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6 Ways to Tackle BFRBs Outside Your Home

Body Focused Repetitive Behaviors (BFRBs) can often make us feel like we have no control over our behaviors and that we’re at the mercy of an endless cycle.  We pick at our skin, pull out our hair, pick our nails, etc.  We tell ourselves we won’t pick or pull again and then end up falling into the same old habits and routines.  Cue the spiral of shame, frustration, guilt and helplessness. 

Understanding BFRBs

Body Focused Repetitive Behaviors include things like skin picking (excoriation disorder), hair pulling (trichotillomania), nail biting/picking, cheek chewing and more.  Unfortunately, due to the shame and embarrassment caused by these behaviors and the possible noticeable consequences (i.e., bleeding fingernails, bald spots, open scabs, etc.), they are often not reported or discussed.  Therefore, they are not as well researched as many other mental health disorders.  

However, there is enough research to suggest that these can be successfully understood and treated in most cases.  The process of a BFRB often starts with an urge to engage in the behavior.  This urge may result from internal or external triggers such as a sensory cue (itchy sensation), emotional cue (boredom or anxiety), cognitive cue (hair is gray/out of place, nails are too long, etc.) or others.  This is not always within the awareness of the person, making resisting the urge difficult to do. 

Treating BFRBs

When working with a mental health professional specializing in the treatment of BFRBs, the evidence-based treatment is the Comprehensive Behavioral (ComB) Model.  The therapist works to increase awareness of the individual’s internal and external triggers.  They come up with competing strategies to implement once they become aware of their urges.  After practicing these competing strategies, they learn that the urges and the sensations pass and they can successfully get through that experience without further engaging in their picking/pulling/biting.  These strategies might include learning new ways to respond to their emotions, finding other ways to “satiate” the physical sensation, or removal of external triggers (i.e., tweezers) from their view.  The more often they get through this, they experience less intense urges and sensations and more confidence that they can successfully manage their BFRBs.

For anyone who’s tried to get control of their BFRB in the past, they will probably say it’s quite the undertaking.  However, this can be much more challenging when we’re in settings where skills are not readily available.  The good news is that we can still set ourselves up for success even in less than ideal locations.

Choose Strategies You Can Implement

Here are 6 ways you can set yourself up to combat your BFRB outside of your home:

  • Place a visual cue to remind you to implement your strategies.  This could be a post-it note, a picture, a single word, or something else entirely that simply reminds you to use your skills.
  • Have a bag of items handy to serve as your competing strategies.  Perhaps you use a hairy squish ball to pull at, hair ties to pull your hair back, long sleeves to cover your arms or a pair of gloves making it more difficult to pick or pull.
  • Focus on mindfulness strategies, specifically attending to your five senses.  By doing this, you may be able to keep yourself out of “autopilot” and stay attentive to your actions.  Often times our BFRBs present with boredom, anxiety, distress or other emotions we’re experiencing when we aren’t being present.
  • Set aside a few moments to review your goals regarding your picking or pulling.  For example, maybe you want that bald spot to grow back in, or you want your cuticles or other scabs to stop bleeding, etc.  Maybe you just want to feel like you’re in more control of your body.
  • Ask for and use your support system.  This may come in the form of talking to someone who knows your struggles while driving home, putting on a podcast that helps you stay focused on your goals.
  • Put something that serves as a tactile stimulus in these locations. One might use a piece of velcro on the back of your steering wheel, or under your desk at work or school.  Using this strategy, you are providing yourself with a less destructive stimulation for your fingers.

Planning is Key

The cycle of any BFRB can be difficult to break, but with a solid plan in place and consistency in practicing your skills and strategies, it can absolutely be done.   

In order to come up with an effective plan, ask yourself these questions?

  • Am I willing to be uncomfortable and push through the urges in this setting?
  • What will I have access to use/bring?
  • Does someone there already know about my BFRB and support my treatment and strategies? If so, how can I use/ask them for help?

Like anything else worth achieving, it will be a process that will include both successes and mistakes.  If you are already seeking professional help, try adding these tips to your list of strategies.  If not and you’re finding yourself struggling to navigate these unwanted picking/pulling behaviors, seek out a professional who specializes in cognitive behavioral therapy for BFRBs.

*This blog was also published on the Anxiety and Depression Association of America website.

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Telehealth: We love it and you will too

Therapy can greatly help people, but it is a lot of hard work; telehealth can take some of that stress away and make it an easier process for all. Because therapy can be so challenging, we want to minimize the time required to make therapy work for you. This means that you will have more time and energy to pay attention to the things that matter to you. The ease and convenience of telehealth may be the answer we’re all looking for. This post will walk you through what is telehealth, the benefits of telehealth, and if it is right for you.

Telehealth explained

By this time in the pandemic, most of us are familiar with some form of telehealth. Telehealth is simply remote healthcare provided via phone or video conferencing. Telehealth rapidly gained popularity in 2020. However, it’s been around for over a century and has a substantial amount of research supporting its use across many fields. In addition to being backed by science, telehealth has greatly improved the accessibility of quality mental health care. Along with this, we’ve noticed it has many benefits for our patients. Below we’ll discuss what providers and patients love about telehealth and if it is appropriate for you.

What we (and our patients) love about telehealth

Telehealth services for most medical and mental health care were effective long before 2020. However, for insurance, privacy, and other reasons it either couldn’t be used by providers or there was a stigma against it. Now that telehealth has been widely used with patients for years, and science firmly demonstrated that it is just as good as in-person most of the time, we want to point out what makes it so great for us and those we treat. Telehealth:

  • Makes therapy more accessible
  • Therapy is more convenient
  • Allows for patients, both adults and children, to feel safer at home
  • Provides invaluable symptom information, as many symptoms present within the comfort of one’s home
  • Allows for more time and energy to be put towards other important areas of your life


First, and possibly most importantly, telehealth makes therapy more accessible. Not only is it more accessible for many providers, it is more accessible for many patients as well. For example, patients dealing with agoraphobia or trauma may have difficulty leaving their home. Remote appointments mean they don’t have to face their biggest fears just to make it to a session. Those who are physically disabled, chronically ill, or have chronic pain can access the care they need without bringing on a symptom flare. Individuals who are deaf/hard of hearing, have a learning or other cognitive disability can greatly benefit. Remote options allow for the use of captions, screen sharing, chat functions, and more. Remote therapy options (along with legislation like PSYPACT), means we can treat patients in over 30 different states. This provides access to effective care which might not be available in many areas. This list isn’t comprehensive, but you get the idea. Remote options make accessing mental health care possible when, in the past, it might not have been an option for many.


