn’t seem to work or makes it worse we talked about why
that might be because there are so many different receptors for each one of the neurotransmitters
there is a really cool table if you’re into this stuff it’s actually on Wikipedia and it talks
also about not only what these receptors do but also what chemicals and medicines act on
these receptors and how Food for Thought GABA has profound anxiolytic effects in part by
inhibiting the cortisol norepinephrine circuits so it turns down the excitatory circuits
patients with PTSD exhibit decreased peripheral benzodiazepine binding sites well we know that
when the body secretes a neurotransmitter goes to the other end and it binds like a lock-and-key
if you will or it knocks on the door and the door gets opened and it goes through however you want
to think about it basically what they found is in patients with PTSD the Kem GABA goes through
and the GABA levels are okay but then it knocks on the door to get let in or it tries to put its
key in the lock and there’s something wrong at the binding sites or the binding sites you know
somebody’s super glued them shut and they’re just not there which is why patients with PTSD tend
to have a harder time de-escalating when their anxiety and stuff gets up because the GABA is
there but it’s got no doors to go through no locks to bind with however you want to whatever
metaphor you want to use this may indicate the usefulness of emotion regulation and distress
tolerance skills due to the potential emotional dysregulation of these clients so remember we
talked about them having a more exaggerated get-up-and-go response to a perceived threat and
they also have a harder time calming down which is basically one of your primary tenants of emotional
dysregulation so one thing clinicians can do is help patients learn that okay their body
responds differently to stress than other people at least for right now so it’s important for
them to understand what emotional dysregulation is emotional regulation strategies as well as
distress tolerance skills to help them until they can calm down to baseline because it sometimes
takes them longer than other people as clinicians we also can help reduce excitotoxin in order to
reduce stress improve stress tolerance and enable the acquisition of new skills when the brain gets
really going when the cortisol is out there and the glucocorticoids are in there it’s actually
toxic and starts causing neurons to disappear which we’re going to talk about in a second it’s
kind of scary NMDA receptors have been implicated in synaptic plasticity.
Which means the brain’s
ability to adjust and adapt as well as learning and memory so these are good receptors I like
them glutamate binds with these receptors and high levels of glutamate are secreted during high
levels of stress glutamate remember is what GABA is made from but high levels of glutamate
it’s an excitatory neural net in the brain and overexposure of neurons to this glutamate can be
excited toxic and may contribute to the loss of neurons in the hippocampus of patients with PTSD
so we’re actually seeing brain volume decrease as a result of exposure to certain chemicals elevated
gluten core glucocorticoid and yeah glucocorticoids increases the sensitivity of these receptors so
you’ve got a bunch of glutamate being dumped and you’ve got a bunch of glucocorticoid you’ve got
cortisol in there making these receptors more sensitive so it’s got they’re more sensitive and
they’ve got more coming in which makes it a whole lot easier to become toxic and start causing
neuronal degradation what does that mean why do we care it may take clients with PTSD more time to
master new skills because of emotional reactivity but also because some of their synaptic plasticity
may be damaged so it may take them a little bit longer to actually acquire and integrate these
new skills it’s not saying they’re stupid they can remember it just fine however when they’re
an emotionally charged state and helping their brain learn that okay this isn’t a threat that’s one
of those sort of subconscious things that has to happen that can take longer if the brain becomes
excited toxic during stress inhibited learning and memory then it becomes excited toxic during
stress which inhibits learning and memory so it’s under stress things are excited toxic neurons
are starting to disappear so I’m wondering and I’m just hypothesizing here I don’t know the
answers obviously or I wouldn’t be practicing it but what happens during the exposure therapies
because that’s exactly what we’re doing is we are flooding the brain with all of these chemicals
and creating basically an excitotoxin now they found some evidence that exposure therapies can
be helpful according to the DOJ website but or not the DOJ I can’t even think of it right
now the VA website but you know I’m wondering long-term what the impact is endogenous opioids
natural painkillers act upon the same receptors activated by exogenous opioids like morphine and
heroin exerts an inhibitory influence on the HPA axis well we know that people take opiates
and it has depressant effects on them it slows them down and calms them down alterations in our
