Anxiety Disorders: Psychiatric Mental Health | @LevelUpRN

Hi, I’m Cathy with Level Up RN. In this video, we will be discussing generalized anxiety disorder,   as well as a few key specific anxiety disorders. At the end of the video, I’m going to give you guys a little quiz to test your knowledge of some of the key points I’ll be covering,   so stay tuned for that. And if you have our Level Up RN Psychiatric Mental Health   Nursing Flashcards, I am just starting in the disorder section of this deck.  Everyone experiences anxiety from time to time and that is a normal thing. However, with generalized anxiety disorder, or GAD, an individual will have persistent and excessive worrying that will cause significant physical and/or psychological symptoms. Females are more likely than males to experience a generalized anxiety disorder, and symptoms include excessive anxiety and worry that lasts for more than six months, as well as symptoms such as fatigue, restlessness,   irritability, muscle tension, as well as insomnia. In terms of diagnosis, it’s important to rule out any underlying disorders, such as hyperthyroidism. Treatment can include talk therapy, as well as cognitive behavioral therapy, or CBT. I covered CBT in a previous video in this playlist,   so if you need a review of that therapy then definitely check that out. Medications used in the treatment of generalized anxiety disorder include SSRIs, SSNRIs, as well as benzodiazepines, and atypical anxiolytics such as buspirone. In terms of nursing care, we want to teach our patient how to recognize the signs of escalating anxiety and teach them interventions to help decrease their anxiety, such as deep breathing and exercise.   It should be noted, however, that if a patient is experiencing severe or panic-level anxiety, then problem-solving is not going to be possible and our nursing care should be focused on the patient’s safety as well as their physical needs. Moving on to specific anxiety disorders now. Two specific anxiety disorders that I would be familiar with include social anxiety disorder and agoraphobia. With social anxiety disorder, an individual will experience anxiety related to social situations due to fear of humiliation or rejection.   Agoraphobia translates to fear of the marketplace, and an individual with agoraphobia will experience anxiety related to public transportation, crowds of people, and being outside the home.   Some patients have anxiety that is produced by a specific object or situation. For example,   arachnophobia is the fear of spiders and claustrophobia is the fear of confined spaces.   Treatment of specific anxiety disorders can include behavioral therapy, such as systematic desensitization and anti-anxiety medications, which we covered earlier in this video.  All right, it’s quiz time. Are you guys ready? Question number one. Is generalized anxiety disorder more common in females or males? The answer is females. Question number two. Name one or more drug classes that are used to treat generalized anxiety disorder.   All right, if you said SSRIs, SSNRIs, benzodiazepines, or atypical anxiolytics,   such as buspirone, then you are right. Question number three. What do you call anxiety that is produced by fear of public crowds and being outside the home?   The answer is agoraphobia. All right, that is it for this video. I hope you found it helpful. Take care and good luck with studying.   Two specific anxiety disorders that I would be familiar with.

mR. Mc!, (http://myweb.ecomplanet.com/RALE5393)

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3 HOURS of Worry Management Skills: The Ultimate Generalized Anxiety Disorder Guide | Dr. Rami Nader

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

mR. Mc!, (http://myweb.ecomplanet.com/RALE5393)

ᵃⁿⁱᵐᵃᵗⁱᵒⁿ ˢᵗᵘᵈⁱᵒ ᴏɴᴇ-ᴛɪᴍᴇ ꜱᴘᴇᴄɪᴀʟ ᴜᴘɢʀᴀᴅᴇ ᴅᴇᴀʟ – ᴍᴀʏ ᴇxᴘɪʀᴇ ᴏɴᴄᴇ ʏᴏᴜ ʟᴇᴀᴠᴇ ᴛʜɪꜱ ᴘᴀɢᴇ. ꜱᴋɪᴘ ᴛʜɪꜱ ᴅᴇᴀʟ ᴀᴛ ʏᴏᴜʀ ᴏᴡɴ ʀɪꜱᴋ ᴀꜱ ᴛʜᴇ ᴘʀɪᴄᴇ ᴍᴀʏ ᴅᴏᴜʙʟᴇ ᴡɪᴛʜᴏᴜᴛ ɴᴏᴛɪᴄᴇ! Animation Studio is a must-have for anyone serious about selling or promoting anything online with video! Damon Nelson. Wow, Paul & Todd, this is a competition killer. “Animation Studio The Animation Creator That You Have Been Waiting For Has Finally Arrived… …..” Pythagorean Betting System ꆛシ➫ The Pythagorean Betting System is my ultimate way to find out which team is undervalued and overvalued in all the major professional leagues, including NBA, MLB, NFL, and NHL. 8 months later, the user says: “The Pythagorean Betting System is … 18:07 The latest testimonial from Anders in Norway. He says: “The Pythagorean Betting System is amazing!… Every day you’re not inside, you’re losing money! God bless you Champ. It’s been an amazing ride!”