Second, telehealth therapy is more convenient. Even if you’re close to your provider’s office, getting to an appointment once a week can be quite the hassle. Parking, gas, traffic, delays at school or work can all impact getting to your session on time. If your child is the one in treatment, convincing them to go to the office after a long day at school could be a struggle. If you’re very busy, it might be hard to find a regular time that works with your demanding schedule. This is especially true if you have to factor in the additional time for commuting. For college students, scheduling therapy between classes allows opportunities to work on mental health without compromising school performance or social life.


Third, most adults and children not only feel safer at home. Home is often where symptoms are most frequently occurring. With the type of therapy we offer at AWCC, therapy within our patients home can provide invaluable information. Working with someone where they feel safe and experience the most symptoms provides therapeutic opportunities. This allows providers to address specific symptoms in ways that are much more difficult in an office setting. In the past, working with a patient in their home meant we had to charge for travel time. The more time we spend time commuting, the less time we have to see patients. Despite being a small practice, we are passionate about helping as many people as we can. Telehealth allows us to help more patients, across various settings, in ways that work for them.

Leaves time for other things in life

Lastly, as we already stated, therapy is hard. What you get out of therapy is directly linked to what you are willing and able to put into it. Telehealth options are often more accessible, convenient, and can allow for more targeted treatment. This means leaves you with more time and energy to put in the hard work to achieve your treatment goals. Because remote sessions are easier to attend and schedule, they also decrease the likelihood that someone will cancel or miss appointments. This means they won’t be set back a week simply due to scheduling conflicts. Remote sessions also mean that you can still attend an appointment when you otherwise may not have been able. For example, if you have to watch your kids or you’re not feeling well, you can usually get to your computer/phone while at home. Therapy is only effective if someone can engage, so whatever makes it more likely that you can make it to sessions and put in the effort will make it more likely that you will succeed and start to feel better.

Is telehealth right for me?

Do you or your family member deal with symptoms of an anxiety, obsessive-compulsive, depressive, sleep, or trauma disorder? Need help managing a chronic health condition, chronic pain, or an eating disorder? Have ADHD, struggle to keep organized, have trouble keeping up with work/school, or possibly have a hoarding problem? Find that fear or worry keep you from doing the things you want to do in life?

If you answered “yes” to any of the above questions, then you/your family member might be a good fit for telehealth at AWCC.

In addition to wanting help managing one of the many conditions we treat, telehealth requires access to a few things. First, you need a device, such as a smartphone, tablet, or computer, that has a working camera and microphone. Second, you need an internet connection that’s stable enough for video calls. Third, you need a private space to have the sessions in. This can be a home office, empty conference room, car, bedroom, or wherever you have privacy and feel safe. 

Telehealth is a fantastic option for almost all of the patients we see at AWCC. However, it isn’t appropriate for all diagnoses and in all situations. Sometimes, people with more severe symptoms, various disabilities, and/or children younger than 10 years old may require either in-person services or a hybrid option. People with symptoms or a condition that would prevent them from being able to effectively engage in treatment via a video conferencing format are similarly unlikely to be appropriate for telehealth.

All in all, telehealth therapy is a fantastic option for almost all of the patients we treat at AWCC. Time and time again, studies have shown that Cognitive Behavior Therapy, the primary treatment we provide at AWCC, provided via telehealth is just as effective as in-person treatment for the types of patients we see and conditions we treat.


All in all, telehealth can be a great option for most of the patients we see at AWCC. Telehealth can increase access and allow you to engage in treatment where you’re most comfortable. As fall approaches, getting your child to weekly appointments can be a nightmare with after school activities and evening traffic. Telehealth can also mean fewer missed appointments, more flexibility, and more time for you to focus on getting better rather than getting to session.  Telehealth can be the difference between being able to get care or having to continue to suffer without it. Patients with a history of trauma, suffering from conditions such as agoraphobia, who are physically or otherwise disabled, or in locations with few treatment options are prime examples of this.

Most importantly, telehealth mental health treatment is proven to be effective for most, if not all, of the conditions we treat at AWCC. We have seen this first-hand with many patients over the last few years. We would not offer it if we did not believe in it.

Everyone knows video calls can suck, but so can facing the hard stuff in therapy; why not do it in sweatpants?

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Sleep? Who has time for that?

The average human spends about one third of their life either trying to sleep or actually sleeping. By age 80, you will have spent about 26 years in bed. As humans we spend a lot of time sleeping. But, we still don’t fully understand why we need sleep in the first place. What we do know is that getting too little of it can have devastating consequences. We also know that people struggling with the following conditions report having difficulty either falling or staying asleep:

  • Anxiety
  • Stress
  • Depression
  • Chronic Pain
  • And many other health conditions

It’s Sleep Awareness Week and Dr. Antler has studied this necessity for almost a decade, so we thought it would be a great time to help you understand:

  • What is it
  • Why we think we need it
  • What happens when we don’t get enough of it
  • What we can do to improve it

What is sleep?

Sleep is defined as a naturally recurring state of altered consciousness during which we experience reduced muscle and sensory activity. Sleep impacts almost every type of system and tissue within the body. There are four stages that fall into two basic types of sleep: rapid eye movement (REM) and non-REM. Stages 1 through 3 are all non-REM sleep.

  • Stage 1: The first few minutes after you fall asleep; a light sleep with the slowing of your heart rate, eye movements and breath
  • Stage 2: Body more fully relaxes and brain activity slows. Most time is spent in this stage.
  • Stage 3: Deep sleep; body is most relaxed; brain slows further and it’s hardest to wake
  • Stage 4: REM sleep; starts about 90 minutes after you fall asleep; most dreaming occurs during this stage; eyes move rapidly and brain activity is close to waking levels; muscles become temporarily paralyzed (we don’t want to act out our dreams!); heart rate, blood pressure, and breathing increase

Usually, people pass through stages 1 through 3 before entering stage four and this cycle, which usually takes 1-2 hours, is repeated three to four times every night. There are many biological processes involved in sleep. Since we don’t have time to go into that here, if you are interested in learning about these processes, you can find more detailed information from the National Institute of Health. Now that we know what it is, let’s see why we need it and what happens when we don’t get enough of it!

Why do we need it?

Scientists still aren’t entirely sure why we need to sleep and research in this area is still an evolving field. That said, recent studies suggest that it may play a housekeeping role in the brain. This includes removing toxins that build up while you are awake, which promotes better functioning the next day. Other studies have found that sleep may be important to our ability to remember information. Specifically, it allows our brains to process and encode information we’ve taken in during the day. Then, helps us to store that information in our long-term memory for retrieval later. Have you ever struggled to remember things from the previous day after you didn’t sleep well the night before? Poor sleep might be the cause. Though we aren’t certain about why we need sleep, we know a lot about what happens when we don’t get enough of it.

What happens when we don’t get enough of it?

