Feeling Lost in Anxious Thoughts & How to Find Your Way Again

Written by Lauren Helm, Ph.D.

We’ve all felt anxiety at some point in our lives (likely many times over, in fact), though perhaps it manifested in different ways. You may have noticed the rapid increase of your heart rate, faster, constricted breaths, the growing tension in your shoulders and neck, cold or clammy hands, or unease in the pit of your stomach. The experience of anxiety is unpleasant, to say the least, and as it builds, it certainly has a way of getting our attention.

Anxiety Has a Purpose

Why do we experience the uncomfortable sensations of anxiety? From an evolutionary perspective, fear and anxiety (two related but slightly different emotions) have a function: they keep us alive. More specifically, fear and anxiety are emotions that occur in response to a perceived threat. When we believe that something may harm us or is dangerous, we feel these emotions and they motivate us to protect ourselves from the danger, typically either by avoiding or escaping the threat.

Without fear or anxiety, we may not react to truly dangerous situations in an adaptive way, and thus not survive as a species. Imagine walking along and crossing paths with a Grizzly Bear. It certainly would not be helpful to feel no fear, and to feel like running up and hugging it! Our emotions give us invaluable information about the environment and about what actions we should take to protect our survival, based on how we feel.

Cognitive Errors

As incredible as our brains are, they also are prone to errors. We are not always able to accurately assess the true amount of danger (or safety) that may be present in our surroundings. Sometimes this means that we may miss a true threat that was present and suffer the consequences. However, in our modern day society, more often than not we experience the opposite – we overestimate the true amount of threat and thereby experience excessive anxiety as a result.

The problem with excessive anxiety is that it can negatively impact the quality of our lives in multiple ways. Prolonged, pervasive anxiety has an impact on our physical well-being, in addition to our psychological well-being. Chronic stress and anxiety can lead to a deterioration of optimal physical functioning, preventing your immune system, digestive system, and heart from performing the best that they can. Chronic anxiety may also interfere with your ability to sleep, eat, and generally function as you’d like to in life.

Depending on the context, anxiety may be an adaptive or problematic force in our lives.  In excess, the symptoms of anxiety can be overwhelming and interfere with our quality of lives, and thus it is often a worthwhile use of our time to become well-versed in the “language” of anxiety. Namely, how does it appear, and why? Once I understand anxiety, what can I do about it?

There are many different theories about what causes problematic anxiety, but this blog will focus on how anxiety may be developed and maintained by certain unhelpful thinking patterns. Cognitive distortions, or inaccurate thinking patterns, typically feed anxious feelings. They also may lead to avoidant behaviors, which perpetuate anxious thoughts and feelings. When the cycle of anxious thoughts, feelings, and behaviors occurs outside of our awareness, we can be left feeling baffled and as if our lives have begun to spiral out of our control. 

Perceived Threat

From an evolutionary perspective, it can be considered advantageous to be very sensitive to possible threat. In other words, our primal ancestors were more likely to survive if they very quickly and accurately responded to potentially dangerous situations. However, in modern day, an over-active threat-detection system can become burdensome. A low threshold for perceiving threat (i.e. situations very easily feel threatening) and an attentional bias to threat (i.e. focusing and narrowing your attention on potential dangers that surround you) can be a constant source of anxiety. Our threat-detection threshold and anxiety-proneness may be partly genetic, but it also is likely a result of having a previous experience that was stressful, anxiety-provoking, or traumatic. Our brains generally keenly remember frightening experiences so that we will readily detect the warning signs in the future and be better able to avoid encountering a similar potentially dangerous situation again. It makes sense that our brains are designed to work this way, but it also means that we have to cope with the surge of anxiety that comes from many "false alarms."

Catastrophic Thinking

Another thinking pattern that feeds anxiety is called catastrophic thinking. Catastrophic thinking occurs when our mind jumps to imagining worst-case scenarios when we are uncertain about an outcome. For example, our mind may imagine that our loved one has been involved in a car accident because they still haven’t returned home 30 minutes after they said that they would. Catastrophic thoughts may also be hidden from our conscious awareness, but still cause us to feel anxious and on edge. Catastrophic thoughts are often triggered by uncertainty and the unknown, and are attempts at anticipating and (ideally) preventing or avoiding very painful, negative imagined outcomes. 

