Video- How Does a Therapist Treat Anxiety Disorder? An Introduction to CBT Skills
If you are reading this, chances are you already know that symptoms of stress can feel overwhelming and, if untreated, can evolve into an anxiety disorder. The good news is understanding the biological roots can be the first step toward success. In this video, ‘Master Your Mind: Essential CBT Skills for Anxiety Symptoms,’ Dr. Rosalie Zuniga from Postpartum Wellness and I discuss what information I provide to clients in the first stages of anxiety treatment. If you want to know about the mind-body connection when you experience anxiety symptoms, check out the first part of this video to dive into the biology of stress. You can find more content in the second part if you’d like to try some practical strategies for managing anxiety disorder. Are you curious but not ready to watch the whole video? You can find an overview below.
The Biological Roots of Anxiety Disorders
Anxiety is more than an emotion; it’s an interplay of biology and psychology. The ‘fight, flight, freeze, fawn’ response is an instinct we have to stress or danger. This is also known as the ‘stress response’. In the modern world, this is not particularly useful. In very few situations, this phenomenon may be helpful (like if a bear is chasing you). However, when we ruminate about our fears, our brain believes we are actually in physical danger, and if it persists, it can evolve into an anxiety disorder.
Anxiety Symptoms
The symptoms of anxiety can vary but have some specific themes:
Excessive Worry: Constant, uncontrollable worry about everyday things.
Physical Anxiety Symptoms: These can include increased heart rate, sweating, trembling, dizziness, and shortness of breath.
Trouble Concentrating: Difficulty focusing on tasks or making decisions.
Sleep Problems: Trouble falling asleep, staying asleep, or restless sleep.
Avoidance: Avoiding situations that cause anxiety can impact daily life and activities.
Panic Attacks: Sudden episodes of intense fear or discomfort, often accompanied by physical symptoms like chest pain or a feeling of choking.
It’s the Thought that Counts
As you have learned, biological reactions to specific triggers creates the stress response. It’s just as important to recognize that avoidance of triggers and catastrophizing will feed the belief that we can’t handle our complex emotions, which leads to anxiety. Below is a helpful equation from Dr. Aaron Beck, the father of Cognitive Behavioral Therapy (CBT)
Dangerous Thinking + Helpless Thinking = Level of Anxiety Symptoms
Dangerous Thinking:
Imagine someone who experiences a setback at work, such as not receiving the promotion they expected. They might engage in dangerous thinking by catastrophizing the situation. For instance:
“I failed, which confirms I’m not good enough. What if people find out? Everyone at work will know I’m incompetent.”
Helpless Thinking:
Helpless thinking involves believing that whatever the imagined catastrophe is, they will not be able to handle it.
Using the same situation, this person may think, ‘I am so embarrassed, and now I have to go to work after this rejection. I’ll be in the bathroom crying all day. I will sit in silence in meetings, and I won’t be able to be of any use now because I’ll be a mess. I don’t think I’ll be able to date because I’ll just keep thinking about how inferior I am.’
CBT in Action:
The video ‘Transform Your Anxiety Symptoms: CBT Skills to Help You Feel Better’ discusses several interventions, such as ‘Decatastrophizing the Fear (Worst Case Scenario)’ and the ‘What Ifs’ to examine and test dangerous thoughts.
Although in a stressed state, we overpredict dangerous outcomes, the reality is that the worst case can happen. Our helpless thinking kicks in when we anticipate we can’t handle the worst-case scenario. I will ask my clients, ‘How could you cope in a healthy and strong way?’ ‘Is there a way you visualize managing the catastrophe in a way you would be proud of?’ My clients who come to me for anxiety treatment in San Diego often will hear me joke that we are not the fragile flowers we believe we are. All humans can survive and thrive under challenging circumstances, which is a vital understanding to manage anxious thoughts.
Where to Find More Information: Therapy in San Diego
For more details about this insightful session and to explore additional resources, visit Therapy in San Diego and Postpartum Wellness. If you are curious about your anxiety symptoms and wonder if you would benefit from treatment, head to Anxiety Treatment in San Diego – Assessment to see where you land on the anxiety disorder scale.
Small Steps, Big Impact: Emily’s Story of Reaching Her Dream
Emily had a burning desire to become a renowned painter, but she often felt overwhelmed and anxious by the enormity of her aspirations. She would head to art shows wondering how anyone could reach such recognition. This left her feeling stuck as she continued working her well-paying, albeit unexciting manager position at a Fortune 500 company. Her free time consisted of watching TV, going to the gym, and visiting art museums with good friends. Her life was not dull, but she knew she was avoiding going after what she really wanted.