Many people think they must get 8 hours of sleep. However, the range most people fall in is more like 6-10 hours. When we’re younger, we tend to need more. Babies sleep as much as 16 to 18 hours a day, whereas children over 5 and teens need 8-11 hours a night. As we age, our need for sleep decreases, with people over 65 sometimes needing as little as 5-6 hours. Whatever our personal sleep requirement, when we don’t get enough of it we call that sleep deprivation. Sleep deprivation has been extensively researched and the impact it has on your health and functioning might surprise you. When we sleep just a few hours less per night for only a few nights in a row people:

  • Are less able to attend to information
  • Have less ability to complete puzzles or various tasks
  • Struggle to remember information
  • Have difficulty regulating emotions

Beyond just impacting your day-to-day activities, it’s also been shown that losing just a few hours of sleep repeatedly is associated with:

  • Cardiovascular issues and other physiological changes
  • Impairment in weightlifting performance
  • More susceptible to illness due to changes in immune markers

There are many studies that have demonstrated the negative impact of sleep loss, but luckily for us, there are also many studies that have looked at how we can make sure we get the sleep we need.

What can we do to improve our sleep?

Not only can improving our sleep help us to avoid the negative consequences of sleep deprivation, improving our sleep can have a positive effect on our mental health, physical health, and even our athletic performance. So what are some things that you can do to improve your sleep?

One is to practice sleep hygiene. Having good sleep hygiene means everything from setting up a good sleep environment to engaging in daily routines that promote healthy sleep patterns. Some simple things you can do to improve your sleep hygiene include:

  • Set and stick to your sleep schedule (both sleep and wake times)
  • Create and follow a nightly routine
  • Avoid activating things (i.e., large meals, bright light, exercise, caffeine, etc.) in the few hours before bed
  • Restrict in-bed activity to only sleep and sex
  • Ensure you have a comfortable mattress and pillow
  • Keep bedroom at a cool temperature (around 65°F)
  • Block out noise and light

Improving sleep hygiene can help some people improve their overall quality of sleep, yet research suggests that the most effective way to improve sleep quality is through cognitive behavioral therapy (CBT). By combining CBT techniques with mindfulness, relaxation, and sleep hygiene, we help patients to change the way they think about, engage with, and actually sleep. The end result is usually better sleep and better overall physical and mental health! In honor of Sleep Awareness Week, we challenge you to choose one of the sleep hygiene techniques above and implement it throughout this week. Sweet dreams!

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Cognitive Distortion Series – General Negativity

The next group of cognitive distortions we’ll review are the faulty thoughts that have a negative foundation. Similar to my last post, we’ll list the distortion, then identify a few ways on how to attack those negative thoughts.


Labeling is simply the act of describing ourself or someone else negatively. For example, we might label someone as “stupid,” “disrespectful,” “horrible,” etc. Although someone’s behavior may be classified as one of these adjectives, that does not mean that person is “horrible” to the core. Here, we are not seeing the person as separate from his/her behavior. Imagine if everyone assigned us a negative label every time we didn’t act our best. There would be no room for error or mistakes to be made.

This cognitive distortion makes it difficult to move past these poor behaviors. It also skews our view of ourself or the other person. With this in mind, it’s not hard to see how this could negative impact our relationship with ourself and/or others.

When we describe ourself or others negatively, we often seek out incidents that support that negative bias. Cutting through this distortion and using these descriptions for behaviors has benefits. It allows us the opportunity to have just as many positives and seek out information that supports those positive labels as well.

The best way to cue yourself into this cognitive distortion is when you use a negative adjective to describe someone. This is used in place of describing that person’s actual behavior. For example, “I’m so stupid.” This is very different than “That was not a great decision.” In the first, we are identifying as all negative. However, in the second, we are simply using that as a description for a behavior, not as a whole.

The next time you do something you consider negative, try describing only your behavior and not yourself as a person. If you try and occasionally become successful with this, it can help improve your self-esteem and decrease depressive symptoms. The same goes for others; you’ll likely notice less resentment and frustration with others if you are able to separate them from their behaviors.

Discounting the Positives

Discounting the positives is another cognitive distortion that is negative at its core. Here, we essentially note the positive, but then dismiss it for any number of reasons. For example, “I got the job, but the company is so desperate, they’d hire anyone right now.” This statement does acknowledge the positive (getting the job), but then immediately disregards it as unimportant.

I like to refer to this distortion as the “yeah, but” distortion. When we have a conversation with someone and they give a complement and then say “but,” it feels like they’ve just taken away that complement. The “but” makes it sound like anything they said before that doesn’t matter. For example, even something as small as “I like those pants, but they are too short” doesn’t feel very positive. Instead, it ends with the negative statement. Wouldn’t it be nice to hear, “I like those pants” and that’s it. The same goes for my first example of the job. Instead of “I got the job, but…” simply stating “I got the job” is all that’s necessary.

What can clue you in to this cognitive distortion is definitely the word “but.” Once you hear that, pay attention to see what you said before that. Then, as yourself if that “but” was actually necessary.

After reading this, I’d like to challenge you to be on the lookout for this distortion and try to hold back the “but” and anything you’d say after that. See how it feels to just acknowledge the positives without regularly dismissing them with something negative. I think both you and any others in the conversation will notice that it’s a much more pleasant interaction.

Negative Filter

There is a key difference between this cognitive distortion and discounting the positives. The negative filter distortion does not recognize any positives at all. For example, “The company is so desperate, they’ll hire anyone.” Here, we didn’t even acknowledged the job offer.

Overall, this distortion is when you look at most things while wearing a negative pair of glasses. There’s no positive spin. Often, it’s difficult to identify positives, even when asked to look for them. However, we can find positives in almost any situation.

Even though we can usually find positives, challenging this distortion does not involve sugar-coating anything. Rather, it simply means identifying the facts and evidence on both sides, not just the negative. For example, when someone passes away, it’s often difficult and very sad, but a positive might be that they are no longer suffering. Getting fired from a job may be positive in any of the following ways:

  • We were unhappy anyway
  • Now we get to spend more time with our family
  • We get to take the break we very much needed
  • It’s an opportunity to try something new

None of these sugar-coat the situation. Instead they look at the opportunities the job loss presents.


When we overgeneralize, we distort a single incident into a pattern of behaviors. Most often, this is going to have a negative foundation and bring about unpleasant emotions or reactions. For example, when getting rejected from a job interview, we might think “This is usually the outcome,” or “I get rejected from a lot of things.”

