– Hey, Psych2Goers. Do you have trouble paying attention? For example, zoning out
while watching this video? Do you think you have
ADHD because of this? Oftentimes, people mistake
symptoms of anxiety for ADHD because of some of the
similar traits they share. According to the Centers
for Disease Control and Prevention data, about 3 in 10 children
with ADHD have anxiety. So to help you get a better understanding of the difference
between ADHD and anxiety, here are six signs to look out for. Number one, you have poor focus because of worrying thoughts.
Are you always distracted by your worries, so much so that you’re unable to focus on the things you’re doing? When fear and apprehension
dominate your thoughts, it may cause you to become restless, and have trouble sitting
still, paying attention, or staying focused in class. According to John Waldrop, MD from Weill Cornell Medical College, when you experience anxiety, your prefrontal cortex, the part of the brain which is essential for thinking, learning, and
remembering, is shut down. Your brain is concentrated
on staying safe.
In contrast with ADHD, you aren’t consumed by worrying thoughts. Instead, it has more
to do with an imbalance in your hormones: dopamine
and norepinephrine, which causes you to be distracted. Number two, you don’t tend to have as many problems with impulsivity. Do you often find yourself
speaking out loud in class without raising your hand? Perhaps you were even labeled
as the troublemaker in school because of the way you
can never sit still. According to Dr. John, a
person with ADHD may feel as if there are dozens of controllers trying to control their
brains at the same time without checking in with each other first. So if you find that you
don’t appear to have as many problems with impulsivity but just struggle to speak up or stand up because of your nerves, then you may have anxiety rather than ADHD. Number three, you have trouble
completing your schoolwork because of perfectionism. Do you have trouble
completing your schoolwork? Perhaps you find yourself procrastinating even if you only have just
one assignment to you.
This struggle could be because
you have so many points you wanna make in so many
ways to phrase the words that leave you wanting
to throw up your hands and ignore them. You’re avoiding starting your assignments because you can’t have
it is less than perfect. If you can relate to this, then it’s more likely you’re struggling with anxiety and not ADHD. Dr. John stated that
while people with ADHD may experience difficulty
completing their schoolwork or performing tasks, it’s often due to trouble
with concentration rather than perfectionism.
Number four, you are
generally more sensitive to social cues. Are you very sensitive to how you come across to other people? Do you find yourself often uncomfortable with your social environment? Perhaps you find it challenging to eat in front of other people, or tend to avoid speaking in public because of an overwhelming fear that people will judge you negatively. According to Dr. John,
if your answers are yes to the above questions, it’s more likely that you
have anxiety rather than ADHD. This is because people
with ADHD usually struggle with understanding or missing social cues rather than being hypersensitive to them. Number five, you experience
a racing heart, clamminess, tense muscles, headaches,
nausea, or dizziness. Do you often experience
headaches, nausea, or dizziness? These are just some of
the symptoms of anxiety. Dr. John stated that anxiety comes from a tiny almond-shaped part at the back of your brain
called the amygdala.
As a watchman for your brain, it is constantly watching out for danger. And whenever it detects danger, it triggers a fight or flight response. However, for anxious people, the amygdala is large and hypersensitive. Because of this, it ends up sending out
a lot of false alarms. You can think of it as a watchman
who cries wolf too often. As a result, your brain may sense threats even in non-threatening situations. And number six, you are unlikely
to show problem behaviors when you’re feeling calm, safe,
and doing things you enjoy.
How do you act when you’re having fun? Whether it’s listening
to your favorite music or playing video games, you
may find yourself feeling calm and safe while doing the things
that you genuinely enjoy. You are neither restless nor feel like you need
to catch your breath. According to Dr. John, anxious
individuals are unlikely to display any problem behaviors
when feeling calm and safe and doing something they enjoy. On the contrary, people with ADHD will experience problem behaviors even when they engage in a particular fun or exciting activity. For example, a person with ADHD may become so engrossed
with painting a picture that they tune out or completely
ignore everything else. This behavior is known as hyperfocus. Did you relate to any of
the signs we’ve mentioned? Let us know in the comments below. If you found this video helpful, be sure to like, subscribe,
and share this video with those who might benefit from it. And don’t forget to hit
the notification bell icon to get notified whenever
Psych2Go posts a new video. As always, the references and
studies used in this video are added in the description below.
Thanks so much for watching
and see you in our next video. (light music).
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– Hey Psych2Goers, welcome back. Think you've never
experienced anxiety before? Well, you might not have realized it because people experience
anxiety in different ways. Your idea of anxiety might not align with
how you experience it. And you may not notice anxiety in someone who grapples with it privately. So, it's important to
remember to always be kind because you can never know
what others are struggling with when they're alone. If you're dealing with anxiety, know that you're not alone
in facing these challenges. Anxiety is a normal part of life.
It alerts us to dangers
and helps us prepare for a wide variety of situations. But according to the Diagnostic and Statistical
Manual of Mental Disorders, DSM, anxiety becomes a disorder
when it starts to impact daily functioning and
different aspects of life. With that said, here are five things people with anxiety secretly do alone. Number one, overthink,
overthink, and overthink. Anxiety disorders are
characterized by excessive or disproportionate worry and fear that gets in the way of daily activities. It may not be as obvious to other people, but those who struggle with
anxiety tend to overthink while in the presence of
others and when alone. Many people who struggle with anxiety tend to dwell on negative thoughts about themselves and their past. They may replay these
past events in their head over and over, trying to think of what they
could have done differently.
And may also imagine
possible future events to try and anticipate
things that might go wrong. Two, confine themselves
to their comfort zone. Everyone feels anxious now and then, but those struggling
with an anxiety disorder constantly adjust their
lives to cater to it. They may stick to activities that calm their racing thoughts, or engage in pursuits that
allow them to avoid the things that make them feel anxious instead of choosing activities
purely for fun or interest. Like re-watching the
same shows over and over because they don't have to
feel anxious anticipating what might happen next. Some people may not even
be able to leave the house out of fear of being in
places and situations where escape may be difficult.
Or they may struggle to leave the house without a certain person
they're scared to lose. Three, withdraw from social interaction. Some people with anxiety may
have a limited social life and turn down invites, not
out of a lack of interest, but to stay home to calm
certain worries and fears. In some cases, the person
may seem uninterested in spending time with others due to a crippling fear of
feeling humiliated, rejected, or looked down on in social interactions. People with anxiety may withdraw socially to cope with their fears
and might avoid their phones or ignore or turn off their notifications to manage their feelings of anxiety, and then feel overwhelmed
and anxious later when they see the backlog of messages. Number four, procrastinate
or struggle to finish tasks. People with anxiety, especially
high functioning anxiety, may seem like completely
put together achievers, but they may also grapple
with getting their work done when they're alone, because anxious thoughts may
force them to procrastinate.
Anxiety also affects working memory, which makes it difficult
to focus long enough to complete tasks. And so, they may then have to rush to get things done on
time, adding extra stress. Then number five, tossing
and turning in bed. Having anxiety doesn't
immediately translate to nervous, jittery energy that
others can easily detect. Someone with anxiety can
seem calm and rested, when in reality, they might be
tossing and turning at night, unable to fall asleep because
of their anxious thoughts. If they do manage to get some sleep, they might be restless or
riddled with nightmares about their anxieties. For example, those with
separation anxiety disorder may have nightmares about being separated from their loved ones. Anxiety disorders are complex and varied, but remember that a certain
level of anxiety is normal and anxiety disorders are those that cause significant distress or impairment in different areas of life.
If you or anyone you know, are struggling with an anxiety disorder, please don't hesitate to
reach out to a qualified mental health care provider. Can you relate to any of these signs? Share with us in the comments and remember to like and share this video with someone who might benefit too. As always the references and studies used are listed in the description below. Until next time, take care friends..
Light music Narrator, Hey Psych2go ers. Before we begin, we would like to thank you all so much for your love and support for our channel Psycho2go.’s mission is to make psychology and mental health knowledge more accessible to everyone, and we hope we’ve helped you along the way.
Now let’s begin As a child.
I loved to be the center of attention.
I wasn’t afraid to introduce myself or speak up, but now there are days when I find it difficult just to look someone in the eye.
It was frustrating to watch my peers build relationships with ease.
While I struggled just to make a connection at all For years, I blamed shyness and lack of self-esteem for these changes, But it wasn’t until college that I truly learned about social anxiety, Just as with any mental illness.
Social anxiety affects everyone differently.
For me, it even changes from moment to moment.
Sometimes my nervousness reveals itself in stuttering or repetitive speech.
Other times I freeze, I’ve learned a myriad of coping mechanisms, some more helpful than others, and techniques to understand the root of my anxiety, but none have been more beneficial than therapy Finding communities such as Psych2go, where I have a voice, as well as the Support system to reach out and relate to, also help me practicing using my voice with confidence, Even when I feel so fragile that I could shatter It’s. Okay, if you don’t, feel ready to join a community or speak up about your experiences, but the team at Psych2go wants you to know that we are here.
Here are seven things: people with social anxiety will understand, Number one being social can be draining, While not everyone with social anxiety is an introvert.
Many people can feel exhausted after a social event.
Worrying can be tiring and trying hard to keep your anxiety under control while interacting with others can be enough for you to require time to recharge for the rest of the day.
It’s, okay, to push yourself to be social but be sure to know your limits and respect them.
Pushing yourself too far may end in more anxiety and exhaustion than you began with, And it’s important to take care of yourself and your needs.
First, Two: you prefer texting over calling.
Do you relate to the dread that comes when you receive a phone call For? They fear that calling someone will bother the other person For others.
They may not know who is calling or know what to say when they pick up.
Phone Calls can be sudden, disruptive, and unpredictable. So you may worry about what the other person is going to tell you Number three.
You feel anxious without direct interaction.
Sometimes you might feel anxious without directly talking or interacting with someone Just being aware that someone is watching.
You can be difficult For some that occurs when they’re eating or doing other simple tasks.
The fear can stem from judgment for doing something wrong or differently, but more often than not people don’t pay attention as closely as you think, Number four.
When it comes to friends, quality is greater than quantity, Not everyone.’s idea of fun includes hanging out with a huge group of people or going to a party.
It can be intimidating to be around a lot of people.
You don’t know, And you’d – much rather prefer to spend time with a few close friends.
The beauty of life is that no two experiences are the same, So there’s a friend out there for everyone, Even if you may be socially anxious.
Five, it’s, not all in your head. Social anxiety can manifest as physical sensations for a lot of people.
These symptoms are similar to feeling embarrassed, sweaty, hands, blushing hyperventilating, but can feel more intense and last longer.
Facing social situations can potentially lead to panic attacks for some people, while others feel physically ill or faint.
These physical symptoms may be scary, but they rarely are threatening to one’s immediate health Number.
Six, you feel, like everyone is judging you When you’re socially anxious it can feel like you’re under a magnifying glass all the time.
You feel overly conscious about yourself and project those worries onto other people about their perceptions of you, but just because you’re monitoring every detail about yourself, doesn’t mean everyone else is too In reality.
People aren’t as focused on you, as you think, and they likely have their worries too And number seven.
You are your harshest judge.
When you’re socially anxious, you might find yourself comparing how you think act, or look to others.
This self-criticism can seriously hurt your mental and emotional health and it’s important to treat yourself more kindly While it might feel like others, make connections more easily or have it so. Well, it’s important to remember that everyone is going through their things and they have worries and concerns.
Just like you do.
When it comes to social anxiety, it can be hard to interact with people or make friends when you’re overly worried.
The truth is, though, there is no normal when it comes to being social.
Everyone has their way of socializing with others, And you’ll find someone who you connect with on the same level.
There’s nothing wrong with leaving early or spending another night at home with your dog.
We hope you enjoyed this and found some comfort.
What have your experiences been with social anxiety? Leave a comment down below to share your thoughts.
If you enjoyed our video, please give it a like and subscribe to our channel for more content like this.
Thanks for watching – and we’ll see you at the next one.
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[Music] high functioning anxiety isn't actually considered a mental health diagnosis instead it's a term many people can relate to when they have anxiety and can still carry out everyday tasks at a functional level it could be the valedictorian in your class your co-worker who has an exceptionally polished resume or it might even be you it's no surprise that this has become widely relevant when roughly 40 million adults struggle with anxiety when someone tells you you're fine or always has a smile plastered on their face they might actually need your help here are 10 signs of high functioning anxiety 1.
You're an overachiever do you consider yourself a perfectionist type a and a planner people with anxiety always feel like they need control in order to feel at ease whether it means making big to-do lists showing up at a meeting early or staying up late studying for a test they already memorized by heart the individual stays busy in order to feel productive one research study shows that it's only when you feel in control that you can deal with stress two no is rarely used in your vocabulary getting things done becomes more important than your health if you sacrifice eating meals on time or cancel plans with friends to do someone else a favor you might have high functioning anxiety you'd rather suck it up and get the work done instead of saying no fearing that it might pile up otherwise you may also be afraid to reject others afraid that you'll hurt them so you bite the bullet and you hurt yourself instead 3.
What is sleep apparently never enough for people with anxiety how can it be when you're constantly tossing and turning in bed consumed by your worries anxiety doesn't need a reason to keep you up you have everything checked off your to-do list and still worry about a million other things 4. you crack cynical jokes for fun are you sarcastic or make jokes about dying chances are you aren't as happy as you seem when you tell the punchline if you're laughing and putting on a show when you're actually suffering this is anxiety it forces you to entertain and mask your intensities behind your witty combat remember you don't have to put up a front lower your guard and tell people what's going on 5. negative self-talk is common and it's so common that you don't even consider it negative just your usual way of thinking people with anxiety are the hardest on themselves they can stand in front of the mirror and pick out flaws at a snap of a finger or beat themselves up if they make one minor mistake they don't give themselves a break always seeking to be a better worker student citizen the list goes on six your coworkers consider you a mystery you might be the helpful reliable worker everyone loves so it's no surprise that you'll get asked to go out once it's time to clock out but you'll usually decline remaining an enigma other people will find it hard to read you not because you want to seem cold or detached but letting loose and socializing without preparing ahead of time actually terrifies you 7.
You're easily startled it's normal to get jumpy during a horror movie but are you startled even during the slightest disturbance afraid that others might find you spineless therapist and right says you may resort to unhealthy habits such as drinking drugs or endless social media scrolling as a distraction eight bad days are normal for you excessive ruminating panic attacks and an inability to relax have all become ingrained in your daily routines that good days become once in a blue moon but instead of outwardly complaining or calling up a friend to talk about it you might just bottle it up since it happens every week you worry that others will find you annoying or a burden nine you constantly seek validation anxiety makes rationality hard to achieve that's why the individual often seeks logic from others they fear their judgment isn't enough so they rely on the support and guidance of friends family and co-workers they don't mean to lean on people 24 7 but it significantly quiets down their loud thoughts on the flip side however some may worry about being a burden so they choose to suffer silently instead of reaching out to others 10.