The 5 Major Anxiety Disorders

When it comes to anxiety disorders, there is no ‘one type’. Each form of anxiety has its own set of symptoms and treatments It is important to remember that, while some symptoms will overlap. No two anxiety disorders are alike This list aims to bring attention to the five major anxiety disorders, and what they mean for the sufferers We at psych2go hope to bring awareness to the growing number of anxiety sufferers and their needs So, without further ado, here’s five anxiety disorders as well as their symptoms and treatments Number one: obsessive compulsive disorder or OCD Obsessive compulsive disorder technically has two components: the obsessions and the compulsions Obsessions can encompass anything from a severe fear of germs to the placement of things around the home and many things in between The compulsions are what the sufferer does to rid themselves of those obsessive thoughts Someone who has obsessions about germs may ritually wash their hands or carry hand sanitizer everywhere they go Someone who has obsessive thoughts about the placement of objects might arrange and rearrange their belongings until they feel just right These obsessions and compulsions can become very intruisive and disrupted to the sufferers daily life As far as treatments for OCD go, there are a couple: There are selective serotonin reuptake inhibitors such as fluoxetine sertraline These medications are meant to help alleviate the symptoms for the sufferer so that they are at a manageable and less destructive level The other widely used treatment is psychotherapy With this, you might run into cognitive behavioral therapy that will be used to help the sufferer essentially reprogram their response to obsessions and compulsions For the most part, medications and therapies are used in tandem to get the best results Number two: generalized anxiety disorder Generalized anxiety disorder or GED is a bit unlike the other anxiety disorders on this list Those who suffer from GED aren’t always able to give a reason for their symptoms In fact, one of the symptoms is a general feel of restlessness or an ease They may also experience worry as one of the symptoms Everyone worries from time to time, but GED causes the sufferer to eternalize those worries and take them to an entirely new level They may think of them in an obsessive manner which will cause a downward spiral of other symptoms such as a disturbance in sleep patterns The treatments available for GED are similar to those of OCD Medications and therapy. In this case, the medications may be benzodiazepines and antidepressants rather than the run-of-the-mill SSRIs Cognitive behavioral therapy is used with GED as well as relaxation techniques and mindfulness Number three: social anxiety disorder Those with social anxiety disorder experienced panic attacks related to social situations This can manifest in a fear of public speaking or stage fright and can be so severe that they avoid going into public altogether Social anxiety can also have symptoms of severe self-consciousness and a general fear of being around others Someone with social anxiety might find it hard to speak when other people are present even if they aren’t addressing the crowd as whole Social anxiety is mainly treated with SSRIs and therapy As we stated before, just because a treatment option looks similar from one anxiety to another it isn’t going to be the same Each sufferer presents their own needs that must be taken into account. Each therapy isn’t going to work the same for each individual Personalization of treatment is key in these situations Number four: panic disorder Unlike the other anxiety disorders on this list, panic disorder rests solely on panic attacks With many other anxiety disorders, panic attacks are just another symptom when it comes to panic disorder those attacks are the symptom Panic disorder is characterized by recurrent panic attacks The sufferer may experience heart palpitations, erasing pulse an intense fear and the feeling that they are hopelessly out of control There isn’t a rhyme or reason to many of these attacks, so the sufferer is essentially lying in wait for the next one to come Panic disorder can be treated in many ways The medications used are some that we’ve heard of such as benzodiazepines and SSRIs We are also introduced to serotonin norepinephrine reuptake inhibitors or SNRIs and beta blockers These medications, as with OCD, are often used in conjunction with therapy to help maximize the usefulness of each Number 5: post-traumatic stress disorder Post-traumatic stress disorder or PTSD can be diagnosed in anyone For the most part you have probably heard it, when someone speaks about veterans or police officers While those careers have a higher rate of PTSD, it is in fact true that anyone can be diagnosed with it PTSD is the result of a very traumatic event or series of events This leaves the sufferer with flashbacks and night terrors where they feel as if they are right back in the event again The sufferer may also suffer from panic attacks as well as phobias associated with people places or even sounds Medications such as fluoxetine venlafaxine may be used in the treatment of PTSD Therapies such as prolonged exposure, cognitive processing therapy, and brief eclectic psychotherapy may be utilized as well Again, this is a situation where the use of medications and therapy together can help give a better outcome than just one alone It is important to note that those with PTSD can lash out in certain situations But there is no need to be afraid of the sufferers There is nothing inherently dangerous about them In fact those with mental illness are exponentially more likely to be the victims of violent crimes than they are to be the perpetrator This is not a complete list of the different anxiety disorders out there by any means, nor is it completely comprehensive in each description There are many kinds of anxiety, these just happen to be the most talked about and diagnosed at this particular moment Regardless of which anxiety disorder the diagnosis is for, it is important to remember that the sufferer is in need of help and acceptance You don’t have to understand anxiety to be able to offer an ear to talk to, or some words to keep them grounded in the moment Remind the sufferer that they are alright, that what they are feeling are just symptoms of their anxiety and that it will pass if given the time Aside from that, just make sure that they know you are there with them and wait it out Do you suffer from one or more of the disorders listed? Share your story in the comments below On a different note, psych2go is now selling t-shirts. Links will be in the description below. As always, don’t forget to subscribe, and thanks for watching.
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Anxiety Disorders in the DSM 5 TR | Symptoms and Diagnosis