We can easily see how this would lead to negative emotions by not seeing the reality of the situation. Perhaps this is only my first or second rejection. The goal here is to scale back how much we are taking that single incident (rejection) and viewing it as our usual outcome. We challenge this by looking at the evidence and the data. How many times has it happened compared to how many times we had a different outcome. For example, I’ve gotten rejected twice, but I’ve been offered many more jobs than that. The idea is that we want to break apart the pattern that this is “common” for us and see that it is, in fact, infrequent. We need to use the facts to identify the pattern and not just our thoughts.

All-or-Nothing Thinking

This cognitive distortion has many different names. All-or-nothing thinking, dichotomous thinking, black-and-white thinking, etc. However, they all indicate the same thing. We see things in terms of extremes. The core of this distortion is struggling to see the gray area on the continuum that is where a majority of life exists. Key words to identify this distortion include:

  • Always
  • Never
  • Everyone
  • No one

These words cue us in to the idea that we are on one end of the continuum or the other. This distortion can be found in thoughts that don’t include these words also, such as “It was a waste of my time.” This indicates that the entire event was wasteful and not one single moment was fun or beneficial. Again, this type of thinking often leaves us in a negative emotional state.

Once we’ve identified it, we want to look at how our language may be a bit extreme and things are not quite as black-and-white as we are indicating. For example, if I have an interview and don’t get the job. I may think “that was a waste of my time.” However, even thought I didn’t get the job, was the entire experience a waste? Likely not. I obtained more interview practice, maybe experienced a new type of interview question, or got some valuable feedback.

This distortion is a bit more extreme than overgeneralizing and can often have a bit of a negative filter feel as well.

Challenging Cognitive Distortions

As mentioned in my previous blogs about cognitive distortions, these thoughts can be challenged. However, we must first identify them as faulty thoughts. Therefore, once you’ve done the work of picking them out, you can use the type of distortion to figure out how to challenge them. I’ve briefly mentioned in the above sections how to do this. You may also need to use more than one challenge strategy, because many distorted thoughts can fall into more than one of the distortion categories. This actually provides an opportunity to challenge them from different angles. However, if you continue to notice your faulty thinking and struggle to move past it, seek out professional help. Someone who specializes in cognitive-behavioral therapy, or cognitive therapy, will likely be able to provide more in-depth training on the skills necessary to challenge these thoughts and reduce the negative emotions.

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Cognitive Distortions Series – Predictions

My last post discussed the overview of this cognitive distortions series. For this group of distortions, we focus on faulty thoughts that revolve around making predictions or assumptions. First, we’ll review the few distortions and then discuss ways to identify and challenge them at the end.

Mind Reading

The first distortion in this series is mind reading. This is just as it sounds. We assume we know what another person is thinking. Often, these thoughts are negative and impact us in that way. A few examples are:

  • She thinks I’m a bad friend
  • They don’t want me here
  • They’re mad at me
  • He thinks I’m stupid

As you can hear in these thoughts, the individual assumes they know exactly what the other person thinks about them. Another common trend, as mentioned above, is that these thoughts are typically negative in nature. Because of this negativity, we usually don’t walk away from this thought with any positive emotion. Instead, it’s common that we feel bad about ourselves. This may even lead us to avoiding that person/situation, or trying harder to “make them” like us or think we are smart.

Other than the negative association we get from these thoughts, the other problem with this is that we don’t actually know what other people are thinking. The only way we can know this for sure is if they verbalize it to us. For example, a blank stare may not mean they think we’re boring; instead it could be that they didn’t sleep well the night before and are struggling to stay awake. Similarly, even behaviors that seem dismissive (i.e., turning away) might not mean they don’t want to hear what you have to say. They could actually have thought you were done speaking or had their attention caught by something quickly that caused them to look away.

This distortion often leads us to a one-track mind. We assume that these are their thoughts and they couldn’t possibly be thinking anything else. However, as we break this distortion apart, it makes room for other possibilities that have nothing to do with us (i.e., they didn’t sleep well).

Fortune Telling

The second distortion in this series is fortune telling. Again, this is fairly self-explanatory. Here, we simply predict the future. Typically, this is also in a negative light and something “bad” is to come. A few examples of fortune telling are:

  • I’m not going to get that job
  • This date won’t go well
  • I’m going to fail my test
  • I’m going to make things worse

It’s honestly going to be pretty hard for us to focus well on an exam if we’re constantly telling ourselves we’ll fail. Similarly, if we assume a date will go poorly, it’s not very likely that we will be our genuine self on that date. Instead, we’ll be acting in a way that reinforces this thought and associated emotion (i.e., smiling less, talking less, not making eye contact, etc.).

The problem behind this distortion is that we really don’t have any idea what is going to happen. Unfortunately, that date might go poorly, but it will be more likely to be terrible if we’ve already decided that’s the outcome. On the other hand, it may be the best date one has ever had!

Here’s the hard part about this one. We like to assume that history repeats itself…because sometimes it does. However, just because you’ve had 20 terrible dates, doesn’t mean that the 21st will be terrible. The same with a test, or an interview, or anything else where we assume the ending. There are many different factors involved that are not the same as they were during those previous experiences.


The third distortion in this list is catastrophizing, or assuming something that’s already happened, or will happen, will be completely unbearable. A couple examples of this distortion are:

  • I won’t be able to deal with that
  • It will be terrible if I don’t get that job

Again, we see a few different predictions in this distortion. We make the assumption that we know the outcome of something. If the event already happened, we make the prediction that we won’t be able to tolerate it. Honestly, we regularly cope with so many things that we never thought we had the capacity to handle. For example, when we see a friend struggle with the loss of a parent, we often have a catastrophic thought that we won’t be able to handle it when one of our parents passes. However, if and when that time comes, we usually are able to figure out a way through it. This does not mean we will handle everything with ease. Instead, it means that we are typically able to implement some coping skills to manage the very difficult situation.

Identifying Cognitive Distortions

When we are trying to determine if thoughts are falling into one of the above distortions, let’s be on the lookout for some of the following key phrases:

  • He/She/They think…
  • He/She/They want…
  • I can’t…
  • I won’t…

This list is definitely not comprehensive, but it does give a general idea of how these distorted predictive thoughts might begin. The biggest way to figure out if you’ve engaged in these distortions is to ask yourself the facts of the situation. Are your thoughts based in facts or assumptions? Did someone give you a sideways look and you assume they thought your outfit was inappropriate? Or, did they give you a sideways look and tell you your outfit was inappropriate? One is fact and one is speculation.

How do I Challenge Predicting Cognitive Distortions?

When we identify that we’ve predicted something, we want to figure out our emotional reaction. If this prediction is causing us stress and anxiety, we may want to actually do something about it. If it doesn’t draw any negative emotional reaction, it may just need to be acknowledged and not addressed. Let’s focus on the problematic distortions. The ones that cause us anxiety or distress in some way.