You're afraid of letting people down you don't know how to break the news to your loved ones if you're not happy with your so-called dream career or don't want the same things as them you often succumb to other people's expectations working hard to be a role model and no matter how tired you are of being you your anxiety will push you to continue performing as if your whole life counts on it did you enjoy this video jaiden animations also covers her own personal struggles with anxiety we think her content holds value and will be helpful for you be sure to check out her videos and show some love thanks for watching you
this episode was pre-recorded
as part of a live continuing education webinar on-demand CEUs are
still available for this presentation AllCEUs.com/Anxiety-CEU I’d like to welcome everybody to today’s
presentation on best practices for the treatment of anxiety I am your host, Dr. Dawn Elise Snipes now not too long ago we did
a presentation on strengths-based biopsychosocial approaches to addressing anxiety while
those are wonderful you know I thought maybe we ought to look at you know what’re some of the
current research so I went into PubMed which is I don’t know it’s a playground for me it’s where
you find a lot of journal articles and you can sort I sorted by articles that were
done and meta-analyses that were done within the past five years so that gives us an idea
about current research I mean there’s a lot of stuff that is still the same like some of
the medications that were known to work ten years ago are still known to be you know good
first-line treatments but there are also some newcomers that we’ll talk about and there are
also, some changes that we’re going to talk about so we’re going to explore some common causes
for anxiety symptoms to treat, we need to and of course, this does play into
the biopsychosocial aspect we need to understand kind of what causes it because anxiety
that’s caused by for example somebody having a racing heart may be different than anxiety that’s
caused for somebody who has abandonment issues so we’re gonna treat the two things differently so
we want to look at some of the common causes we’re gonna look at some common triggers for anxiety
Do you know what are some of these common themes that we see in practice I will ask you to share
some of the themes that you see that underline or underlie a lot of your client’s anxiety and
identify current best practices for anxiety management including counseling interventions
medications physical interventions and supportive treatments so we care because anxiety can
be debilitating and a lot of our clients have anxiety a lot of our clients have anxiety
comorbid with depression and they’re looking at us going how can I feel anxious and stressed out
and like I can’t sit still and be depressed at the same time you know when you’re depressed you’re
supposed to want to sleep well a lot of times people who have both issues want to
sleep but they can’t so I want to help clients understand that also sometimes anxiety when
people are anxious for long enough the body starts kind of holding on to the cortisol the body
recognizes at a certain point this is a losing battle I’m not going to put energy into
this anymore so it starts withdrawing some of its excitatory neurotransmitters so to speak and
people will start to feel depressed the brain has already said this is hopeless this is
you’re helpless to change the situation so then people start feeling hopeless and helpless
which is sort of the definition if you will of depression low-grade chronic stress and anxiety
arose energy and people’s ability to concentrate so if we’re going to help them become their uber
selves we need to help them figure out how to address anxiety not just generalized overwhelming
debilitating anxiety but also panic social anxiety and those minor anxiety triggers that come along
that may not meet the threshold for diagnosis anxiety is a major trigger for addiction relapse
if you have a client who is self-medicated before or had an addiction for some reason anxiety is a
major trigger increased physical pain when anxiety goes up people tend to tense their muscles when
they tense their muscles they tend to feel more pain I mean think about when you’re stressed you
tend to have more pain like in your neck your back and things that already hurt may hurt more
why because serotonin which is one of our major anti-anxiety neurotransmitters is also one of our
major pain modulators so when serotonin levels are too low because anxiety is high then our pain
perception is going to be more acute and people can have sleep problems if they’re stressed out
your body thinks there’s a threat you’re not going to be able to get into that deep restful
sleep you may have you may sleep a lot but it’s probably not quality sleep which
means your neurotransmitters may get out of whack your hormones make it out of whack and your body
is going to start perceiving yourself in a persistent state of stress when you’re exhausted
the body knows that we may be the weakest link in the herd so it continues to secrete cortisol
to keep you on alert a little bit so you may again you may be resting kind of like when
you have a new baby at home those first couple of months that my children were home from the
the hospital I slept but I didn’t sleep well I mean the slightest little noise and I was awake and I
was looking around and you know I felt it I felt exhausted and a lot of new parents do so triggers
for anxiety abandonment and rejection and we’re going to talk about ways we might want to deal
with these things but some of the underlying themes that I’ve seen in a lot of clients and when
I do the research and a lot of what themes that come out include low self-esteem if someone has
low self-esteem they’re looking to be externally validated oftentimes they’re looking for somebody
else to tell them you’re lovable you’re okay so that can lead to anxiety about not having
people to tell them you’re okay which makes their relationships tenuous and can make them
dysfunctional irrational thoughts and cognitive distortions may lead people to believe that if I’m
not perfect for example I am not lovable so we’re going to look at some irrational thoughts and
cognitive distortions unhealthy social supports and relationships when you’re in a relationship
it takes two to tango and even if your client is relatively mentally and physically healthy if they
are in a dysfunctional relationship they can fear abandonment and rejection if that other person
is always saying if you don’t do X I’m going to leave you or if that other person is always
cheating on them or whatever so relationships can trigger abandonment anxiety and ineffective
interpersonal skills can lead to relationship turmoil and social exile if our clients are in
relationships even if they’re not completely dysfunctional if our clients are not able to ask
for what they need and set appropriate boundaries and manage conflict effectively because conflict
happens in every relationship then they may start to argue more which may lead to fearing may lead
to relationships ending in the past and them going well every relationship I get into ends which
means I must not be lovable so they start fearing abandonment and rejection these are four areas
that we can look at one more assessing clients another issue is the unknown and loss of control
a lot of times negative self-talk and cognitive distortions can contribute to that if I don’t have
control of everything then it’s all going to be a disaster negative others when clients hang out
or when people hang out with negative people it kind of wears on you after a while you notice
that people who tend to be more negative pessimistic conspiracy-minded tend to hang out
with people who are also negatively pessimistic and conspiracy-minded so if you’re hanging out with
somebody who tends to be anxious then the anxiety can be palpable and it can kind of permeate
physical complaints can lead people to be anxious because they don’t know what’s causing it
like I said earlier sometimes if your heart starts to race if you don’t know what’s causing it for you
can start thinking I’m having a heart attack or I’m gonna die when people have panic attacks for
the example they truly think they’re having a heart attack and it’s I’ve had them they are very
very unpleasant experiences but when people start having physical complaints and it can be you
know they have a weird rash that they can’t get to go away or whatever but when they don’t know
what it is and they can’t control it they can’t make it go away they start thinking about all
the worst-case scenarios and going online and getting on WebMD which usually gives you all the
worst-case scenarios um so physical complaints are important we need to normalize the fact that
nobody’s pain-free all the time and you know the fact that you may have an ache or a pain or a lump
or a bump or you know a cough most likely you know when we look at probability the probability of it
being something significant is pretty small now do you want to get it checked out probably but
you know the probability that is anything to be worried about is relatively small and a sense
of powerlessness can trigger fear of the unknown and loss of control for somebody who doesn’t
feel like they have any agency in their life if they have an external locus of control or
if they felt victimized all of their life then they may fear not being in control they may be
holding on and saying okay this is the one area of my life I can control when I grew up you know
I grew up in a very chaotic environment I had no control I was bounced around in the foster system
yadda yadda yadda now that I’m an adult you know I can control these things and I am going to hold
on with white knuckles and if I can’t control everything then that terrifies me to death and
loss are other triggers for anxiety and it can be people or pets and pets are important I don’t
want to minimize pets because you know they are little parts of a lot of our families so making
sure we check that my daughter’s dog for example is it’s getting old she’s getting older she’s 14
now I think and you know she’s in decent health we took her to the vet and the vet said yeah she’s
got a little heart murmur but that’s expected for a 14-year-old dog and but when she goes out if she
doesn’t come back when I call her I have this rush of anxiety for a second oh my gosh I hope this
wasn’t the day so anxious around losing people and you know if she when she crosses the bridge
she will and you know I’m okay with that I’m I have a harder time dealing with my daughter’s
emotional turmoil when that happens and because she’s grown up with this dog so you know those
are the types of things that we want to talk about with our clients what things are weighing on you
that you may not even be thinking about because I know in the back of my mind there’s always that
worry about one of our donkeys and her dog jobs and promotions can trigger anxiety if people are
afraid they’re gonna lose their job if they’re always afraid that you know they’re gonna walk in
and get a pink slip or get fired you know we want to help them look at how realistic they are
you doing what you need to do to achieve and keep your job and sometimes it’s not easy to
the answer I mean the first thought that a lot of us have is well you know if you’re doing the right
a thing so just do it but there are those bosses out there and I’ve had some amazing bosses
a lot of them and I’ve had two horrendous bosses and those two bosses I could never I
never felt like I was able to do anything right and so going to those jobs there was always this
anxiety about what I’m what am I going to get in trouble for today so you want to talk with people
about does your job cause anxiety what can you do to moderate that anxiety the same thing with
promotions people may get anxious about whether they’re going to get promoted to safety and security
you know when you lose safety and security you can feel anxious so if there’s a break-in at
the house next door or shooting down the road or you start watching the news you can feel very
unsafe and insecure quickly so we want to help people figure out how safe and secure are you
really and a lot of it goes back to looking at facts when people lose their dreams and hopes
or fear that they’re going to lose their dreams and hopes they can start to get anxious you know
they have this dream that they’re going to be a doctor or I just finished the presentation on
helping high school students transition to college and a lot of high school students for example
start college with these wide eyes and hopes to save the world and they want to be doctors
and engineers and this and that and they get into it and they realize that it’s a lot harder
then they thought or they realize that you know what I don’t like this but I’ve already
committed to it so what do I do I want to help people but I can’t I can’t cut it doing this you
know for me I figured out in my second year that I wasn’t going to medical school because I wasn’t
going to pass calculus and that caused a lot of anxiety it was like okay what am I gonna do now
Do you know what career should I choose to help people figure out do they have dreams that have
maybe kind of crashed and burned and you have to find new ones you know okay that one we’ve got to
accept it figure out that it’s not going to be and what can you do now people may also have dreams
about relationships they get into relationships and see themselves with this person forever
and then this relationship ends and or starts to get rocky and they’re like but that’s my dream
what happens if that’s got to happen because it’s my dream I don’t know how to function if
that goes away we want to help people be able to rewrite their narrative and then sickness spiders
and other phobias kind of go in with death a lot of times when people get sick they start getting
anxious that oh my gosh what if this is terminal oh my gosh what if this is you know incurable
if I get bit by a spider it’s gonna kill me and which is rare you know there are very few spiders
that is actually that poisonous same thing with snakes going over bridges I’ve shared with you all
that is not one of my irrational fears you know I am just terrified that you know something’s going
to happen and I’m going to get pushed off the side of the bridge which is completely irrational but
we need to help people look at those and identify the thoughts that they’re telling themself about
those phobias and dealing with that anxiety failure is another –trigger for anxiety especially in
this culture our culture American culture is large part puts a high premium on success
and perfectionism so when people realize that they’re not perfect they may start to get anxious
because they feel like if I’m not perfect then I’m a failure you know those cognitive distortions of
all-or-nothing thinking and they start with that negative self-talk you know you can’t do anything
right so those are some of the issues that you know we often see in counseling sessions so what
do we do you know somebody comes in and is like I can’t live this way doc anxiety depression and
substance disorders as well as a range of physical disorders are often comorbid so this is the first
the thing we need to realize is that we’re very rarely dealing with a very simple
the diagnosis you know when somebody comes in we need to figure out you know if they come in and they’re
presenting with depression all right let’s talk about that and then we start realizing that there
depression started to occur after a long period of being anxious okay so we need
to deal with that but we also need to help them with their sense of hopelessness and helplessness
we need to develop that sense of empowerment and then substance disorders we know that substance
use is often a way of self-medicating but we also know that it monkeys with the neurochemicals
in the brain and can contribute to anxiety and depression the same thing to physical issues pain
from physical disorders anxiety about having physical disorders medications you’re taking for
physical disorders can all contribute to anxiety so we need to look at the person as a whole and go
what are all the things that are contributing to the anxiety and what are all the things that the
anxiety is contributing to so we have started having this big list of stuff that needs to be
addressed and then we can start figuring out okay where we start so knowing that these things
are comorbid helps researchers explore pathways to mental disorders so they can start figuring
out you know what little string can we pull to unravel this blanket of anxiety so it doesn’t
suffocate somebody and for us, as clinicians, it provides us key opportunities to intervene in you
know sometimes clients will come in and start talking about their
anxiety and their physical issues you know maybe their anxieties about you know heart
palpitations and because that’s a common one we may want to encourage them to go see the doctor to
get that ruled out you know rule out anything that has to do with hormone imbalances or you know
heart conditions or anything else that might be contributing to it which can help them address
it and if they do have physical disorders let’s go with hormone imbalances that are contributing
to the heart palpitations then they can start to treat that if they don’t start to treat that then
no amount of talk therapy we do is going to get them to the quality of life that they’re looking
for because they’re still gonna feel those so we want to make sure that we’re addressing them
holistically anxiety disorders should be treated with psychological therapy pharmacy therapy or a
combination of both and what they found and this is no surprise this is kind of old news is that
counseling Plus pharmacotherapy tends to have the best outcomes but separating the two have
similar outcomes in many cases but that’s just looking at and I hate to call it simple anxiety
but we’re just looking at anxiety symptoms here we’re not looking at the full quality of life and we
want to make sure that we’re also including any medical issues behavioral therapy is regarded
as the psychotherapy with the highest level of evidence, there are a variety of cognitive
behavioral approaches ranging from acceptance and commitment therapy to dialectical behavior
therapy to CBT to debt you know any of those that deal with the thoughts and the cognitions that fall in
that realm and it is effective in the current conceptualization of the etiology
of anxiety disorders includes an interaction of psychosocial factors such as childhood adversity
or stressful events and a genetic vulnerability so the psychosocial factors and these are other
things when we do our assessment we want to pay attention to because our approach to treatment
is going to be different for people for example who have trauma-related brain changes maybe
then for somebody who doesn’t so, we want to look at childhood adversity and stressful events
that it may have caused basically what I tell clients is like rewiring of the brain there
are trauma-related brain changes in soldiers and especially in children or in people who’ve been
exposed to extreme trauma that is designed to protect them but it also can cause complications
kind of later on in dealing with anxiety coping skills that were learned that are ineffective you
know sometimes people grow up in a household or an environment or a situation where they don’t learn
effective coping skills so we need to kind of help them unlearn those and learn new ones build on
their strengths and trauma issues that may still need to be dealt with such as domestic violence
you know if they grew up a lot around a lot of domestic violence they may think you know I’m
out of that situation it’s over I don’t want to think about it it’s not bothering me anymore or a
parental absence and I put absence because it can be death it can be a parent that just packed up
and left it could be a child that got put up for adoption whatever put the child in a position of
feeling like they were rejected by a parent can be very traumatic and bullying among other things
but there are a lot of trauma issues that people once they’re out of that situation often say you
know I’m out of it it’s not a big deal I dealt with it let’s move on and they don’t realize the
full ramifications and how that’s contributing to their current anxiety and their current self-talk
and cognitions of current stressors if somebody has a lot of current stressors that are also going to
impact whether they develop generalized anxiety you know we’re kind of stacking the deck here and
the current availability of social support if they don’t have effective current social support then
they’re gonna have difficulty bearing the weight of everything on their shoulders so we want
to look at all these psychosocial factors when we do our assessment now going back to the trauma
issues if you’ve taken the trauma courses at all CEUs you know that some people are not ready
to acknowledge that the trauma is still bothering them or work on the trauma and that’s okay we
can educate them that it might be an issue and then let them choose how to address it but
we want to bear in mind the fact that you know this could be sort of an underlying force
motivating some of the current cognitions and genetic vulnerability so you take any three
people and you put them or 300 people and you put them through roughly the same psychosocial
situations they’re all probably going to react a little bit differently based on their prior
experiences but also because of their genetic makeup there are certain permutations and they
found four we’ll talk about later that make the brain more or less responsive to stress and
more or less responsive to serotonin which is your calming chemical so brains that are less
responsive to serotonin isn’t going to you know send out as much or send out serotonin as easily
so people can stay kind of tensed and wired that’s an oversimplified explanation but that’s
all you need for right now so genetic vulnerability impacts people’s susceptibility
to the effects and development of dependence on certain substances which can increase anxiety
when people are detoxing from alcohol when they’re detoxing from benzos when they’re detoxing from
opiates they can feel high levels of anxiety when they take opiates some people find that opiates
have wonderful anti-anxiety properties not that I am advocating for the use of opiates I’m
just client experiences have shown that that can be true so some people are going to be
more susceptible to the anti-anxiety effects of certain substances and some people are going
to be Cerrone to become dependent on substances where others may not and that part of that is
genetic vulnerability and they estimate about 30% the predictability of the development
of anxiety disorders is genetic and genetics also impact which medications are effective
if you have genetic makeup then SSRIs might be helpful if you have genetic makeup be then
atypical antipsychotics may be more effective and SSRIs might not do anything which is why
a lot of our clients get so frustrated because they know there’s no way to figure out exactly what I
guess there is now that there’s genetic testing out there but up until then it was harder to
figure out which medications to start with and most physicians matter of fact I don’t know of
a single physician that starts by saying well let’s do a genetic profile to see
what med to start you out with most we’ll start with events as with an SSRI or some other
anti-anxiety medication some sort of benzo that’s been my experience so we may want
to encourage clients to consider genetic testing if they’re having difficulty finding a
medication regime that works for them and they are feeling like they have to have medication
genetic vulnerability also affects what’s going to make somebody more vulnerable now than all of you
in class today you know thinking about sleep you know sleep may not be a big deal for some of you
I know people who can go days or weeks with four or five hours of sleep and they feel fine it’s
not a big deal, not me I need eight or nine hours of sleep so genetically for whatever reason I am
programmed to need a lot of sleep so when I don’t get that much sleep I tend to be it tends to be
harder for me to deal with life on life’s terms and I know that that makes me more vulnerable to
being irritable so genetic vulnerability affects who can become addicted and affects what medications
work best and affects what situations are going to tend to make somebody more vulnerable to
anxiety so our medications and I know the type on here is small but we’re going to go through
the first-line drugs are the SSRIs selective serotonin reuptake inhibitors and SNRs is
selective norepinephrine reuptake inhibitors now the names are a little bit deceptive because
selective norepinephrine reuptake inhibitors also increase available serotonin but the mechanism
of action is different the mechanism of action for each SSRI is a little bit different as well
which is why you can put somebody on Prozac and they have an awful experience and you can put them
on Zoloft and they have a much better experience like I said earlier a lot of the research pre
five years ago had been done on medications and Zoloft Paxil luvox Lexapro Celexa and their
generics have all been found to be effective at treating anxiety in certain people no one
the medication works for everybody in the last five years Effexor has come on the radar and it has
been found effective according to the hamilton rating scale for anxiety so that’s another one to
consider if clients are not successful or getting the treatment effect that they need for on some
of the other medications obviously, none of us probably are prescribers but we do need to educate
clients about why the first drug or even the third drug that the doc tries may not work so they
don’t start feeling helpless and hopeless like I said earlier there are at least four different
genetic variations which are correlated with the development of generalized anxiety disorder and
different medications are more or less effective depending on the genetic makeup of the person
there’s a high mortality rate moving on to two benzos the recommendation has switched
to back off from the use of benzos now for some doctors will prescribe an SSRI and for the
first four weeks while the SSRI is building up in the system they will also prescribe a benzo
to be taken as needed to moderate the anxiety and you know you could argue on either side
of that, if somebody has a history of substance use or substance dependence benzos are really
a bad idea because they do have a high rate of dependence but the other reasons that they are now
cautioning against the use of benzodiazepines is that there’s a higher mortality rate among benzo
users compared with non-users there’s an increased risk for dependence with use for more than six
months and that’s a long time to be using benzo and when we’re talking about dependence and six
months we’re talking about somebody who uses it like every four hours or every eight hours
depending on your benzo every single day not a PRN user if somebody’s using it at night to
help them go to sleep or you know three or four times a week when the anxiety gets high
the risk of dependence is relatively low but a lot of people with anxiety because if they find
the right benzo makes them feel so much better they may not want to be off of it and for a lot of
people when that benzo reaches its half-life and starts getting out of the system even more their
anxiety spikes you know they have rebound anxiety which they want to medicate with more benzos
that’s gonna be an issue for them to discuss with their doctor there’s also an increased risk
of dementia identified in long-term benzodiazepine users again this is for the people who use you
know throughout the day every day for six months or relatively every day for six months or more
and it doesn’t matter if it’s you know we’re talking about somebody who’s 65 or somebody
who’s 35 who’s been using benzos for you know six months a year two years the risk of later
life dementia is greatly increased according to the research benzodiazepines also don’t treat
depression okay so if you’ve got somebody who has concurrent anxiety and depression there’s a much
higher suicide risk if they’re on benzodiazepines so being aware and generally that suicide risk
comes from overdosing on benzodiazepines but not always other treatment options you know if the
benzos aren’t something that people want to touch you know they scare the living daylights out of
me and SSRIs and SNRIs don’t seem to be working then tricyclic antidepressants can be tried on those
your older generation antidepressant Seroquel is used a lot and there are some there’s some
research that shows it can be effective with anxiety like some of the antidepressants and
depending on the person the benzos Seroquel can make people very very very sleepy so you know
it may not be the side effects of the Seroquel the weight gain and the fatigue and you know
sleepiness may be an unacceptable side effect for some clients and boosts perón is the third option
boost Barone works more like an anti-depressive serotonin reuptake inhibitor and that it takes
you know four weeks or so to kind of build up in the system studies have shown that there’s really
no long-term benefit to taking it but after six months to eighteen months of use it has been shown to
be effective in talking with clients a lot of clients report that boost bar when they take it
doesn’t necessarily help them stop being anxious like a benzodiazepine does but it helps them not
go from zero to 200 in 2.3 seconds it kind of you know keeps them from having this gush of a freak
out reaction every time something goes wrong which a lot of clients report helps because they feel
more stable throughout the day after remission medication should be continued for six to twelve
months and during that last six months first six months keep it as is last six months you know
they say that tapering is best it’s best not to stop somebody cold turkey on any of these but
it’s important for people once they’re in remission to not just suddenly go okay I feel
better I don’t need any of this anymore they need to work into it and make sure they’ve developed
the skills and tools that they need to deal with some of the anxiety that is going to
happen in life so physical signs and symptoms of anxiety may include fatigue irritability muscle
tension or muscle aches try laying feeling twitchy being easily startled trouble sleeping nausea
diarrhea irritable bowel syndrome headaches so the first thing we want to do with clients when we’re
talking to them well second thing first thing is to say get a physical to let’s rule out physiological
causes of this but we can also help clients look at you know what might be causing these
things that you can do to mitigate it what might be contributing to your fatigue what might be
contributing to your irritability and your muscle tension or your muscle aches I mean let’s look at
economics did you recently get a new bed or do you need to get a new bed what about your desk chair I
know you know I get more muscle tension and muscle achy when I do a lot of mousing because I have
deplorable posture being becoming aware of that helps and then I’m like okay well I know it caused
unfortunately, it’s unpleasant but it’s not a big deal trembling or feeling twitchy you know
that can be caused by low blood sugar that can be caused anxiety that can also be caused
by early onset Parkinson’s symptoms you know there’s you know it can be worst case scenario
or it can be something benign so we want to have people figure out you know when you start
trembling or feeling twitchy is there something that it’s related to you know I know when my
son gets excited he’s he just sits there and you can see him almost shake because he’s so
excited about something so we want to have people prevent misidentification we don’t want them
to jump to that worst-case scenario we don’t want them to go onto WebMD and go oh my gosh I’ve
got cancer I’ve got this debilitating disease and I’m going to die in six months probabilistic Lee
speaking it’s not gonna happen yes get a doctor’s opinion I’m certainly not going to tell them it’s
all in your head I want them to get an evaluation but I do want to in the meantime
help them think about how likely is this and other things for headaches and this is
one another one of those that can be frustrating as we get older our eyesight starts to go and
you know there was a period there I did fine and then after I hit 45 my eyesight just started
to like steadily and kind of rapidly in my mind decline so I have to get my eyeglass prescription
changed every couple of years and that can cause headaches so instead of starting to worry
about oh my gosh I’ve got a headache all the time maybe I’ve got a brain tumor you know I know that
it’s probably my glasses or I’m grinding my teeth so other biological interventions that
have been evaluated there’s something called the floatation rest system that reduced environmental
stimulation therapy reduces sensory input into the nervous system through the act of floating
supine which is on your back in a pool of water saturated with Epsom salt you know I’m looking at
this going sounds good and you can’t quite get the same experience in a bathtub because
you’re not floating you’ve got pressure points and you’re still hearing stuff clients can sort of
simulate it with you know earplugs or whatever but it’s if they can access this it’s been shown
to be effective the float experience is calibrated so that sensory signals from visual
auditory olfactory gustatory thermal tactile or tactile vestibular gravitational and preceptive
channels are minimized which means you don’t see here taste touch smell feel nothing as is most
movement and speech so you want people to lay just like completely motionless and not talk which can
be hard for some people with anxiety in the study the study I looked at fifty participants
reported significant reductions in stress muscle tension pain depression and negative effects and it
was accompanied by significant improvement in mood characterized by increases in relaxation happiness
and well-being I read the study I’m like where can I sign up you know it sounds in looking at some of
the research this was more effective for addressing anxiety than something like a massage
Tai Chi also produced significant reductions in anxiety there was approximately a 20% treatment
effect 25% treatment effect in patients with anxiety and fibromyalgia who practiced twice a
week for a year now you know we want to look at the confounding things here is it the Tai Chi
itself or is it learning to control the muscles and becoming more in tune with your body and
learning to control your breathing helps people reduce their anxiety either way you know
Tai Chi helps people do that and it was shown that after a year after the first six months, there was
a significant treatment effect but after a year you know it kept growing and after a year it was
about 25% so Tai Chi can be effective acupuncture at the HT 7 median Meridian can
attenuate anxiety-like behavior induced by withdrawal from chronic morphine treatment through
the meditation of the GABA receptor system what does that mean that means if you if the
acupuncture is done in very certain places the anxiety behavior the GABA a receptor
system GABA is your main calming relaxation neurochemical that is triggered and causes your
body to sort of flood that receptor system and this research was done on people who were detoxing
from morphine treatment but we can look at generalizing the results and I would be interested
to see further studies on it pain other things we need to do to help people with anxiety when people
are in chronic pain they often have anxiety that oh my gosh this is getting worse or it’s never
gonna get better or I just can’t take this pain anymore or they may get anxious that they’re going
to be rejected because they can’t do some of the things they used to do because they’re in so much
pain so there’s a lot of guilt and anxiety that can kind of revolve around pain what can we do
to help clients guided imagery is generally very helpful if we can help them imagine you know if
that pain in their shoulder imagine the pain is like the color red flowing out of their arm
or other focus mindfulness so you know when you think about something you know when you get a shot
if I don’t think about it it doesn’t hurt near as much as if the nurse says okay now one two three
and you know she’s counting down and I’m getting prepared and I’m focused on it I had
another nurse one time who she was just talking to me and you know put the alcohol on my arm
and just kept on talking and didn’t tell me she was getting ready to give me a shot and before I knew
it she had given me a shot and she was like okay we’re done I’m like you didn’t give me a shot yet
she said yes I did it’s like oh so not focusing on it and next time you have an itch for example
if you’ve ever been driving on the interstate and you can reach on your foot I get those on
the bottom of my foot sometimes and I’m like okay I’m not going to pull over to each my foot if you
focus on something besides the itch eventually it goes away I’m not saying the pain is gonna completely
go away but the more people focus on it the more it hurts physical therapy can help so encourage
them to get a referral and encourage them to do a self-evaluation if nothing else of ergonomics in
their car at work where they watch TV and spend most of their time at home and they’re sleeping
so those are the four places that they spend most of their time what do their ergonomics look like
and that can help a lot of people mitigate a lot of pain hormones are another thing that
we need to look at imbalances of estrogen and testosterone can contribute to anxiety symptoms
heart palpitations fatigue irritability having people get a physical we can’t as clinicians do
anything about it but doctors can rapid heart weight rate sweating palpitations are not uncommon
in women in perimenopause or menopause so a lot of women start feeling like they’re developing
generalized anxiety and/or something’s going wrong when they start reaching that mid-40s to mid-50s
area and they start having some of these symptoms again we’re not going to diagnose it but we do
want them to recognize that it may not be anything you know is catastrophic this is something that a
a lot of women experience and help them figure out how to deal with that supportive care biologically
now you know this isn’t gonna treat anything but we can help them minimize their vulnerabilities
help them create a sleep routine so their brain and body can rebalance this can help repair any
adrenal issues that may be going on and improve energy levels people with anxiety don’t sleep well
so helping them figure out how to get some quality sleep is important nutrition minimizing caffeine
and other stimulants are going to be a big help because those make people feel anxious and encourage
them to work with a nutritionist to try to prevent spikes and drops in blood sugar which can trigger
the stress response when your blood sugar goes way up or way down you can start getting kind of shaky
and feel weird and that can cause people anxiety because they might think oh my gosh I’m having a
stroke or a heart attack or you know I don’t know what these tremors are so it’s important that
they don’t miss identify symptoms and encourage them to drink enough water dehydration can lead
to toxic Ardea which is increased heart rate sunlight vitamin D deficiency is implicated
in both depression and anxiety mood issues vitamin D has been found in those main areas where
serotonin receptors are found vitamin D receptors are found so we know the serotonin and vitamin D
have something going on sunlight prompts the skin to tell the brain to produce neurotransmitters and
set circadian rhythms which impact the release of serotonin your calming neurochemical melatonin
which is made from breaking down serotonin and helps you sleep and GABA so sunlight actually
helps increase the release of GABA when it’s time to start calming down and going to sleep
exercise studies have shown that exercise can have a relaxing effect and encourage clients to start
slowly there’s not a whole lot of new research on exercise and anxiety aromatherapy has been
used a lot, especially in other countries in the treatment of people with anxiety people with
hospital anxiety people women who are giving birth and they have some birth anxiety there they’ve
been found to be effective in a lot of those studies essential oils for anxiety include
lavender rose Bedevere ylang ylang bergamot chamomile frankincense and Clary sage encourage
clients to just go to a health food store and you know sniff some of these and see if it makes them
feel happy and calm and content the aromatherapy molecules enter the nasal membranes and they
will start triggering neurochemical reactions and so you don’t need to apply it you don’t need
to ingest it all you need to do is so encourage clients if they’re open to it to think about this
because aromatherapy can be integrated into their bedroom for example with an atomizer or a Mr.