natural opioids may be involved in certain PTSD symptoms such as numbing stress-induced analgesia
and dissociation again think of any clients you’ve had who have been abused or even taken and not like
the side effects of opiates are what opiates do to some people make them feel more relaxed stress
induced and analgesia they don’t have as much physical pain sometimes they just it’s there
I don’t care pill another interesting factor is now truck zone which is used to oppose opiate
appears to be effective in treating symptoms of dissociation flashbacks in traumatized persons so
basically, they’re saying if we undo the endogenous opioids we can treat these symptoms it highlights
the risk of opiate abuse for persons with PTSD though because if endogenous opioids produce
some of these numbing symptoms and dissociative symptoms so they can get away from the pain and
the flashbacks then if they add to that you know oral opioids it could prove to be a very tempting
cocktail we do want to as clinicians figure out how we can assist them with their physical and
emotional distress tolerance so they don’t feel the need to numb and escape and you know I
can’t imagine what some people have seen have gone through and I’m not trying to take that away
from them, I’m trying to help them figure out how they can stay present and learn to integrate it
changes question marks in brain structure and one of the questions that’s come up in the research is
because there aren’t any longitudinal studies that looked at it was the hippocampal volume as low to
begin with which created a predisposition for PTSD or did PTSD create the smaller hippocampal volume
interesting hippocampus is implicated in the control of stress responses memory and contextual
aspects of fear conditioning so it helps you to find these triggers in the environment that
help you become aware with your senses about when there might be a trauma prolonged exposure
to stress and high levels of glucocorticoids damage the hippocampus we’ve talked about that
hippocampal volume reduction in PTSD may reflect the accumulated toxic effects of repeated exposure
to increased cortisol levels what I called earlier the flatter the Furious having you know your body
holding on to cortisol for this extreme stress and then when it perceives stress it’s either
nothing or it’s extreme there are no kind sort of mild stressors out there that decrease hippocampal
volumes might also be a pre-existing vulnerability factor for developing PTSD the amygdala yet
another brain structure is the Olympic structure involved in the emotional process and it’s
critical for the acquisition of fear responses functional imaging of studies has revealed hyper
responsiveness and PTSD during the presentation of stressful script cues or trauma reminders but
also patients show increased amygdala responses to general emotional stimuli that are not trauma
associated such as emotional faces so they show an increased responsivity to things they see on the
TV that aren’t trauma-related to people crying to people showing anger’s going to have a
stronger emotional amygdala response than people without PTSD so clients with PTSD may be more
emotionally responsive across the board leading to more emotional dysregulation again an area that
we can help provide them with tools for early adverse experiences including prenatal stress and stress
throughout childhood has profound and long-lasting effects on the development of neurobiological
symptoms the brain is developing and if is exposed to a lot of stress and some of these excited toxic
situations how does that differ in the amount of damage caused versus a brain that’s already kind
of pretty much-formed programming may change for subsequent stress reactivity and vulnerability
to develop PTSD so if these happen during childhood or at any time the brain can
basically reprogram and go that it’s a really dangerous place out there so I need to hold
on to cortisol and I need to hold on to these stress hormones because every time I turn around
it seems like there’s a threat so I am going to be hyper-vigilant and respond in an exaggerated way
to protect you from the outside world adult women with childhood trauma histories have been shown
to exhibit sensitization of both neuroendocrine and Audino stress responses so basically they’re
showing hypo cortisol ISM a variety of changes take place in the brains and nervous systems of
people with PTSD and we talked about a lot of those the key take-home point is stress can
actually get toxic in the brain and cause physical changes not just thought changes in the brain
preexisting issues causing hypo cortisol ism where the brain has already downregulated whether it’s
due to chronic illness or chronic psychological stress increases the likelihood of the development
of PTSD this points to the importance of prevention and early intervention of adverse
childhood experiences we really need to get in there and help these people develop distress
tolerance skills understanding of vulnerabilities so they’re not going from flat to furious all
the time and so that they can understand why their body kind of responds and why they respond