Once we’ve determined that our thought is a problematic prediction, we need to get back to the facts. Identify what has actually happened regarding the situation and how your thought has strayed away from that information. Then, the goal is to remind ourselves that we don’t know anything beyond the facts. We have to live in uncertainty until something more comes of the situation, or until the situation ends.

Here’s an example where I’ll incorporate the predicting distortions: I just took a test and assumed I failed (fortune-telling). Because I failed, my mom will be furious with me and not let me hang out with my friends (mind-reading). On top of that, this test was so important, that I won’t get into college and I’ll be mortified (catastrophizing).

First, did I get my grade back yet? No, so I’m not sure if I failed. I know I don’t feel confident that I aced the test, but that doesn’t mean I failed. I won’t know my actual score until it is graded and returned by my teacher. Until then, I have to wait. Assuming I failed is not going to make that waiting time any more pleasant.

Second, did I study? Yes, so even if I did poorly on the test, I know my mom saw me studying and trying to understand the material. She usually says she wants me to try my hardest. I feel like I tried hard, maybe not the hardest, but I did try. If my trying wasn’t reflected well in my grade, I can figure out a new study strategy after that. Until then, I’m not sure if my strategies worked, so I have to wait.

Third, even if she is upset, does she usually keep me from my friends? If not, why am I making this assumption. If she usually does, then, missing a night out with my friends will be a bummer, but not the end of the world. They hang out a lot and I’ll just go the next time.

Last, is one test really what makes or breaks a college acceptance? If that’s the case, will I honestly not be able to get into any college, or just not the one I want? Assuming it’s not the only thing, then why would I place so much importance on it. Usually, they look at grades over a few years, GPA, ACT/SAT scores, essays and many more factors. Why am I assuming this one test will determine my future?

If Cognitive Distortions Continue

Challenging our thoughts can be very difficult and take some time to learn. Often, these thoughts may leave us feeling down, disappointed, hopeless, anxious or stressed. If you feel like you engage in cognitive distortions on a regular basis and you’re experiencing negative emotional states because of it, you may want to seek professional treatment. Look for a therapist who specializes in cognitive-behavioral therapy (CBT) to help you learn how to identify and challenge your specific distorted thoughts.

a man holds his head while sitting on a sofa

Cognitive Distortions Got You Down?

Cognitive distortions are thoughts that are not factually based. They commonly occur in my daily life. Is this because I’m a psychologist that focuses on cognitions and thought processes? Maybe, but these distortions are also in my own thoughts and the thoughts of people in my personal life. All that to say that cognitive distortions are very common and most people get caught up in these erroneous ways of thinking.

Understanding Cognitive Distortions

Cognitive distortions are simply thoughts we have that are not based in fact. They can be irrational or exaggerated, but they can also be very convincing. These thoughts, in turn, impact how we view ourselves, others and the world around us. Some of the ways these faulty thoughts arise are through:

  • Assumptions
  • Comparisons
  • Regret
  • Viewing things in extremes

When we use these as guides for our thoughts, behaviors, and emotions, we may be setting ourselves up for a negative outcome. These may include:

  • Failure
  • Disappointment
  • Frustration
  • Reduced self-esteem
  • Avoidance of activities we wanted to engage in

Below are a few other common names for cognitive distortions:

  • Thinking traps
  • Thinking errors
  • Distorted thoughts

Most of us don’t want to live in this distorted world. Therefore, it’s important to get a handle on our faulty thought process and figure out how to identify, challenge and change them.

What Causes Cognitive Distortions

Being human is all it takes to experience thinking traps. Automatic thoughts happen, well, automatically and can appear valid. When we mistake these thoughts for truths, we tend to experience unpleasant emotions and possibly engage in unhelpful behaviors. So, in this instance, thoughts lead to negative emotions. However, this process can also go the other direction. If we are in a negative emotional state (i.e., anxiety or depression), we are more likely to experience distorted thoughts. This emotional state also makes it more difficult for us to see the irrationality of the thoughts and challenge them accordingly.

Some people engage in more distorted ways of thinking than others. And some of us are much better than others at identifying these distortions and actively working our way out of them.

Cognitive Distortion Series – What’s to Come?

I want to use this post to kick-off a series on cognitive distortions. There are numerous distortions that deserve to have a bit more attention devoted to them. Therefore, in the coming posts, I’ll define a few distortions, how to identify them and specific ideas on how to best challenge them. The goal being to get unstuck from these negative ways of thinking and get back into a life of progress and growth.

If You’re Looking for Help Now

Focusing on cognitive distortions is at the heart of the very popular cognitive-behavioral therapy approach. If you find that you struggle with cognitive distortions, you’re experiencing anxiety and/or depression, or others are commenting about your negativity, and you’re not sure what to do about it, it may be beneficial to seek out professional help.

man standing in the middle of woods

Living a Life of Uncertainty

If we know anything for certain, it’s that everything is uncertain.  Sure, we can make educated guesses and estimations, but uncertainty remains a constant in our lives.  If there’s any question about this, just look back on 2020 through present day and you’ll see a trend of uncertainty.  So many questions and so few clear-cut answers.

Most recently, a significant amount of uncertainty has revolved around COVID and sending kids back to school.  I would argue that in 2019, many parents didn’t think twice about sending their kids to school.  However, over the past one and a half years, things have drastically changed.  There are so many more unknowns from what will the safety protocols look like to will my boss be mad if I have to stay home because my child is quarantined and everything in between.  Tolerating some unknowns is unavoidable, especially in these times. 

Uncertainty itself isn’t a problem

To be frank, there’s nothing inherently wrong with uncertainty and not knowing everything.  In fact, I’d argue that if we knew everything that lies ahead of us, there wouldn’t be much joy or motivation in life.  However, some people struggle with uncertainty.  They feel that they cannot tolerate not knowing.  This is actually the core of anxiety.  Anxiety’s nemesis is uncertainty.  

When it comes to anxiety, there’s so many questions:

  • What is going to happen?
  • What if…?
  • When will you be home?
  • Will people think I’m stupid?
  • What if I have a panic attack?
  • Is this [insert health symptom here] a sign of cancer?
  • Will I get sick?

Not everyone with anxiety will have all these questions.  Typically, there is only a specific area that someone with an anxiety disorder worries about.  For example, uncertainty about social situations, health, danger, etc.  The main exception to this is when someone struggles with generalized anxiety disorder. Regardless of the type of anxiety, there is a component of uncertainty to it.