It
can be incorporated in a lot of different places again where they’re not applying it or ingesting
it in any way all they’re doing is smelling it they’ve used it in defusing aromatherapy in
hospital emergency rooms and they found that it reduces stress and irritability the people in
emergency rooms and I’ve been to enough emergency rooms over the years to know that
people who are in ers typically are not in the best mood so if it can help those people then
it’s probably going to have some sort of an effect so psychologically helping clients realize
that their body thinks there’s a threat for some reason that’s why it triggered the threat response
a system which is what they call anxiety so they need to figure out why is there a threat
you know sometimes it’s like the fire alarm going off in my house it just means that the windows are
open and there’s a strong breeze there is no fire there is no problem there’s just a malfunction
it’s a false alarm a lot of times clients get this threat reaction they get this stress
reaction and it’s not a big deal right now so they can start modifying what their brain responds to
and again those basic fears that a lot of people worry about failure rejection loss of control the
unknown and death and loss distress tolerance is one of those cognitive interventions that have
taken center stage in anxiety research and it isn’t about controlling your anxiety you know
helping people recognize their anxiety acknowledge it and say okay I’m anxious it is what it is
how can I improve the next moment instead of saying I’m anxious I shouldn’t be anxious I hate
being anxious and slang with that anxiety let it go just accept it is what it is have the client
learn to start saying I am feeling anxious okay so distract don’t react because I explain to them
the whole notion of feelings comes in the crest and goes out in about 20 minutes it’s like a wave so once they
acknowledge their feeling if they can distract themselves for twenty or thirty minutes you know
they figured out there was no real threat if they can distract themselves for twenty or
thirty minutes those emotions can go down and then they can deal with it in their wise mind and encourage
them to use distancing techniques instead of saying I am anxious or I am terrified or whatever
have them say I am having the thought that this is the worst thing in the world I am having the
thought that I cannot handle this because thoughts come and go and that comes from acceptance and
commitment therapy functional analysis makes it possible to specify where and when with what frequency
with what intensity and under what circumstances the anxious response is triggered so it’s
important that we help clients develop the ability to do functional analyses on their own so
when they start feeling anxious they can stop and say okay where am I what’s going on how intense
is it what are the circumstances and they start trying to figure out what causes this for
them so they can identify any common themes from their psychoeducation about cognitive distortions
and techniques to prevent those circumstances or mitigate them can be provided so if the client
knows that they get anxious before they go into a meeting with their boss and it’s usually a high
the intensity of anxiety okay so we can educate them and help them identify what fears may be related
to techniques to slow their breathing and calm their stress reaction and help them figure out
times in the past when they’ve handled going in and talking to their boss and it wasn’t
the end of the world you know there’s lots of different things we can do there for them there
but the first key and it gives them a lot of a huge sense of empowerment to start becoming
detectives in their own life and going okay now under what situations does this happen positive
writing this was another cool study each day for 30 days the experimental group and this
was high school-aged youth in China but you know the experimental group engaged in 20 minutes of
writing about positive emotions they felt that day so they’re writing about anything positive
that make them happy that made them enthusiastic gave them hope whatever long-term expressive
writing positive emotions so after 30 days it appeared to help reduce test anxiety by helping
they develop insight and use positive emotional words so it got them out of the habit of using
the destruction and doom words and encouraged them to get in the habit of looking at the positive
things and being more optimistic it’s a cool activity that clients can try it’s not gonna
hurt anything if you have them journal each day for 30 days mindfulness also came up in the
research and was shown to be effective in a meta-analysis of six articles about mindfulness
based stress reduction four about mindfulness-based cognitive therapy and three about fear of
negative appraisal and emotion regulation was reviewed all of these showed that mindfulness
was an effective strategy for the treatment of mood and anxiety disorders and is an effective
in therapy protocols with different structures including virtual modalities so you know if you’re
doing it via teleconference mindfulness can still be helpful mindfulness helps people start learning
how to observe what’s going on and become aware of what’s going on more aware of those circumstances
which will help them complete their functional analysis but it also helps them become aware of
vulnerabilities and head off things in the past and if they’re taking better care of themselves
that they’re living more mindfully then they may not experience as many situations that trigger
their anxiety mindfulness also encourages clients to learn acceptance that radical acceptance of
it is what it is I’m not gonna fight it I’m angry right now I am anxious right now however I’m
feeling right now is how I feel and that’s okay it’s hard for clients to get to that but once
they get a hold of that and they truly believe it and they can say all right it’s fine I’m not gonna
feel this way forever I’m gonna do something else until the feeling passes it helps and that’s where
the labeling and letting go comes in mindfulness can also help them identify trigger thoughts
what thought were you having right before you started feeling anxious if people are mindful or
let’s start back when people are not mindful they often notice or don’t notice that they’re getting
anxious until they’re like super anxious when people are mindful they become more aware of
subtle cues address unhelpful thoughts when they say or believe it’s a dire necessity for adults
to be loved by significant others for almost everything they do always running gonna happen
why is it a necessity what we can encourage them to do is concentrate on their self-respect
on winning approval for practical purposes you know for promotions or whatever but it’s not about
me being lovable it’s about me getting a promotion and making more money and focusing on loving
rather than being loved because when we give love we generally get love back with unhelpful thought
number two people feel they aren’t able to stand it if things are not the way they want them to be
or are not in their control so encourage clients to focus on the parts that are in their control
and other things in life which are going well and to which they’re committed number three misery
is invariably externally caused and is forced on us by outside people and events just by reading
that makes me feel disempowered so encouraging clients to focus on the fact that reactions such
as misery or happiness are largely caused by the view that people take of the conditions so if
you see it as a tragedy and devastating then it’s probably going to produce misery if you
see it as an opportunity and a challenge it’s probably going to produce a different emotional
reaction, if something is or may be dangerous or fearsome people, should be upset and
endlessly upset about obsessing about it a lot of people with anxiety get stuck on this you know
if I feel like it’s fearsome I need to worry about it getting on a plane for example if I fear that
that’s dangerous that I need to think about it and worry about it that’s not going to do any
good so encourage clients to figure out how to face it and render it harmless if possible and
when that’s not possible accept the inevitable so looking at airplanes you know facing it means
researching to figure out how dangerous is it really and realizing that it’s not
that dangerous so that helps render it a little bit harmless in their mind it proves to them
that it’s not as dangerous as it could be and when it’s not possible accepting the inevitable you
know you got a fly so getting on there figuring out how you’re gonna get through it hurricanes
are the same way people especially in places like Texas Louisiana Florida may obsess as soon
as it starts coming to hurricane season or if a hurricane is spotted out in the Atlantic somewhere
they start checking the weather every hour or more wondering what the path is going to be and you
know what there’s you can’t change the path of the hurricane so all you can do is board up your house
evacuate if necessary and deal with the fallout child driving is just another example I’ll give
you know my children are learning how to drive and that’s kind of scary and fearsome you know what’s
gonna happen when they’re out there you know you see crashes all the time well render it harmless
by making sure they’ve got good training on how to drive make sure they’re good drivers and then
accepting that some things are just not within my control it’s easier to avoid than face life
difficulties and responsibilities well running from fear is usually much harder in the long run
so encourage clients to look back at times when they’ve avoided difficulties and responsibilities
and the eventual outcome you know what happened there people believe they should be thoroughly
competent in achieving in all possible respects or they will be isolated rejected and failures we
need to encourage clients to accept themselves as imperfect with human limitations and flaws and
focus on what makes them loveable human being what qualities like courage and intelligence and
creativity and those things that can’t be taken away what inherent qualities do they have that
make them awesome people because something once strongly affected people’s lives they should
indefinitely fear it if you got lost you know when little kids get lost it’s terrifying when
you’re grown up if you get lost you turn on the GPS and you figure out your way but some people
still, you know freaked out about getting lost if they got lost once so we want to help people look
back at past episodes that may be contributing to the current anxiety and compare the situation’s
you know are you the same person or is this not a big deal now that you’re older wiser stronger
encourage them to learn from past experiences but not be overly attached to or prejudiced by
them yeah you could have maybe got lost in the past and it was a horrible experience well you
were six I can see where that would be terrifying and a horrible experience but it doesn’t have to
continue to impact you that way now when you’re you know 26 getting lost you know could be an
opportunity to try a new restaurant or something people must have complete control over things
well this doesn’t happen so encourage clients to remember that the past and the future are
uncontrollable we can’t change the past it is what it is we can learn from it so it doesn’t repeat
but we can’t change it and the future is largely uncontrollable I mean there are a lot of things I
can do to stay moving toward a rich and meaningful life but life is going to throw me curveballs
sometimes and there’s nothing I can do to plan for or control that we can control our actions in the
present to stay on our preferred path and general develop general skills to deal with adversity
should it arise so we want to help clients develop those general problem-solving skills and
the general support system so when they are thrown a curveball you know it doesn’t knock them upside
the head people have virtually no control over their emotions and cannot help feeling disturbed
by things well encourage them to think about the fact that they have real control over destructive
emotions if they choose to work at improving the next moment and changing inaccurate thoughts then
they’re not going to experience the destructive emotions as intensely or as frequently when you
feel an emotion you feel how you feel but again you don’t have to wrestle with it fight it and
nurture it you can say this is how I feel how do I improve the next moment when it comes to
cognitive distortions encourage them to find alternatives when they start to personalize things
if somebody laughs when you walk out of the room then the and the person starts getting anxious
thinking oh they were making fun of me I wonder what they thought I wonder if I had something
stuck to the back of my dress and they start getting all panicked about it that doesn’t do
any good encouraging them to think you know what our three alternate explanations that hadn’t but
had nothing to do with you for why they laughed magnification of the worst thing you know taking
something and saying if this happens then it’s going to be a catastrophe and minimization going
along with that a lot of times when people magnify and see a catastrophe they minimize not only
their strengths and resources but all the other stuff that they’ve got going for them all
they’re seeing is this catastrophe so encouraging them to focus on the facts of what is actually
happening and what is the high probability event and encourage them to get information
and look at the broader picture you know yes you got into a car crash and your car is totaled and
that is unfortunate you know it sucks but you know that is not going to cause you to lose
your job and then become homeless and penniless and yadda-yadda it might cause your insurance to
go up but okay so you don’t have a car but what are the resources that you have who can who do
you work with that might be able to give you a ride to work you know let’s look at the resources
you have and work around so problem-solving helps with magnification and also focusing on you know
let’s be grateful for what didn’t happen you know you could have been killed but you weren’t the
car was totaled it’s replaceable all or nothing thinking again have them think about what else
could have been happening like Brittney suggested finding the exceptions instead of saying she
always does this look for exceptions when has she not done that what else has she done instead
of this selective abstraction and filtering is when people look for the good the bad and the
ugly a selective abstraction means you kind of see what you expect to see so if you expect
something to be devastating you see only the devastating aspects of it which kind of goes with
the magnification and minimization you filter out the stuff a lot of times when people are in a bad
mood or are anxious they see the negative because that’s the state of mind they’re in so encouraging
people to complete the picture alright there’s all this bad stuff now what’s the good stuff you
know to encourage them to look at the good the bad and the ugly so they get a wide view of exactly
what’s going on and encourage them to remember that hindsight is twenty-twenty when people have
something embarrassing happens or they get anxious about something that happened they look back
and they go I should have or I could have or oh I wish I wouldn’t have when you were in that
the situation you did what you did and you know maybe you may have had a reason for it or you know
you may have not had other options or it may have just been a bonehead thing to do but okay so you
made one mistake hindsight is 2020 that’s gonna that mistake is gonna stand out just like the
great big letter on the eye chart because you’re thinking back and you’re looking at it and that’s
all you see but encouraging clients to remember that other people are too busy worrying about
themselves to remember what they did jumping to conclusions encourages clients to remember to
get all the data if your significant other male significant other comes home and is smelling like
perfume don’t just jump to the conclusion that he was cheating on you maybe he went to the
mall to get a new tie and walked through the perfume area and got spritzed or bought you some
perfume or who knows maybe the person sitting next to him at work sprayed her perfume on the desk
and some of it filtered on there are all different reasons that that might happen so encourage people
to get all the data mind reading we can’t do it you know you can’t read somebody’s mind you don’t
know what they’re thinking so ask them what you think about this don’t assume anything and
emotional reasoning encourages people to step back from a situation and ask themselves am I feeling
anxious about this because I’m feeling anxious and I’m looking for reasons that it should be scary
or am I feeling anxious about this because it’s really scary for some reason there are facts
support my anxiety a lot of times when we go into new situations we may feel anxious because it’s
a new situation but when we step back we say you know what there’s nothing to be worried
about here you know no big deal I got this and move on so instead of rolling with it and trying
to figure out okay I feel anxious so there must be a reason not necessarily very likely a false
alarm other psychological interventions relaxation skills encourage people to learn how to relax
not only physically but mentally diaphragmatic breathing helps encourage them to breathe
through their stomach and put their hand on their belly and feel their belly expand and contract
slows breathing down which triggers the rest and digestion reaction in the brain which is calming
meditation can be helpful for some people some people find trying to quiet their minds too
frustrating because they’ve got too much monkey mind going on that can be later or maybe
never for some people, we don’t want to increase their anxiety with interventions cute progressive
muscular relaxation also has a lot of research support and remembers with cute progressive
muscular relaxation we’re Sakura get them to attach a cue AK you word like relax or breathe
with the relaxation response so they tense their muscles and then relax their muscles and as
they relax their muscles they say their “quack”-word like relaxed and they work from head to toe or
from toe to head tensing and relaxing different muscle groups so they become more aware of what a
tense muscle feels like versus a reactive relaxed muscle there are great scripts that are online
that people have already recorded that can walk people walk clients through CPM are I highly
encourage it because once they get used to it then they can just think that cue they can think
relax and as they exhale they will start to feel their entire body kind of relaxing because it’s
trained when it hears that just like when you hear the word pop quiz when you were in high school
you had a stress reaction well we want to use it in reverse and train the body so that when
it hears a cue word relaxes helps them develop self-esteem because fear of failure and rejection
a lot of times come from needing other people’s approval to help them develop a rational idea of
their real self develops compassion self-talk instead of saying I’m an idiot or I’m stupid or
I’ll never measure up to anything encourage them to talk to themself like they would talk to their
child or hopefully their best friend and encourage them to spotlight strengths whenever they feel
like they’ve got an imperfection to identify these three strengths that they have so they’re you know
balancing out the imperfections and the strengths of cognitive restructuring reframes challenges in
terms of current strengths, not past weaknesses so if you’re going to give a presentation in front
of 60 people and you hate public speaking instead of thinking about you know this is terrifying
because the last time I went up in front of people I forgot everything I was going to say and drop
my note cards well that’s a past weakness what is your current strength you’re prepared to know
the material you ‘yoyo’ so encourage people to look at all the strengths and resources they
currently, have them develop an attitude of gratitude and optimism because as I said with
that the positive writing exercise when people are in a grateful optimistic frame of mind they
tend to see more of the good stuff they see the bad stuff too but they can also see more of the
good stuff and some of the bad stuff they see opportunistically instead of as a devastation
acceptance and commitment therapy says that some of the reasons that we’re miserable are
fear we get fused with our thoughts we think I am terrified well if I am terrified then I can’t
I mean if I am I can’t get rid of anything I am if I’m having the thought that I’m terrified
well I can get rid of a thought I can forget things easily encourage people to evaluate their
experience and empower them to look at things as challenges and opportunities instead of hardships
encourage them not to avoid their experiences so things that are scary gradual exposure and
finding exceptions like for me bridges you know I love public speaking so that’s not a
thing but when I go to a bridge you know when I Drive to the bridge you know when I’m on the
bridge somebody else is driving I get used to doing that when I Drive over a bridge than when
I Drive over one of those bridges that open up I hate those bridges um I know y’all are just like
oh my gosh yeah it’s an irrational fear I realize that but instead of going straight for the bridge
that opens up going for the little bridges first and then thinking back over times that I’ve gone
over bridges and there’s been no problem you know there are exceptions nothing happened it wasn’t a
big deal sometimes I didn’t even notice it until somebody pointed out hey look down there at that
pretty water and I’m like oh we’re on a bridge so encourage people to not avoid their experiences
get used to them embrace them and learn that they have the power to deal with them and stop reason
giving for the behavior you know use the challenging questions if something is fearsome let’s look for
at the evidence for and against it instead of you know making excuses for social interventions
improve their relationship with their self which goes with self-esteem improvement people are going
to feel less anxious about getting their needs and wants to be met if they know what their needs and wants
are so part of that is becoming mindful cuz a lot of our clients don’t know what they need and want
they just want to feel better but they don’t know how they don’t know what they need to feel
better so helping them identify their needs and wants and encouraging them to be their own best friend
you know when they get a promotion take themselves out to dinner pat themselves on the back whatever
it is don’t rely on other people to do it because other people it’s not that they don’t care but
other people are often very involved in thinking about their stuff and they may not notice
encourage them to develop a method of internal validation so they can feel like they are all
that ‘no bag of chips and they realize why they are lovable human beings and they accept the
the fact that everybody is not going to like them and nobody is gonna like them all the time and
that’s okay you know my kids don’t like me all the time my husband doesn’t like me all the time
I’m okay with that I know I can be challenging but you know most of the time you know they like me
and that’s okay and there are some people you know who don’t like me at all and okay there’s
nothing I can do about that helping our clients develop an okayness with that helps relieve a lot
of anxiety because a lot of people feel like they have to be liked by everybody and if somebody
doesn’t like them it’s like what did I do wrong oh my gosh encourage them to develop healthily
supportive relationships with good boundaries develop assertiveness skills so they can ask for
help when they need it anxiety a lot of times you know that’s the body saying there’s a threat well
if there’s a threat maybe you need some help you know dealing with it so people need to be willing
and able to ask for help and not feel like that’s going to lead them to be rejected and allow them a
certify this will allow them to say no to requests again without feeling like that’s going to result
in them being fully rejected describe the ideal healthy supportive relationship and encourage
them to separate the ideals from the reals you know let’s look at if you had the best relationship
what would it look like okay you know warden June Cleaver we got that now how realistic is that
you know let’s look at you know rephrasing this a little bit so it’s less extreme you know warden
June Cleaver never fought their kids were perfect you know all those extreme words let’s look at
what’s real what happens in real relationships encourages people to identify who would be
a good partner in supportive relationships I’m not meaning necessarily romantic I’m meaning
friends and where they can be found you know where would you find people that you could be friends
with and encourage them to play through what it means when gaming cuz a lot of times again this
goes with my reading you know what it means when your friend doesn’t return your text right
away what does it mean when your friend cancels dinner on Friday night what does it mean when
you see where I’m going with this and a lot of times clients with anxiety and rejection issues
and low self-esteem will go to the worst-case scenario so encourage them to go back to finding
the exceptions what else could have been happening what else could it be that caused this and it’s
not about you so anxiety is a natural emotion that serves a survival function excessive anxiety can
develop from lack of sleep nutritional problems neurochemical imbalances failure to develop
adequate coping skills cognitive distortions low self-esteem and a variety of another stuff recovery
Ambala involves improving health behaviors making sure your body’s functioning and making the
neurotransmitters it needs and you know release them as needed to identify and build on current
coping strategies address cognitive distortions and develop a healthy supportive relationship with
self and others 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 dr.