Probability Overestimation

Furthermore, probability overestimation occurs  along with catastrophic thinking – this is when we overestimate how likely it is that the “worst-case scenario” has or will occur. When we are feeling anxious, we often feel very certain that the worst-case scenario will occur even though realistically-speaking, the chances are much lower (or are little to none) that what we fear will actually happen. This feeling of certainty that the negative outcome will occur motivates us to take action to prevent it from happening ("it's better safe than sorry!"). Unfortunately, we may anxiously expend significant energy and time trying to prevent something that is not actually like to happen at all, without finding substantial or long-lasting relief. 

Worry

Worry and catastrophic thinking go hand-in-hand. When we worry, we dwell on the many possible negative “what if” scenarios, and use extensive cognitive energy to plan for or prevent these potential future threats from occurring. In moderation, planning for future threats can be helpful, but when it begins to take excessive time and energy (which is quite exhausting), it becomes maladaptive and interferes with your ability to function optimally. More often than not, the cost of worrying exceeds the benefits (it may become a waste of energy) and actually feeds the anxiety that it is intending to placate. Because worrying tends to happen in the form of verbal or analytical thinking and planning, it is thought that worrying can act as a form of cognitive avoidance that prevents full processing of emotions associated with catastrophic thoughts. Excessive worrying that is difficult to control can cause us to be constantly on-guard and on-edge, leading to muscle tension, concentration & sleep difficulties, and trouble relaxing. Worrying can also be self-reinforcing - if we believe that we thwarted a negative outcome because we worried (a coping strategy, of sorts), we will most likely engage in worrying again in the future. Unfortunately, worrying rarely pays off in the way we intend for it to.

These are just a few ways that our patterns of thinking can create and maintain anxiety, leaving us feeling trapped in our minds. Now we will explore strategies intended to help individuals suffering from anxiety develop more adaptive ways of responding to anxious thoughts, so that they can get unstuck. We will explore two evidence-based treatments provide strategies for managing unhelpful, unproductive thinking patterns.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) identifies how certain types of thoughts or ways of thinking in response to perceived threats actually create more difficulty for us, and potentially lead to anxiety, stress, low mood, and other problems. Simply put, situations do not cause negative emotions; our perceptions of them do.  

Some of the unhelpful or inaccurate patterns of thinking (cognitive distortions) related to anxiety include catastrophic thinking, probability overestimation (overestimating the likelihood of a negative outcome), worry, filtering out the positive and only seeing the negative, jumping to conclusions, mind reading (thinking you know another person’s intent for acting in a certain way, when this may not be true), personalizing, and black and white thinking. CBT therapists help individuals to alleviate the consuming nature of anxiety by using various strategies to address these cognitive distortions.

The various approaches that are used in CBT to deal with these types of “inaccurate” thinking patterns have historically served a common purpose: correct and change the “thinking errors” that create anxiety. Over time, CBT has evolved and has placed more emphasis on helping people to generate more flexible, adaptive thoughts and responses to their thoughts. Instead of merely trying to replace one problematic thought with a more helpful one, CBT can help an individual to generate more balanced and healthy thoughts, and more easily identify and non-reactively respond to problematic, anxiety-provoking thoughts.

In other words, if you notice that you are thinking in inaccurate ways, it is likely best to recognize that it may not be helpful to act on this inaccurate thought, and better to generate a new, alternative way of thinking about the situation that helps you to successfully reach your goals. Instead of trying “not to think” a thought (suppressing or shut out a problematic thought), modern versions of CBT emphasize helping you create more thoughts that are based on a more balanced review of available information, and are informed by your goals in a particular situation. Cognitive rigidity, or getting stuck in one narrow way of thinking, is usually what contributes to us further being consumed by anxious thinking and behaving. Thus, CBT encourages you to increase your cognitive and behavioral flexibility (working towards developing a wide range of thinking and responding).

Cognitive Restructuring

Cognitive restructuring is a CBT intervention that helps individuals get “unstuck” from the “mind traps” that thinking errors create. Socratic questioning is often used to help facilitate cognitive restructuring and get at the truth. This approach is usually built into CBT therapy sessions to help change problematic thinking patterns.

Here is an example of methods you might use with a therapist to "restructure" a problematic thought:

1. Identify and write down the "hot" or emotionally-charged thought elicited in response to a particular situation.
2. Challenge the thought (i.e. “Is this a realistic thought?” “Is it helpful?”) and write down your answers.
3. Explore and write down the objective evidence for or against the thought (i.e. What are the facts? Has this happened before?) to discern whether the thought is accurate or not.
4. Identify other possible alternative explanations that are based on the facts in order to put the thought in perspective.
5. Generate and write down a new, balanced, and more helpful thought about the triggering situation from which to act on. 