Tolerating uncertainty is paramount

I do want to make it very clear that not everyone who struggles with uncertainty has an anxiety disorder!  There are times when all of us ask these types of questions.  However, when these questions become so overwhelming and we’re constantly either seeking reassurance or avoiding them, it is problematic and likely time to seek professional help.  If you notice yourself struggling with tolerating uncertainty, look into cognitive-behavioral therapy (CBT).  This is the gold-standard treatment for navigating the various anxiety disorders.  The goal of therapy regarding uncertainty, is not that you never experience it.  The goal is not that you’ll find yourself loving uncertainty.  Instead, the purpose of this type of therapy is to learn how to tolerate it.

Getting back to the idea that everything in life is uncertain, learning how to be okay with that will decrease overall distress.  We want to be able to:

  • Go with the flow
  • Accept changes in schedule
  • Have flexibility in our routine
  • Understand that we can tolerate the unknown
  • Build confidence that we can cope with the outcome of the uncertainty

Not only do we want to be able to do these things, but we don’t want to have to approach these aspects of our life with anxiety and fear.  If you’re unable to do these on your own, that is okay too. There are professionals out there, who do specialize in CBT, who can help you through this process. Remember, the relief you feel when you finally get certainty only lasts until the next uncertain situation arises.  Unfortunately, that’s waiting for you right around the corner.

black flat screen tv turned on displaying yellow emoji

What Should I Expect?

The decision to seek out therapy is often one that is not made lightly.  Occasionally, people may grapple with this decision for quite some time before actually contacting a treatment provider.  There are many reasons for this. They may:

  • be unsure what to expect
  • feel nervous about what people will think of them
  • be concerned about therapist judging them
  • have financial obstacles
  • be concerned about repercussions if insurance “finds out” about their treatment

Although the list continues, I want to provide insight into what those of you, who may be new to seeking out therapy, can expect.  The goal of this post is to give a general outline of the therapy process. Ideally, you’ll make the decision to start therapy based on your needs and not on the above concerns.  

First Contact (Call or Email)

Typically, when you call to inquire about services, my first step is to understand if I would be able to help based on what concerns you have.  For example, I am highly specialized in cognitive behavioral therapy (CBT) for anxiety, OCD and related disorders. Therefore, if you call asking for help with alcohol addiction, I would not feel like the appropriate person to help.  If the concern is outside of my skill set, I discuss that and provide appropriate referrals I have that are better equip to meet your needs.

If you are in need of services that I provide, we then discuss the process of therapy (outlined more in this blog) and logistics.  This administration discussion includes fees and payment policies, questions regarding out-of-network benefits, scheduling, and method of meeting (i.e., virtual or in-person).  Other questions and concerns are answered and addressed so you can make an informed decision about proceeding with scheduling an appointment.  

The First Session

During the first session, you will be asked a number of questions.  Most health providers in various disciplines as many of the following basic questions.  They may include:

  • Why you’re looking for treatment
  • History of what you’ve been experiencing
  • Medical/medication questions
  • Family background
  • Education/Occupation background
  • Social support system

Now, these questions may seem like a lot, but they all serve a purpose.  One of the main goals is to understand what’s going on with you and the various ways your symptoms interfere, or don’t, in different parts of your life.  It also helps me understand you as a whole person and not just as the presenting.  I do my best to make this a comfortable discussion and try to keep things light hearted along the way, as I understand it may have taken quite a bit of bravery to take this step.

At the end of this session, the assessment may not be finished. Therefore, during the next session, I finish gathering necessary information to ensure that I have a full understanding of your concerns.  I do it this way to make sure that when we set out on our treatment path (discussed shortly), something else doesn’t unexpectedly come up that would’ve been helpful to know in the beginning.  This still happens and can be addressed effectively. However, the treatment plan will be more accurate if I have most of the information early in the process.  After we wrap up, I typically ask if you’re willing to schedule another appointment.  If you don’t feel comfortable with me, there is no pressure to schedule a second appointment.  This saves the hassle of you canceling later or showing up and feel uncomfortable.  If you agree to continue, we’ll schedule and you get your first homework assignment(s). That’s right…you get homework and I’ll explain why shortly 😉

Subsequent Sessions

After the completion of the assessment/intake questions, we develop your individualized treatment plan together.  This plan is specific to your personal goals you have for therapy.  There may be times when we have to discuss the goals you set. For example, we don’t want unattainable or unrealistic goals (i.e., never be anxious again).  Typically, I like to set goals that will help us understand if we are making progress in therapy. For example, get to sleep by 10pm 5 of 7 nights per week.  

Once we have agreed on the treatment goals, I will educate you on what we’ll be doing.  We will likely spend about one full session on cognitive behavioral therapy (CBT). This gives you a good understanding of why we will approach your treatment goals using those techniques.  I’ll also teach you about anxiety/OCD/other presenting problem(s), again so you can see how CBT works toward meeting your specific treatment goals and better managing your symptoms.  

After we’ve developed the treatment plan and done the education, we begin with the treatment.  Treatment looks different for everyone based on individual symptoms and goals.  However, there will almost always be a homework component.  

Use of Homework in Therapy

Homework is a very useful tool for building new skills and learning new ways to respond to things.  Ultimately, CBT is a very active treatment process and homework helps you develop your skills between sessions.  As most of us know, the more you practice something, the better, and easier, it usually gets.  We apply this same idea to the skills and strategies learned in therapy as well.  Ideally, homework encourages treatment progress, so you can spend less total time in treatment.  

Getting Started

This may sound like a great plan, but it can still be pretty overwhelming to figure out where to start.  There are many ways to approach this daunting task.

  • Talk to friends or family who you know have been/are in therapy.  Even if their therapy focuses on something else, they can ask their therapist for an appropriate referral.  This way, you’re getting a name from a trusted source. 
  • Conduct an online search in your area.  This will provide a large number of responses, which can be difficult to sort through.  To narrow the results, put in specific search terms that detail the type of therapy you’re looking for (if you have this information), or the type of problem you’re experiencing. 
  • Post for a recommendation on a neighborhood/city social media page or email listserv if you have that available. 

Regardless of how you connect with a therapist, please ask them questions to make sure they are competent in what you’re seeking.  No matter who you see, you can always ask for, or look for, a new therapist if it isn’t a good fit.  This is your treatment and your life! As a therapist, most of us truly want to help you reach your goals and live the life you want!

woman wearing gray jacket

Talking About OCD Isn’t Enough

Do you struggle with obsessive-compulsive disorder (OCD)?  Have you seen multiple therapists with minimal lasting changes?  Do you think this means that you’re beyond help and there’s no hope for you to stop living under the thumb of your OCD?  These are questions I am frequently asked.  When people call to inquire about services, they often ask if treatment will help for their OCD. In general, a number of people are skeptical of therapy. Some are discouraged because the therapy they’ve had in the past has not been helpful for them.  When they start talking about their treatment history and how many providers they have seen, this makes sense!  Let’s discuss the difference between what people think treatment for OCD will look like and what it should look like.