One Saturday, Emily decided that instead of her normal routine of grocery shopping and cleaning the house, she would focus on doing one thing that aligned with her dream. She grabbed her sketchbook and pencils and went outside to simply draw what she saw around her. No more, no less. After thirty minutes of sketching, Emily felt accomplished. She didn’t worry about creating a masterpiece; instead she had fun with the process of improving her skills one drawing at a time, and gave herself an internal ‘gold star’ for every improvement she made.
As days turned into weeks, Emily’s confidence grew and her anxiety waned. She started experimenting with different techniques and subjects, pushing herself to explore new styles and perspectives. Some days were challenging and overwhelm would creep in, but Emily would just take smaller steps and she noticed her anxiety was more manageable than she anticipated.
Eventually, Emily’s hard work began to pay off. Her sketches caught the eye of a local art gallery owner who offered her a small exhibition space. Excited but anxious, Emily accepted the opportunity.
The night of her art show arrived, and Emily watched people admire her artwork. She felt a sense of pride knowing that each piece represented countless small actions taken toward her dream. Some visitors even expressed interest in purchasing her work, leaving Emily feeling that much more energized.
Years passed, and Emily’s reputation as an artist continued to flourish. She traveled the world, showcasing her paintings in prestigious galleries and sharing her story of how she became so accomplished. Young women would come up to her in awe, asking her how she accomplished such an outstanding reputation. Emily explained that it was the minuscule day to day work that had led her to her achievement. As Emily learned, it wasn’t the height of the ladder that mattered, but openness to understand that small steps and patience are the key to managing the anxiety and overwhelm she had at the beginning.
The Science of Small Steps
BJ Fogg, behavioral researcher and founder of the Behavior Design Lab at Stanford University, asserts that the baby steps we make are the path to success in ‘Tiny Habits: The Small Changes that Change Everything’. “It’s easier to create habits and change than most people think, and it’s faster than most people think,” . “It can even be fun, if you do it in the right way” Bogg states in an interview with NPR.
Most of us have heard the old Chinese Proverb “A journey of a thousand miles begins with a single step”. We can visualize this by comparing two ladders that are the same height but the number of rungs are different. Oftentimes we dismiss our small efforts as ‘not enough’ or a waste of time. However, if one can conceptualize this in terms of two ladders, we can see that this method can not only be easier, more fun and faster, but also make something we believe is impossible entirely possible.
While the idea of big goals may lead to overwhelm and shut down, it’s the small, consistent actions taken towards them that pave the way to accomplish what we never thought we could. By embracing the importance of our tiny efforts, you can make significant strides throughout your journey.
The extra demands combined with the typical stress around the holidays can cause many to fall into the trap rigid thinking and the belief that life should be idyllic. If you struggle with anxiety, this season can be an especially difficult time. Perfectionism is something cognitive behavioral therapists see often. Here are some good CBT-based tips on how to help yourself during the rest of 2023 and into the New Year.
Do Not Strive For Flawless
Perfectionism is a self-imposed expectations and the subsequent stringent judgments on you, others, or a situation. You are with yourself every day and you see every mistake you make, so we tend to have quite a long checklist of our real and perceived mishaps. When you focus on self-defeating thoughts, you become hypercritical and begin to put more weight on the negative aspects of oneself. Inevitably, this leads to depression, low-self esteem, and a sense of frustration. Of course, this isn’t beneficial to you and the people who love you. When you find yourself revisiting that list of mistakes, it’s time to combat them by a CBT technique termed a ‘positive data log’. Write down events that were ‘good enough’, or events that were just fine in spite of being imperfect you begin to be more flexible, and it’s easier to see things in a more useful way.
Stop Comparing
With so many social media apps, unrealistic advertising, and other messages promoting perfectionism, it’s impossible to not compare your life with an idealized sample of others. For perfectionists, it’s not easy to remember to take a step back and assess reality. When we engage in perfectionistic comparison, we typically measure ourselves next to someone we already think is ‘better’ in some way. However, all that time comparing can have real consequences. A recent study among TikTok users reflected disruptions in sleep, low self-esteem and overall lower life satisfaction after approximately 30 minutes of scrolling through social media.