Snipes by subscribing
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Drew Linsalata: on episode 217
of the anxious truth, we’re gonna do 10 More of the most
frequently asked questions about anxiety and anxiety recovery. So
let’s get to it Hello, everybody, and welcome back
to the anxious truth. This is podcast episode number 217 to
one seven were recorded at the end of July 2022. Welcome, I am
Drew Linsalata, creator and host of the anxious truth. This is
the podcast that focuses on all things anxiety, anxiety
disorders, and recovery. So welcome. If you’re new here,
welcome aboard. If you’re a returning listener, welcome
back. Today we’re going to do part two of our frequently asked
questions. These are 20 of the most frequently asked questions
about anxiety and anxiety recovery that I encounter in my
many years in this community and doing this work that I do.
Last
week in Episode 216, we did the first 10. So go back and listen
to that if you have not. And today in 217, we’re going to do
the second 10. The show notes for these two episodes are quite
detailed. So you can find the show notes for this episode at
anxious truth.com/ 217. And I have included in there all the
links to all the other resources and podcast episodes that I’ll
talk about here. So go to the anxious truth.com/ 217. And
check that out. And while you’re on my website, I would like to
remind you that the anxious truth is more than just this
podcast episode. There are 200, and somewhat other podcast
episodes as a ton of free social media content.
There’s my free
morning newsletter called The anxious mourning. And there is
three excellent books and anxiety and anxiety recovery
that I have written that are helping 10s of 1000s of people
around the world. So while you’re on the anxious truth.com,
check out all of those resources, they’re good, and most of
them are free, so go ahead and avail yourself of them. And if
you are enjoying my work, and it’s helping you in some way,
and you would like to help me keep it free of sponsorships and
advertising.
All the ways to do that can be found at the anxious
truth.com/support. So check that out. Never required, always
appreciated. So let’s get into part two of our frequently asked
questions. And we’ll get right into it. We’re going to do 10
today. So question one this week is whether recovery is possible, even if
you’ve suffered for many years. And the answer to that is
sure is this is a short answer. Many, many members of our
community can turn things around even after years of dealing with
disordered anxiety. For me, it was over 2025 years of my life
on and off and three or four major episodes. So yeah, the
amount of time that you have suffered with this. I’m not
gonna say it doesn’t matter completely, but it is certainly
not a reason why you could not get better you can do that. Yes,
you may build some habits, but at some point, the hole can only
get so deep. And I think that’s what people worry about, like,
oh, I keep digging a deeper and deeper hole.
I’ve been digging
for 20 years. So how am I ever going to crawl out of this hole?
That’s not the right way to visualize it. I like to say the
hole can only get so deep once you are to the point where
you’re avoiding everything your housebound or stuck in one room
or you’ve got yourself down to eating only three foods because
you’re afraid or you know, you’re super restricted there’s,
there’s only so much restriction you can impose on yourself. So
assume that the hole has gotten as deep as it is ever going
to get. You just start decorating and get comfortable
in that hole. you personalize it, hang artwork like you
put in a stereo system, and listen to your favorite music
while you’re there.
So if the hole doesn’t get deeper, you
just get more comfortable in it. That doesn’t matter. You can
turn this around, it doesn’t matter how long you have
suffered, I promise you can get better. I was 20-plus years, 25
plus years. I know people even longer than that, that have
dealt with this, and one woman over 40 years. And she has
turned things around. She’s well on the way to recovery. So yes.
In terms of resources, Episode 124 of the anxious truth talks
about that. So you can go check that out. So question number two
today? What if I don’t have panic attacks, and I just feel
anxious all day? So there are two things that I
want to address in this question. First of all, there’s
a misconception that people that have panic attacks are somehow
calm or not anxious between attacks. And that is 100% not
true. Like people with panic disorder, I had panic disorder,
I was anxious all day long, too. So if you’re in that boat, and
you don’t have panic attacks, the first thing I want you to be
aware of is that that’s not necessarily a special condition.
And it’s not like people that do have panic attacks, have attacks, and then are calm the rest of the day.
It doesn’t work that
way. So don’t feel bad about that. Now, being anxious
all day can be the result of the same mechanism that drives
things like panic disorder, you can start to learn to be anxious
just because you’re anxious. And the longer this goes on that
becomes part of the puzzle for a lot of people. Like I’m anxious
all day long. I can’t figure out why. So now I start to become
anxious about being anxious.
That’s one of those things or
another reason why you might be anxious all day long. And this
starts to get into the realm of generalized anxiety or
generalized anxiety. disorder. A lot of people that have gad are
anxious all day long, but not everybody that’s continually
anxious has gad. So really God is defined by excessive worry
and focus on external things to the health of your family, your
health, doing good at work, not letting people down taking care
of everything being perfect being a people pleaser, like
those are things where we are trying to control the world to
an excessive degree. And that’s sort of the hallmark of
generalized anxiety disorder, it’s based on that sort of
stuff. And then it gets off the rails and gets carried away. So
people with gad can have a general background anxiety that
lasts all day long too. So there could be that and then you could
also begin to just be anxious about being anxious because you
can’t solve the anxiety problem. So it’s not that this is a
special thing or it can’t be fixed.
Sometimes if you’re
the in that gad camp, get a look at some of the underlying things
that go with that. Things like excessive worry, overthinking
over planning, perfectionism, and people-pleasing, are things that can
drive anxiety state, but that you think could be good
things about your personality. Gotta look at that. So I talked
about this in Episode 119. I had Dave Carbonell on and we talked
about generalized anxiety disorder, and episode 148 of the
podcast covers this. But if you’re anxious all day long, you
don’t have panic attacks. It’s okay, you can still get better I
promised. So Question three, how can I drive during a panic
attack or anxiety spike, it’s not safe. So this one, I did two
podcast episodes that specifically talked about this
Podcast, episode number 55. podcast episode number 105.
We’re specifically about driving and driving anxiety. So there’s
an assertion here that people will make that when you are in a
high anxiety state or a state of panic, that you
lose control and have no agency anymore.
Like some
external force rolls in and possesses you and makes you do
things or prevents you from doing things. This is a thing
that you have to start to challenge has that ever been
True? Now, you are most certainly afraid you’re very
uncomfortable. But the choices that we make in those moments in
an attempt to alleviate that fear and escape from the
discomfort are not involuntary.
So, when talking about whether is it
safe to drive during a panic attack, you have to realize
that, yes, a rapid heartbeat during panic is involuntary, you
can’t control that, and yes, maybe feeling a little short of breath
is involuntary. Yes, feeling nauseous is involuntary. Feeling
a little depersonalized is involuntary. That’s all true.
But the things that we do to add fuel to that fear, fire, omg
omg, calling for help trying desperately to get to a safe
place trying to run away from it. Those are voluntary. Those
are choices that we make.
So you can’t control how you’re going
to feel. But we do have some agency in what we do about that.
And you have to realize that the uncontrollable feeling or the
idea that you will completely lose control of your
mind and your body or that you do lose control of your mind and
body is you know what you’re doing, and you know what
that activity looks like, and you’re calling that
uncontrollable. But really, we do have choices, we are making
choices to do those things. So it’s important to consider that
because that sort of challenges the narrative that says it’s not
safe to drive because I lose control. Well, no, you choose to
help to fuel a frantic state in your frantic effort to try and
get away from the fear. But there is a choice there. And
there’s an agency that’s important when you’re talking
about driving. And I would urge you to consider another thing.
And that is all the times that you have been anxious behind the
wheel or experienced full-blown panic behind the wheel, and you
have run home with that car or pulled over immediately or got
off the highway or the motorway.
In all of those situations, you
are surprisingly adept at maneuvering your vehicle, even
though you’re insisting that you can’t and you must stop
maneuvering the vehicle. So sometimes we have to insert a
little bit of objectivity here, take two steps backward
from that emotional reaction of oh my god, I’m out of control.
It’s horrible. And look at the facts like, Am I out of
control? Or am I just worried that I will be and have I ever
even shown any sign of being unable to control my vehicle?
Now, I’m not saying that driving with a panic attack is
comfortable or easy in any way, shape, or form and it’s okay to
pull over and let it pass.
It’s okay. But you got to
start to challenge that narrative. But in the end,
you’re the only ones that get you’re the only one that gets to
decide whether you should drive or not. I can’t tell you Yes, go
ahead and drive. I can tell you to start to really try and think
objectively about the way you’re evaluating that. And let reality
be a bit of a guide.
But I cannot tell you now, go ahead
and drive you only you can determine that. Again, take a
listen to podcast episodes, 55 and 105. And maybe those
will help. So let’s go on to our next question. Question five.
What if you have a real medical condition? Okay. This is
unfortunately, common human beings have medical conditions
all the time. More than one thing can be true at a time. So
when this happens, you have to remember that you have an actual
medical or health issue and can also be caught in the
grips caught in the grips of disorder and anxiety, those two
things will get glued together, and you will stick them together
and think that they are one big giant ball of fear. But really,
they are not. So there are two things in the face of a health
challenge or a medical condition, that medical
the condition can cause actual restrictions, lifestyle
restrictions, but it can also cause fear, uncertainty,
vulnerability, anxiety, worry, and normal things like human beings
that are having health problems will normally experience those
states.
But then there’s the extra state on top of that. So
that’s the medical condition itself and the normal human
reaction to that. And then there’s the disordered part that
comes on top of that, which is now I am going to excessively
worry beyond what is helpful about my health
condition. I’m going to try to make predictions, I’m going to
write giant horror stories and screenplays in my head about
what might happen even though it’s not happening.
Now. I’m
going to ruminate and worry and ruminate, and worry and research
and Google, and I’m going to try to solve this problem in my
head. But you can’t, that’s the part that you don’t have to do
that part is not required, that part is not helping you
in any way. It’s kind of hurting you in terms of
mental health. Right? So you have to recognize there are two
things, oh, I’m worried right now, I’m concerned, I’m afraid I
feel uncertain and vulnerable because of this medical
condition. Okay, that’s okay. And that sucks. And my heart
goes out to you. But that’s part of being human. But the part
where you latch on to it and spend 24 hours a day, every
waking moment trying to solve this problem and writing stories
about it in your head that’s not needed, then in many cases, your
anxiety level goes up, because you’re doing that, and then
you’re anxious because you’re anxious.
So it’s important to
step back again, try to insert a little objectivity, and say, Oh,
I see what’s going on here. I don’t have to say, Well, I have
a health condition, and it sends my anxiety through the roof. No,
I have a health condition. And that makes me feel certain
things. And then I am adding on top of that with some of the
habits that I think are safety or protection for me. And I can
recognize that and begin to tease that apart and start to
work on those other habits. So that’s my answer to what if I
have a real medical condition, people will often say like,
well, I have a real medical condition. So all bets are off
to bed like I’m going to have to be an anxious mess. No,
that’s not true. Now I did an episode of the podcast with my
friend Jessica Seidner. Jessica doesn’t have anxiety disorders,
like, as we are aware. But we did a great episode together,
where she talked about having to deal with the increased anxiety
of breast cancer diagnosis, which came right on the heels of
losing her husband.
So she had a lot going on with her medical condition
and a huge life loss. And her anxiety went up because it
normally did. And we talked about how she had to work
through that which might be helpful. I also did an Instagram
live on this topic, probably a year and a half or two years
ago. So again, if you go to the show notes for this episode, the
anxious truth.com/ 217.
Under this question, you’ll see that
link to Instagram. So next question, we are on to question
number 6789 10. Okay, so the question, I think five or six,
how do you accept anxiety or surrender to it? So this is a
question I get every day. And this question is really like
other statements in code? This question is really, it’s
super scary to surrender. So please tell me how to do it
without being afraid or uncomfortable. Right? So there
is no way to do this without being afraid or uncomfortable.
And I know that’s a glib answer, a brutal answer. It’s it sounds
like a cold answer. But we need to confront these things. It
doesn’t help us to try desperately to make it easier or
fluffy, or it doesn’t work that way.
So you also have to
recognize that when you ask the question, but how am I supposed
to accept this or surrender to it? What you’re doing is
insisting that you must continue to resist it. But why? Why do
you think you have to continue to resist it? So if you are in
this camp right now, where you want to keep asking, but I don’t
understand how I’m supposed to surrender, or how I’m supposed
to accept it. What you’re telling me is number one, I
don’t want to be afraid, which I understand I’m not picking on
you for that nobody wants to be afraid. And number two, no, no,
no, I How am I supposed to I can’t if I drop all this
resistance, then it’s going to come and get me? And my answer
is yes. Correct. So how can I accept or surrender is an
insistence that you’re not supposed to accept or surrender
because you have to continue to fight it and resist it? Because
if you don’t, you won’t be safe.
And if you want one big step
that you can take toward acceptance and surrender, is to
face the harsh, brutal, cold reality that all the things
that you are doing to resist it, stop it, make it go away. All
your rituals and safety behaviors and escape behaviors
are doing nothing. Don’t leave a big pregnant
pause. They’re lit doing nothing, no amount of tapping
your cheeks sniffing oils, drinking cold water popping
men’s calling for help snapping rubber bands, chanting, counting
backward from 100. None of those things is doing
anything because that danger has never actually existed. So in
terms of how can I accept and surrender, I will say if I
walked up to you and said, I am so tired from having to hold up
the moon all the time, but I can’t stop holding up the moon
or it will fall to the ground, you would look at me and say,
no, no, you can stop holding up the moon, because you’ve never
been holding up the moon, it doesn’t fall to the
ground, it’s okay, you can let go.
The same thing applies here. So
the thought that you can’t possibly accept anxiety or
surrender it and by the way, acceptance doesn’t mean liking
it, do not get confused, you can still hate it, and you can still
want it to not happen. That’s all normal and you can’t control
that’s human, you’re allowed to be human. Accepting doesn’t mean
liking it. But accepting and surrendering means you will drop
all of those safety behaviors, all of those resisting
behaviors, because you must face the realization that they are
doing nothing, they have no impact on your safety at
all.
They’re just designed to make you feel different. But
feeling different isn’t safer at all, because you’re never in
actual danger from feeling anxious. Right? So you’re gonna
have to confront the reality behind that question. But how am
Did I suppose to surrender or accept? Well, look what those
questions mean. So next question is, what exposures can
I do get ready for dot dot dot, pick an event, a wedding, a
concert, a family vacation, something. And so in the end,
this is a simpler answer. You have to remember what exposures
are therefore, people think, or they get confused. And they
think, Well, I’m learning to drive on the highway. Again, I’m
learning to go shopping, I’m learning to stay home alone.
Again, you’re not learning to do anything. The
only thing that you’re learning to do, which is portable across
situations and challenges, and context is learning how to
get better at experiencing anxiety and fear.
So we only do
exposures, do specific things like drive go for a walk or
stay home alone or eat food that you’re afraid of. So that
it will trigger that anxiety, we were intentionally triggering
anxiety, fear, uncomfort, discomfort, uncertainty, all of
those things were intentionally triggering them so that you can
practice feeling them and moving through them in a new way, a
the more productive way that ultimately teaches you that you
don’t have to save yourself from them. So if the exposure is not
to the event, the task, or the place where the food or
whatever the exposure is to the feelings, then every exposure is
an exposure that works for other things.