differently than others and you know as we talk about this and of course I’m regularly bringing up
DBT buzzwords if you will think about your clients if you’ve worked with any who’ve had borderline
personality disorder what kind of history do they have did they have just a great childhood no we
know that people with BPD generally had pretty chaotic childhoods so this research is also
kind of underscoring why they may react and act the way they do that flat to furious people with
hypo cortical ism may or may not have PTSD so we don’t want to say well you’re fine if you don’t
have PTSD symptoms we do know that every trauma potentially can cause the body to down-regulate
and I kind of look at it as conserving a little bit more of the energy that it needs each time so
instead of conserving 60% now it’s conserving 65 and 66 each time it encounters a stressor in order
to prepare for potential ongoing threats in the environment hypercortisolism sets the stage for
the flattened the furious leading to toxic levels of glutamate upon exposure to stressors which
can cause the theorized reduction in hippocampal volume and persistent negative brain changes now I
always say the brain can you know rebalance itself and all well that’s part of the plasticity that is
the really cool thing about our brain however as far as regenerating those neurons I haven’t found
any evidence in the research that we found a way to help people regenerate once we’ve already those
neurons are gone they’ve been killed off the brain has to find a workaround so it does take time
but I do believe people can minimize some of the impact of the trauma they may have experienced
people with PTSD are more reactive to emotional stimuli even stimuli unrelated to trauma again
think about some of your clients especially if you work in a residential situation where you’re
around on 24/7, you know for 30 or 60 days, and you may see some clients that seem to get upset
over everything and you’re like ah such a drama queen or such a drama king and to yourself not
to anybody else but when you think about it from this perspective it gives you a different
perspective and you might say oh maybe their body responds differently they’ve got more emotional
dysregulation because of prior trauma they’re not trying to overreact this is their body’s response
because it’s perceived threat so many times it gives me a different approach to working
with that client hypercortisolism results when the brain perceives that continued effort is futile
feelings of fatigue set in akin to reduced stress tolerance so think about you know when you’ve had
a really long stressful period you know weeks or months maybe you’re dealing with an ailing family
member or something it’s just a lot of stress and you start getting really tired and when you’re
really tired and you’re worn down and somebody gives you one more thing it’s that one more thing
normally wouldn’t bother you but right now you just can’t take it so we can see how there’s a
reduced stress tolerance when somebody’s already at this stage reducing fatigue in our clients can
be accomplished in part with psychological factors including motivation or knowledge of other people
who are dealing with similar things support groups feedback about their and making sure they have
frequent successes not once a week but I want to have them keep a journal every day of something
good that happened or something positive that may indicate they’re moving forward in their
treatment goals and knowledge of an endpoint.
Where are we going with this when is the treatment
going to end I don’t want most clients don’t want to be with us forever no matter how lovable
we are do you want to feel better and be done with us so having to help them see that there
is an endpoint we’re going to accomplish this goal this month and then we can reassess 46% of
people in the US are exposed to adverse childhood experiences so like I said this is a huge area
for early intervention where we can prevent people from developing PTSD later in life how awesome
would that be instruction and skills to handle emotional dysregulation including mindfulness
vulnerability prevention and awareness emotion regulation distress tolerance and problem-solving
could be wonderful additions to health curriculums anything any skills groups you do with children
or adolescents or even adults I mean just because they’re adults doesn’t mean that they’re safe
from PTSD or that they’ve crossed any threshold where they’re too old to learn we’re never too
old to learn of those exposed to trauma education about and normalization of their heightened
emotional reactivity and susceptibility to PTSD in the future may be helpful in increasing their
motivation for their current treatment protocol whatever it is but it also just normalizes things
so they don’t feel like they’re overreacting or they don’t feel guilty for being so tired
or whatever they’re experiencing right now are there any questions I know I went through
a lot of really complicated stuff but I thought it was really interesting not only the way
our brain reacts in order to protect us but how cross-cutting a lot of this stuff