Decatastrophizing

To more specifically target catastrophic and probability overestimation, thinking traps that fuel anxiety, decatastrophizing is a cognitive restructuring technique that is very helpful for providing perspective and relief. Decatastrophizing helps to reduce the believability of catastrophic thoughts, which as mentioned above, often feel much more likely to happen than they actually are.

If you feel trapped in an anxious thought loop, you may try using decatastrophizing. A therapist trained in decatastrophizing can help you work through catastrophic thoughts that are particularly difficult for you to unhook from.

The first step of decatastrophizing is to more clearly uncover the catastrophic thoughts and negative core beliefs that are often lurking beneath surface-level anxious thinking. Specifically, the downward arrow technique is used to dig below the automatic thoughts that we are consciously aware of to get at the core negative beliefs that are driving our anxiety. For each thought that is uncovered, it is followed up by a "What If" prompt, such as "If that were true, then what would that mean? What does your mind tell you will happen?"

Here is a hypothetical example of how the downward arrow technique might be applied for someone struggling with social anxiety is as follows:  

• Client: "I feel super anxious about going out with this new friend because I'm afraid I'll say something stupid."
• Therapist: "If you did say something stupid, then what would happen?"
• Client: "If I say something stupid, then they may think I'm stupid, and not like me."
• Therapist: "If that were to happen, then what would that mean?"
• Client: "If they thought I was stupid and didn't like me, then that might mean that I am unlikeable"
• Therapist: "What does your mind tell you would happen then, if you were unlikeable?"
• Client: "Well then no one would like me. I would have no friends. Actually, my mind is telling me that I would never be able to make friends."
• Therapist: "And then what? What would that mean? What's the worst case scenario?"
• Client: "If I didn't have friends, it would feel like I've lost everything - I would be miserable. I think it would also mean that there's something wrong with me. Something fundamentally flawed to make me unlikeable. That would be terrible"
• Therapist: "And on an emotional, experiential level, how likely does it feel that this would actually happen? How real does it feel?"
• Client: "Oh, like 98-100%"

By uncovering core catastrophic thoughts, and probability overestimation, we get a sense of what the client was actually guarding against by not going out with her new friend - facing the fear that she was fundamentally flawed, and thus would not be able to retain any relationships in her life. Usually, catastrophic thoughts and core beliefs like this drive entrenched anxiety and other painful emotions. By clearly identifying what thoughts are really behind our emotional and behavioral reactions, we can more directly and effectively challenge them. 

The second phase of decatastrophizing can then move into nonjudgmental questioning and testing of these thoughts. Questioning the actual likelihood that these anticipated outcomes will come true by evaluating factual evidence that supports or does not support these thoughts, helps our minds begin to absorb in important information: whether or not we are likely to face these worst case scenario outcomes at all. Additionally, by bringing emotionally-charged thoughts more fully into our conscious awareness, and seeing what they are really made of, their believability and charge is diminished. Another component of decatastrophizing entails inquiring about and planning for how you would be likely to respond, even if the worst-case scenario were to happen.

• Therapist: "Based on the facts of your past experience, have you ever experienced having everyone dislike you before? Have you lost all of your friendships and relationships with others?"
• Client: "Well, no, I've lost a few friends before, but that wasn't because they thought I was stupid, as far as I know, we just realized we didn't have a lot in common. I guess I've never lost all my friendships, especially not all at once or forever - I've always had at least someone in my life, or connected with someone new later down the line."
• Therapist: "Based on the evidence, how likely would you say it is that you would actually lose all relationships in your life?"
• Client: "Haha, well in reality, it seems like it's pretty unlikely. Probably like 0-3% likely to happen."
• Therapist: "What would have to happen for you to actually lose all relationships in your life, so that you were never able to make any more friends?"
• Client: "Gosh, I guess it would have to take something really big...actually, I'm not really sure there would be something that would guarantee I had no friends, unless I just stopped wanting them entirely, which I don't really see happening..."
• Therapist: "And if you actually did lose all of your friendships at one point, how could you potentially cope and respond? How have you gotten through something similar in the past?"
• Client: "I probably would keep making the effort to put myself out there the best I could. Maybe make sure to go to events with people that are more likely to be nonjudgmental, and have similar interests in me. If I had trouble with it emotionally, I could go back to therapy and or support groups. It would be really hard, but I'd find a way."
• Therapist: "What's a new way of looking at this upcoming time out with your friend?:
• Client: "Well, now I realize more fully that I don't actually risk as much as I thought I would. If it goes well, great, but if not, it's not the end of the world. I feel in my gut that I will always have the connection I need, with someone. I guess it's worth the risk to go and try out this experience, and who knows, maybe I'll have some fun?"