Right? So if you’re
getting ready to go to, for instance, you’re going to a
concert all you got tickets to a concert, how can I expose myself
to that? I mean, yes, can you do things that sort of mimic a
concert? Yeah, that doesn’t hurt in any way. But remember, you’re
only you’re not afraid of the concert, you’re afraid of how
you will feel at the concert. So if you want to take a cruise
around the world get better at staying home alone for two
hours. That’s what I tell people all the time. If you want to go
back to work, then get better at walking around your block.
Because you’re really in the end, you’re learning a new way
to relate to anxiety across all contexts. And if you can
adopt this, then you don’t have to worry about specific
exposures for every single thing you might have to do in your
life, life gets a lot simpler that way.
And your recovery
starts to become a little wider and more durable. So it’s really
important, like think about that. I’m only doing these
things because they trigger my anxiety, the anxiety, fear,
that’s the exposure, not the task or the place. So let’s move on to the question.
You know, in 10. I know which one I want to take, we’re on
seven right now. This question is what does this method work if
I have trauma too. So first of all, I always have to say this
is not a method like I’m not teaching them. This isn’t the
drew method. It’s not my method. I didn’t invent any
of this. These are just the principles of a cognitive
behavioral approach to anxiety disorders. So there are
parallels between anxiety disorder, recovery, and trauma
resolution, that’s 100% True, a lot of things will look the
same.
If you’re working with a trauma resolution specialist,
some of the things that you would hear would sound a lot
like the things that I talked about, but they’re not
the same. And the issue here is, let’s assume that you do have a
traumatic background and you’ve experienced some traumatic
events in your life. And maybe that that trauma did spawn your
anxiety disorder that can happen. But then what I always
say is that one problem, the trauma has now become two
problems. You have trauma and an anxiety disorder. Right? So you
have to realize that it doesn’t mean that the anxiety disorder
doesn’t count because it’s only the trauma if you had one
problem now you have to That’s okay though, don’t freak out.
You can successfully deal with both of those issues. A lot of
people do, right? A lot of people do that work on both
fronts. But traumatic experiences do not mean that the
anxiety disorder doesn’t count, so some people are under
the assumption that like, well, this all sounds good, but
I have trauma.
So what you’re saying doesn’t apply to me.
Okay, you may have trauma, and I’m very sorry for the things
that you’ve lived through. That’s possible. But in the end,
if you will have learned to be afraid of your heartbeat, or
your breath or you have learned to be afraid of, you
know, depersonalization or jelly legs, and you refuse to go out
of the house, or you are convinced that you have some
sort of health problem, and you will only eat foods as a
result. Maybe some trauma spawned that, but
But knowing about that trauma doesn’t help you become less
afraid of your heartbeat.
Now you’re afraid of multiple
things. So maybe you are having, you know, you’re afraid of the
experience. But now you’re also afraid of yourself. So you
have to do both things. But of them, if two
problems, you can solve them both. So traumatic experience
can be a roadblock 100% to executing the recovery plan that
we’re always talking about here. It’s 100% true if you have
lived experiences that teach you that you are always unsafe, the
world is dangerous, you are weak, you’re not capable, you’re
stupid, and you’re not worthy of being better. trauma can do that
to you. And if you have those beliefs about yourself, because
of your past experiences, that can 100% present a roadblock to
doing the work that I was talking about, have to
acknowledge that and I always will always well never going to
invalidate that.
So in that situation, you’re going to have
to work on that too, right? You’ll have to work on that.
It’s kind of hard. And this is different for everybody, right?
There’s no set answer to this on the other side. So in that
situation, you may find you have to do a little bit of work on
yourself before you can effectively do this recovery
work that I’m talking about.
Some other people find
that their anxiety disorder is so bad, that they’re so wracked
with panic and irrational fear that they can’t do the
trauma work until they put out this fire. So some people have
to do this first and then go back to the past and do that
work. Some people can do it at the same time. It’s individual,
it depends. So there’s no set answer to this. But I can
tell you that you can recover from both trauma and
anxiety.
And the things that I’m writing about which are
geared toward anxiety recovery can be effective while
you do that. It’s just a very individual situation. But please
don’t feel that since you have lived the traumatic background,
you can’t get better. That’s not true. That’s not fair. And I
understand why you might think that but it’s not true. You
can get better. It’s not easy. But there’s hope for you
too, I promise. So last few questions. This is a really
common one I’m accepting, why am I still anxious? So I might
argue that if you are asking why you’re still anxious, then
you’re not accepting. We can’t qualify for our acceptance.
I’m accepting. I’m accepting this, but I also want it gone.
Well, you can’t have both of those things. Think about that
for a second. I know it sounds a little bit glib and a little
silly.
But think about it. There’s truth in there. I’m
accepting this, but I also don’t want to accept it, and I’m not
accepting it. I know you want your anxiety to go away,
but accepting and doing all the things we talked about. It’s not
a recipe for banishing it, right? If that’s why you’re
doing this like you are hoping that if you do the Claire weeks
acceptance or the Dru surrender, or the Josh Fletcher willful
tolerance, if I do this, then it will stop. You’re trying to skip
the part where you have to experience the anxiety and use
it as a classroom.
It’s super important. So if you’re trying
to skip that, and you’re just hoping that okay, I except, wait
a minute, how come it hasn’t gone away? You’re missing the
whole process. And you’re going to wind up disappointed,
frustrated, and do and ask this question I don’t
understand. I’m accepting why isn’t gone away. So
expectations are important. Understanding the concepts of
recovery. Why are you accepting that is that the whole thing? Or is
it just part of it? That’s important, aiming at the right
target is important. So in this situation, I did episode 192 of
the podcast, which is linked in the show notes here, go listen
to that, that will probably help you. And this is related to
question number nine, which is, I’m doing my exposures.
But it’s
not working. This is what you think you’re doing. I’m doing
all the things I’m doing exposures but not working. Why?
And there are a couple of common explanations for this. Number
one would be we’ll ask you a couple of questions. And this is
right at the show notes. Are you trying to do exposures without
being too afraid? Are you trying to do your exposures without
triggering high anxiety or panic? Are you only doing
exposures now and then when you’re forced to or when you’re
having a good day? Are you doing exposures while also using all
of your soothing and coping tools to calm you down if it
gets uncomfortable? These are all red flags as to why exposure
might not be working.
So remember what I said a couple of
questions before the point of exposure are not doing the
task. The point of the exposure is experiencing the fear the
anxiety, the discomfort you want that you need that if you’re
trying to find ways to do your exposure tasks without feeling
that or minimizing it or soothing or calming it or making
it’s easier Don’t do the exposure, there’s no point in it. Because
you’re not, you’re not learning to drive again, you’re learning
how to get better at experiencing anxiety. So this is one of the
main reasons why people will say my exposures aren’t working
well, okay, but you’re not doing exposure, in some
cases, for a common mistake. The other thing would be that you
know, that you’re supposed to experience that experience,
panic, but you are still hanging on to those who escape
behaviors and those rituals.
So some people get close to like
real exposure, I would say real exposure, but most effective
exposure, but they still hang on to like, well, there’s a line
that I just can’t cross with anxiety and panic. And when I
get close to that line, I will break out all of my copings
skills. And I will break out my, safety skills and my make it
go away skills. And that’s the response prevention part. So
we’ve talked about exposure and response prevention, ERP, which
is very commonly used in the OCD community, you hear ERP in that
community all the time, but even for all of the
anxiety disorders. Exposure is always ERP. So doing the things,
you’re doing the things, you’re intentionally triggering this
comfort, and you’re doing that without using your old
responses, your safety responses, and soothing responses, you’re
preventing those responses.
So one of the reasons why
another key reason why exposure might not be working air quotes
for you is first of all, what does working mean? It doesn’t
mean to make it go away. Remember, it means teaching you how to get
better at being anxious. But why do you think it’s not working?
Well, one of the reasons is doing the exposure without doing
the response prevention. I’m out there driving on the highway,
but I’ve got my mints and my cold water and I got my radio
on, I’m calling and I’m talking to my friend or I bring my
husband or my girlfriend with me that that’s one good reason why
it might not be working. Right. So if you go to
anxious truth.com and just search for the word exposure,
you’ll see quite a few podcast episodes where we talked about
this in more detail. And then question 10 Final question for
the day. This is a big one. How do I deal with a setback? So
this is a such question I hear every single day and I the
word setback, I almost want to be stricken from the vocabulary.
Many times when people are in the recovery process, they
feel like they’re doing great because they’re not experiencing
anxiety or panic.
Like they’re feeling good. That’s, that’s
awesome. We want everybody to feel good. I want you to feel
good to write, I want you to have good days. We all want to
have good days. Everybody deserves a good day. So when you
start to string good days together, and you’re feeling
pretty good. And it’s been a while since you had a panic
attack, or it’s been a while since you had those scary
thoughts or it’s been a while since you’ve had an
anxious day and then you have an anxious day or the thoughts come
back or you have a big panic attack one night. A lot of
people will say up, it’s a setback. That’s not a setback.
That’s not a setback, right? If the core principle of
recovery, is to learn that anxiety and panic are not
emergencies, then how is feeling that a setback, it’s no longer
an emergency, you are trying to learn that it’s not an
emergency, we do not declare it a special event.
We don’t
retreat from it. So setback is usually a red flag word and it
indicates that you’re still insisting that the only
successful recovery is one year where you will never feel
anxious or panicky ever again. And if you’re trying to recover
to that degree, where you never you can guarantee that you never
panic or ever have another scary thought in your life.
You’re going to be disappointed and frustrated. So
setback is not feeling things. If you haven’t felt anxious for
two weeks, and then today you feel anxious. Well, your job
today is to move through those feelings and practice being
better at being anxious. That’s not a setback. That’s just life
happening. And that’s an opportunity to get even better.
Like we want it we get to the end of the road to recovery
when we don’t care if we’re anxious or not. And I know that
if you’re in the thick of it right now you are thinking that
is an insane statement.
But that is truly where you are headed
with this. That is when the war is over. So if every time you
experience anxiety, you yell setback and want to know what to do
I do with a setback? You’re kind of missing the point and you’re
not being fair to yourself. Okay, so the only true thing
that I might call setback is setback is also really what
happens when we say up all bets are off and I’m going to return
to my old rituals.
I’m gonna go back to my figuring it out
trying to fight it trying to resist it hiding from it. Going
back to my compulsive. My compulsions, like that, might be
setbacks. Yes, if you start to revert to those old habits, I’ll
call that a setback with you. But how you feel and what you
think is not the setback. But even if you do start to revert
to those old habits as soon as you waive the setback flag and
one piece of advice just remember, oh wait, I have to start doing what I was
doing before. No problem that happens to everybody move
forward again. So if anxiety returns after some time, right
at the show notes here your job is not to wring your hands
and try to figure out why and how to stop it and declare
a disaster.
Your job is to surf through it, move through it
like you presumably did as part of the progress that you said
you had made. So I did do an episode on this early on in 2015
of the podcast, episode 14 talks about the nonlinear nature
of recovery and goes over setbacks. But I know setback is
a thing that we talk about all the time in this community.
Hopefully, this helps. And that is it. Those are our second 10
frequently asked questions about anxiety and anxiety recovery. We
are done with episode 217. If you have not heard to 16 go
ahead and listen, because those are the first 10 questions you
know, we’re done because he told me that music. Anyway, I will
pay you out as usual. Afterglow by Ben Drake, you can
find Ben and his music ed Ben Drake music.com Go check them
out and tell him I said hi, I will ask you a favor. If you’re
listening to the podcast on iTunes on Apple podcasts or
Spotify or some platform that lets you rate and review.
Please
leave a five-star rating and maybe take a second to write a
review because it helps other people find the podcast. If
you’re listening on YouTube. Sorry, there’s no video this
week. But if you’re listening on YouTube, Like the video,
subscribe to the channel, and leave a comment. You know the deal. I
appreciate you guys coming by all the time spending time with
me giving me your attention. Hopefully, I’m able to help you.
I’m doing the best I can. I’m hoping it’s working out for you.
I’ll be back next week. We’re gonna do it again. I don’t know
what I’m gonna be talking about. But I will be here. And as
always remember, this is the way Unknown: this is where your
story begins. You got the feeling that you go yeah, you’re
doing fine. Now in the city, you live fast. No looking back on
the past. Never get another chance.
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Narrator, Hey Psych2goers, welcome back. When was the last time you felt completely at peace with your life and self? Sometimes our minds can linger in dark spaces with negative influences like anxiety Are there times when the voice of anxiety is louder than your own? Does it become difficult to discern between thoughts based on reality and thoughts that are merely lies clouding your mind, Identifying which thoughts are fear-based and false is the first step in shifting your mindset, which then helps you shift your self-image and life as a whole. So with that said, here are six common lies. Your anxiety may try to trick you into believing and how you can reframe those thoughts instead Number one. Everyone is focused on their flaws. The first time, gym, goers are often hesitant and timid due to the lack of experience and confidence in a new environment. They think they’ll stick out as the least experienced person in the room or that other gymgoers will judge them harshly over their body. What they don’t realize is that everyone there is too focused on themselves and improving their bodies to worry about others Replace the gym with other social settings, and you’ll realize the same applies. Remember that everyone has insecurities of their own, including the person you’re, interacting with Reclaim your mental space by focusing on being present with your setting or the people, you’re sharing time with You, ‘ll find that the less you focus on internalizing. Those negative feelings and the more you focus on being yourself, regardless of those insecurities the more confident you’ll, feel Number two. You’re not ready. Think of someone you admire, whether fictional or not If they refuse their call to action, whether that be accepting an invitation to a magical, wizarding school or volunteering themselves as a tribute in the Hunger Games all because they felt like they weren’t ready for Their world. Would be deprived of an important contribution When faced with a choice, to take a leap of faith? Remember that greatness comes when you act before. You feel ready Trust yourself to learn along the way and trust that your path will unfold gradually. As you carry on Number three, Your self-worth should be earned. The only factor that changes how connected you feel to your level of self-worth is a belief that is influenced by what you’ve been taught. Sometimes it’s not about adding more to your life through money, accomplishments, and material possessions to feel self-worth. Sometimes it’s about removing limiting thought patterns and unlearning the beliefs that convinced you to think less of yourself Throughout life. You may be conditioned by negative experiences, people, or trauma to believe that self-worth is something you must earn before you’re allowed to claim it, but that isn’t true. While there are things you should work hard to earn in life like a dream, job, or financial independence, self-worth is a feeling you innately deserve to have Number four. You must complete X by Y time in your life to be successful. Are you telling yourself? You must reach a certain goal at a certain time in your life to be deemed successful, or do you have a checklist with milestones you’d like to hit and are hard on yourself for not making those goals when you plan to This lie is exaggerated, Even further, when you look around and feel as though everyone is more successful than you or doing better in life than you are, The truth is, everyone is on their timeline and life is not a race. What looks like immediate success on the surface could be a goal that was years in the making for someone you admire. A successful goal is worth celebrating, no matter how long it takes. What matters most is your determination and persistence in making it happen. Number five. It or you will always be this way. Anxiety can trap your mind in a loop, causing you to believe that its presence will be a constant all your life. Your anxiety will lie to you by recalling all the times you failed to overcome it. You might think that you, ‘ll, always feel weak in the face of your fears or insecurities, but all of that is part of anxiety,’s negative influence, Bad memories are more easily remembered than good ones due to survival and evolution. When undergoing a negative experience, the two emotional, processing regions of the brain alerts you to what feels dangerous In an attempt to protect you, your brain imprints, these negative feelings into your memories, so that you can better prepare for future possibilities of similar experiences For every negative Memory that you have tried thinking about two other positive memories as well. This practice will help reframe your past in a positive light and can encourage a more optimistic view of your future And number six Change is bad. Are you afraid of change? Many of us are We’re scared of change because of its uncertain nature. Anxiety brings this fear to a new level, sometimes to the point where you feel paralyzed A bad breakup two years ago might leave room for the love of your life to arrive later. Not making the baseball team now could lead you to discover a passion for a new sport, and a conflict with a friend could be what deepens your bond with them. In a way you could, ‘t have imagined possible. Change can be good as long as you allow it. So did you relate to any of these When these thoughts or lies arise? Don’t force yourself to fight them off. If that proves to be a challenge at first, Allow them to appear like clouds forming in the sky, watch them pass through your mind, and let them float away You don’t have to believe or hold onto any of them With practice you’ll find They float into your mental space less and less Know that these thoughts are not your own and that there is an inner voice, encouraging you with positivity, underneath those fear-ridden thoughts. If you found this video helpful like and share it with friends that might find insight in this too Remember to subscribe to Psych2Go and hit the notification bell for more content. All the sources used are added in the description box below. Thank you for watching. Until next time, calming music
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CEUs are available at AllCEUs.com this episode was pre-recorded
as part of a live continuing education webinar on-demand, CEUs are still available for this presentation at AllCEUs.com/counselortoolbox I’d like to welcome everybody to today’s
presentation of dialectical behavior therapy techniques emotion regulation we are going to
start by reviewing the basic premises of DBT and the reason we’re doing that we’re only
going to do it in this one because emotion regulation we’re starting kind of at
the beginning but we want to go over what is the theory underlying a lot of what we’re going
to talk about we’ll learn about the HPA axis and this isn’t something that Linehan talks about
in DBT but it is important for understanding our physiological stress reactions will define
emotion regulation identify why emotion regulation is important and how it can help clients ourselves
staff yay and we will finally explore some emotion regulation techniques there are things
besides just preventing vulnerabilities that we can provide to clients to help them regulate
their emotions before moving into that distress tolerance realm of skills and activities so basic
DBT premises everything is interconnected when you get up in the morning if you’re having a bad
the day you know you didn’t sleep well your back hurts you’re cranky you got a lot of stuff to do
it’s raining outside you know yay you’re noticing all the negatives your thoughts
maybe more negative you may be more likely to notice the negative you may be more likely to have
what we call commonly call a bad attitude if you start to have a better attitude what happens to
what you observe and we’ll talk about that in a little while the reality is not static what is true
right now in the present may not be true which is you know was the future from what
the present was half a second ago so reality changes when we look at a situation when we look
at an event, we’re looking at how am i reacting and what is my feeling about the situation right now
you know we can learn to change where we’re at but with the information, I have right now what’s
going on and a constantly evolving truth can be found by synthesizing different points of view
because most of the time as humans it’s just kind of part and parcel of being humans we don’t have
the whole picture and I did the best I could with these little graphics here think back if you will
to some of PJ’s experiments when he was trying to demonstrate egocentrism when we’re looking at
this yin and yang sort of model the girl’s stick figure what does she see if you ask her what
color is this orb she would probably say black because we’re assuming she sees the black side
if we ask this little thick figure model over here what color is the orb she’s seeing the white
side so he’d say white now if we asked a little confused guy who is standing kind of on the third
side or the south side he sees both of them so he hears the stick figure girl say it’s black he
sees a stick figure boy say it’s white and he’s going well it’s kind of both you can synthesize
both perspectives and figure out that this is an orb that has multiple colors even though she
can’t necessarily see those colors and he can’t necessarily see those colors so BBT says let’s try
to take a look and see if there are blind spots see if there are things we’re not seeing or things
we didn’t observe the basic assumptions of DBT and well people do their best if we didn’t think
that we probably wouldn’t be in this profession so people are doing their best with the tools they
have and the knowledge they have at any given time and I added that extra part people
want to get better and be happy most people don’t want to be miserable if it seems like they don’t
want to get better then we need to ask ourselves what is the benefit to staying miserable why is
it is scarier more threatening more awful to look at getting better or being happy and that’s one of
those motivational things we’re not going to go there today but in general people are going to
choose the most rewarding option when prevents presented with multiple options okay now this
one area in that I kind of diverge from the official statement is clients need to work harder and be
more motivated to make changes in their lives I’ve had a lot of clients who have been working their
butt off but they may not have the right tools it’s like trying to unscrew something that is
Phillips head with a butter knife they’re working hard but it’s not going anywhere because
they can’t get any traction so I crossed out the work harder and I tend to replace it with work
smarter clients need to work smarter they need to have more tools they need to have more effective
tools and some of the tools they have may be awesome if we just tuned them up a little
bit sharpen their oil and grease them whatever you need to do and be more motivated to make changes
in their life and you’re saying well they’re in therapy they’re coming here for whatever reason
there why aren’t they motivated to make changes well again let’s look back at motivation and what’s
the most rewarding choice is if they tried to make changes before and it hasn’t worked out and
they’ve been told that it was their fault they were being resistant or you know they were blamed
in some way or they just felt disempowered what’s going to make them motivated to try to do that
again please let me run the gauntlet most people don’t want to do that so we need to help
clients work smarter and understand that they are working hard and they need to continue to do so
and we’re going to help them get more effective tools and we need to help them get more motivated
we need to help them see that this time it’s going to be different maybe a little bit different
but this time we’re trying something new it may be different even if people didn’t create their
problems they still must solve yep you know if you grew up in a dysfunctional household you
didn’t create that problem but it is negatively impacting you today so you’re going to have to fix
it if you want to be happy which is the whole goal of the lives of suicidal or addicted
people are unbearable and when we’re talking about DBT we’re generally talking about people
who are highly emotionally reactive and suicidal self-harm those behaviors are away at this point
that they’re trying to figure out how to tolerate what seems like an unbearable situation in their
head addiction is much the same way it provides some relief from something they feel they have no
control over people need to learn how to skillful live skillfully in all areas of their life well
yeah because every area is interconnected if you’re stressed out at work do you just
leave work go home and you have not stressed out anymore no that’s not the way it works it would
be great if it did but it’s just not even if you don’t take all your stresses of work home with you
it has taken a toll on your energy level so when you get home you’re more vulnerable to emotional
upset or just fallen asleep on the couch at 6:00 p.m.