was it not just PTSD we’re talking about necessarily but a lot of this information
applies to our clients with chronic fatigue burnout and chronic stress and we can
see that those people also are at risk at higher risk of PTSD should they be exposed
to trauma and none of us is immune I mean there are tornadoes there are hurricanes
there are you know things that happen that really stink so the more we can help clients
be aware of things develop skills and tools to prevent as much harm as possible I
think the more effective we are as clinicians depending on the client and I can do some
more research on the VA website because they’re really into medications for PTSD I
know ketamine which is a horse tranquilizer has been shown to be effective in people
with PTSD and there have been some others that have kind of given me pause ketamine
is a hypnotic you know most of the drugs they’re trying out right now are really in my
opinion they’re powerful drugs but a lot of them all of them that I know of have
pretty high addictive potentials too so they make me nervous but you know when you’re
weighing the when you’re going from a harm reduction model that’s not necessarily not
necessarily such the be-all-end-all I guess that’s interesting that you use ketamine in the ER it’s definitely powerful effective stuff and like I said earlier some of the
stuff that some of my clients and some people have seen done experienced I couldn’t even
imagine and you know sometimes for them to actually survive we may need to look at some
of these more intense more powerful drugs PTSD and veteran trauma is not are not my focus
right now and yes marijuana is being experimented with or looked at used whatever however you want
to look at it for PTSD treatment with veterans there’s pretty much not a drug out there they
haven’t tried to throw at it to see well what will this do I believe they were even using
LSD experimentally for a little while too you the VA I mean if you’re interested in this
topic let me see if I could pull that down into here, we go to the National Center
for PTSD US Department of Veterans Affairs has a lot of information if you go for
professionals, it has a ton more information if you can get on get some of your SI CEUs on
demand they do have some free CEUs for PTSD here I’ve never taken any of them but what
I’ve looked at when I’ve looked at like the PowerPoints the presentations and stuff I’m
sure they’re good so if you’re you do focus a lot on PTSD and you can get on-demand CEUs
then this might be a place to get some good free ones aside from DBT are there any other
evidence-based practices for therapy that you’ve seen work best in combination with the
medications cognitive processing therapy when you’re working specifically with veterans
and there is a free course on that too and this one I have gone through
and it’s really awesome CPT dot must seed and here I’ll just put it
into that education and this is a free course oops and here’s the other one ah golly everyone and
embryo does have a lot of research effectiveness with people with PTSD too so yes I would
definitely encourage people to explore all options alrighty everybody I really
appreciate you coming today and sticking with me through this topic and I will see
you on Thursday if you have any questions please feel free to email me or you can
always also send it to support that all CEUs com either way I get it and otherwise I
will see you on Tuesday thanks a bunch if you enjoy this podcast please like and
subscribe either in your podcast player or on YouTube you can attend and participate
in our live webinars with Doctor Snipes by subscribing at all CEUs comm slash
counselor toolbox this episode has been brought to you in part by all CEUs
com providing 24/7 multimedia continuing education and pre-certification training to
counselors therapists and nurses since 2006 used coupon code consular toolbox to get
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you agree with these points? Did you learn something new? Remember, if you or anyone you know is struggling with anxiety or any other serious
mental health concern, please do not hesitate to reach out to a mental healthcare
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Which means the brain’s
ability to adjust and adapt as well as learning and memory so these are good receptors I like
them glutamate binds with these receptors and high levels of glutamate are secreted during high
levels of stress glutamate remember is what GABA is made from but high levels of glutamate
it’s an excitatory neural net in the brain and overexposure of neurons to this glutamate can be
excited toxic and may contribute to the loss of neurons in the hippocampus of patients with PTSD
so we’re actually seeing brain volume decrease as a result of exposure to certain chemicals elevated
gluten core glucocorticoid and yeah glucocorticoids increases the sensitivity of these receptors so
you’ve got a bunch of glutamate being dumped and you’ve got a bunch of glucocorticoid you’ve got
cortisol in there making these receptors more sensitive so it’s got they’re more sensitive and
they’ve got more coming in which makes it a whole lot easier to become toxic and start causing