In this example, by the end of the exercise, the client's negative beliefs were put in perspective and objectively evaluated, given her the chance to obtain healthy distance from the thought that she may risk being rejected not only by this new friend, but all others in her life. The downward arrow technique and thought-challenging could have also been applied to the belief that the client was fundamentally flawed or unlikeable, which caused her to feel unsafe in herself and her relationships. There are many ways that these cognitive restructuring strategies can be used to help free ourselves from the anxiety-labyrinth created in our minds.

Acceptance & Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) guides individuals in becoming aware of not only their thoughts, but also their enmeshment, or fusion, with these thoughts. Cognitive fusion refers to how much we believe our thoughts, and thereby grant them power and “reality” in our lives. We often forget that every thought filters how we see the world, and dramatically impacts our direct experiencing of life. Regardless of how “true” our thoughts may be, they are still just thoughts.

Cognitive Defusion

Thus, ACT therapists help individuals practice cognitive defusion, reducing our entanglement with our thoughts. In other words, by taking our thoughts less literally, we learn how to become less attached to and controlled by our thoughts. We learn how to see them for what they really are. A thought is just a thought, an electro-chemical reaction. Thousands and thousands of thoughts stream through our minds per day. With ACT, we learn how to give them less power over us, and take back the power of choosing which thoughts we want to listen to (for example, being guided by a thought that supports us in acting in valued ways, as opposed to avoidant ways). With ACT, we focus less on changing the thought itself, and more on changing our relationship with the thought. We learn to relate to thoughts as just thoughts, products of a very active mind, instead of products of reality. Holding our thoughts lightly, seeing them from a healthy distance, and responding to them nonjudgmentally can allow us let them go so that we can get out of our minds and back into our lives.

Cognitive defusion techniques are practices that help us achieve this aim. These techniques may include exercises such as:

• Labeling your thoughts "I am having the thought that..." or "I notice that my mind is having a judgmental thought."
• Singing your anxious thought out loud (or in your mind) to the tune of a silly song (like Twinkle Twinkle Little Star or any other song of your choice) 
• Thank your mind for the thought, such as "Thank you mind for that thought. I appreciate your contribution but I got this."
• Repeating an anxiety provoking word over and over in your mind until you begin to hear it as just a word
• Ask what the thought is in the service of. Is it in the service of your values or in the service of avoidance of discomfort?
• Watch your thoughts: Imagine your thoughts are like a news scroll reel, constantly streaming information that you can watch from a distance.
• Practice mindfulness of your thoughts, such as using the Leaves on a Stream mindfulness meditation.

These are just a few ways that cognitive defusion can be promoted, helping us to take our thoughts less seriously, leaving them with less power over us. When our thoughts have a less powerful hold on our experience, they become less threatening. We then have more freedom to invest our attention and energy elsewhere. For a more comprehensive list of cognitive defusion techniques, visit this list on the Association for Contextual Behavioral Science's website.

Additionally, ACT asserts that we have limited control over which thoughts or emotions we experience. The problem is less in the content of our thinking or feeling, and more in what we do with these thoughts or emotions, or how we relate to them. In other words, we can change our relationship with our thoughts so that we can focus our energy on what is truly worthy and important to us, instead of using most of our energy on trying to simply manage or reduce unpleasant thinking. 

In sum, awareness of our thinking patterns is often the first step, and changing how we approach our thoughts is the next step along the way of healing and wellness.

These two approaches may resonate differently for different people. Both CBT and ACT are evidence-based treatments for anxiety, and can help those who struggle with the reign of anxiety get back into living full and meaningful lives.

If you are interested in having assistance with unhelpful thinking patterns, Dr. Lauren Helm is trained in both CBT and ACT. If you'd like to speak with Dr. Lauren Helm, a licensed clinical psychologist at Rise Psychology trained in exposure therapy, please click here. 

Follow Rise Psychology on Facebook or Twitter (@risepsychology). 

References

Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.

Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. Basic Books.

Ellis, A. (1962). Reason and Emotion In Psychotherapy. New York: Lyle Stuart

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.

Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. Worry and its psychological disorders: Theory, assessment and treatment, 239-256.