Hey there, everybody, and welcome to this presentation on diagnosing anxiety and panic in the DSM 5tr. I’m your host Dr. Donnelly Snipes in this presentation. Very briefly, we’re going to review the diagnostic criteria for anxiety disorders or at least most of them in the DSM 5 tr. So let’s talk a little bit about anxiety disorders in general, when we’re talking about anxiety disorders, we need to remember that fear and anxiety may be expressed as fighting agitation, tantrums fleeing freezing fawning clinging, or withdrawal, or what I call the final f, Which is um politely forget about it, because people, just don’t have any more energy left, so they kind of withdraw anxiety. Disorders differ from each other regarding the types of objects or situations that cause fear, anxiety, or avoidance behaviors and the associated beliefs. Anxiety disorders represent a response that is not developmentally culturally or, I also add, contextually normative in terms of intensity or duration. So when we’re looking at what somebody is anxious about, we want to examine, obviously culture and development, something that a five-year-old is afraid of is not necessarily going to be the same thing that a 25-year-old is afraid of. We also want to look at context, though, something that uh, you’re, afraid of in one context, you may not be afraid of in another like for children being around strangers may not be stressful for them when they are at home or when they’re. At school, somebody comes in to do a presentation versus when they are alone and they don’t have a caregiver around. Interestingly, from August 2020, through December 2020, the percentage of adults reporting symptoms of an anxiety disorder rose from 31 4 to 36 9. Now, when you go through the DSM and you start adding up the prevalence of these anxiety disorders, it is really hard to get to a number anywhere close to 36 9. So the numbers in the DSM and the numbers in the uh national health survey, don’t seem to jive very well. We also have to remember that during 2020 we were at the beginning of the pandemic, so there was more anxiety. You would expect that, but even the 31 percent that it was before 2020 seems to be higher than what is identified in the DSM. So I think that’s interesting the anxiety chapter in the DSM 5tr, just like in the DSM 5, is arranged in order of diagnosis which appears in children first, so separation, anxiety, and disorder appear first, and generalized anxiety. The disorder is down a little way, whereas you might expect some of the quote more common disorders to be first, but that’s not how the DSM is arranged. However, in this presentation, I did put generalized anxiety first, when we talk about generalized anxiety, we’re talking about excessive anxiety most days for six or more months, and the anxiety is about a variety of things. It’s not just about one particular thing like health or an individual or a phobia. It is about a variety of things. The worry, in addition to being excessive for the person’s developmental age, culture, and context. The worry is difficult to control the anxiety or the feeling of anxiety is associated with three or more symptoms in adults or one or more symptoms in children, feeling restless or feeling keyed up or on edge, easily fatigued difficulty concentrating, or mind going blank, irritability muscle, tension Or sleep disturbance, I want you to think about it. Anxiety is part of the fight or flight response, so we would expect somebody to experience anxiety. Would it be experiencing symptoms of hpa, axis activation, or activation of the threat, threat, response, or stress response? Whatever you want to call it, so we would expect all of these symptoms or any of these symptoms. When the fight or flight system is engaged, the body is not focused on higher order, processing, memory, or concentration it’s focused on self-preservation protection the person becomes more vigilant because they are trying to protect themselves from threats. They’re not able to relax enough to get good quality sleep because guess what they are keyed up. They’re scanning for those threats, muscle tension and I’ve mentioned in other videos. When I used to play tennis, my coach always used to say don’t stand flat-footed on the baseline, because it takes more time and it’s harder for you to run and spring into action to where that ball is going to be. Now. That is not a threat per se, but the same thing is true for people with anxiety disorders, when you are when you’ve got that muscle tension, it’s kind of like standing on your toes on the baseline. In tennis, you are primed and ready to go and it makes it easier to theoretically fight or flee. These symptoms have to cause clinically significant distress. People can have subclinical anxiety disorder where they have a lot of worry about a variety of things, but it is either not excessive for what they’re worried about, or it doesn’t cause them clinically significant distress. Overall, they report a decent quality of life. It doesn’t interfere with functioning in major areas of their life and generalized anxiety disorder, as well as all of the disorders, are not better explained by a medical, mental, or substance use disorder, and we’re going to talk in the end about differential diagnosis Of the anxiety disorders in general because there’s a lot of overlap between the symptoms, as well as the differential, diagnosis, and comorbidities for anxiety disorders. Remember the difference is often what the person experiences anxiety about and the cognitions associated with the diagnostic features of generalized anxiety disorder. Well, this section, as with most of the sections in the anxiety chapter, pretty much just recapitulated the diagnostic criteria and it elaborated a little bit. One interesting feature is that for generalized anxiety disorder, they noted that adults tend to worry about general life, things like paying bills and getting a promotion, or what’s going to happen with this or that or what’s going on in the world. Kids tend to worry about their competence like performing at school or their ability to be competent in relationships. Sometimes they worry about disaster now, with the coming of the pandemic. We can probably add that too, but other disasters like hurricanes and fires and floods and those sorts of things can prompt a lot of worry in children and punctuality. Interestingly enough, some children become very concerned about being punctual, and so it’s interesting to note that there is a difference in what they worry about, which makes sense, because adults have different responsibilities than kids do, and you notice that, except for disaster, a lot of these worries revolve around the primary life areas or functions of the person. You know: kids, are,  n’t worried about paying bills or or maintaining or parenting, or some of the things that that adults worry about associated symptoms. Well, let me talk about disaster. Quick, I’m trying not to go too far off the rails today, because we’ve got a lot to cover, but it’s important to recognize that children have a difficult time, understanding, the prevalence and likelihood of things. So when there is a disaster such as you know, we’ve had several in middle Tennessee over the past two years and a child watching the news or hearing about the news may not understand how close or far away that disaster was or the likelihood of It recurring adults are better able to understand. You know it’s a 100-year flood or there’s the chance of it happening again. Do you know whatever? The probability is depending on what you’re talking about children don’t understand that they see it on the news it feels like, since it’s on the news, it’s kind of in their house. So it feels like it’s right in their space and it’s hard to know when it’s going to end or when it’s going to happen again, which can prompt them to have a lot more worries about disasters. Parents can help by explaining some of the things to them and explaining to children the probability of another disaster occurring, and you know how they’re safe right now and the steps that they can take. It won’t do everything, but it is important again to recognize children’s different cognitive abilities compared to adults, associated symptoms with generalized anxiety, disorder, and other somatic symptoms that are not as intense as those seen in panic disorder. So we will also see potentially heart racing clammy, skin, rapid breathing other things, and an upset stomach that isn’t specifically indicated in diagnostic criteria, but we know it happens when that fight or flight response is kicked off the prevalence. Remember I said if you start adding up the prevalence of all these anxiety disorders. You’re going to be hard-pressed to get anywhere close to 31 percent and according to the DSM 5 tr between one percent of adolescents and three percent of adults in the? U s experience generalized anxiety disorder according to the National Center on Health Statistics in 2019. Now that was before the pandemic. 15 6 of adults experienced symptoms of generalized anxiety disorder in the prior two weeks. The development, and course the mean onset, is rarely before adolescence, and is I’m? Sorry, the mean onset is 35 and rarely before adolescence. So this is one of the disorders that has a much later onset than other disorders, which I did find to be somewhat interesting. Now we’ll move on to separation. Anxiety, separation. Anxiety is the first disorder in the chapter because it tends to be the one that presents earliest and it can be diagnosed as early as preschool separation. Anxiety is characterized by developmentally inappropriate, excessive, recurrent anxiety about separation from major attachment figures. To be diagnosed, the person has to have three or more symptoms. It can be diagnosed in childhood. It can be diagnosed in adulthood if it’s diagnosed in adulthood. You do not have to have a childhood onset of separation anxiety. It actually can have an adult onset, so that is something to remember: symptoms, three or more distress due to or in anticipation of separation from home or from major attachment figures, anxiety about losing a major attachment figure, or possible harm to them. Anxiety about something bad happening to the person, the patient, which would cause them to be separated from an anxiety from an attachment figure. So they have fears about something happening to the attachment figure, causing separation, and fears about them, something bad happening to themselves, causing separation, a reluctance, a refusal to go out or away from home because of fear of separation. Now, generally, this is leaving home and separating from that attachment figure, but in some cases, it can include even being reluctant to leave the house to be cut with the attachment figure because they’re afraid that when they’re out there, they may get separated. Now think how this might occur if there was a child who happened to be at a carnival and got separated from their caregiver that might prompt future fears of separation when in public places, fear of or reluctance to be alone, or without major attachment figures. Refusal to go to sleep without being near a major attachment figure, nightmares about separation, or physical complaints in reaction to or in anticipation of separation. So they have those physiological symptoms of anxiety now note here they keep talking about major attachment figures because remember this can be diagnosed in adulthood. We’re not talking about the primary attachment from infancy. We’re talking about the person’s current major attachment figure, whether that be their significant other, their parent, or whomever that happens to be the fear, anxiety, or avoidance, is persistent, lasting at least four weeks in children and adolescents, and typically six months or more In adults – and you’ll find that’s a common theme where a lot of these situations or conditions have to last six months or more and be causing clinically significant distress for six months or more to rank a diagnosis. Although the symptoms often develop in childhood, they can be expressed throughout adulthood. It can be diagnosed in adults in the absence of a history of childhood separation, anxiety, or disorder, and, as I said, it causes clinically significant distress or impairment in one or more areas of functioning. The diagnostic features section repeats the diagnostic criteria with some elaboration and examples. It’s a pretty straightforward diagnosis in terms of development and, and course the onset of separation. Anxiety can be any time from preschool through adulthood, but generally before the age of 30. So you can have diagnoses of separation anxiety up through the 20s, there may be periods of exacerbation and remission, although most child onset cases do not experience ongoing, clinically significant impairment. I thought that was kind of an interesting associated feature. Now these are not diagnostic criteria. These are features that are associated with separation anxiety but didn’t rank in the diagnostic criteria, sadness or apathy. Well, if somebody is perpetually anxious that hpa axis is going to down-regulate some which may contribute to apathy, if they are perpetually anxious, they may also start feeling hopeless and hopeless, which is associated with feelings of sadness and depression. They may have difficulty concentrating well. The mind is not focused on concentration. If it’s in a perpetual state of fight or flee, there may be social withdrawal just stepping away from everything, because they don’t have the energy to engage with others. Because the anxiety is so pervasive in older children you may see homesickness or pining when they are away at camp or or something like that. Now. A lot of children who don’t have separation, anxiety, or disorder, experience homesickness when they’re away at camp. For the first time, however, this is also associated with separation, anxiety, the child migs or the person may exhibit anger or aggression towards separators. So anybody who’s causing a separation between the patient and their major attachment figures may provoke anxiety, anger, and perceptual disturbances. Now these are not hallucinations. These are when a person is alone, for example at night, and they feel like somebody’s watching them, or they think they see something moving in the shadows. It’s not there and by turning on the light. So there are no more shadows. You know that goes away. It’s, not a persistent uh hallucination that the person is experiencing, but perceptual disturbances are more common in children than they are in adults, and we want to make sure we don’t