neuronal degradation what does that mean why do we care it may take clients with PTSD more time to
master new skills because of emotional reactivity but also because some of their synaptic plasticity
may be damaged so it may take them a little bit longer to actually acquire and integrate these
new skills it’s not saying they’re stupid they can remember it just fine however when they’re
an emotionally charged state and helping their brain learn that okay this isn’t a threat that’s one
of those sort of subconscious things that has to happen that can take longer if the brain becomes
excited toxic during stress inhibited learning and memory then it becomes excited toxic during
stress which inhibits learning and memory so it’s under stress things are excited toxic neurons
are starting to disappear so I’m wondering and I’m just hypothesizing here I don’t know the
answers obviously or I wouldn’t be practicing it but what happens during the exposure therapies
because that’s exactly what we’re doing is we are flooding the brain with all of these chemicals
and creating basically an excitotoxin now they found some evidence that exposure therapies can
be helpful according to the DOJ website but or not the DOJ I can’t even think of it right
now the VA website but you know I’m wondering long-term what the impact is endogenous opioids
natural painkillers act upon the same receptors activated by exogenous opioids like morphine and
heroin exerts an inhibitory influence on the HPA axis well we know that people take opiates
and it has depressant effects on them it slows them down and calms them down alterations in our
natural opioids may be involved in certain PTSD symptoms such as numbing stress-induced analgesia
and dissociation again think of any clients you’ve had who have been abused or even taken and not like
the side effects of opiates are what opiates do to some people make them feel more relaxed stress
induced and analgesia they don’t have as much physical pain sometimes they just it’s there
I don’t care pill another interesting factor is now truck zone which is used to oppose opiate
appears to be effective in treating symptoms of dissociation flashbacks in traumatized persons so
basically, they’re saying if we undo the endogenous opioids we can treat these symptoms it highlights
the risk of opiate abuse for persons with PTSD though because if endogenous opioids produce
some of these numbing symptoms and dissociative symptoms so they can get away from the pain and
the flashbacks then if they add to that you know oral opioids it could prove to be a very tempting
cocktail we do want to as clinicians figure out how we can assist them with their physical and
emotional distress tolerance so they don’t feel the need to numb and escape and you know I
can’t imagine what some people have seen have gone through and I’m not trying to take that away
from them, I’m trying to help them figure out how they can stay present and learn to integrate it
changes question marks in brain structure and one of the questions that’s come up in the research is
because there aren’t any longitudinal studies that looked at it was the hippocampal volume as low to
begin with which created a predisposition for PTSD or did PTSD create the smaller hippocampal volume
interesting hippocampus is implicated in the control of stress responses memory and contextual
aspects of fear conditioning so it helps you to find these triggers in the environment that
help you become aware with your senses about when there might be a trauma prolonged exposure
to stress and high levels of glucocorticoids damage the hippocampus we’ve talked about that
hippocampal volume reduction in PTSD may reflect the accumulated toxic effects of repeated exposure
to increased cortisol levels what I called earlier the flatter the Furious having you know your body
holding on to cortisol for this extreme stress and then when it perceives stress it’s either
nothing or it’s extreme there are no kind sort of mild stressors out there that decrease hippocampal
volumes might also be a pre-existing vulnerability factor for developing PTSD the amygdala yet
another brain structure is the Olympic structure involved in the emotional process and it’s
critical for the acquisition of fear responses functional imaging of studies has revealed hyper
responsiveness and PTSD during the presentation of stressful script cues or trauma reminders but
also patients show increased amygdala responses to general emotional stimuli that are not trauma
associated such as emotional faces so they show an increased responsivity to things they see on the
TV that aren’t trauma-related to people crying to people showing anger’s going to have a
stronger emotional amygdala response than people without PTSD so clients with PTSD may be more
emotionally responsive across the board leading to more emotional dysregulation again an area that
we can help provide them with tools for early adverse experiences including prenatal stress and stress
throughout childhood has profound and long-lasting effects on the development of neurobiological