Whalley, M. G. (2015). Self-help tools for panic. Psychology Tools

Resources

http://www.webmd.com/balance/guide/how-worrying-affects-your-body

http://www.apa.org/divisions/div12/rev_est/cbt_gad.html

Cognitive Distortions and Restructuring Handout:

http://www.reconnect.salvos.org.au/common%20mindtraps.pdf

Exposure Therapy: Find Freedom From Fear & Anxiety

Written by Lauren Helm, Ph.D. 

“Face your fears.” The wisdom of this adage is built into exposure therapy, an intervention that has been extensively researched and shown to be very effective in treating various anxiety disorders. What is exposure therapy? This blog will break down why exposure therapy is used for anxiety, and how it works:

Why Exposure Therapy is Used for Anxiety

Anxiety disorders are characterized by anxiety that has taken on a life of its own, interfering with a person’s relationships, work, and quality of life.  Although fear and anxiety are normal emotional responses to threat (these emotions motivate us to avoid potentially harmful situations), anxiety disorders are characterized by pervasive and functionally-impairing levels of anxiety. It is proposed by behavioral psychologists that anxiety disorders develop as a result of classical, operant, and vicarious conditioning, important psychological concepts from learning theory that inform and guide exposure therapy.

Classical conditioning (Pavlovian conditioning) refers to associative learning. A conditioned response usually occurs after repeated pairing of a conditioned stimulus (usually a neutral stimulus) with an unconditioned stimulus. If an aversive stimulus (e.g. a loud, startling noise) that leads to an unconditioned response (e.g. a startle response) is repeatedly paired with a neutral stimulus (e.g. a fuzzy teddy bear), the two stimuli become linked, and the neutral, conditioned stimulus (e.g. the fuzzy teddy bear) will now evoke a similar response (e.g. a startle response, now considered a conditioned response) to the aversive stimulus. Classical conditioning is thought to play a role in the development of chronic, problematic anxiety. For example, let's imagine that a person becomes unpredictably violently ill and experiences serious, uncontrollable vomiting (i.e. the unconditioned stimulus) while he is shopping in a grocery store. He feels very anxious and on edge (i.e. the unconditioned response) as a result of the unexpected and severe nature of the illness. For some reason, he becomes ill on a few separate trips to various grocery stores, just by coincidence, and begins experiencing severe anxiety (i.e. the conditioned response) associated with even thinking about going into a grocery store (i.e. the conditioned stimulus). He stops going to grocery stores because of the severe anxiety and fear of experiencing another illness episode (even though grocery stores are not the direct cause of either becoming sick or the original anxious response) and his ability to take care of his needs is compromised. 

Operant conditioning is also thought to play a role in the development and maintenance of anxiety disorders. Operant conditioning is a behavioral principle that refers to the learning that occurs because we experience either "reinforcement" or "punishment" as a consequence of something that we did or didn't do. This is learning that occurs as a result of the consequences of our actions. Reinforcement refers to anything that feels rewarding to us, and brings us pleasure or relief. Punishment refers to anything that is aversive or painful - something we do not want to experience. The man in our example above who became very ill found substantial relief (i.e. reinforcement) from avoiding going into grocery stores, which reinforced his use of avoidance behavior, and made him more likely to do avoid grocery stores in the future. When we avoid or escape something that makes us feel afraid, we feel relief, and simultaneously may make the conclusion that because we found relief, we must have escaped true danger. In sum, fear and anxiety are reinforced and strengthened as a result of the short-term relief that avoidance behaviors provide. An avoidance behavior is anything we do (or do not do) to avoid or escape something that causes (or "triggers") anxiety. However, avoidance of anxiety can lead to an escalating cycle of anxiety and avoidance. The next time we encounter the feared stimulus (i.e. the thing that triggered our anxiety, whether it be a person, place, thing, thought, memory, emotion, or physical sensation) in the future, the more likely we are to experience a more heightened fearful or anxious response (because we believe it to be truly dangerous), and to have stronger urges to avoid or escape.

Vicarious conditioning is social or observational learning - meaning that we learn by watching the consequences of others' behavior as they interact with the world. A young child may learn that the world is a dangerous, scary place by watching her mother look frequently frightened and anxious, commenting that she must always be on guard because otherwise she will get hurt. Perhaps a fear of dogs is developed by watching a friend get seriously injured from being bitten by a dog. We learn about the dangers of the world by observing others go through something frightening, and how they react, even if we have not directly experienced the same thing ourselves.

