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 towards 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 my 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. If you’d like to try some practical strategies for managing anxiety disorder, you can find more content in the second part. 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 a natural 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 (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 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, which 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, the biological reactioni 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 difficult 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 a 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 a belief 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’m going to 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 a few 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. When we anticipate we can’t handle the worst-case scenario our helpless thinking is kicking in. I will ask my clients, ‘How could you cope in a way that is healthy and strong?’ ‘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 difficult circumstances, and this 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.
Feeling isolated from time to time is natural, but it is important to understand why and nip it in the bud before it becomes something deeper. This article will give you the rundown of why you feel lonely, how you feel lonely, and what to do if you feel lonely.
So Many Ways to Be Lonely
In order to keep away the lonesome blues during the holiday season, it is important to understand why you are feeling this way. According to Psychology Today, there are 7 distinct types of loneliness. Here is a run-down.
#1. A New Situation – You are a new person in a new place. If you just switched jobs, moved to the city, or are the new person at school what you are feeling is new-situation loneliness.
#2.I am Different – If you feel as though you are different from the people around you, you may be experiencing this type of loneliness. Maybe everyone around you grew up together except you. It could be you feel deeply passionate about a social issue that no one else around you cares about.
#3. No Romantic Partner – Sometimes, simply not having a partner during the holidays can drag you down.
#4. No Pets– Maybe you deeply want a fish, cat, or dog, but right now is just not the right time. Maybe seeing pictures of cats dressed up like Santa depresses you. This is no-animal loneliness in action.
#5 No Available Friends – This tends to happen when your friends and family make life changes. No one has time for you, and you feel lonely.
#6 Bad Friends – If you do not trust your friends, you may feel lonely. You can have a lot of fun with a lot of bad friends over the years. However, at the end of the day, you ultimately felt unfulfilled.
#7. No Warm Body – Maybe you are completely satisfied with your social life and your work-life balance. However, you miss the feeling of another person sharing your home. Living alone can be difficult sometimes, especially around the holidays.
10 Tricks to Keep Loneliness at Bay
1. Find Like-minded People to Connect With – Try joining a Meetup.com group, a book club, or a workout class. Eventually, you will have a community.
2. Stay Healthy – This includes getting enough sleep, eating healthy foods, and exercising. All of these things have been found to improve mood.
3. Work on Existing Bonds – We now know intimate bonds are necessary to happiness. Work on fortifying your current friendships, whether long-distance or close-by.
4. Learn from Your Experiences – Ask yourself what you can learn from your loneliness, and how you can put your new appreciation for connections into practice.
5. Mindfulness – Identify your thoughts when you feel lonely. Many times you will have self-defeating thoughts about your state of mind. Realize these are just thoughts and do not attach any significance to them.
6. Show Self-Compassion – Develop and nurture compassion, love, and acceptance of yourself. You can treat yourself to an act of kindness, or meditate on directing love toward yourself. In addition, you can practice self-soothing techniques.
7. Get Comfortable with Yourself – It sounds cliché, but in order to beat loneliness, it is important to try and become comfortable alone. Sometimes people get down about doing fun activities alone. However, if you learn to work through the self-conscious thoughts you can actually start enjoying time with yourself!
8. Get that Pet –Sometimes, you just have to go for what you want in the pursuit of happiness! Animals can increase our ‘feel good’ hormones, so heading to the dog park or even a petting zoo can help.
10. Make Giving a Habit – Giving doesn’t necessarily mean money. This time of year especially, there are many opportunities to volunteer in the community.
Conclusion
When dealing with loneliness during the holiday season, it is important to remember you are not alone. So if you are feeling blue, cut yourself some slack and practice some the above tips.