symptoms the brain is developing and if is exposed to a lot of stress and some of these excited toxic
situations how does that differ in the amount of damage caused versus a brain that’s already kind
of pretty much-formed programming may change for subsequent stress reactivity and vulnerability
to develop PTSD so if these happen during childhood or at any time the brain can
basically reprogram and go that it’s a really dangerous place out there so I need to hold
on to cortisol and I need to hold on to these stress hormones because every time I turn around
it seems like there’s a threat so I am going to be hyper-vigilant and respond in an exaggerated way
to protect you from the outside world adult women with childhood trauma histories have been shown
to exhibit sensitization of both neuroendocrine and Audino stress responses so basically they’re
showing hypo cortisol ISM a variety of changes take place in the brains and nervous systems of
people with PTSD and we talked about a lot of those the key take-home point is stress can
actually get toxic in the brain and cause physical changes not just thought changes in the brain
preexisting issues causing hypo cortisol ism where the brain has already downregulated whether it’s
due to chronic illness or chronic psychological stress increases the likelihood of the development
of PTSD this points to the importance of prevention and early intervention of adverse
childhood experiences we really need to get in there and help these people develop distress
tolerance skills understanding of vulnerabilities so they’re not going from flat to furious all
the time and so that they can understand why their body kind of responds and why they respond
differently than others and you know as we talk about this and of course I’m regularly bringing up
DBT buzzwords if you will think about your clients if you’ve worked with any who’ve had borderline
personality disorder what kind of history do they have did they have just a great childhood no we
know that people with BPD generally had pretty chaotic childhoods so this research is also
kind of underscoring why they may react and act the way they do that flat to furious people with
hypo cortical ism may or may not have PTSD so we don’t want to say well you’re fine if you don’t
have PTSD symptoms we do know that every trauma potentially can cause the body to down-regulate
and I kind of look at it as conserving a little bit more of the energy that it needs each time so
instead of conserving 60% now it’s conserving 65 and 66 each time it encounters a stressor in order
to prepare for potential ongoing threats in the environment hypercortisolism sets the stage for
the flattened the furious leading to toxic levels of glutamate upon exposure to stressors which
can cause the theorized reduction in hippocampal volume and persistent negative brain changes now I
always say the brain can you know rebalance itself and all well that’s part of the plasticity that is
the really cool thing about our brain however as far as regenerating those neurons I haven’t found
any evidence in the research that we found a way to help people regenerate once we’ve already those
neurons are gone they’ve been killed off the brain has to find a workaround so it does take time
but I do believe people can minimize some of the impact of the trauma they may have experienced
people with PTSD are more reactive to emotional stimuli even stimuli unrelated to trauma again
think about some of your clients especially if you work in a residential situation where you’re
around on 24/7, you know for 30 or 60 days, and you may see some clients that seem to get upset
over everything and you’re like ah such a drama queen or such a drama king and to yourself not
to anybody else but when you think about it from this perspective it gives you a different
perspective and you might say oh maybe their body responds differently they’ve got more emotional
dysregulation because of prior trauma they’re not trying to overreact this is their body’s response
because it’s perceived threat so many times it gives me a different approach to working
with that client hypercortisolism results when the brain perceives that continued effort is futile
feelings of fatigue set in akin to reduced stress tolerance so think about you know when you’ve had
a really long stressful period you know weeks or months maybe you’re dealing with an ailing family
member or something it’s just a lot of stress and you start getting really tired and when you’re
really tired and you’re worn down and somebody gives you one more thing it’s that one more thing
normally wouldn’t bother you but right now you just can’t take it so we can see how there’s a
reduced stress tolerance when somebody’s already at this stage reducing fatigue in our clients can
be accomplished in part with psychological factors including motivation or knowledge of other people
who are dealing with similar things support groups feedback about their and making sure they have
frequent successes not once a week but I want to have them keep a journal every day of something
good that happened or something positive that may indicate they’re moving forward in their
treatment goals and knowledge of an endpoint.