What It Is & How It Works

In exposure therapy, a therapist collaborates with her client to generate a list of relevant anxiety-provoking experiences (that are not actually dangerous) intended to elicit the very fear that the person has been avoiding. Exposures are developed based on the types of situations and emotional experiences that are avoided and cause problems in an individual's life. Although this may seem counter-intuitive, it is an extremely effective behavioral approach that helps individuals free themselves from the problematic cycle of anxiety and avoidance. Essentially, the reinforcement of avoidance is “blocked” during exposure therapy, and the client completing exposures begins learning how to face his or her fears without avoidance. In doing so, habituation occurs, which is like desensitization. When someone is exposed to something fear-provoking (that does not lead to a negative outcome) over enough time, the fear-provoking situation begins to lose potency. So long as the situation the client is exposed to is not truly dangerous, anxiety and fear will naturally drop off. With repeated exposures, the level of anxiety that is triggered becomes less intense and long-lasting. When avoidance is prevented during exposure therapy, the fear/anxiety response is no longer reinforced and strengthened. This leads the fear response to extinguish, fading away as time passes. New learned associations often occur after the feared-outcome does not occur, and the belief that the anxiety-causing situation was dangerous becomes less powerful and salient (e.g. "I guess I am safe and okay after all!"). 

Most people have trepidation about starting exposure therapy. It is understandably very uncomfortable, at least in the short-term. However, the long-term benefits can far outweigh the discomfort that may occur along with exposure therapy. Usually, it turns out that we hold beliefs about emotions (especially the emotions of fear and anxiety) that interfere with our willingness to effectively face our fears.

Common myths about emotion typically include beliefs that:

• Fear or anxiety will continue to escalate (without a ceiling effect or peak) indefinitely until the person gets away from whatever is causing them anxiety
• Fear or anxiety will become so intense that it will cause physical harm or death
• Fear or anxiety will become so intense that it will cause psychological damage, insanity, a loss of control, etc.

These beliefs often reflect a fear of emotions stemming from a commonly-held belief that emotions are dangerous. In and of themselves, emotions are not dangerous – they are physiological sensations (along with thought & urges). The sensations are designed to motivate us to act. The feelings that come along with emotions may be experienced as overwhelming (especially when we don’t understand them or it feels as though they can do us harm), but they will not hurt you (and it is not physically possible for them to intensify beyond a certain point). Frequently, exposure therapy results in the added benefit of being able to tolerate and accept intense emotions, and the learned experience that it is safe to fully feel your emotions. It’s what you do with your emotions that count – how we ACT can have a beneficial or detrimental effect on our lives and well-being. Therapists help you to learn how to effectively respond to your emotions, so that they don’t restrict your way of life.

A therapist who is well-trained in exposure therapy principles and will explain in more detail why it is not the case that intense, acute emotional experiences cause harm. In fact, one of the principles of exposure therapy is to ensure that individuals are absolutely not caused harm – otherwise that would defeat the point! Exposure therapy is all about learning that despite the anxiety, there is no danger, but rather, safety. Once this is sufficiently experientially learned and processed (not just known intellectually), dramatic change begins to occur.

Don’t worry – your therapist will collaborate with you to figure out the best pace of treatment. Depending on your needs, you may opt to participate in flooding (which essentially means that you face some of your most intense fears right away), or the more commonly used approach, gradual exposure (you work your way up an exposure hierarchy, starting with mild-moderate fears). Both approaches have been found to be equally effective, but differ in the length of time that they may take to complete, and in the likelihood of premature drop-out. Remember, exposure requires repeated practice facing your fears until a re-learning occurs. Sticking with exposure therapy until anxiety has naturally begun to dissipate (or tolerance of anxiety has increased) is essential for success.

It isn't easy by any means. But for many, completing exposure therapy can be deeply worthwhile. Finding out that you can successfully face your fears helps you to learn on an experiential level that you are *safe,* even if fear or anxiety show up. It may also help you connect with the tremendous strength and resilience that you have within you to help you move through challenge - inner resources that are invaluable for rebuilding a fundamental sense of trust in our ability to navigate what life brings us.

Are you interested in using exposure therapy to tackle your fears? If you'd like to speak with Dr. Lauren Helm, a licensed clinical psychologist at Rise Psychology trained in exposure therapy, please click here. 

Follow Rise Psychology on Facebook or Twitter (@risepsychology). 

References

Bandura, A. (1985). Model of causality in social learning theory. In Cognition and psychotherapy (pp. 81-99). Springer US.

Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20(2), 261-282.

Barlow, D. H., Rapee, R. M., & Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23(4), 551-570.

Feeny, N. C., Hembree, E. A., & Zoellner, L. A. (2004). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10(1), 85-90.

Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. Oxford University Press.

Hofmann, S. G. (2008). Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical psychology review, 28(2), 199-210.

Blog reposted from Center for Stress & Anxiety Management blog: http://www.anxietytherapysandiego.com/blog/2015/2/21/swy4tbpb4algabok9hnlhw46us518b

Obsessions & Compulsions Can Consume Your Life

OCD can cause tremendous suffering and emotional pain, and consume your time, energy, and vitality.

Written by Lauren Helm, Ph.D.

OCD Awareness week is October 8th – 14th, an international effort started by the International OCD Foundation (IOCD) to spread awareness about Obsessive-Compulsive Disorder (OCD), which is estimated to affect 1 in 100 adults in the U.S. It is characterized by obsessions and/or compulsions that cause significant distress or impairment, or last more than 1 hour per day, on average. For each individual, OCD can look somewhat different, but the obsessions and compulsions that characterize OCD share certain features that we can learn to recognize with educated awareness. If you or someone you know has been diagnosed with OCD, you are probably aware of the tremendous suffering the disorder can cause. However, there are often many obstacles to getting diagnosed and treated. Not knowing the possible signs of OCD or that there are effective forms of treatment can block many from getting the treatment they need. This blog is intended to spread the word about some of the ways that OCD can manifest, and some of the ways that you or a loved one may seek help.

Getting to Know Obsessions

Do you struggle with thoughts or images that you found disturbing or unwanted, that repeatedly invade your mind, leaving you exhausted, worn thin and on edge from the endless battle they invite? Perhaps these thoughts are so opposite to who you see yourself to be, they make you shudder, and cringe at the fact that they crossed your mind…and yet they will not leave you alone, returning again and again, no matter how much time you spend monitoring your thoughts, no matter how hard you try to push them away when they appear, and how much energy you expend at attempts to ban them from your awareness.

You might feel confused or disgusted when you find yourself imagining doing something uncharacteristically sexual or violent, and terrified by the fear that you will act on the impulse. You might be unable to overcome the fear that you will accidentally cause someone harm or death, such as causing an accident while driving or dropping a sleeping infant. You might be tortured by terrible, frightening or disgusting images that violate your mind, the immoral or blasphemous images “tainting” who you are. Thoughts of contamination or of becoming ill might plague your mind, making your body and the environment feel constantly unsafe and in need of cleansing.

These examples of obsessions are not all inclusive, but are examples of common types of obsessions that those with OCD may experience. Obsessions are intrusive, unwanted thoughts, images, impulses and doubts that cause substantial distress and suffering, such as intense anxiety, shame, guilt or disgust. Although obsessions manifest somewhat differently for each individual, the common themes that underlie unwanted thoughts, images or impulses can be thought of as violations of the integrity of the body, mind, spirit, or sense of self/identity. Obsessions may be thoughts about contamination or illness, causing violence or harm to others, violating others, losing control, imperfection, engaging in religious blasphemy or moral violations, or unwanted sexual thoughts. The person suffering from obsessions does not actually act on these thoughts, but is often tortured by the fear of doing so and of what these thoughts mean about their character. Some people with OCD are preoccupied with “doing the right thing,” avoiding harm, or maintaining “purity” of the body (and/or mind or spirit), and the content of obsessions often feel particularly incongruent with who they are, adding to the spiral of confusion and distress, and fueling the motivation to heavily guard against these thoughts. To find relief, many individuals begin engaging in compulsions. A vicious cycle is created - the more that threatening, unwanted thoughts are pushed away, the more they return with ferocity and power.

Getting to Know Compulsions

Do you feel an uncontrollable urge to arrange things until they feel “just right,” becoming upset or agitated if you are prevented from doing so? Or perhaps the need to wash your hands again and again to eradicate a sense of contamination, experiencing a sense of urgency and need to get rid of the feeling of being “dirty” as thoroughly and quickly as possible?  Do you have a hard time leaving the house without repeatedly checking that the door has been locked more than once or twice, even driving back home long distances because of lingering doubt? Do you find yourself compelled to count to a certain number, or in multiples, to get your mind to finally let go of an obsession, or to feel safe again? Do you feel you have to eat the food on your plate in a certain order or specific rotation of your plate else you won't eat because of anxiety? Are you always asking others for reassurance to make things feel “right again,” to the point that both you and others are feeling burnt out from the constant need for reassurance? Do you compulsively mentally rehash events again and again, in a sort of mental loop without reprieve, looking for a way to prevent a feared outcome?