Are co-workers, ex’s, or family on social media fueling your feelings of inadequacy and stress? If you want to kick perfectionism to the curb, un-follow (or kindly mute) your “competition”, and kindly remind yourself that social media is not a representation of reality, even if just over the holidays.
Temper Family Expectations
Family can cause a lot of distress around the holidays, and even more so when you have lofty expectations. There is already enough pressure around this time of the year without adding perfectionism to the mix. Remember, you can’t control the actions of your family, but you can control your own. Part of walking the walk is that you can identify and reduce acting and thinking in ways that are not productive.
Trying to change others can be akin to entering a faulty debit card pin at checkout. You are in a hurry, and your code won’t work. Instead of admitting defeat, you continue to enter the same thing with growing frustration. Your blood pressure is rising, as is that of the cashier and the people behind you in line. The behaviors may be known and comfortable, yet stress and anxiety could have been avoided if you simply stopped repeating the same unproductive habits and expectations.
Beat Perfectionism by Shifting Perspectives- A CBT Experiment
On days when everything goes wrong, take a minute to consider how much worse things could be to shift your negative perspective. The following are three other tricks to engage your positive lens.
1.Incorporate a daily gratitude practice. According to CBT research, gratitude improves mental health, emotional health, sleep, and self-esteem. Each morning, night, or both write down 5 things you are grateful for, and that is all. Apps like 5 Minute Journal can remind you to practice journaling, and it’s easy to complete.
2. Acknowledge Your Power. Cognitive behavioral therapists emphasize that it’s vital to recognize that we all have control to choose our perspectives. We choose which thoughts to pay attention. Reorienting yourself to the positive can add more value and warmth to the way you experience your life.
In Part 3, I’ll be discussing cognitive-behavioral approaches to coping with loneliness over the holidays. As always, please let me know how these tips work for you. Other ideas? Please share. Enjoy the rest of your month and experiment with your new tools. What to know more about cognitive behavioral therapy? Click here for an FAQ: Cognitive Behavioral Therapy/CBT in San Diego
FYI- Many insurance companies are waiving copayments for their clients who would like to receive online counseling at this time. Please connect with your mental health insurance provider to see if you are eligible.
Have you ever spoken to a friend on FaceTime? Participated in a Zoom meeting for work? Chances are you have virtually connected with someone via video at some point. The world is becoming more virtual as technology improves and many have smartphones that allow you to reach out to someone quite easily.
Now that much of the nation is practicing social distancing or are in places that many non-essential services are shut down due to COVID-19, we are staying home to flatten the curve and protect those who are more vulnerable to the virus. In the past, this could mean weeks of skipped therapy or inability to access help when we all need it the most. Online therapy can provide treatment while also addressing the anxieties, stressors, and fears this pandemic has caused.
Recent research reflects that online therapy can be just as effective and sometimes, more convenient in our busy lives. Also, virtual therapy can feel more comfortable for some as it is conducted while you are in your own environment. As with traditional therapy, you receive the same treatment and can discuss what you need to with your therapist as if you were face to face.
Let’s talk about the benefits of online therapy
1 It doesn’t just have to be on video
If you aren’t comfortable with video, online therapy offers other methods. Some therapists offer text-based therapy and allow you to contact them throughout the week. This can be especially useful for those with social anxiety, panic and agoraphobia. Second, there is audio therapy – in this method, you and your therapist will meet on Zoom or the telephone.
2 No commute
Commuting for therapy appointments can be cumbersome. Add the costs associated (transportation, parking, childcare and missing work for appointments) it can become a financial and scheduling burden. Many people don’t begin therapy or stop going because of the difficulties in traveling to their therapist. Online therapy removes these hindrances and makes it easier to find a time that is convenient for yourself and your therapist.
3 Great if you are uniquely abled
If you have accessibility issues or physical limitations including being housebound, online therapy is an excellent choice for you.
4 Still covered by insurance
Many insurances cover online therapy sessions, however, it always good to contact your healthcare insurance to see if they are covered under your policy.
5 As always, it is confidential
As with your visits to your therapist are private and confidential, so are your online visits! Online therapy is completely confidential and the same rules that apply offline are still applied online. The therapy itself can sometimes cause stigma around mental health; online therapy reduces this. That way you are more comfortable with the sessions and your communication during them.