Whatever it is so we need to help people
learn how to live skillfully in each area so the exhaustion or negativity or whatever it is
from one area doesn’t bleed over into the other area so we need to learn how to juggle stresses
in all of our areas to prevent vulnerabilities and people cannot fail in treatment when someone
relapses when someone you know backslides whatever word you want to use I look at it as a learning
the opportunity I say okay you made a different choice than we wanted you to make a different choice than
you were hoping you would make so let’s learn from and figure out why that was the most rewarding
choice than what was on your treatment plan the goal that you’re working toward why what
happened what were you more vulnerable so you didn’t choose the newer behaviors because they
weren’t as readily available let’s use this as a learning opportunity to figure out what’s going
on it’s not a failure it’s a learning moment or a teachable moment so what is emotion regulation
emotional dysregulation will start there results from a combination of high emotional
vulnerability so you’ve got somebody who is kind of reactive and extended time needed to return to
baseline so that when they get upset it takes them longer to de-escalate and get back to baseline
and an inability to regulate or modulate one’s own emotions so I want you to think about some
the time that you’ve been driving on the interstate and you’re just driving along cruising along and
heaven forbid if this has happened I hope not but if it did you’re probably just late a semi comes
along and runs you off the road onto the shoulder and oh my gosh you get onto the shoulder your legs
just to go in like this you can’t even press the gas pedal because you are so stressed out you’re
gripping your knuckles are white from gripping the steering wheel so tight your heart racing you’re
breathing fast you’re in full-out fight-or-flight mode so you went from a1 on the stress meter
you know kind of cruising along aware of the fact that you need to be cognizant of dangers to
a5 of oh crap that could have been bad alright so you take a couple of deep breaths you
your breathing goes down a little bit you get to the point where you can press the gas
pedal and you pull back out onto the highway now are you returning to baseline and just like
la-dee-da cutting around like you were before most likely not you’re a little bit more
on edge and you’re checking your bat rearview mirror more often you’re looking back making
sure nothing’s in your blood spot more awesome so you’re not returning to that same level of less
stress Tunis if you will you stay a little bit elevated because your brain is gone you know I
thought it was kind of a safe situation but I’m realizing now that not so much so I’m going to
keep you on higher alert and it’s going to take longer for you to return to baseline because
you’re looking for those threats now you’re much more aware that it could happen to people who
come from invalidating environment people who are regularly chronically stressed they’re constantly
looking around for anything else that is going to threaten them anything else that’s going to stress
them out so they’re not going from a 1 to a 5 back down to a 1 again they’re going from a 1 to a 5
back down to a 2 and then back up to a 5 and then now we’re only going down to a 3 it’s that
stress is ramping up so we need to figure out how to help people deescalate get back down to that
one and realize okay I got this that was an unpleasant situation but I got this now emotional
vulnerability refers to the situation in which an individual is more emotionally sensitive or
reactive than others or then they normally would be you know some people this is kind of and when
we’re talking about personality disorders this is pervasive when we’re talking about someone who
has been under a bunch of stress for six months this may be a situational sort of thing that we
need to help them figure out how to get out of but it may not be something that is completely
and utterly pervasive in any event when you are stressed you know you’re already kind of on edge
and something happens do you react the normal way that you normally would if you were just like
sitting there and going off oh well okay let’s figure out how to handle this or does it throw
you up sort of into the stratosphere and for a lot of people with emotional dysregulation when
they’re their relaxation is on the brink of chaos so they’re standing there teetering
and they’re going okay I cannot take one more wind or it’s going to push me over and then they
call them damp they get upset and they’re kind of on freefall for a while they get their balance
again but then they’re still right there on that precipice they never come down so what
we want to look at is what’s going on with these people that’s making them more reactive that’s
making them more alert and more hyper-vigilant to stresses and stressors some of these may be
because of differences in the HPA axis which play a role in making people more vulnerable or
reactive and we’re going to talk about the HPA axis in a minute environment of people who are
more emotionally reactive or often invalidating and what does that mean well pick Jane Jane
has had a heck of two years you know there’s just been death after death a job loss
she lost her home she’s living in an apartment right now but she’s not happy and you know yeah
you can just pile stuff on okay so James struggling right now she’s holding on and really
trying to do the next right thing she’s trying to make ends meet trying to do what’s right
by our kids just feeling stressed out and then something happens something that most of us
would react with it to you know it’s annoying but it wouldn’t throw us into utter chaos well James
on that precipice Jane’s already at a four maybe a four and a half depending on the day so when
this happened just that too puts her on a scale of one to five puts her at a
six-and-a-half which is in freefall but people may not understand that they may not understand
what’s going on in Jane’s life and they’re like this is not that big of a deal why are you just
overreacting which makes Jane feel guilty Phil is self-conscious and feels misunderstood so
then she feels isolated and rejected and we’ve talked about basic fears being rejection isolation
failure loss of control and the unknown well James kind of experiencing all of those right now and
the people around her instead of being validating and going okay you were already stressed out I
can see how this was just the straw that broke the camel’s back they’re going what is your
the problem so she doesn’t feel like she’s got social support she’s out there on an island unto
herself so we want to help Jane with emotional regulation because we know she’s up here and we
know she doesn’t like going into that freefall but how do we help her emotional regulation is the
ability to control or influence which emotions you have when you have them and how you experience or
express them and that’s a quote straight out of Linda hands book so emotion regulation prevents
unwanted emotions by reducing vulnerabilities so you can go through life you can go through
the day you can experience stress but instead of feeling overwhelmed or enraged you might feel
mildly irritated for a second and then choose to move on emotion regulation helps people learn how
to change painful emotions once they start so you don’t get stuck nurturing that emotion or feeding
into it and being angry with yourself because you got angry about something you have no control over
it teaches that emotions in and of themselves are not good or bad they just are it’s your brains
hardwired way of responding based on waiting for it the information that it has at this particular
point in time spiders if you’re afraid of spiders that is your brain’s way you see a spider and you
feel fear it’s your brain’s way of going threat spiders can be a poisonous big threat so you want
to get away from it that’s your body’s way your brain’s way of going let’s survive we want to do
this now you can figure out you can learn more about spiders so in the future when you encounter
then you realize that they’re not you know 99% of them are not threatening to humans but right now
at this moment your brain is saying warning getaway you probably want to do that so it teaches
that emotions internet themselves are just prompting us to do something they are survival
responses and suppressing them makes things worse telling yourself I shouldn’t feel afraid does that
do any good if your kid comes to you and tells you that you know I’m having a crappy day or I
hate this does it usually do any good to tell them well you shouldn’t feel that way feel better you
know just be happy does that work I’ve never had an experience where that worked now it may work
for some people but so we want to help people identify their emotions and not get consumed
by the emotions are effective when acting on the emotion is in your best interest so sometimes
it’s in your best interest expressing your emotion gets you closer to your ultimate goals sometimes
expressing your emotion gets you closer to your short-term goals like making the pain stop
and true pain is unpleasant however in the big scheme of things 15 minutes from now 3 hours
from now is that getting you closer to the goals that you want to achieve or was it just a
stopgap expressing your emotions will influence others in ways that will help you so if you want
to influence others in ways that are positive and will help you then emotions can be very kinder
that can be very helpful emotions are sending you an important message and we already talked about
that so I’m thinking the devil’s advocate amigos well I can think of a client that goes you rage
is a great emotion to express is it in my best interest yeah gets people to leave me the heck
alone does it get me closer to my ultimate goals yeah it reduces my stress by getting people to
leave me the heck alone will it influence others in ways that will help you, yeah it make them
go away and are these emotions sending you an important message yet rage is telling me that
these people like everybody are a threat to me so in the short term when you look at it that
way it can be tricky to see but we want to help people get outside of this immediate threat and
say where you want to be what happiness looks like to you or however you want to define
that ultimate goal and then once you get into distress tolerance was your Thursday talk about
how do you endure unpleasant emotions so you don’t take the stopgap route now on to our favorite
HPA axis the hypothalamic-pituitary-adrenal axis is our central stress response system and doesn’t
get too caught up and all the psychobiology of this I think it’s good to be cognizant of but
we’re not prescribing hypothalamus place in the brain release is a compound
called corticotropin-releasing factor or CRF which triggers the release of adrenocorticotropic
hormone from the pituitary gland which triggers the adrenal glands to release stress hormones
particularly cortisol and adrenaline now your adrenal glands are actually on your
kidneys and why is that important what I want you to see or understand is there are a lot of systems
involved there are a lot of hormones involved there’s a lot of stuff involved it’s not just box
you know you’re releasing a bunch of chemicals in your body that are altering the neurochemicals
and the other hormones to prepare you for spiders the adrenals control chemical reactions over large
parts of your body including the fight-or-flight response and produce even more hormones than
the pituitary gland so you’ve got these adrenals this is kind of your stress area if you will it
produces steroid hormones like cortisol which is a gluteal corticoid which means it makes your
body release glucose what we know is that glucose is blood sugar energy all right so it increases the
availability of glucose and fats for the long-term fight-or-flight reaction it also produces sex
hormones like DHEA and estrogen okay why is that important because we know that when estrogen
goes up serotonin availability goes up so if there are the adrenals are busy doing something
else it may cause other hormonal imbalances and it also produces stress hormones like adrenaline
that is going to ramp you up they’re going to increase your respiration increase your heart rate
all that kind of stuff so once you have that whole reaction we talked about and the perceived threat
passes cortisol levels return to normal great this is what happens in the ideal situation but what if
the threat never passes what if we’re working with a client who is constantly fearing rejection
and isolation they need external validation because they don’t feel good enough as they are
they don’t have social support because their emotional reactivity kind of pushes everybody
away so they’re constantly feeling this threat of rejection isolation failures loss of control
and the unknown they’re holding on just like you were holding on to the steering wheel after you
ran off the road and you got back on you know you kept chugging because you wanted to get to
your destination but you were scared witless okay so you’re chugging along what’s going
on what’s going on in that body the amygdala and the hippocampus are intertwined with the
stress response the amygdala modulates anger fear or fighter flight and the hippocampus helps
to develop and store memories when you’re under stress and think about a time when you are under
a lot of stress were you effective at learning and paying attention to the good things and the bad
things or were you just trying to make the pain stop and make the threat go away from the brain of the
child or adolescent is particularly vulnerable because of its high state of plasticity which is
why do we see people who tend to have personality disorders much of their trauma and stuff really
started early in their development and which is why it’s pervasive in every area or many areas
of their life, bad things are learned emotional upset prevent learning new positive things to
counterbalance it if you’re in a bad mood if you’re scared if you’re threatened you know if
you’re hungry homeless put whatever stuff is there are you paying attention to the
bluebirds that are flying around and singing pretty songs or are you paying attention
to the fact that you got an a on a test maybe not so, we need to understand this person who lives
in a chronically stressful environment may also have an overactive HPA axis so they’re already
they’ve already got some adrenaline and cortisol going on they live kind of in this state
of hyper-vigilance and then something happens and they’re just like through the roof kind of like
when you scare a cat what happens to the brain one is a chronic threat to its safety and a constant
the underlay of anxiety is constant undercurrent as it learns your brain forces synaptic connections
from experience and pruned away connections that aren’t utilized by people who feel a lack of control
over their environment are particularly vulnerable to excessive stimulation of the stress response
now it’s not just children abuse and neglected children pop right up there but abuse and
neglected adults think about a client you’ve worked with who’s been in an abusive relationship
for years does she have all the happy connections or is she pretty much terrified exhausted and
stressed out most of the time adults with anxiety or depressive disorders it doesn’t even
have to be an abusive or neglectful situation if you have someone that forever whatever reason has
clinical anxiety or depressive symptoms they are in this state of constant threat and constant of
people if you will so they’re not seeing they’re not able to learn and take in as much of the
good stuff so there’s more bad stuff coming in they’re paying attention to more of the bad stuff
or unpleasant stuff the synaptic connections that form the foundation of people’s schema of
themselves in the world become skewed towards the traumatic event at the expense of a synaptic
Network-based on positive experiences and healthy relationships so we had this client here and these
are her negative experiences she has a lot of them and she’s got these going through her head a lot
and it’s not they don’t just go away whenever she meets somebody and she’s like well they’re going
to leave me whenever something happened she feels isolated and alone she may fear so she’s got
really strong connections to those memories and past experiences and when you’re in the midst
of all this, there’s not a lot of happy stuff and even when she appears happy a lot of times she’s
faking it she’s not seeing and remembering all the happy stuff she just wants to avoid the pain
another example I could give you is thinking about a city planner now a city planner only has a
the certain budget just like we only have a certain amount of energy the city planner looks and says
what roads and what connections between cities get the most traffic and let’s devote our resources
and strengthen those connections because we know we’ve got all kinds of traffic going over there
and those roads that don’t travel those back roads we don’t need to pay much attention to
them right now because we need to make sure that those roads that are used the most are strong
but that’s the best analogy I can give without putting out strings and everything else but so
the hyper-vigilant state active IDEs activated by the stress response that disrupts our ability
to focus and learn you know we’re just trying to not die we’re trying to not be consumed by pain
it impairs the ability to form new memories and recall information due to the physiologic changes
in the hippocampus, it’s not time to learn and process and do all that kind of stuff have you
ever tried to study for a test when you had 16 other things going on that you are stressed about
how well did you remember this stuff over here sometimes people relate things to prior experience
well most of the time so maybe they’ve had a lot of dysfunctional relationships and they start to
get in a relationship which side is going to be triggered the negative memories are the positive
memories and then you have somebody who may be attached to some positive relationships they start to
get into a relationship and they remember some of the positives because there have been some really
good relationships but you know they may remember the negative too but most likely they’re going
to remember more strongly the positive so what’s their reaction going to be if we’re trying to help
our clients develop a healthy support system we need to help them address some of those highways
that are going towards the negative memories emotion regulation is transdiagnostic or useful
with many disorders it helps people increase their present focused emotion awareness it says right
now right here right now what are your feelings what are your physical sensations what are your
thoughts and what are your urges it helps people increase cognitive flexibility because it helps
the kind of step back and take a look and say okay what are my options let me step back from
being intertwined with this feeling and go okay I feel angry got it what are my options here what
do I usually do what I want to do when I’m on autopilot what are some other options I could
do that might help me move toward where I want to go identifying and preventing patterns of emotion
avoidance and emotion-driven behaviors we don’t want to get into the situation of constantly trying
to avoid unpleasant emotions by lashing out by hurting ourselves or by doing things reactively
when I feel this way I must smoke a cigarette I must cut myself I must fill in the blank we want
to help people find alternate ways and be able to step back and say that is an option is it the
option I want to choose today increasing awareness and tolerance of emotion-related physical
sensations sometimes these physical sensations are just so powerful and so overwhelming and
sometimes the rush of adrenaline and that foggy wibbly-wobbly feeling you get in your head when
you have just adrenaline coursing through your veins is so overwhelming that people don’t know
what to do with it and are afraid it won’t stop so let’s help them increase their awareness and
tolerance of this helped them understand that it passes and use emotion-focused exposure procedures
when they get upset help them think about things in the group sessions that get them a little bit
revved up you know we don’t want to precipitate a full-scale crisis or talk about something that
happened last week that got them upset and let’s apply these procedures emotional behavior is
functional to change the behavior it’s necessary to identify the functions and reinforcers of the
behavior so when they did it you know let’s talk about cutting because you know that is one of
those behaviors that we see are self-injury it’s what is the function of that behavior cutting
or self-injury is a way of inflicting physical pain where the person has control and they focus
on that and they feel a sense of mastery when the stuff going on in their head feels completely
uncontrollable and intolerable it diverts their attention and it also is something that they
they can control how much pain they’re in so that’s how it’s functioning now is the best
the response we want no but we can see why somebody might engage in that behavior and what reinforces that
behavior well when they do that not only do they get a reprieve from this emotional turmoil that
they don’t feel like they can touch or control or do anything with but their body also releases
endorphins release natural painkillers to kill that physical pain which makes them feel a little
a bit better so they’ve got kind of a double whammy on reinforcers there so we understand that
now we need to find something else that they can do and help them figure out how to tolerate
the turmoil emotions function to communicate to others and influence and control their behaviors
and serve as an alert or an alarm to motivate one’s behaviors so let’s talk about the first
one communicate to others so I’m communicating to a rat around me the people around me through my
emotions what’s going on if I’m angry I’m lashing out I’m going to influence people’s behavior and
they’re probably going to back off if I am sad or crying or scared that might bring them closer
and in a more supportive sort of thing you know again you’ve got to look at some of the behavior
self-injury can elicit a caretaking response but these emotions before somebody start
acting out the behaviors the emotions serve as a cue that okay Sally is getting ready to go in
free fall so they can start reacting sooner and it serves as an alert or an alarm to the person to
motivate their behaviors if they know you’re on the precipice if you know you’re right on the
edge of being vulnerable cranky being irritable that day can motivate your own
behaviors to figure out how to reduce some of your vulnerabilities and identify obstacles to
changing emotions now we can’t just say be happy and all of a sudden somebody’s like oh I
don’t know why I didn’t think of that I’m just going to go ahead and be happy that’s just not
how it works we want to look at organic factors do they have an organic long-standing chemical
imbalance of some sort and it may not be neurochemical it may be hormonal they may have too
much estrogen too much testosterone too little estrogen too little testosterone whatever let’s
figure out you know have them go see their doctor and figure out if there is something fibroids
or moans whatever that might be affecting their mood okay once we identify anything that we can
tweak there we can’t measure neurotransmitters we’re out of luck there because they’re found
in so many places in the body that there’s no way to isolate how much serotonin is actually
in the brain can’t do it yes we want to look at other factors that are biological imbalances
neurochemical imbalances that are caused by chronic stress that cause addiction to sleep
deprivation and nutritional problems so what sort of chemical imbalances are we precipitating
by keeping the stress going and keeping the adrenaline going keeping your body revved up
all the time we want to look at obstacles well let me stay with biological factors here real
quick the organic things if we can refer to the physician and we can figure out ways to address
those that give the person one step forward so they’re not feeling as depressed or they’re not
feeling as reactive people with hyperthyroid you know when their thyroid is overactive may have
some anxiety issues or some other mood issues that can be addressed with medication then we
Looking at situationally caused things is the ways we can help them reduce their chronic stress
sometimes there are some easy right-now sort of solutions other times but chronic stress comes
from issues that are so long-standing it’s going to take a while it’s not that we can’t do it but
it’s going to be a process so we move on and we say okay addiction we know that when people use
stimulants rev them up and then they crash and it makes them more than emotional yo-yo caused
by the substances or the addictive behaviors also makes them more vulnerable to emotional
reactivity sleep deprivation is all kinds of hormones out of whack and tends to make people more
irritable that’s one almost everybody can look at addressing right now and nutritional problems
if they’re not eating well not eating at all encourage them to see a nutritionist to