mislabel that as something related to a psychotic disorder, children with separation, Anxiety tends to be described as demanding intrusive and in need of constant attention. According to the DSM now, I would argue when we get down a little further that this may be true of all people with separation, and anxiety, adults may appear dependent and are likely to contact their major attachment figures throughout the day and track their whereabouts. They are also often overprotective as parents and pet owners. Interestingly enough, the DSM did mention pets where the person with separation anxiety may be excessively concerned about knowing where their pet is at all times. The prevalence of separation. Anxiety in children is approximately four percent, and in adolescents and adults, it ranges from one to two percent. In the culture section, the DSM talked about the importance of differentiating separation, and anxiety disorder from the high value, some cultural communities place on strong interdependence among family members. Specific phobias is the next in the line of disorders we’re going to talk about and a specific phobia is pretty straightforward. There’s a marked, fear or anxiety about an object or a situation about 75 percent of people that have one phobia have more than one phobia, and I think, if you think about it, even if it doesn’t rise to the level of being a Diagnosable phobia you can think about. If you have one what we’ll call irrational fear, you probably have a couple of others when I started to think about it. I’m, like yeah, i have i have a couple in there. The stimulus almost always produces an immediate fear response and is actively avoided. The fear is disproportionate to the threat that persists for guess what six months or more and causes clinically significant distress – and I have this bold and italicized because it’s important to remember that. Having a fear – and I’ve talked in other videos about my fear of bridges, I also have a fear of enclosed spaces. I hate you know those little water, tubes and tunnels and things that make me feel closed in. Does it cause me clinically significant distress or cause me to have to alter my life to get around it? No, so it doesn’t rise to the level of a specific phobia. A lot of people have fears that may not have a um basis or the fear may be disproportionate to the threat. In reality, we recognize it, but it doesn’t cause us clinically significant distress, so it would not be diagnosable as a specific phobia and the specific phobia is not better explained by another mental disorder and I’m thinking here more obsessive, compulsive disorder. But in the differential diagnosis list on the anxiety disorders, there were a lot, so we’re just going to go through all of those. In the end, the diagnostic features again for specific phobias were pretty much a restatement of the diagnostic criteria-associated features. Interestingly enough, some people are arousal. Well, that makes sense when the HPA axis kicks off. A lot of people have a um increased heart rate, sort of a panic sort of feeling about them, not to the level of a panic attack necessarily, but they have that aroused state in preparation for fight or flee. Other people may have what they call a vasovagal response in which their heart rate decelerates their blood pressure drops, and they may faint my grandmother used to do this. Oh my gosh, and it wasn’t necessarily hers. Wasn’t phobia-related, but when she would get startled she would fall out and for the longest time the doctors, couldn’t figure out exactly what was going on. But ultimately my guess would be. It re had something to do with with anxiety or generalized anxiety. The prevalence of phobias is between eight and twelve percent, it peaks in adolescence at sixteen percent. So sixty percent of adolescents have specific phobias. The development, in course usually develops before age, 10 or after a trauma, and the presence of phobias is a risk factor for neurocognitive disorders in older adults. Why is this? We’ve again, we’ve talked in other videos about how hyperactivation of that stress response system keeps levels of glutamate and norepinephrine and stuff high in the brain which causes neurodegeneration, which can lead to neurocognitive disorders additionally, because of social withdrawal and avoidance and restructuring Of their daily lives, to avoid the phobic stimulus, there tends to be less stimulation for the person with specific phobias, which may also lead to a decline in what they call cognitive reserve and social anxiety disorder in social anxiety disorder. There’s a marked fear of social situations when in which one might be judged. So you’ve got generalized anxiety, which is anxiety about a lot of things over at least six months. We have a specific phobia, which is something specific. Like enclosed spaces or spiders, or snakes, um separation, anxiety, which is anxiety or fear of being separated from an attachment figure, and then social anxiety, which is fear from being in situations in which one might be judged by children. The symptoms have to be present not only in relationships with adults but in relationships with their peers. It’s natural for children to be somewhat anxious if they’re interacting with adults if they’re having the same anxiety when they’re interacting with their peers, then that’s really what we’re going to look for for a trigger The person has an excessive fear of being embarrassed, rejected or offensive, and the offensive seems to be increasing in popularity or not popularity in commonality, um very quickly, with Twitter and Facebook and tick tock, and all these other things and trying to be politically correct. A lot of people have developed a level of social anxiety, maybe not to the level of being a disorder, but, a level of social anxiety, because they fear not saying the right thing because they fear being canceled. Social situations almost always trigger anxiety and social anxiety disorder. Social situations are actively avoided or endured with intense fear, and the level of fear is disproportionate to the potential consequences. People may have a high level of fear and anxiety uh before going out and giving a performance in front of 10,000 people the level of anxiety for that would probably be different than giving a speech in front of six classmates. You know you see the difference here, but a person with social anxiety disorder. They would have that same level of fear in front of six people. They knew as opposed to ten thousand, that they didn’t persist again for six months or more causing clinically significant distress and is not due to another medical, mental, health, or substance-related condition. There is a note that social anxiety disorder can be performance only and you do want to specify that if it only has to do with giving speeches performing sports music, or anything like that, the diagnostic criteria features section, gave further examples of the symptoms that were identified in The diagnostic criteria associated features with social anxiety. The person may be passive or shy. They may want to kind of blend into the wall. They may be somewhat withdrawn because they don’t want to be out there in the limelight. They don’t want to be in this position where they fear being judged. On the other end of the spectrum, though, there’s a proportion of people with a social anxiety disorder who are highly controlling of situations, and they may try to control the conversation and control other people in the situation to avoid feeling out of control. Use of substances, substance, use, misuse or abuse is often associated with people with social anxiety disorder, and I have parenthetically heard liquid courage is what we used to call it back in the day I don’t know if it’s what they still call it but using substances to help temporarily allay anxiety. Interestingly, as alcohol leaves, the body people tend to have an enhanced anxiety response. So using alcohol before a social situation may end up causing more problems for some people, but that’s that’s up to them. Additionally, you may see a worsening of physical illness symptoms such as tachycardia or increased tremor in people with social anxiety disorder, so if they already have something that causes a tremor or a tick that may get worse, if they already have something that causes tachycardia, that may Get worse in situations in which they fear being judged. Now I have here increased pain, a question mark that’s not identified in the DSM 5t. However, we know that hyperactivation of the hpa axis contributes to ultimately development of systemic inflammation and the worsening of autoimmune disorders. So I would be interested to see what the actual numbers are for that and no, I could not find any research that compared the rates of increased pain with social anxiety, specifically prevalence. Seven percent of people in the United States experience social anxiety, disorder now brace yourself. This is not a typo. 2 3 percent of people in Europe can be diagnosed with social anxiety disorder. So what is that? A third? What’s different in the United States? That is contributing to significantly higher rates of social anxiety fear of being judged and fear of offending people. Just saying additionally, social anxiety disorder does tend to be highest in non-Hispanic whites. So what is unique about nonhispanic? Whites in us I’ll leave you to talk about that and panic disorder, people with panic, disorder, experience, recurrent unexpected surges of intense fear or discomfort that peak within minutes and has a and accompanying four-plus symptoms. Now I have bolded and italicized unexpected here there are expected panic attacks when you’re in a situation in which you’ve had a panic attack before when there is a known trigger for the panic attack that’s an expected panic attack that doesn’t count towards our diagnosis here, which I don’t know seems a little strange, but okay, the panic attacks have to be unexpected. That is, they come from out of the clear blue and the panic attacks need to be characterized by four or more of the following symptoms palpitations, which is when it feels like your heart, is like fluttering, pounding, heart or tachycardia, which is racing heart, sweating, trembling or Shaking a feeling of shortness of breath or smothering you just can’t don’t feel like you can breathe, feeling like you’re, choking chest pain or discomfort, nausea or abdominal distress, feeling dizzy, unsteady lightheaded or faint chills or heat, sensations, numbness or tingling. Derealization, in which things just don’t feel real. You feel like you’re kind of a dream or depersonalization. You don’t feel, like you, ‘re part of your own body, anymore, with fear of losing control or going crazy and fear of dying. Now I’ll mention it, even though it’s pretty obvious. Many of these symptoms are also symptoms of a heart attack. It is important if you are a clinician not to assume that somebody who is experiencing a panic attack it’s, it’s, just a panic attack and to dismiss it. It’s important to take every panic attack seriously when somebody’s experiencing it and work with their medical provider to help them differentiate between what’s a panic attack. How do I know when I’m having another panic attack versus how do I know when I need to go to the ER and their doctor will work with them on that culture? Specific symptoms of panic may include tinnitus or ringing in the ear and neck. Soreness headache, uncontrollable, screaming, or crying. Interestingly, even though these are culture-specific symptoms, the DSM said those don’t count toward the required four plus symptoms. Additionally, at least one of the attacks – unexpected attacks has been followed by one month or more of both of the following persistent concern or worry about additional panic attacks or their consequences and a significant maladaptive change in behavior related to the attack avoidance of situations where You think they might happen again or ritualized, or superstitious behavior or extreme behavior, like changing your diet completely or doing something extreme to try to prevent the attack, so the unexpected attack happens and then for the next month or more. Both of those persistent concerns about it happening again and significant maladaptive changes in behavior are occurring, it has to cause clinically significant distress and it’s not due to another mental medical or substance use disorder. Interestingly, for panic attacks, there were no specifiers, but in the diagnostic features, it did note that panic attacks can be full meaning four or more symptoms or limited symptoms, so it doesn’t meet all of them. Doesn’t meet four symptoms or more, but the person’s having a panic response. If the person has never had a full-blown panic attack, uh, four or more symptoms, then you would not diagnose panic. Disorder frequency can be relatively regular like one per week or it can come in bursts where they, where they have multiple, really close together, then they go weeks months, or even years without having them, and then they have another burst of panic attacks, and there could also Be instances where they just have a panic attack, and then they may go for a couple of years or more before they have another one. It still qualifies as panic disorder. There is no code for remission of panic disorder and the expectation is unfortunately that if somebody has had a panic disorder at some point, they probably will have another panic attack at another point. Remember that expected panic attacks occur with known triggers, and there are many culture-related diagnostic issues due to expected triggers. So if you read through the culture-related diagnostic issues, a section of the DSM 5tr, you will find they talk about a lot of culture-bound triggers that can cause a panic attack in people’s associated features. People who have panic attacks. Panic disorder may also cause intermittent anxiety about health or mental health. They tend to be more somatically sensitive. That means they’re more aware of what’s going on in their body. Well, that makes sense if you’ve already had your body kind of go haywire on you once makes sense that you would be a little bit more hypersensitive to it happening again. They may have increased anxiety about their ability to tolerate daily stress there. A lot of times this may stem from the fear that if they experience too much stress it, ‘ll trigger another panic attack and they may have more extreme behaviors to control panic. The prevalence of panic disorder is about the same two and two percent to three percent in both the: u s in europe and Europe, the only