Also, communication online is encrypted through an HIPAA compliant platform called VSee. VSee is free for the you and can be downloaded onto your phone or computer.
6 Your therapist must be licensed in the state you live in
Some may be licensed in more than one state. So, you know you are getting quality healthcare by a reputable and credited provider to meet your mental health needs. This also means they are aware and comply with all Health Insurance Portability and Accountability Act (HIPAA), ethic and legal practices.
7 You can have access to a specialist that you cannot find locally
You may want a certain type of therapy such as cognitive-behavioral therapy (CBT), dialectical behavioral therapy or other evidence-based treatment. Oftentimes, therapists formally trained and specialized in these modalities for panic, anxiety, and other diagnoses are much easier accessed virtually. You may more likely to find a suitable and qualified therapist if you go beyond the location you would stay in to visit a therapist in an office.
Online therapy isn’t the best choice for everyone, and some mental health disorders may be better treated in person. Clients who are actively at risk of harm to self or others are not suitable for teletherapy services. If you are feeling suicidal, it is better to be seen in person. That said, during the quarantine many therapists are allowing for online sessions regardless.
Many of my clients are finding that treatment for their anxiety and worry during this time of uncertainty has been surprisingly easy, and it is a great way for your counselor to see where you live, meet your pets and maybe even family members. If you’re interested in learning more- please don’t hesitate to reach out!
Here’s to all of us taking great care of ourselves, and making it through to the other side stronger and thriving!
Ambiguity, a sense of uncertainty about what’s going on or what might happen, is part of life. This blog post explores dealing with the unknowns in life and how to handle them.
When Your Environment is Unpredictable
Wow, what a week. Coronavirus or COVID-19 is all over the news and it seems that panic has set in. It is understandable to be anxious when uncertainty is all around us. Our world has been thrown off, and a new normal is here for the near future.
Human distaste for the unknown is well-grounded in experimental psychology, and research has shown that when given the choice, most of us feel calmer knowing that something bad will happen in the near future vs. it possibly happening. This phenomenon is apparent even if it causes us intense stress. Daniel Gilbert, author of the best-selling book Stumbling on Happiness writes:
“Consider an experiment by researchers at Maastricht University in the Netherlands who gave subjects a series of 20 electric shocks. Some subjects knew they would receive an intense shock on every trial. Others knew they would receive 17 mild shocks and 3 intense shocks, but they didn’t know which of the 20 trials the intense shocks would come. The results showed that subjects who thought there was a small chance of receiving an intense shock were more afraid — they sweated more profusely, their hearts beat faster than subjects who knew for sure that they’d receive an intense shock”.
WAYS TO HANDLE ANXIETY
We can’t eliminate uncertainty in our lives, but we can manage our reactions to the unknown in healthy ways using one technique that the best cognitive behavioral therapists employ:
REST Technique or Radical Acceptance
When you become overwhelmed or feel anxious, your first instinct may be to act impulsively or panic. There is a healthier method – Take a REST.
Relax
Evaluate
Set an intention
Take action
Relax
Step one is to literally freeze and stop whatever you are doing. Breathe. Step away from the situation for a few seconds. Try to find a different perspective on what is happening and create a space between yourself and the impulsiveness you may feel. You can even tell yourself out loud to “Relax” or “Rest”. Slow your breathing down and calm down before you decide on another course of action.
Evaluate
Ask yourself what is going on – what are the facts in the situation? You don’t need to solve an ambiguous problem or discover any answers right now. You only have to evaluate what is happening to your physical, mental, and emotional self. Move on to looking at other people around you. At this point ask yourself “How do I feel?” and “Are the people around me in immediate danger?” Think right here, right now.
Set an Intention
“Step three is to set an intention to do something.” You can also treat an intention as a goal or plan. Decide what you will do, pick a distraction or self-soothing skill and ask yourself “What do I need right now?” Whatever you choose isn’t permanent, it is only for right now.
Distractors and soothers that help get you out of the uncertainty trap do not have to be expensive or time-intensive. Good examples of immediate coping skills are:
Count all the greens or blues in your vision.
Describe a wall or other item in detail.
Alphabetize movies, songs, cities, etc. in your head or on a sheet of paper.
Breathe 4 seconds in, hold for 4 seconds, and out for 6.
Pay close attention to the living things around you
Clean, fix something, do anything where you move your body for 5 minutes.