make sure they’re getting something balanced that they will adhere to not something that
they look at and go yeah that looks great but no way I’m eating nuts skill factors what can we help
they with we can identify cognitive responses that are obstacles which as I can’t do that
I won’t do that resistance in some way my response to that obstacle is set to look at it and weigh
the positives and the negatives do a decisional balance exercise to address the cognitive
responses and figure out why is the dysfunctional or unhelpful reaction more rewarding why is it
more rewarding to be angry or scared than to look at doing things and thinking of things that will
help you feel happier what’s the disconnect generally, it comes back to prior failures and fear of
failure because they’ve been down that road before and it’s such a letdown when they’re feeling
good for like three weeks and then they crash behavioral responses that are obstacles to
changing emotions if somebody lashes out when they get upset they lash out and throw things
and then they feel guilty so this behavioral response may lead to having more difficulty
changing emotions because we’ve got to help them figure out how to pause before the behavioral
the response so they don’t compound the situation with more negative emotions and environmental factors
people places and things being in environments where you’re surrounded by people who either agon
negativity or who bring out you know they’re there with you they’re talking about conspiracy theories
they’re just negative about everything or they’re critical of you or remind you of situations where
you’ve been criticized before so first, we want to help people identify and label emotions a lot
of our clients are relatively Alex Simon you know they have a small repertoire if any of
noting their emotions they just generally go from situation to reaction and label what they
felt is kind of a mystery so we want to help them and doing it retrospectively is fine at first
because that’s probably all you’re going to be able to get the event profiting the emotion what
were your thoughts your physical sensations and your urges help me describe this in enough detail
that if we were going to give it to an actor or an actress they could recreate the situation what
expressive behaviors were associated with that emotion you know did you cry did you throw
things did you hit the wall what were your interpretations of that event at the moment not
retrospectively but at the moment what were your interpretations of what was going on
what history before the event increases your vulnerability to emotional dysregulation lots
of big words what happened before that that already stressed you out or had you on edge
and you know we go through a whole bunch of different things and this is you know behavior
chaining we’re looking at kind of what led up to the event what made you more vulnerable and what
were you feeling at that time and then what were the after-effects of the emotion or the reaction
on your other types of functioning so after this event and you went into freefall and you got angry
and you lashed out and you screamed and you threw things how did that affect your work how did that
affect your relationships with your family how did that affect your mood and just generally your
sense of being in yourself for the rest of the day changing unwanted emotions okay so we started
labeling them we figure out what we’re feeling we figure out that yeah when we feel that way
we act in ways that you know make us feel worse afterward what do we do about it let’s change
All alright we already talked about the obstacles and we’re trying to address those but in a moment
check for facts ask yourself what are the facts for and against your belief if you believe that
someone did something to be antagonistic towards you okay what was their motivation what is the
facts for and against that also ask yourself is this emotional or factual reasoning am I making
a decision based on how I felt I felt attacked therefore I must have been being attacked or
facts you know I felt attacked yes but that was because this person said ABCDE and all of those
were very attacking and I felt like I needed to defend myself so those are to check the facts sort
of steps or you can go with problem-solving so let’s change the situation that’s called cause
any unpleasant emotion like I said with spiders at the moment you may not have enough information
to not feel scared but maybe your spouse loves hiking and camping and you want to go but
you’re afraid of those aren’t spiders so how can you change the situation so spiders don’t
trigger that same reaction increase knowledge increase exposure there are a lot of different
ways but problem-solving says ok what can I do so my reaction my correct reaction is not one of
threat or anger but it is one of at least mild acceptance prevent vulnerabilities which helps
reduce reactivity if you are a hundred percent you know you get up and you’re like this is going
to be a good day to day things that come your way are probably going to roll more like water off a
duck’s back then smack you upside the face like a mud pie so we want to prevent vulnerabilities from the turn
down the stress response because when you’re not when you’re not up here already then you know
you can fluctuate a little bit more and they help the person be aware of and able to learn and
remember positive experiences so if you turn down that vulnerability and somebody’s in a good place
or a better place than they were at least they’re going to be able to notice and we’re going to
want to encourage them to notice the positive experiences you know instead of thinking that all
people are threatening all people are going to hurt me all people are going to leave they might
notice that you know there’s Sally over here who’s worked here for 15 years with me and you know
she’s there she sometimes calls in sick but then she comes back she’s generally in a good mood
you know she’s not such a bad person and you start noticing some of the things that are
not self-fulfilling processes building mastery through activities that build self-efficacy
self-control and competence smuggle we don’t want to say you don’t want to set a goal
where somebody needs to go an entire week without having an emotionally reactive response let’s
say go for hours or maybe even a whole day that would be wonderful but first, we’ve got to talk
about how to reduce those vulnerabilities so we set the person up for success what things can you
do and well and we’re going to get down here in a minute what can you do if you wake up and you’re
feeling vulnerable you know the creepy crowds are going around they cancel school
for the entire week for school the county school system kids are off for an entire week
because of illness right now but you wake up in the morning and you’ve got a fever and a sore
the throat you’re like I don’t want to go to work and get out of bed today what can you do
to prevent being grumpy and overly reactive throughout the day’s mental rehearsal and this can
go for if you’re getting ready to do something scary or threatening seeing yourself do that and
do it successfully and this can even be during the day just envisioning yourself getting up and eating
your breakfast driving to work going through your day seeing that one person at the office that
always has some sort of snarky comment to say or whatever irritates you laughing at it or dealing
with it just fine going through everything in your day as you would like to see it happen envision it
see see what you can do rehearse it rehearse how to handle negativity you know if you know you’re
going to have to go in for your annual evaluation with your boss okay so mentally rehearse how it’s
going to go how are you going to react what’s going to happen so you’re prepared for it you have
your responses and it takes some of the unknown out of the situation physical body mind care pain
and illness treatment and the acronym for this is please I changed one of them to laughter
it used to be physical illness and that was both PNL but I like laughter anyway we’ll get there
when you’re in pain or when you’re sick you’re vulnerable to being a little bit cranky you know
that’s just because your body is already saying you are weak you know back in the day when you had to
defend yourself against predators the sick ones and the ones that were in pain were the ones
that usually got taken out first as a part of our brain that still remembers that for whatever
the reason so when we’re in pain or when we’re sick our body keeps that cortisol keeps our cortisol
levels higher and the stress response a little bit higher so we want to deal with those things but
know if we wake up and we’re in that situation moment that was a little bit more vulnerable
so we need to handle it with care and laughter you can’t be miserable and happy at the same time laughter
releases endorphins laughter helps people feel a little bit better and find something to laugh at
and have on my phone I keep comedy skits every once in a while I’ll just pop one in even if
I’m not having a bad day pop it in because I like to laugh eat two-sport mental and physical
health avoid addictive or mood-altering drugs or behaviors that are going to put you on that
the up-and-down roller coaster that goes up and it goes even further down than you were when you
started to get adequate quality sleep and exercise also helps increase serotonin and release
endorphins which help people be in a better mood mindfulness is a judgemental observation and
description of the current emotions we’re not going to go deep into this right now
another class on mindfulness and you can also google it remembering that primary emotions
are often adaptive and appropriate I know I said that like six times much emotional distress
is a result of your secondary responses shame over having it I shouldn’t feel this way anxiety
about being wrong you know maybe this is the wrong way to respond or you know what if
I’m wrong about this or rage doing due to feeling judged for feeling that way I feel this way
and you’re telling me I shouldn’t how dare you so mindfulness is kind of an exposure technique
because it helps people identify that yes I feel that way but it helps them learn to step back and
figure out how to not judge that and just go okay I feel that way better or worse whatever that’s how I
feel exposure to intense emotions without negative consequences that non-judgmental acceptance just
going all right is what extinguishes the secondary emotional responses of feeling guilty
about it or feeling ashamed or angry at yourself for being angry so think of it this way if you
can’t see this one’s the best Bruce Lee picture I could come up with scenario one is an unpleasant
experience the person has an unpleasant emotion and then feels guilt shame or anger for feeling that
an emotion so instead of having to deal with one emotion one-on-one now you’re having to fight for
different unpleasant emotions and you start acting to try to stop the avalanche of negativity in the
absence of adequate skills now Bruce Lee he was able to take out four or five at a time but most
of us you know we would be beaten because all of these adversaries would be coming at us and
we would be building on them in scenario two and this is where we want people to get they have an
unpleasant experience which is part of life they identify unpleasant emotions again part of
life is sucky but part but they can deal with one emotion they’re like okay I’m
angry what do I do about it instead of I’m angry what do I do about it and I’m guilty and you
see how you know she’s got this she can take that one emotion so what we’re helping people do is
uncomplicated this regulation is common to many disorders people with dysregulated emotions
have a stronger and longer-lasting response to stimuli yes they’re already kind of stressed
out they’re already hyper-vigilant if you want to say they’re already wound up a little bit and
then something happens and it amps for months now we have a scale of 1 to 5 if they’re already on
a 4 and it amps them up 2 points they’ve fallen off the scale they’re in freefall so we need to
understand that what we perceive as an excessive emotional reaction they may not have been starting
from the same place that we were, we’re starting from a 1 if they’re starting from a 4 you know
then their reaction to the same thing you seemed pretty reasonable emotional dysregulation is often
punished or invalidated and increases hopelessness and isolation emotional regulation means we help
people use mindfulness to be aware of and reduce their vulnerabilities so we help them take it so
they’re not at a 4 there may be a 2 you know they’re in therapy for a reason we’re going to
help them work on the other stuff and get them down to a 1 but right now let’s help them figure
out ways, they can take down their stress response take down their just underlying anxiety, and stuff
identify the function and reinforcers for current emotions when they happen was understand where
they came from because they’re functional do that chaining worksheet check for facts ok now that
I know how I feel I know what my reactions are I know what my thoughts are I know what my urges
are let’s check the facts in the situation for and against that forces people to kind of step
back which lets the urge sail out some and then problem-solves what can I do right now to improve
the situation and what can I do in the future so I don’t necessarily experience this exact
the same situation again how can I break that mold okay so emotion regulation doesn’t provide us
with a whole lot of distress tolerance skills, emotion regulation is really about preventing
vulnerabilities and helping people figure out okay here’s where I’m at how do I pause so then
I can choose from my disgust distress tolerance problem-solving or interpersonal effectiveness
skills but it’s a big step how awesome would it be if you could eliminate some of your
vulnerabilities and think about it just for a minute or two what vulnerabilities you’ve
got going on in you right now and how many of those you know could you potentially over
the next week or two kinds of address sleeping and eating maybe you have 16 things going on
and you could pare it down to eight there are a lot of different things that you might
be able to kind of pull out of the rabbit hat if you will and what kind of a difference
would it make if you’re talking to your staff and looked around at your organizational environment
what vulnerabilities are there environmental vulnerabilities physical vulnerabilities my best
friend’s working somewhere right now where pretty much everybody is required to work doubles because
they are so short-staffed they’re going to start getting vulnerable pretty soon so look around
what can you do to moderate that so they can model effective emotional regulation but they
can also not be emotionally dysregulated by a client who has emotional dysregulation issues all
right so that concludes our discussion today if you have any questions I would love to hear them
if you want to discuss that’s awesome if you want to get on to your next client you know I totally
understand that I want to wish everybody a happy Valentine’s Day for me I don’t particularly pay
a lot of attention to Valentine’s Day but it is the eve before half-price chocolates
and that is my kind of my kind a day you you you you if you enjoyed this podcast please like and
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As found on YouTubeHi, My name is James Gordon 👻🗯 I’m going to share with you the system I used to permanently cure the depression that I struggled with for over 20 years. My approach is going to teach you how to get to the root of your struggle with depression, with NO drugs and NO expensive and endless therapy sessions. If you’re ready to get on the path to finally overcome your depression, I invite you to keep reading…
(light upbeat music) – [Narrator] Hello,
Psych2Goers and welcome back. All right, so how do you know it’s a disorder and not a trait? Who wouldn’t be a bit awkward when walking into a
room full of strangers? Shyness is a trait. It’s the initial awkwardness that precedes forced small talk. The mere dislike of the spotlight, but it’s not distressing. Social anxiety, on the other hand, is the pervasive, intense fear of being judged, humiliated, rejected, or embarrassed in a social setting that leads to anxiety or avoidance. Although shyness and social anxiety share similar physical symptomatology, some traits differentiate them.
And please remember this video is meant to be informative and should not be used as a rubric for self-diagnosis. If you have any personal questions or concerns regarding this topic, please consult a licensed professional. With that said, here are seven signs
that you’re not just shy. Number one, avoiding or
escaping very public settings. When you find yourself
in new surroundings, do you open up after a while or stick to a familiar group of people? Or maybe a bathroom nearby or leaving early seems
like a better sanctuary? Although a shy person
may feel uncomfortable at a party where they don’t know anyone, someone with social anxiety will avoid public settings altogether.
This symptom can devolve into agoraphobia. Public situations such as dining out at a restaurant, dating, or returning an item to a store can be harrowing for someone with an anxiety disorder, where there are opportunities for rejection or embarrassment. If avoidance is not possible, those who have social anxiety may try to escape the whole situation by using extreme avoidance and escapist tactics or safety behaviors. The problem with safety behaviors is that they provide the illusion of surviving the event. However, you still feel guilty for not controlling your anxiety. Number two is feeling very
self-conscious in front of others. Do public settings make
you feel uncomfortable? Does it feel as though people are watching and judging you? You might not even have
everyone’s attention, yet you still have an inexplicable fear that at some point something will happen and everyone will start judging you. To someone who doesn’t
suffer from social anxiety, this might sound illogical, but that’s the thing.
Social anxieties sometimes
don’t have logic. They can arise at the most random moment and make you suddenly feel as though the spotlight has fallen on you. Some physical symptoms involve sweating, heart palpitations,
and panic attacks. Number three is fear of physical symptoms that may cause you embarrassment. Can you feel a certain
set of physical symptoms kicking in as soon as you step out? Do you constantly cool your burning cheeks with the back of your hands? One way social anxiety can pass shyness is through physical cues. Both have physiological similarities such as blushing, sweating,
rigid posture, and trembling.
However, for someone with social anxiety, their bodily response
can make them anxious. These physical symptoms add to the workload of
stepping out into society. You constantly worry about how others might judge you for displaying these outward symptoms. Even having your mind go
blank for a few seconds can make you feel like you left a poor impression. Number four, fear that others will notice that you look anxious. Are you quick to avert your
eyes after a quick greeting? Are you more comfortable looking around while interacting with others? While shyness can be the
initial driving force, it wears off with time to the point that you become comfortable holding steady eye contact. On the contrary, social anxiety does not wear away after the first
few moments of interaction. As you feel its presence, all the while you are reluctant to engage in open interaction. Since your social anxiety is a tangible experience for you, you fear that it’s also noticeable for those around you. Thus, producing more anxiety. Number five, having
anxiety in anticipation of a feared activity or event.
Is the mirror your trustee audience months before a public event? Before a big event, like a presentation, it’s normal to feel a bit anxious. If it’s shyness holding you back, it can diminish over a while. However, if you
experienced social anxiety, you might think for months about all the things that could go wrong. In some cases, these thoughts can accumulate in your mind and lead you to avoid
the event or situation. This behavior can be particularly damaging if it’s school or work-related.
Having an honest support system can help alleviate the
worst of the jitters. Number six, a past
negative social experience. Is there a rigid memory of things going awry in a social setting? When you first experience a setback at a social event, it tends to take root in you in the form of dread. However, if it was just shyness, the next time you encounter such a setting and come out unscathed, some of that dread chips away. But when you’re socially anxious, no amount of chipping away is sufficient. You are always expecting the worst possible consequences. You lose interest in even working on basic social skills. Although the definitive cause for social anxiety is unknown, researchers believe that
underdeveloped social skills can lead to social anxiety. Being teased or bullied for being socially awkward can lead you to fear
further social interactions and exacerbate social anxiety. And number seven, spending time after a social situation analyzing your performance and identifying flaws
in your interactions. Do you mull over conversations
way into the night? Are you constantly thinking up how you should have responded long after the topic is over? Sometimes we revisit past moments to learn from them and become better.
But obsessing over a past detail usually ends with insecurities creeping out from the corners of your mind to make you feel inferior. However, for someone with social anxiety, obsessing over a small detail does not feel like a choice. Social anxiety is about seeing yourself through the lens of someone else. Hence, you might be prone to dwelling on and analyzing past interactions, especially conversations. The trigger is in the part of the conversation that you keep replaying. Only when you figure out a better response can you let it go. Letting go is a difficult step and it might take some time to learn. Everyone experiences
anxiety to varying degrees. Hence, professional advice tailored to meet individual needs is essential to ensure positive results. Your apprehensions are by no means a reason for you to
swear off from society. By seeking appropriate support and help, you can soon view the outside world as your conquered battlefield. Have you ever had the two mixed? What has helped you cope
with social anxiety? Feel free to leave a comment down below with your thoughts,
experiences, or suggestions.
If you found this video helpful, be sure to hit the like button and share it with those out there, pondering the two. Don’t forget to subscribe to Psych2Go and hit the notification
bell for more new videos. Thanks for watching.
As found on YouTubeShow me the simple steps to overcome shyness & cure social anxiety ➫ The Shyness and Social Anxiety System was created by Sean Cooper, a former social anxiety sufferer. Learn how to overcome your quietness, erase your insecurities and be confident around people using proven psychology.
Hello, welcome, back to Mind Matter with Dr.
Ogochukwu Ojiaku. Last time we discussed Prejudice, and discrimination
around mental illness, and how we can fight stigma and support individuals with mental
illness. If you have not watched the last video already,
please endeavor to do so, in other to stay up to date. Today we will be discussing anxiety disorders. This is going to have multiple series. Anxiety disorders are among the most common
of all psychiatric illnesses. It is a mental health diagnosis that is characterized
by feelings of worry, apprehension, and intense fear that are strong enough to interrupt one’s
daily activities. I wanted to discuss anxiety today because
many people are unaware that anxiety can be a mental health disorder that requires
professional intervention. Of course, Anxiety is a normal human emotion. However, there are different levels of anxiety
disorders there is; Mild, moderate, and severe levels, and then there is panic disorder.
Mild and moderate levels of anxiety are
normal levels actually, these two can be motivational (For instance, if you have an upcoming exam,
this is the type of anxiety that motivates one to study harder to be successful
on the exam), (In the mild level of anxiety: vital signs are normal, however, there are often
increased awareness of one’s surroundings; in the moderate level of anxiety, there is
mild increase in heart rate, a moderate increase in muscle tone, a subjective feeling of worry,
or apprehension and narrowed perception); then we have the severe level of anxiety and Panic
disorder these two levels are considered pathological, which means they are abnormal. The severe level of anxiety causes the pupils
to dilate, diaphoresis, increased muscle rigidity, causes urinary frequency, diarrhea, and sweating
profusely. Panic disorder on the other hand causes
significantly increased symptoms. However, today, we’ll be focusing on the
mild, moderate, and severe levels of anxiety. In our future series, we will address the
different types of anxiety which will include panic disorder. Anxiety is considered pathological
• When it is disproportionate to events, • When it is sustained over a long period
of time • When it impairs one’s function
• And when it is unrelated to any identifiable event or situation in a person’s
life.