disorder that had a marked difference between the; u s and other countries. Interestingly enough was social anxiety, disorder. The development of panic disorder, the median age – is 20 to 24 in us and 32 worldwide. So that is a little bit divergent. You know the prevalence, and the number of people that experience it worldwide are pretty comparable, but the median age for panic disorder is much younger in us than in other countries. Additionally, they speculate that older adults may attribute symptoms to medical conditions, so they may be underrepresented in the prevalence rates because when they’re having these panic symptoms, they’re, attributing them to medication, side effects, or other health conditions that they already have. So let’s talk about some of the risk and prognostic factors for anxiety disorders in general. Anxiety disorders often develop afterlife stress. This could be a death, a severe illness, a disaster, a big move becoming a parent adverse childhood experiences, or aces that’s just to name a few that those aren’t all of the causes, but I think it’s interesting that becoming A parent was in there as a life stress that often triggers the development of anxiety disorders. I mean I’m a parent myself. I can see how that could happen, but it’s not something that I had considered in the past as a risk factor for the development of anxiety disorders. People who’ve been bullied have an increased risk of developing anxiety disorders. The heritability of anxiety disorders ranges between 30 and 75 percent. I found that interesting, but they didn’t explain in any of the diagnoses whether they were looking at twins that were raised in the same household or twins that were raised in different households. If they’re raised in different households, it gives more credence to a genetic component. If they’re raised in the same household, then they experience the same psychosocial, and environmental stressors. Both of them are so. I don’t know what the actual data is on that person with negative affectivity. They tend to be more brooding, more depressed, more irritable people who are more self-conscious. People who ruminate more also all of these kinds are combined often referred to as neuroticism. They are at higher risk for the development of anxiety disorders. Attentional bias to threat was noted in generalized anxiety disorder as being an associated feature, but research shows that people with any anxiety disorder tend to have a stronger attentional bias to threat, which means they tend to be more hyper-vigilant. They tend to be more aware when there are, threats in the environment, and anxiety disorders by and large – tend to be much more frequent in women than in men. Interesting, not sure. Why again, my assumption is this is people who are biologically female and it seems to be consistent across cultures. Therefore, I am wondering what the genetic predisposition might be that may cause this. It seems like it’s, less about environment and shaping and behavioral training and more about a physiological response. But additionally – and these last two were not in the DSM. However, I did a PubMed search for risk factors for anxiety disorders and those who have a more external locus of control. That means they believe that things happen in the world by fate. By chance, there’s not a they. Don’t have a whole lot of control or ability to change what’s going on destiny is preordained, etc. People with that outlook who have a more external locus of control, tend to have much higher rates of anxiety and depressive disorders, and again not in the DSM, but in the PubMed. In the literature. People who have a lack of emotional support also tend to be at greater risk for developing anxiety disorders seems pretty self-explanatory in terms of suicidal thoughts. Anxiety itself increases the risk of suicidal thoughts. All of your anxiety disorders carry with them an increased risk of suicidal thoughts. People with separation anxiety have that generalized anxiety, related to increased risk, but people with specific phobias, interestingly enough, have an increased transition from ideation to attempt in a study that was cited in the DS well mentioned in the DSM, but they didn’t say what the study Was they looked at adults and they found that up to 30 percent of people who had their first suicide attempt? It was related. They also had a specific phobia or it was related to that specific phobia so that’s 30 percent is a big number uh. When we’re, especially when we’re talking about suicide attempts and suicidal ideation, if you have somebody with a specific phobia, we often downplay that because we think it’s just a fear of this or a fear of that. But that fear can feel very, limiting and oppressive to a lot of people, and again 30 percent of them. Uh, 30 percent of people who have attempted suicide also had specific phobia functional consequences. Now I could go on a diatribe about the functional consequences of anxiety disorders. The DSM didn’t have much to say about it, so let’s talk about some of these limited independent activities. This is especially true in agoraphobia and separation, anxiety, people who are afraid of leaving the house for fear of being separated from their significant other or for fear of being separated from their safe place, and people who have social anxiety, who fear being in social situations, may Have a lot of restrictions on their life activities and limited activities that they feel safe or comfortable doing by themselves, not in the DSM 5 tr, but in the literature, also the functional consequences of impaired relationships. People with anxiety disorders may be because of their restrictions on life activities and their um potential need to know where people are and their separation, anxiety, etc. A lot of times, people with anxiety disorders struggle in their relationships, because it can feel overwhelming to the partners. As I mentioned earlier, people with anger, and anxiety disorders, have higher rates of autoimmune issues. Continuous or excessive levels of stress hormones contribute to systemic inflammation, which will trigger depression or is associated with triggering depression and associated with worsening of autoimmune conditions and obesity. I thought this one was interesting, but it makes sense when you look at it. People with anxiety disorders, who often are restricted in their life activities, may feel worn down and exhausted. From being stressed out, all the time may not have a lot of energy to do. Other stuff tends to be more prone to develop obesity so that’s an interesting functional consequence now differential diagnosis, I told you there was a laundry list of them. Generalized anxiety, a disorder in gad. Excessive anxiety is about a variety of things for at least six months. Separation, anxiety, the worry or the anxiety is about separation from the attachment figure. Okay, that’s pretty clear, agoraphobia. The fear is about being trapped or helpless in situations in which escape is difficult. The fear surrounds being away from their safe place, not being away from a person they want to be in a place where they feel safe, and it needs to be not specific to one setting so being trapped or helpless in a situation. I give the example of an MRI that closed MRIs. Oh my gosh, I can’t stand them. I’m terrified of them, but that is specific to one setting and I’m not afraid to leave the house for fear of being trapped or helpless in a situation, social anxiety, anxiety is about being judged negatively, and illness anxiety and this illness anxiety. Falls under somatic disorders but illness anxiety. The worry is about the illness, not separation, judgment, or being away from your safe place, so that’s a differential diagnosis of your basic anxiety disorders in terms of other disorders because there’s that criteria not better explained by another mental health or medical disorder. In psychotic disorders, people who have hallucinations and delusions may also have anxiety, but their worry or fear surrounds hallucinations or delusions and is not reversed by context or the presence of an attachment figure. So a person with psychotic disorders, if their major attachment figure shows up does.  n’t help them feel more comfortable if they turn on the light to eliminate the shadows that don’t make them feel more comfortable, and the hallucinations are not due to psychotic disorders. The hallucinations are not due to something present in eating disorders avoidance behavior is only related to food and food-related cues. According to the DSM, however, one of the main criteria for your eating disorders is an excessive fear about weight, shape, and size, and it’s important to recognize that, because people with eating disorders may avoid mirrors and scales and food, obviously certain foods, and that could All be related to their eating disorder, body, dysmorphic disorder. The fears are only related to people being offended by a particular perceived flaw in obsessive-compulsive disorder. The fear is an object or situation as a result of obsessions. So if they start thinking about germs on their hands – and they keep thinking about it, then they start developing a fear of getting germs on their hands, so the fear becomes the object of their obsessions. Their obsessions turn to cause what they’re. Thinking about becoming a fear in the autism spectrum, the person lacks sufficient age, appropriate relationships, and social communication capacity in anxiety disorders. The person often has sufficient age-appropriate relationships and can communicate socially, and socially understand others, just fine. What we’re, looking at in anxiety, is fear of being judged conduct. Disorder. School avoidance is a very common symptom of conduct disorder, but school avoidance is not due to worry or fear in conduct, disorder, school avoidance, and conduct disorder are due to not wanting to be told what to do. Thank you very much in oppositional defiant disorder, the oppositional behaviors occur in response to multiple situations, not just separation or situational anxiety, not just in response to an anxiety-provoking threat. So if somebody has separation anxiety, they may become oppositional about leaving their major attachment figure. If somebody has a social phobia, they may become oppositional about engaging in situations that would prompt that anxiety, or if they have a specific phobia, maybe they’re afraid of snakes. They may become oppositional about doing something like going hiking because they are actively avoiding that phobic stimulus if they are actively avoiding a phobic stimulus or an anxiety-provoking stimulus. It’s, probably not oppositional defiant. Now you can have both you can have them. Co occurs, but you do want to differentiate. What is the cause of the behavior? Prolonged grief is characterized by intense longing and yearning for the deceased, not fear of separation from them. Now you can have prolonged grief and separation. Anxiety, co occur, but you can’t. Have somebody who develops a fear of separation from others after a particularly particularly traumatic loss? That can happen, but you do want to differentiate and diagnose appropriately and in depression and bipolar. A lot of people who are in a major depressive episode may have reluctance to leave home, but this is due to a lack of motivation and energy to engage and apathy. It’s not due to fear of something out there. They just don’t care or they don’t have an energy personality. A person with a dependent personality relies too much on others. It’s not that they fear uh their safety or loss of attachment figures and avoidant personality disorder, broader avoidance patterns, and a pervasive negative self-concept, differentiate, avoidant, personality disorder from anxiety, and related disorders, not in the DSM I’m. Bringing up for differential diagnosis. Anxiety is related to apprehension and vigilance of physiological sensations and may have an onset after a concussion pots is a postural orthostatic tachycardia and when people have it, when they stand up, their heart rate will jump 30 or more beats just from when they move from sitting To standing and that can feel very scary, they can also get light headed they can. Faint hypoglycemia can also produce symptoms of anxiety sweating and agitation in people, so we want to differentially diagnose. I believe I read a study that more than 25 of Americans are pre-diabetic and don’t know it. Co-morbidity and anxiety disorders are comorbid with each other. So if you have one, you probably have some of its buddies. It’s also comorbid with depression. Bipolar PTSD, prolonged grief, obsessive-compulsive disorder, obsessive-compulsive personality disorder, somatic symptom, related disorders, so any of your physical symptom disorders, anti-social personality, specifically social anxiety, common commonly may co, occur with anti-social, oppositional, defiant disorder and substance use disorders. Physically autoimmune diseases may increase the risk of psychiatric disorders partially due to thyroid dysfunction when that hpa axis goes offline. It also affects the functioning of the thyroid cardiovascular issues like supraventricular tachycardia can also be misdiagnosed and is often misdiagnosed for panic disorder. Hormone level fluctuations, especially extreme hormone fluctuations, can contribute to anxiety, related symptoms, high levels of estrogen or testosterone, nutrient deficiencies, or toxicities. So too, much or too little of certain vitamins and minerals can also cause anxiety-like symptoms. Environmentally poverty is a high risk factor for the development of anxiety disorders, for obvious reasons and socially adverse childhood experiences that include abuse, neglect, abandonment, or mental illness in the household. Are all risk factors for the development of anxiety disorders later in life? Anxiety disorders represent an anxiety response that is developmentally culturally and contextually excessive it’s persistent or recurrent, and causes clinically significant distress, so that differentiates it from people’s run-of-the-mill anxiety. If you will multiple anxiety disorders are common. This presentation covered some of the more common anxiety disorders but did not cover selective mutism substance-induced anxiety or other specified and unspecified anxiety disorders. Finally, it is important to rule out or diagnose comorbidly any physiological causes of anxiety. Symptoms include cardiovascular issues, pots, or diabetes.
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What’s normal anxiety — and what’s an anxiety disorder? | Body Stuff with Dr. Jen Gunter | TED