Your mental health is important, why mental health apps? Sometimes you cannot afford to see a therapist, do not have time to go to one, or one isn’t accessible where you live. Perhaps you aren’t ready to see one but would like to see what therapy all is about. Maybe you see a therapist, but need help to put the helpful techniques they have given you into practice. Mental health apps can be very beneficial, free, low-cost or affordably priced, and offer a way to help give you therapeutic help on the go. So which ones are best? There are so many out there!
Mental health apps that I recommend:
1. Headspace
Headspace is an app that just about anyone can use, whether you are dealing with stress, anxiety, lack of focus, or sleeping difficulties. It teaches you to “meditate and live mindfully”. Meditation has been shown to reduce stress, lessens anxiety, support emotional health, and enhances self-awareness. This app provides small meditation modules to accommodate people’s busy schedules and “SOS exercises in case of sudden meltdowns.” You can take advantage of their free trial and if you like it, you can make the jump to a monthly subscription.
2. Youper
Youper is an app that is powered by AI – “your emotional health assistant”. This app allows you to have conversations, guidance through meditations that are personalized for you and trackers that help you monitor your emotional health and mood. This technology created by doctors, scientists and engineers;focuses on the science and pursuit of happiness – helping those with depression and anxiety live happier lives with treatments personalized for them. This app also works in conjunction with seeing a therapist, as you can ‘share’ your information. Many of my clients use this app as complements many of the CBT techniques we use right in session.
Youper is free to download and have some free features; more advanced features are based on a subscription plan.
3. FitMind
This app offers meditation training as part of a “mental fitness” approach. FitMind uses traditional techniques used since ancient times with western science. Using daily challenges, along with access to meditation instructors; FitMind can help you learn to meditate in a way that works for you. Again, meditation is a useful tool for improving mental health because of all of the health benefits you get from practicing it. This app is free and offers in-app purchases.
4. Sanvello
Sanvello is an app designed for stress, anxiety, and depression using strategies and resources that can help you with the symptoms and situations you are dealing with at the moment. You can customize goals; like mindfulness, building confidence and thinking positively. Based on clinically proven techniques, this app offers tracking for mood and sleep, tools for relaxation and meditation and you can connect to a group of your peers for further support. Free to sign up and install.
5. MoodKit
This mental health app uses four tools that are designed to enhance your mood, identify and change unhealthy thinking, track mood, and create journal entries. Managing negative feelings thoughts by identifying situations that cause stress, changing how you think, monitoring your mood through tracking, and developing self-awareness through writing is all of the ways MoodKit is designed to help you improve your mood and mental health. This app is only available on the iPhone and iPad, but is just $4.99.
Mental health treatment is no longer limited to the office and self-help books. Whether you are on the road, want quick help, or establish a daily cognitive behaviorally based self-care routine, there has never been so many options on how to start. It’s good for you, and most apps have a free trial! Jump in and let us know how it goes.
Earning your clinical license opens up a world of possibilities, so you want to begin gaining ASW supervision hours as soon as possible. Regardless, the process can be confusing for the best of us. Throughout my years of providing ASW and LCSW supervision, there are certain questions that I’m asked on a regular basis. Here’s a nice compilation of many of these inquiries, as well as one vital tidbit that is often overlooked:
I have all of my hours, but I’ve been putting off the exam for months/years. Is there a timeline?
So, there are a couple of key points to remember:
The 6-Year Rule-
You can spend 10+ years earning IMF/ASW supervision hours, however, the only ones that count are the ones accrued during the last 6 years.
Abandonment of Application-
You don’t want this to happen! The consequences of abandonment can range from paying a new application fee to starting from square one. Per the BBS website, the criteria for abandonment are the following:
Associate Social Worker does not submit the remaining documents or information requested in the application deficiency letter within one (1) year from the date of the deficiency letter
Applicant does not complete the application within one (1) year after it has been filed
ASW does not sit for an examination within one (1) year after being notified of initial eligibility to take the examination
Applicant does not take an examination within one (1) year from the date the applicant was notified of failing an examination
The applicant fails to pay the initial license fee within one (1) year after notification by the Board of successful completion of ASW requirements.