This type of anxiety interferes with perceptions,
memory, judgment, and motor responses, so they require professional treatment and therapeutic
intervention. Initially, anxiety present as several physical
illness states. People experiencing anxiety may complain of,
chest pain, heart palpitation, sweating, and even feel as if they’re about to have a heart
attack. Of course, we want to make sure that the Individual
gets proper work up, to rule out cardiac-related issues or other possible causes of their symptoms.
Often, anxiety is diagnosed or correctly
identified after unnecessary assessment and diagnostic evaluation, this is due to the
high level of somatic symptoms of anxiety disorder. Research has shown that untreated high levels
of anxiety predispose people to other serious health problems; therefore, with that said,
the first step to seeking treatment is to talk to your medical provider to make sure
that your symptoms are not due to other physical problems. Of course, If anxiety is diagnosed, a mental
health professional can work with you to design the best treatment plan for you. Sadly, many people with anxiety disorder do
not seek treatment, because they are unaware that anxiety is treatable.
As stated earlier, anxiety is among the most common psychiatric illnesses, it is distinguished
by the degree of anxiety experienced by the client, the duration of the anxiety, the severity
of the anxiety and the behavioral manifestation seen in the client experiencing the anxiety.
It is important very important to know that
Anxiety ranges from acute state to chronic disorders and they are often associated with
physical symptoms such as chest pain, chest tightness, weakness, and shortness of breath)
In the future, we will explore the different types of anxieties that exist, which will
include: panic disorder • Agoraphobia • Specific Phobia • Social Anxiety • and Generalized
Anxiety Disorder
If you or someone you know is experiencing a medical or mental health emergency, please
call 911, you can also call the crisis line number (866-903-3787) or go to the nearest
emergency room for treatment.
Our email address is located in the description
please feel free to send us your general questions. We will randomly select questions to be addressed
in our future videos. Please like, comment, subscribe, and share
this video with your friends and families. Thank you for watching. I am Dr. Ogochukwu Ojiaku. Thank you.
.
As found on YouTubeShow me the simple steps to overcome shyness & cure social anxiety ➫ The Shyness and Social Anxiety System was created by Sean Cooper, a former social anxiety sufferer. Learn how to overcome your quietness, erase your insecurities and be confident around people using proven psychology.
Number four, you are
generally more sensitive to social cues. Are you very sensitive to how you come across to other people? Do you find yourself often uncomfortable with your social environment? Perhaps you find it challenging to eat in front of other people, or tend to avoid speaking in public because of an overwhelming fear that people will judge you negatively. According to Dr. John,
if your answers are yes to the above questions, it’s more likely that you
have anxiety rather than ADHD. This is because people
with ADHD usually struggle with understanding or missing social cues rather than being hypersensitive to them. Number five, you experience
a racing heart, clamminess, tense muscles, headaches,
nausea, or dizziness. Do you often experience
headaches, nausea, or dizziness? These are just some of
the symptoms of anxiety. Dr. John stated that anxiety comes from a tiny almond-shaped part at the back of your brain
called the amygdala.
As a watchman for your brain, it is constantly watching out for danger. And whenever it detects danger, it triggers a fight or flight response. However, for anxious people, the amygdala is large and hypersensitive. Because of this, it ends up sending out
a lot of false alarms. You can think of it as a watchman
who cries wolf too often. As a result, your brain may sense threats even in non-threatening situations. And number six, you are unlikely
to show problem behaviors when you’re feeling calm, safe,
and doing things you enjoy.
How do you act when you’re having fun? Whether it’s listening
to your favorite music or playing video games, you
may find yourself feeling calm and safe while doing the things
that you genuinely enjoy. You are neither restless nor feel like you need
to catch your breath. According to Dr. John, anxious
individuals are unlikely to display any problem behaviors
when feeling calm and safe and doing something they enjoy. On the contrary, people with ADHD will experience problem behaviors even when they engage in a particular fun or exciting activity. For example, a person with ADHD may become so engrossed
with painting a picture that they tune out or completely
ignore everything else. This behavior is known as hyperfocus. Did you relate to any of
the signs we’ve mentioned? Let us know in the comments below. If you found this video helpful, be sure to like, subscribe,
and share this video with those who might benefit from it. And don’t forget to hit
the notification bell icon to get notified whenever
Psych2Go posts a new video. As always, the references and
studies used in this video are added in the description below.
Thanks so much for watching
and see you in our next video. (light music).
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When it comes to friends, quality is greater than quantity, Not everyone.’s idea of fun includes hanging out with a huge group of people or going to a party.
It can be intimidating to be around a lot of people.
You don’t know, And you’d – much rather prefer to spend time with a few close friends.
The beauty of life is that no two experiences are the same, So there’s a friend out there for everyone, Even if you may be socially anxious.
Five, it’s, not all in your head. Social anxiety can manifest as physical sensations for a lot of people.
These symptoms are similar to feeling embarrassed, sweaty, hands, blushing hyperventilating, but can feel more intense and last longer.
Facing social situations can potentially lead to panic attacks for some people, while others feel physically ill or faint.
These physical symptoms may be scary, but they rarely are threatening to one’s immediate health Number.
Six, you feel, like everyone is judging you When you’re socially anxious it can feel like you’re under a magnifying glass all the time.
You feel overly conscious about yourself and project those worries onto other people about their perceptions of you, but just because you’re monitoring every detail about yourself, doesn’t mean everyone else is too In reality.
People aren’t as focused on you, as you think, and they likely have their worries too And number seven.
You are your harshest judge.
When you’re socially anxious, you might find yourself comparing how you think act, or look to others.
This self-criticism can seriously hurt your mental and emotional health and it’s important to treat yourself more kindly While it might feel like others, make connections more easily or have it so. Well, it’s important to remember that everyone is going through their things and they have worries and concerns.
Just like you do.
When it comes to social anxiety, it can be hard to interact with people or make friends when you’re overly worried.
The truth is, though, there is no normal when it comes to being social.
Everyone has their way of socializing with others, And you’ll find someone who you connect with on the same level.
There’s nothing wrong with leaving early or spending another night at home with your dog.
We hope you enjoyed this and found some comfort.
What have your experiences been with social anxiety? Leave a comment down below to share your thoughts.
If you enjoyed our video, please give it a like and subscribe to our channel for more content like this.
Thanks for watching – and we’ll see you at the next one.
Snipes by subscribing
at all CEUs comm slash counselor toolbox, this episode has been brought to you in part by all
CEUs calmly provide 24/7 multimedia continuing education and pre-certification training to
counselors therapists and nurses since 2006 have used coupon code consular toolbox to get
a 20% discount on your order this month.
They’re just designed to make you feel different. But
feeling different isn’t safer at all, because you’re never in
actual danger from feeling anxious. Right? So you’re gonna
have to confront the reality behind that question. But how am
Did I suppose to surrender or accept? Well, look what those
questions mean. So next question is, what exposures can
I do get ready for dot dot dot, pick an event, a wedding, a
concert, a family vacation, something. And so in the end,
this is a simpler answer. You have to remember what exposures
are therefore, people think, or they get confused. And they
think, Well, I’m learning to drive on the highway. Again, I’m
learning to go shopping, I’m learning to stay home alone.
Again, you’re not learning to do anything. The
only thing that you’re learning to do, which is portable across
situations and challenges, and context is learning how to
get better at experiencing anxiety and fear.
So we only do
exposures, do specific things like drive go for a walk or
stay home alone or eat food that you’re afraid of. So that
it will trigger that anxiety, we were intentionally triggering
anxiety, fear, uncomfort, discomfort, uncertainty, all of
those things were intentionally triggering them so that you can
practice feeling them and moving through them in a new way, a
the more productive way that ultimately teaches you that you
don’t have to save yourself from them. So if the exposure is not
to the event, the task, or the place where the food or
whatever the exposure is to the feelings, then every exposure is
an exposure that works for other things.
Right? So if you’re
getting ready to go to, for instance, you’re going to a
concert all you got tickets to a concert, how can I expose myself
to that? I mean, yes, can you do things that sort of mimic a
concert? Yeah, that doesn’t hurt in any way. But remember, you’re
only you’re not afraid of the concert, you’re afraid of how
you will feel at the concert. So if you want to take a cruise
around the world get better at staying home alone for two
hours. That’s what I tell people all the time. If you want to go
back to work, then get better at walking around your block.
Because you’re really in the end, you’re learning a new way
to relate to anxiety across all contexts. And if you can
adopt this, then you don’t have to worry about specific
exposures for every single thing you might have to do in your
life, life gets a lot simpler that way.
And your recovery
starts to become a little wider and more durable. So it’s really
important, like think about that. I’m only doing these
things because they trigger my anxiety, the anxiety, fear,
that’s the exposure, not the task or the place. So let’s move on to the question.
You know, in 10. I know which one I want to take, we’re on
seven right now. This question is what does this method work if
I have trauma too. So first of all, I always have to say this
is not a method like I’m not teaching them. This isn’t the
drew method. It’s not my method. I didn’t invent any
of this. These are just the principles of a cognitive
behavioral approach to anxiety disorders. So there are
parallels between anxiety disorder, recovery, and trauma
resolution, that’s 100% True, a lot of things will look the
same.
If you’re working with a trauma resolution specialist,
some of the things that you would hear would sound a lot
like the things that I talked about, but they’re not
the same. And the issue here is, let’s assume that you do have a
traumatic background and you’ve experienced some traumatic
events in your life. And maybe that that trauma did spawn your
anxiety disorder that can happen. But then what I always
say is that one problem, the trauma has now become two
problems. You have trauma and an anxiety disorder. Right? So you
have to realize that it doesn’t mean that the anxiety disorder
doesn’t count because it’s only the trauma if you had one
problem now you have to That’s okay though, don’t freak out.
You can successfully deal with both of those issues. A lot of
people do, right? A lot of people do that work on both
fronts. But traumatic experiences do not mean that the
anxiety disorder doesn’t count, so some people are under
the assumption that like, well, this all sounds good, but
I have trauma.
So what you’re saying doesn’t apply to me.
Okay, you may have trauma, and I’m very sorry for the things
that you’ve lived through. That’s possible. But in the end,
if you will have learned to be afraid of your heartbeat, or
your breath or you have learned to be afraid of, you
know, depersonalization or jelly legs, and you refuse to go out
of the house, or you are convinced that you have some
sort of health problem, and you will only eat foods as a
result. Maybe some trauma spawned that, but
But knowing about that trauma doesn’t help you become less
afraid of your heartbeat.
Now you’re afraid of multiple
things. So maybe you are having, you know, you’re afraid of the
experience. But now you’re also afraid of yourself. So you
have to do both things. But of them, if two
problems, you can solve them both. So traumatic experience
can be a roadblock 100% to executing the recovery plan that
we’re always talking about here. It’s 100% true if you have
lived experiences that teach you that you are always unsafe, the
world is dangerous, you are weak, you’re not capable, you’re
stupid, and you’re not worthy of being better. trauma can do that
to you. And if you have those beliefs about yourself, because
of your past experiences, that can 100% present a roadblock to
doing the work that I was talking about, have to
acknowledge that and I always will always well never going to
invalidate that.
So in that situation, you’re going to have
to work on that too, right? You’ll have to work on that.
It’s kind of hard. And this is different for everybody, right?
There’s no set answer to this on the other side. So in that
situation, you may find you have to do a little bit of work on
yourself before you can effectively do this recovery
work that I’m talking about.
Some other people find
that their anxiety disorder is so bad, that they’re so wracked
with panic and irrational fear that they can’t do the
trauma work until they put out this fire. So some people have
to do this first and then go back to the past and do that
work. Some people can do it at the same time. It’s individual,
it depends. So there’s no set answer to this. But I can
tell you that you can recover from both trauma and
anxiety.
And the things that I’m writing about which are
geared toward anxiety recovery can be effective while
you do that. It’s just a very individual situation. But please
don’t feel that since you have lived the traumatic background,
you can’t get better. That’s not true. That’s not fair. And I
understand why you might think that but it’s not true. You
can get better. It’s not easy. But there’s hope for you
too, I promise. So last few questions. This is a really
common one I’m accepting, why am I still anxious? So I might
argue that if you are asking why you’re still anxious, then
you’re not accepting. We can’t qualify for our acceptance.
I’m accepting. I’m accepting this, but I also want it gone.
Well, you can’t have both of those things. Think about that
for a second. I know it sounds a little bit glib and a little
silly.
But think about it. There’s truth in there. I’m
accepting this, but I also don’t want to accept it, and I’m not
accepting it. I know you want your anxiety to go away,
but accepting and doing all the things we talked about. It’s not
a recipe for banishing it, right? If that’s why you’re
doing this like you are hoping that if you do the Claire weeks
acceptance or the Dru surrender, or the Josh Fletcher willful
tolerance, if I do this, then it will stop. You’re trying to skip
the part where you have to experience the anxiety and use
it as a classroom.
It’s super important. So if you’re trying
to skip that, and you’re just hoping that okay, I except, wait
a minute, how come it hasn’t gone away? You’re missing the
whole process. And you’re going to wind up disappointed,
frustrated, and do and ask this question I don’t
understand. I’m accepting why isn’t gone away. So
expectations are important. Understanding the concepts of
recovery. Why are you accepting that is that the whole thing? Or is
it just part of it? That’s important, aiming at the right
target is important. So in this situation, I did episode 192 of
the podcast, which is linked in the show notes here, go listen
to that, that will probably help you. And this is related to
question number nine, which is, I’m doing my exposures.
But it’s
not working. This is what you think you’re doing. I’m doing
all the things I’m doing exposures but not working. Why?
And there are a couple of common explanations for this. Number
one would be we’ll ask you a couple of questions. And this is
right at the show notes. Are you trying to do exposures without
being too afraid? Are you trying to do your exposures without
triggering high anxiety or panic? Are you only doing
exposures now and then when you’re forced to or when you’re
having a good day? Are you doing exposures while also using all
of your soothing and coping tools to calm you down if it
gets uncomfortable? These are all red flags as to why exposure
might not be working.
So remember what I said a couple of
questions before the point of exposure are not doing the
task. The point of the exposure is experiencing the fear the
anxiety, the discomfort you want that you need that if you’re
trying to find ways to do your exposure tasks without feeling
that or minimizing it or soothing or calming it or making
it’s easier Don’t do the exposure, there’s no point in it. Because
you’re not, you’re not learning to drive again, you’re learning
how to get better at experiencing anxiety. So this is one of the
main reasons why people will say my exposures aren’t working
well, okay, but you’re not doing exposure, in some
cases, for a common mistake. The other thing would be that you
know, that you’re supposed to experience that experience,
panic, but you are still hanging on to those who escape
behaviors and those rituals.
So some people get close to like
real exposure, I would say real exposure, but most effective
exposure, but they still hang on to like, well, there’s a line
that I just can’t cross with anxiety and panic. And when I
get close to that line, I will break out all of my copings
skills. And I will break out my, safety skills and my make it
go away skills. And that’s the response prevention part. So
we’ve talked about exposure and response prevention, ERP, which
is very commonly used in the OCD community, you hear ERP in that
community all the time, but even for all of the
anxiety disorders. Exposure is always ERP. So doing the things,
you’re doing the things, you’re intentionally triggering this
comfort, and you’re doing that without using your old
responses, your safety responses, and soothing responses, you’re
preventing those responses.
So one of the reasons why
another key reason why exposure might not be working air quotes
for you is first of all, what does working mean? It doesn’t
mean to make it go away. Remember, it means teaching you how to get
better at being anxious. But why do you think it’s not working?
Well, one of the reasons is doing the exposure without doing
the response prevention. I’m out there driving on the highway,
but I’ve got my mints and my cold water and I got my radio
on, I’m calling and I’m talking to my friend or I bring my
husband or my girlfriend with me that that’s one good reason why
it might not be working. Right. So if you go to
anxious truth.com and just search for the word exposure,
you’ll see quite a few podcast episodes where we talked about
this in more detail. And then question 10 Final question for
the day. This is a big one. How do I deal with a setback? So
this is a such question I hear every single day and I the
word setback, I almost want to be stricken from the vocabulary.
Many times when people are in the recovery process, they
feel like they’re doing great because they’re not experiencing
anxiety or panic.
Like they’re feeling good. That’s, that’s
awesome. We want everybody to feel good. I want you to feel
good to write, I want you to have good days. We all want to
have good days. Everybody deserves a good day. So when you
start to string good days together, and you’re feeling
pretty good. And it’s been a while since you had a panic
attack, or it’s been a while since you had those scary
thoughts or it’s been a while since you’ve had an
anxious day and then you have an anxious day or the thoughts come
back or you have a big panic attack one night. A lot of
people will say up, it’s a setback. That’s not a setback.
That’s not a setback, right? If the core principle of
recovery, is to learn that anxiety and panic are not
emergencies, then how is feeling that a setback, it’s no longer
an emergency, you are trying to learn that it’s not an
emergency, we do not declare it a special event.
We don’t
retreat from it. So setback is usually a red flag word and it
indicates that you’re still insisting that the only
successful recovery is one year where you will never feel
anxious or panicky ever again. And if you’re trying to recover
to that degree, where you never you can guarantee that you never
panic or ever have another scary thought in your life.
You’re going to be disappointed and frustrated. So
setback is not feeling things. If you haven’t felt anxious for
two weeks, and then today you feel anxious. Well, your job
today is to move through those feelings and practice being
better at being anxious. That’s not a setback. That’s just life
happening. And that’s an opportunity to get even better.
Like we want it we get to the end of the road to recovery
when we don’t care if we’re anxious or not. And I know that
if you’re in the thick of it right now you are thinking that
is an insane statement.
But that is truly where you are headed
with this. That is when the war is over. So if every time you
experience anxiety, you yell setback and want to know what to do
I do with a setback? You’re kind of missing the point and you’re
not being fair to yourself. Okay, so the only true thing
that I might call setback is setback is also really what
happens when we say up all bets are off and I’m going to return
to my old rituals.
I’m gonna go back to my figuring it out
trying to fight it trying to resist it hiding from it. Going
back to my compulsive. My compulsions, like that, might be
setbacks. Yes, if you start to revert to those old habits, I’ll
call that a setback with you. But how you feel and what you
think is not the setback. But even if you do start to revert
to those old habits as soon as you waive the setback flag and
one piece of advice just remember, oh wait, I have to start doing what I was
doing before. No problem that happens to everybody move
forward again. So if anxiety returns after some time, right
at the show notes here your job is not to wring your hands
and try to figure out why and how to stop it and declare
a disaster.
Your job is to surf through it, move through it
like you presumably did as part of the progress that you said
you had made. So I did do an episode on this early on in 2015
of the podcast, episode 14 talks about the nonlinear nature
of recovery and goes over setbacks. But I know setback is
a thing that we talk about all the time in this community.
Hopefully, this helps. And that is it. Those are our second 10
frequently asked questions about anxiety and anxiety recovery. We
are done with episode 217. If you have not heard to 16 go
ahead and listen, because those are the first 10 questions you
know, we’re done because he told me that music. Anyway, I will
pay you out as usual. Afterglow by Ben Drake, you can
find Ben and his music ed Ben Drake music.com Go check them
out and tell him I said hi, I will ask you a favor. If you’re
listening to the podcast on iTunes on Apple podcasts or
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Please
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subscribe to the channel, and leave a comment. You know the deal. I
appreciate you guys coming by all the time spending time with
me giving me your attention. Hopefully, I’m able to help you.
I’m doing the best I can. I’m hoping it’s working out for you.
I’ll be back next week. We’re gonna do it again. I don’t know
what I’m gonna be talking about. But I will be here. And as
always remember, this is the way Unknown: this is where your
story begins. You got the feeling that you go yeah, you’re
doing fine. Now in the city, you live fast. No looking back on
the past. Never get another chance.