Transcriber We live in a culture that doesn’t take mental health issues seriously. There’s a lot of stigma. Some people tell you to just suck it up or get it together or to stop worrying or that it’s all in your head. But I’m here to tell you that anxiety disorders, they’re as real as diabetes, Music Body Stuff with Dr Jen Gunter Hi. Again It’s, Dr Jen, and I’ve noticed something with my patients. They often describe to me some classic symptoms of an anxiety disorder. Constant worry, trouble, sleeping tense muscles, and struggle with concentrating, But they aren’t getting treatment. There are a lot of issues with mental health care in this country. Some people, don’t have insurance that would cover it. Some have been dismissed or minimized in the past and don’t think seeking help will do any good. Some worry about the stigma and whether it could affect future jobs or relationships But severe anxiety. Isn’t a moral or personal failing It,’s a health problem, just like strep throat or diabetes. It needs to be treated with the same kind of seriousness. Before we can talk about anxiety disorders, let’s talk about anxiety itself. Anxiety is the very real and normal emotion we feel in a stressful situation. It’s related to fear, But, while fear is a response to an immediate threat that quickly subsides anxiety is a response to more uncertain threats that tend to last much longer. It’s all part of the threat detection system that all animals have to some degree to help protect us from predators. Anxiety starts in the brain’s amygdala a pair of almond-sized nerve, bundles that alert other areas of the brain to be ready for defensive action. Next, the hypothalamus relays the signal setting off what we call the stress response in our body, Our muscles tense, our breathing and heart rate increase and our blood pressure rises. Areas in the brain stem kick in and put you in a state of high alertness. This is the fight-or-flight response. There are ways the fight or flight response is kept somewhat in check with an area of higher-level thinking called the ventromedial prefrontal cortex. It works like this. If a person sees something they think is dangerous, like a tiger that sends a signal to the amygdala saying it’s, time to run The ventromedial prefrontal cortex can say to the amygdala: Hey, look The tiger’s in a cage. You know what a cage is. They can’t escape from a cage. It’s, OK, to calm down It’s, a feedback loop that can help keep the response in check. The hippocampus is also involved. It provides context by saying things like Hey: we’ve seen tigers in cages before We’re in a zoo. You are extra safe With anxiety. These threat detection systems and mechanisms that reduce or inhibit them are functioning incorrectly and cause us to worry about the future and our safety in it. But for many people, it goes into overdrive. They experience persistent pervasive anxiety that disrupts work, school, and relationships and leads them to avoid situations that may trigger symptoms. Anxiety disorders are not at all uncommon, Based on data from the World Mental Health Survey. Researchers estimate that about 16 percent of individuals currently have or have had an anxiety disorder. These include social anxiety, disorder, panic, disorder, agoraphobia and phobias. Studies have shown that people with anxiety disorders, don’t just have a different way of reacting to stress. There may be actual differences in how their brain is working. One model describes a possible mix. Ups in the connections between the amygdala and other parts of the brain, The pathways that signal anxiety become stronger And the more anxiety you have, the stronger the pathways become and it becomes a vicious cycle. The good news is there’s, treatment for anxiety and that you, don’t have to suffer. Remember this isn’t about weakness. It’s about changing brain patterns and research shows that our brains can reorganize and form new connections. Throughout our lives, A good first step is to do the basics, Eat a balanced diet, exercise regularly, and get plenty of sleep. As your mind is part of your body. It might also help to try meditation Instead of our heart rate, rising and our body tensing with mindfulness and breathing. We can slow down the fight or flight response and improve how we feel in the moment through cognitive behavioral therapy. A form of talk therapy can also be fantastic In it. You learn to identify upsetting thoughts and determine whether they’re realistic Over time. Cognitive behavioral therapy can rebuild those neural pathways that tamp down the anxiety response. Medication can also give relief in both the short term and the long term. In the short term, anti-anxiety drugs can down-regulate the threat, and detection mechanisms that are going into overdrive. Studies have shown that both long-term medications and cognitive behavioral therapy can reduce the overreactivity of the amygdala. We see anxiety disorders, High blood pressure, and diabetes. They can be treated or managed over time, And the same is true for an anxiety disorder too.