I’d like to obtain my ASW/LCSW supervision through video conferencing. Am I eligible?
Per the California Business and Professions Code section 4996.23 videoconferencing can be used for LCSW supervision when an intern works/volunteers at one of the following:
Any government entity
A school, college, or university
An agency that is both charitable and non-profit. You can find out if your workplace meets these criteria by checking if they are considered a ‘501(c)(3); by the IRS
The ASW supervisor is responsible for ensuring client confidentiality, including a HIPAA compliant platform for video sessions. Skype is not HIPAA compliant, but there are other programs that are- your supervisor should be able to tell you what platform they are using and how they know it’s in line with privacy regulations.
My hours are complete, and my exam is scheduled! Am I still required to maintain weekly LCSW supervision?
Until you have your license in hand, you want to complete an hour of individual or two-hours of group LCSW supervision.
Do I really have to sit for the Law and Ethics exam? Is this something I need to retake annually until I earn my license?
Yes! There are no loopholes on this one- no matter how much training and classes you have taken.
Once you pass the Law and Ethics exam, you have completed your requirement as long as you keep your license active. Get this done quickly, as you may not be able to complete your annual renewal without a passing score.
Which study guide do you recommend?
The majority of my interns recommend the Therapist Development Center (TDC) programs for both the exams. TDC not only provides materials on content but also test taking strategies that will help IMF/PCCI/ASW interns approach the exams in a logical and educated manner.
When can I start collecting LCSW Supervision hours?
It’s exciting to finally earn your graduate degree, and you’re probably chomping at the bit to start collecting hours. Many have contacted me and said, ‘I’m waiting for my BBS number, but I want to start supervision this week!’
In this case, patience is the key. Don’t spend time and money on clinical supervision until you have that intern number in hand, as hours won’t count until then.
My former supervisor can’t be found. How can I verify my hours?
At the beginning of ASW intern supervision, it’s critical that you and your supervisor create and sign the following documents, all located on the BBS’s website.
Supervisor Responsibility Statement
Supervisory Plan
Any letters of agreement or other documentation agreeing to the ASW Supervisor/ Intern relationship.
Just as important, discuss how you plan to document logged hours. I encourage all of my supervisees document their hours in detail and have me initial and sign it each month.
As soon as your time with each supervisor is complete, print out the Experience Verification Form and complete this together.
ASWs are fully responsible for all original paperwork. If you follow these guidelines, you will be in good shape if for any reason you can’t connect with your previous supervisor(s)
I am the only social worker/counselor at my job. How can I earn my hours if I don’t have a clinical supervisor at my agency?
There are a lot of ASWs in a position where clinical supervision is not readily available. Fortunately, your intern supervisor does not need to be employed by your agency.
If you are the lone ranger in your company, I recommend searching out some group supervision to expand your support system, increase your exposure to new opportunities, and see what others in the field are doing. Several of my interns that were in group have helped connect one another to jobs, resources, and even have partnered in private practices!
There’s one question I’ve never been asked, but what everyone should know……
The 104- week rule
Several years ago, an ASW Intern I had been supervising for a year came to my office to get her last hours signed. She had been working with several supervisors throughout her time and worked hard to get her hours wrapped up as soon as possible, often putting in 60+ hours a week so that she could meet that 40-hour clinical max.
As we were finishing up her paperwork, we came to the realization that although she had easily met 3200 clinical hours, she was two months under the 104-week requirements. She was terribly disappointed, and we spent two more months getting those last few weeks in.
The story has a happy ending- Margaret Miller, LCSW now has a thriving private practice at my office- you can check her website out here. So now you know- in addition to the 6-year window, interns have to meet a minimum of 104 weeks of ASW supervision, so expect to spend between 2-6 years gathering your experience.
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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 (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 can evolve into an anxiety disorder.
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.