To contend with the power of obsessive thoughts, images or impulses, those with OCD may engage in compulsions, which are mental or physical behaviors that are intended to neutralize or reduce distress caused by obsessions, as well as the perceived likelihood of acting on obsessive thoughts/impulses. Compulsions can be thought of as a coping strategy, a way of getting relief from the overwhelming nature of obsessions. The short-term emotional relief that comes after engaging in compulsions is thought to reinforce continued obsessions and compulsions in the long-term. Compulsions themselves can be distressing, extremely time-consuming, and difficult to resist, leading those who suffer from OCD to feel at the mercy of their obsessions and compulsions.

The Cost of OCD

Both obsessions and compulsions can eat into individual’s lives, taking up more than 1 hour per day (sometimes occupying most or all of a person’s waking hours in severe cases). Not only do obsessions and compulsions cause emotional distress, they also can interfere with a person’s ability to function socially, within the workplace, or academically. Family members or loved ones are also often affected, as it can be hard to watch their loved one with OCD suffer, and to not know how to help. Sometimes, others in the person with OCD’s life can unknowingly reinforce obsessive-compulsive behaviors when trying to help.

Treatment for OCD  

The good news is, there are effective psychological and pharmacological treatments for OCD. Research strongly supports use of cognitive behavioral treatment (CBT) with Exposure and Response Prevention (ExRP or ERP) for helping those with OCD get relief -- a therapist who uses ERP will help someone with OCD to confront and respond differently to obsessions and the distress obsessions cause, and to avoid compulsions and other behavioral patterns that reinforce or maintain OCD. Additionally, SSRI medications have been found to reduce symptoms in OCD (you can ask your medical doctor or psychiatrist for more information about medication treatment options for OCD).

Building Awareness

As mentioned above, OCD Awareness week is happening soon, and the IOCDF has events that will occur throughout the week in various cities. IOCDF's website has information about about events happening near you, as well as informational resources and tools. A very informative list of common obsessions and compulsions can be found on the IOCDF website here. IOCDF also has a search tool for finding therapists in your area that work with OCD. The American Association for Anxiety and Depression (ADAA) also has free educational resources and links for support groups, apps, and a therapist search tool.

Finding Help

If you are concerned about possible signs of OCD in yourself of someone you care about, please know that there is hope! You are not alone, and there are many resources available for support.

Although it can be very helpful to learn about signs of OCD, and tempting to self-diagnose, please remember that a diagnosis of OCD can only be made by a qualified and credentialed mental or medical health professional. If you do not already have a treatment provider who treats OCD, the first step is to find a qualified mental health professional (preferably someone who specializes in OCD). You can ask your family doctor or primary care doctor for referrals. A medical doctor (MD) can also discuss medication treatment options with you - it may be helpful to work with a psychiatrist who specializes in working with OCD if possible. 

In order to find a psychotherapist who can perform CBT and ERP, you may search online therapy directories that focus on OCD and anxiety, such as online directories offered by ADAA or IOCDF, or your local state psychological association. It can be helpful to know what to look for in a potential therapist, because not all therapists use the type of treatment modality that is recommended as first-line of treatment (exposure and response prevention). This article by the IOCDF provides tips for what to look for during your search for a therapist, and what you might ask a potential therapist. Finding a treatment provider that you trust can help you stick it out even during the really challenging up's and down's that will inevitably be a part of your recovery process.

In addition to seeking therapy and/or medication treatment, you may look into local support groups for OCD as well. OCD Seattle, a local organization, has information about support groups in the Seattle area.

If you'd like to speak with Dr. Lauren Helm, a licensed clinical psychologist at Rise Psychology, for help with OCD, anxiety, or related issues, please click here. Dr. Lauren Helm is trained in using CBT and exposure therapy to treat OCD.

Follow Rise Psychology on Facebook or Twitter (@risepsychology). 

References

Clark, David A.; & Radomsky, Adam S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders. Available online 18 February 2014. DOI: 10.1016/j.jocrd.2014.02.001 http://www.sciencedirect.com/science/article/pii/S2211364914000128 ↩

Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American journal of psychiatry, 164(7), 1.

Resources:

https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd

https://adaa.org/screening-obsessive-compulsive-disorder-ocd