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4 Signs of Generalized Anxiety Disorder

Everybody gets anxious or worried every once in, a while. But what, if you feel very anxious and worried a lot of the time and you’re just not sure why You might have generalized anxiety, a disorder a mental health condition that’s different from regular anxiety. You might feel Symptoms of a generalized, anxiety disorder including your anxiety persisting. Over a long period the. Anxiety and worry affect your day-to-day life like your job or your social life. You experience multiple physical or emotional symptoms, for example, having trouble getting or staying asleep, feeling, irritable, or becoming tired easily Certain medications or medical conditions can also make you more anxious or worried If you aren’t sure what’s going on talk to your doctor, You don’t have to deal with this worry and anxiety by yourself, bright, music, .
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Understanding Anxiety – A Psychiatrist Explains Symptoms, Medication Options and Therapy

Fear is something that everybody experiences. We all have fear, and fear is a normal response to a threat. The difference with anxiety is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators could be rational if you know that the elevator reached the maximum capacity or you know for sure that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone to be afraid of elevators, even though it’s a perfectly functioning elevator you know has been recently installed and checked and technically is flawless, and you still have anxiety about that. Anxiety disorders are a large family with several individual disorders, but it’s important to know that sometimes they happen together or you may have one and a little bit of another one. But the most common are panic disorder, social anxiety disorder, we have also generalized anxiety disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder that is mostly seen in children. In psychiatry, probably the most successful group of illnesses or disorders that we can treat successfully are anxiety disorders. The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that, we can use medications that are just as needed, for example, panic attacks. Many people use a type of medication called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone who has only sporadic attacks, but not for someone who has chronic, what is called generalized anxiety disorder, because it’s easy to become dependent on those medications. The other mainstay type of treatment in terms of medications is antidepressants, specifically the so-called serotonergic antidepressants. Some of them, for example, are sertraline or paroxetine and these medications increase the transmission of serotonin in the brain and can alleviate some of the symptoms of anxiety. When we are thinking of treatment for anxiety disorders without medication, we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases several chemicals, like cortisol and adrenaline, but also changes the heart rate, breathing, and so forth. And so there are many activities, including meditation, yoga, tai chi, and sports in general, aerobic exercise, that can down-regulate the activation of the stress response system. In addition to self-help, another type of non-medication, non-pharmacological treatment for anxiety disorders is therapy. Counseling. And several types are specific for anxiety and they’re being developed through research and they are highly effective. One of the most common and most well-known is cognitive behavioral therapy, which is a systematic training of the patient to identify certain thoughts and beliefs that can be challenged, and the challenge of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety is avoidance. Unfortunately, avoidance is the worst thing that we can do because it will perpetrate and make it chronic. The more we avoid something, the more powerful that fear becomes, or that anxiety. Therefore, one of the treatments for anxiety is to try not to avoid the triggers, is to expose ourselves as much as we can tolerate that. For example, if public speaking is a source of anxiety, some of us can get trained and go to Toastmasters, and go to a setting where we feel safer and slowly and progressively expose ourselves. Because the brain learns not to react. With more practice, we lose that fear. If you believe that you have an anxiety disorder, I would say the first thing to do could be a screening for that. That could be done by your primary care physician or yourself. One of the most common tools to screen for anxiety disorder is called General Anxiety Disorder-7. GAD-7. And that’s widely available in the public domain on the Internet. And if you have a suspicion of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist because this, can be very effective and the therapist would be prepared to tell you, “I think you need medication in addition to therapy.”.
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Magnesium’s Effect on Mood: Anxiety and Depression