Take Action
Lastly, take action. Mindfully move ahead slowly and meaningfully toward what you are doing. Slow and deliberate often helps us get what we want to be done faster than rushing through. Even if this is not the final solution to your problem, it is a healthy and effective way to thwart any impulsive behaviors or panic that may set in when uncertain.
Once you start getting used to using the REST technique, you will begin to identify when you are distress and can implement these steps in a few seconds. You will be ready to spring your new habit into motion and “REST” when you feel like you are in a similar situation again.
QUIZ: HOW WELL DO YOU MANAGE UNCERTAINTY?
Everyone has a different level of tolerance for ambiguity. Wondering how good you are at tolerating ambiguity? There is an easy way to find out. The Tolerance for Ambiguity scale will tell you. You will respond to a set of 16 statements about your attitudes and behaviors. Whether your score is particularly high, or lower than you expected, it is interesting to know where you stand. This information might also be helpful to a therapist who you consult to help you manage anxiety.
Of course, if you follow the directions given by healthcare professionals for the coronavirus, you will feel like you have some control and they are good precautionary habits to have in our current environment.
Also, make sure you stay connected with your support system via phone and video and limit your use of social media, which is less interactive and in turn, increases our anxieties.
References
Matthew McKay Ph.D., Jeffrey C. Wood PsyD, et al… The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, … (A New Harbinger Self-Help Workbook) New Harbinger Publications; Second Edition, Revised edition (October 1, 2019) Print.
As the world has been inundated with news of the coronavirus, I want to share this great post by fellow therapist and gifted writer, Brianne Rehac, LMHC in how we all are coping with anxiety differently. Take good care of yourself and your loved ones this weekend! Warmly- Karen
“This week, I have spoken to many people about their heightened emotions since the outbreak of coronavirus disease 2019 (COVID-19).
Everyone has a definition of what is a stressful event for them. And everyone reacts to those events differently. If you find that you have not felt impacted at all by reports of the coronavirus outbreak, that is a perfectly okay response. If you find that you have been more anxious, sad, irritable or angry lately, that is completely normal, too. Our reaction to stressful events is a product of a multitude of factors including, our proximity to the event, socioeconomic status, personal history, and personality. Some people who may respond more strongly include individuals who are managing a mental health condition (like anxiety), children, and first responders/healthcare professionals.
Sometimes responses to a stressful event don’t present as emotions. Instead, you may notice a change in sleep patterns; change in appetite; difficulty concentrating; worsening of a chronic health problem (like GERD or chronic pain); change in behavior (stocking up on essentials or changing your routine); or increased use of alcohol or other drugs.
It is really important that during stressful times, you continue to take care of your physical and mental health. That means sticking to your treatment plan, including taking medications as prescribed; attending routine appointments; adhering to any special diet you may have. It also means reaching out to your supports—family, friends, doctors, therapists, and support groups. You’re connecting to them not just for yourself, but for them, too. Let’s all check in with each other on this, okay?”
—Brianne
Hotlines:
SAMHSA’s Disaster Distress Helpline
Toll-Free: 1-800-985-5990 (English and español)
SMS: Text TalkWithUs to 66746
SMS (español): “Hablanos” al 66746
TTY: 1-800-846-8517
National Suicide Prevention Lifeline
1-800-273-8255
Nacional de Prevención del Suicidio
1-888-628-9454
Options For Deaf + Hard of Hearing
1-800-799-4889
Veterans Crisis Line
1-800-273-8255
Text 838255
house, she would focus on doing one thing that aligned with her dream. She grabbed her sketchbook and pencils and went outside to simply draw what she saw around her. No more, no less. After thirty minutes of sketching, Emily felt accomplished. She didn’t worry about creating a masterpiece; instead she had fun with the process of improving her skills one drawing at a time, and gave herself an internal ‘gold star’ for every improvement she made.
on you, others, or a situation. You are with yourself every day and you see every mistake you make, so we tend to have quite a long checklist of our real and perceived mishaps. When you focus on self-defeating thoughts, you become hypercritical and begin to put more weight on the negative aspects of oneself. Inevitably, this leads to depression, low-self esteem, and a sense of frustration. Of course, this isn’t beneficial to you and the people who love you. When you find yourself revisiting that list of mistakes, it’s time to combat them by a CBT technique termed a ‘positive data log’. Write down events that were ‘good enough’, or events that were just fine in spite of being imperfect you begin to be more flexible, and it’s easier to see things in a more useful way.