What is Therapy?

What do you think about when you hear the word therapy?  Many people often assume a therapist sits in a chair with their notepad and asks, “How do you feel?”  They may also visualize someone lying on a couch talking about whatever is on their mind, receiving an occasional nod or “mm hmm” from the therapist.  Here, the person often feels validated, heard, and just allowed to let out whatever they’re feeling within a safe space.  This is a form of therapy often referred to as talk therapy. While it is useful for treating certain presenting problems or concerns, it is not recommended for OCD.  The leading practice for treating OCD is a specific type of cognitive-behavioral therapy (CBT) called exposures with response prevention (ERP). Keep reading to learn more about why talk therapy is not recommended for OCD and why you should seek a therapist who specializes in CBT and ERP if you want to conquer your OCD. 

Research Suggests CBT

Throughout the years, research has shown many times over that cognitive-behavioral therapy (CBT), specifically exposures with response prevention (ERP) is the first-line treatment for OCD.  Numerous studies have displayed that this type of therapy is absolutely the most effective for producing both short- and long-term gains in people suffering from OCD.  In fact, approximately 80% of people who participate in ERP treatment for OCD respond well to the therapy and are able to make significant gains.  Once they terminate their treatment, they often maintain these gains independently.  Booster or maintenance sessions are offered as needed to help with long-term management of OCD and to help generalize the skills learned to any new OCD symptoms.

Exposure with Response Prevention (ERP)

Now that we know research suggests ERP, let’s quickly take a closer look at what it is and how it works.  ERP is a specific technique used under the cognitive-behavioral therapy umbrella.  It is focused on thoughts, feelings, and behaviors and how these can trick us into maladaptive patterns of OCD.  By learning about this cycle, we are much better equipped to break it!  

For OCD, treatment will focus on identifying the triggering thoughts.  Once these thoughts have been identified, we can understand the distress (feelings) they cause.  These feelings then lead one to behave in a way that is compulsive, ritualistic, and/or avoidant.  The distress often decreases after this behavior or avoidance is completed.  This might not sound like a terrible idea, because no one wants to feel distress!  However, the problem comes from the idea that this behavior or avoidance actually increases the likelihood that we will experience those thoughts in the future.  By escaping the feeling and engaging in a behavior that “supports” the thoughts, we are actually strengthening those intrusive thoughts and encouraging them to continue.  Therefore, we are more likely to experience the thoughts and engage in the exact same cycle numerous times over.  

Once this cycle is identified, the goal of therapy is to slowly begin approaching these triggers (exposure), while decreasing the compulsive behaviors (response prevention).  Now, this may sound like an impossible feat.  Rest assured, a well-trained therapist will be able to help find an appropriate starting place so that there can be success in the process.  They often set up a hierarchy, or exposure-to-do list, of the compulsive behaviors that are interfering in the person’s life.  Likely, the sufferer would not start with the most difficult exposure practices.  Instead, they’d probably start with an easier task so they can learn about the process and feel a sense of accomplishment before moving on to harder exposures.  Although individual goals will be set with the individual, the general goals of this type of treatment are:

  • Learn how to tolerate distress caused by the trigger
  • Intrusive thoughts are just that…thoughts not facts
  • One can tolerate not knowing for sure
  • One can start to live with OCD instead of in reaction to OCD

When this exposure process is experienced, these goals are met. Intrusive thoughts actually get challenged and changes (learning) happen within the brain.  As more exposures occur, more learning happens and anxiety and distress decrease.  As the anxiety and distress decrease, the intrusive thoughts decrease in frequency and intensity.  Once this technique is learned and practiced, the OCD becomes much more manageable.  Then, the strategy can continue to be implemented in the future if OCD changes content or themes.  This may sound well out of reach and far too hard.  It is hard and I am not going to say it isn’t.  But, if one is willing to endure the distress and anxiety in the short-term to complete the exposures, there is an opportunity for huge long-term benefits and relief from symptoms.  Because what we know for sure, is the current cycle of doing what OCD wants, is not working!

Why Traditional Talk Therapy Isn’t As Effective

As mentioned, people have usually been to a few different therapists before finding my clinic.  This is usually the result of a therapist not adequately trained in CBT/ERP, or to them engaging in the less effective therapies for their OCD, i.e., talk therapy.  Talk therapy can actually be counterproductive to the individual with OCD, as it often focuses heavily on the thoughts and feelings and less on the responses to them.  What this may do is stress the importance of the thought instead of learning that we can have and tolerate distressing thoughts without needing to react to them.  Another thing that may happen is they might try to come up with strategies on how to avoid potential triggers with the goal of decreasing anxiety and distress, which actually strengthens the OCD.  Another common thing I’ve heard regarding previous therapies is that they try to rationalize their way through the thoughts.  On the surface, this doesn’t sound like a bad idea.  However, with OCD, this can become a sneaky reassuring compulsive behavior, as it provides a sense of certainty.  Since we’re talking about OCD here, that reassurance and certainty only lasts for a short period of time before one has another intrusive thought and feels like they need that reassurance and certainty again so they can feel better.  Hence, we’re back to that vicious cycle.

The Good News

Once the correct type of treatment with the right provider has been found, one can progress leaps and bounds when it comes to management of their OCD.  Although it is a chronic disorder, it is absolutely something that can be managed and kept at bay.  It will ebb and flow over the course of a person’s lifespan, but the strategies learned in CBT/ERP are most often able to be adjusted and applied to the various presentations.  Once an individual is able to shift the power dynamic from living under OCD’s thumb to being able to effectively cope with intrusive thoughts and urges, they are able to regain so much emotional freedom from their OCD that it truly can be life changing.  Now, this doesn’t mean that they may not need a booster or maintenance session for refreshers to continue honing their skills.  But ultimately, they can lead happy, healthy, productive lives and that, in itself, is success!

This post is not to say that traditional therapies do not have their time and place where they shine and are extremely beneficial. Instead, the focus is that OCD is not one of the disorders best suited for that type of treatment.  In short, if you are looking to experience freedom from intrusive thoughts and in search of therapy, please ask specifically about cognitive-behavioral therapy and exposures with response prevention.  It will be hard work, but the things we work the hardest for are often the things we want the most; in this case…freedom and relief.  The way I answer the question at the beginning of the post about if treatment will help is, “Yes, but it’s going to take time and hard work for both of us, but if you’re in, I’m in.”

The Magic Behind CBT

CBT?  What’s that?  And what do you mean, magic?

Cognitive Behavioral Therapy (CBT) is one of the most evidence-based, well-researched psychotherapies out there.  Honestly, if you search it, you will be bombarded with an insane number of results.  Having so much information available on such a life-changing topic is actually a fantastic thing!  However, it can be problematic for a consumer, as it might simply be too much.  It may be overwhelming to figure out where to start or what you even want to know about it.  That’s where this easy-to-digest piece on the basics behind CBT, what it is and how it works comes in.  