let’s talk about magnesium’s effect on mood especially anxiety and depression there are a lot of things that magnesium does in the body it’s involved in probably actually more   than 300 different enzymes involved in biochemical pathways but I want to emphasize just one area the   effect of magnesium on neurotransmitters which are hormone-like but instead of traveling through the   blood they travel through the nervous system now a magnesium deficiency is extremely common well over   50 of the population is deficient and probably a lot more that have a subclinical deficiency   but it’s very difficult to test magnesium since only one percent of your whole body’s   magnesium is in the blood the rest is in the bone it’s in the teeth it’s in the muscle and it’s also   inside the cell so you kind of have to go by symptoms and just take some magnesium consume   foods with higher magnesium and see if these symptoms go away so if you’re deficient in magnesium   you can get anxiety depression low tolerance to stress you’re not going to sleep that well you’re   going to be irritable and have brain fog other than that you’re going to be good to go but magnesium   has some direct effect on increasing serotonin serotonin is the hormone that kind of brings you a state of well-being it makes you feel calm happy and without stress number two   magnesium can decrease cortisol so cortisol is a stress hormone and if it’s too high it puts you   in a state of stress so many people have chronic elevations of cortisol and they’re stressed out   and magnesium can help them all right number three magnesium can lower adrenaline okay so   that’s going to help your sleep number four you can increase GABA which is a neurotransmitter   involved in relaxation and feeling calm and even sleep number five magnesium can increase melatonin   it’s going to help you sleep all right number six it can increase the parasympathetic nervous system which is that that’s part of the nervous system that’s responsible for rest and digestion   so it calms you down it’s an active wave in your body that’s pushing things down to keep   things calm so let’s say for example you ran up the stairs or you’re exercising and then you stop   the parasympathetic kicks in there and bring your pulse rate down and calms you down without that   everything would stay fairly elevated for a long period and in practice I used to measure   the parasympathetic nervous system I had a a test it’s called heart rate variability which measures   the autonomic nervous system and when people would come in with very low parasympathetic function   if they were to exercise their pulse rate would go high and it just would not come down   so they have to do very very light things and not a lot of exercise all right number seven   magnesium decreases the sympathetic nervous system so this is the opposing nervous system   this is the nervous system that keeps things turned on and it keeps you from sleeping so   magnesium can chill that out and another name for the sympathetic nervous system is flight or fight   all right there you have it magnesium’s effects on your mood before you go if you have a question   about a product or you’re new to keto and you want to know how to begin keto or you’re on keto and   you need a debug because it’s not going as smooth I have a keto consultant standing by to help you this is just for the people in the u.s. hopefully in In the future, we’ll be able to answer everyone’s call   but I put the number down below so you can call and get some help. ᵃⁿⁱᵐᵃᵗⁱᵒⁿ ˢᵗᵘᵈⁱᵒ ᴏɴᴇ-ᴛɪᴍᴇ ꜱᴘᴇᴄɪᴀʟ ᴜᴘɢʀᴀᴅᴇ ᴅᴇᴀʟ – ᴍᴀʏ ᴇxᴘɪʀᴇ ᴏɴᴄᴇ ʏᴏᴜ ʟᴇᴀᴠᴇ ᴛʜɪꜱ ᴘᴀɢᴇ. ꜱᴋɪᴘ ᴛʜɪꜱ ᴅᴇᴀʟ ᴀᴛ ʏᴏᴜʀ ᴏᴡɴ ʀɪꜱᴋ ᴀꜱ ᴛʜᴇ ᴘʀɪᴄᴇ ᴍᴀʏ ᴅᴏᴜʙʟᴇ ᴡɪᴛʜᴏᴜᴛ ɴᴏᴛɪᴄᴇ! Animation Studio is a must-have for anyone serious about selling or promoting anything online with video! Damon Nelson. Wow, Paul & Todd, this is a competition killer. “Animation Studio The Animation Creator That You Have Been Waiting For Has Finally Arrived… …..” Pythagorean Betting System ꆛシ➫ The Pythagorean Betting System is my ultimate way to find out which team is undervalued and overvalued in all the major professional leagues, including NBA, MLB, NFL, and NHL. 8 months later, the user says: “The Pythagorean Betting System is … 18:07 The latest testimonial from Anders in Norway. He says: “The Pythagorean Betting System is amazing!… Every day you’re not inside, you’re losing money! God bless you Champ. It’s been an amazing ride!”

Alprazolam Treating Anxiety and Panic Disorders – Overview

Alprazolam is a prescription. Medication used to treat anxiety and panic disorders. Alprazolam belongs to a group of drugs called benzodiazepines. These work by lowering abnormal excitement in the brain, Alprazolam, comes in tablet and oral solution forms and is usually taken two or three times a day with or without food Common side effects of alprazolam include sleepiness lightheadedness, tiredness and loss of coordination. Alprazolam can also cause drowsiness. Do not drive or operate heavy machinery until you know how alprazolam affects you Take this medication only if it is prescribed for you by your healthcare provider For RxWiki. I’m Stephen Lozano.

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