What is Cognitive Behavioral Therapy? 

CBT is a type of therapeutic intervention that focuses on thoughts, feelings, behaviors, and physiological sensations.  Any time we experience a situation, we have thoughts and feelings associated with it.  Then, we may also notice, or not, physiological sensations in response.  Once our body very quickly processes these pieces of information, we react/respond (behavior).  This sounds extremely simple because it really is.  It is not a complicated process once we understand it, but that does not mean that if we are stuck in a maladaptive cycle that it is easy to get out of it.  Let’s run through an example to give real-life context.  We will use the same situation and go through it with two different “people” to show just how much a person’s internal CBT cycle plays a role, even when the situation is the exact same. 

CBT Cycle in Action

The Situation
Someone is holding a dog in their arms.  Picture a dog in someone’s arms; there are no obvious signs of aggression and the dog is small enough that it is possible for their owner to hold it.  

Person A: Adaptive/Positive Experience
Person A sees this dog in the arms of its owner and has an automatic thought about it.  This thought could be something like Oh, look at that cute dog, Isn’t that sweet, or even I hope that dog is okay.  These thoughts will elicit some type of feeling, which could be happiness, joy, care, or others.  Along with these more positive emotions, Person A probably wouldn’t notice anything physiological; however, they’d likely have calm muscles, a normal heart rate, regular breathing patterns, etc.  Behaviorally, Person A may want to approach the dog/owner and ask to pet it or tell the owner they have a cute dog, but at the very least, they may have a slight smile (yes, that’s also a behavior).  Because they left this situation in a positive mood and mindset (and potentially positive feedback from the dog or owner), they are likely to repeat this cycle the next time they encounter a similar situation. Not a problem; there’s nothing wrong with this cycle.

Person B: Maladaptive/Negative Experience
Person B sees the exact same situation and their initial thoughts might be What if they put the dog down?, Did it try to hurt someone and that’s why they picked it up?, or It doesn’t look friendly.  Based on the nature of these thoughts, you can probably assume that they would likely have a different set of emotions.  Person B likely experiences fear and anxiety.  Based on this, they may notice physiological symptoms of an increased heart rate, sweating, muscle tension, upset stomach, etc.  It is highly unlikely that Person B will respond with the same behaviors as Person A. Instead, they may try to quickly walk past the dog/owner, cross the street if that’s possible for them, or even turn around and escape entirely.  When they leave this situation, they will no longer be experiencing fear or anxiety; instead, they will experience a sense of relief and safety.  Because they experienced this relief, they will also be more inclined to repeat this cycle when they encounter a similar situation. This, however, can turn into a problematic response if this happens every time they see a dog.

What’s wrong with escaping an anxiety-provoking situation?
It is sometimes encouraged to escape certain anxiety-provoking situations. In fact, there are absolutely certain situations that escape is necessary for survival! However, when our need to escape less threatening situations starts interfering with our lives, it becomes problematic and we need to learn how to respond differently. 

How does CBT help?

The whole idea behind CBT is learning how to respond differently, while challenging the negative thoughts along the way.  When we do this, we start to learn that our thoughts are not always facts and may or may be true.  We also begin to learn that those negative emotions and unpleasant physiological sensations we’re experiencing, don’t stay around forever!  Once this is understood and learned, a person becomes much more empowered and can look at various unpleasant situations through a new lens.  Not sure what I mean? Let’s get back to the example of Person B to show it more clearly.

Person B: Breaking the maladaptive/negative cycle
Person B will still see the dog and begin their initial thought process.  In turn, they will experience the distressing emotions and physiological sensations.  However, instead of running away or escaping, they respond differently and approach the situation.  At this point, Person B makes a conscious decision to go toward the dog/owner.  As they approach, their anxiety and fear may temporarily increase; however, if they stop to chat and/or even keep moving at a calm pace past the dog/owner, their anxiety will slowly begin to decrease.  Now, this might not seem like a big deal at all, but it was actually a great educational moment.  Instead of avoiding something they feared, Person B chose to actively approach it and they were able to learn a few things. 

  • Their emotions ebb and flow and they can tolerate those changes 
  • Their physiological symptoms ebb and flow as well 
  • They can respond in a different way
  • Their thought was just that…a thought! 

The dog didn’t get down, the owner didn’t “sick” the dog on Person B and everything turned out okay.  This would not have been experienced had Person B resorted to avoiding the situation like they usually do.  Instead, they are starting to put some cracks in the thought that this situation (and others like it) are threatening.  If they continue to use an approach strategy as often as they can, they will soon learn that their fears about this type of situation may have been exaggerated compared to the actual threat of a situation.  

That’s great, but what if something bad does happen? 
I won’t go into significant detail here, but I’ll do a quick explanation and example.  One could easily argue that driving in a car is dangerous and threatening, but most adults of driving age take that risk daily.  However, if we end up in a car accident (as many of us have or will), why don’t we stop driving?  After all, the danger was just proven to us and something bad did happen!  Well, for a few reasons.  One is that we have had many more times driving when we didn’t get into an accident, so we’re able to see that, although it’s possible, it does not mean it is highly probable.  A second reason is that we may lose our job, social life, family, etc. if we allow this anxiety to prevent us from driving.  Another reason is that we learned that, although it was unpleasant and uncomfortable, we tolerated it!  We were able to handle the situation, problem-solve as necessary and move forward with the understanding that what happened was the exception and not the rule.  So, if Person B experienced the dog getting down, barking at them, or even biting them, they would have learned that they can handle the situation, even if they didn’t like it.  Scary things happening to us doesn’t have to be a bad thing.  They are wonderful learning experiences, even when it’s hard to see that in the moment.  

So, where’s the magic? 
Well, that’s just it…there isn’t any.  We don’t need any magic wands or smoke and mirrors; rather, we simply need to make an adjustment in our actions to make the magic happen!  We are retraining our body and our brain by responding differently and approaching situations instead of avoiding them.  This process alone begins building new pathways in your brain, getting you closer to taking control of your anxiety and fear.  Even though it is a simple process, it can be difficult depending on the severity of the negative emotions and thoughts.  It will take time, patience and practice, but with those things, CBT can do wonders for making significant life changes toward a happier lifestyle!  My challenge to you is this: the next time you’re faced with a fear that you would usually avoid, try looking at it from a new perspective and approaching it instead of avoiding it.  Maybe it’s a phone call you’ve procrastinated, or an assertive discussion you’ve been debating, or even looking at a bug outside.  Whatever it is, see what happens if you approach it.  Good luck!