Uncategorized Archives - Page 2 of 2 - Anxiety Wellness Center of Chicagoland

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

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.

Overgeneralizing

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.

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.

Catastrophizing

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.

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.

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.

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.

Search for a treatment provider under specific organizations or foundations related to your presenting problem. For example, for OCD, there is an International OCD Foundation (IOCDF) website that lists providers associated with that organization. Some others include Anxiety and Depression Association of America (ADAA) and International Association of Eating Disorder Professionals (iaedp).

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!

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!

When Reassurance Backfires

Does this look good? Read this for me, does it sound okay? Is it too harsh? I have this weird sensation in my leg, what do you think it is? Should I get it checked out? Did I do that okay? Was I awkward? If this sounds like you, let’s have a chat about what impact the reassurance you receive is actually having on you.

You probably assume that the reassurance you’re seeking from others is helpful in some way. It answers questions you’re unsure of, helps you feel more confident, decreases unpleasant emotions, and provides you with relief. But, how often does that confidence, certainty, and relief last? Not very long, most likely. And why did you feel like you needed it in the first place?

Getting stuck in this cycle of feeling like we need reassurance from others, causes us to lose trust in our decisions and ourselves. We, then, begin convincing ourselves that we need this reassurance from others to move forward. When we look at this from a cognitive-behavioral therapy (CBT) perspective, it’s easy to see how this could be problematic. We experience a situation; this situation leaves us with uncertainty about it or the outcome of it (thought component); we feel uncomfortable/distress about this uncertainty (feeling/emotional component); we seek reassurance from others (behavioral component). Then, once we seek reassurance and someone gives us the “answer,” our level of distress or discomfort decreases and we experience relief. This actually reinforces the idea that we need to seek reassurance from other people. That reassurance took away our distress and provided us with some degree of certainty. Because our need for reassurance has been strengthened, the next time we find ourselves in a similar situation (uncertain and uncomfortable), we are more likely to seek reassurance again. Thus, not allowing us to trust our own judgment and abilities to manage the situation, and encourages us to avoid any discomfort.

Let’s use an example: I’m writing an email to another professional. I’ve read it a few times, but I’m not sure if it sounds good enough or if I missed a small mistake. I’m nervous about sending it, so I ask someone to proofread it to make sure I didn’t make any typos and I communicated clearly and professionally. They agree and provide me with the reassurance that it sounds good and I can send it. I feel better because someone else checked my work and said it was okay. The next time I have to send a similar email, I’ll probably ask someone to check it for me. Why? Well, I’m beginning to convince myself that the only reason I didn’t have typos and it sounded good enough was because someone else looked it over. I also don’t think I can handle the discomfort/distress of sending it without getting it checked! What happens if I miss a typo? What will they think? What if it’s not professional? All of these questions are flying through my mind and I can easily fix it by asking someone else! So, why not?

Learning how to manage these questions and uncertainties is a key skill to navigating so many areas of our lives! It’s important to move away from this need for immediate relief and figure out how we can handle some of these questions on our own. Sometimes, this means we don’t get an answer and have to sit in uncertainty and discomfort. The other thing that reassurance can “do for us” is teach us that we cannot handle making a mistake, sounding unprofessional, saying something harsh, etc. Simply put…that’s not true! We can cope with these situations, but constantly avoiding them via reassurance will not bolster our confidence, it does just the opposite! Think about all the uncertainties we sit with on a daily basis. We can’t be certain that our day will go as planned, if we’ll spill something on ourselves, if something happens that causes us to be late, if someone gets sick, if we get into an accident, if we get a distressing phone call, and so many more! If we’re able to sit with uncertainty for so much of our day, then why do we convince ourselves that we can’t manage in these other very specific situations? Also, when these more routine uncertainties and uncomfortable situations do arise, we move into problem-solving mode and figure out how to get things done and work through them. We cope with that unknown and as a result, we build confidence in ourselves.

I’m not discounting that there is a time and a place for reassurance. However, when it’s overused and a “go-to,” it becomes problematic. It’s not easy to change the way we typically respond to uncertainties that bother us, but it is absolutely possible. The end goals are to learn how to tolerate not knowing, cope with whatever happens, and learn how to trust ourselves again and those are all amazing outcomes. So, the next time you feel the need to seek reassurance, try to approach the situation on your own and see what happens!

Resolution Breakdown

2021 Here we are! We’ve been through quite a bit over the past year and there was a lot of hope that this year would be better, right?! Even on the heels of a much less eventful year, many of us use the New Year to set goals (either new or repeated) for ourselves. Setting those goals is usually easier than keeping them. But, why?

Have you already dropped your New Year resolutions? Are you back to eating all the food, drinking all the drinks, sleeping in instead of waking up early, and anything (everything) else you set yourself up for in 2021? Maybe you had amazing intentions for this year and you didn’t even get started! Guess what…that’s okay. You read that right, it’s okay! You might be wondering why it’s okay to drop the health/fitness/wellness/organization intentions when it isn’t even one month in to 2021. Well, the problem doesn’t come from dropping the goals or intentions, or “falling off the wagon” as so many say. The problem comes from watching that “wagon” you fell off drive away and leave you in the dust. Why did you watch it drive away? What stopped you from trying to get back on it? Are you going to wait for another one to come around so you can “get on” and start over?

You might say, “Well, how do I do that?!” Looking at our reaction to this can be really helpful in stopping this pattern and actually figuring out how to make changes, even if they’re small. Why do we set ourselves up for more disappointment and continue down the path of not making changes? Did we prioritize the wrong thing? Did we choose that goal for the wrong reason? Do we think it will be too hard? Not worth it? We won’t succeed? We won’t get the satisfaction from it we want? We could go on and on with so many more self-defeating thoughts that keep us from getting back on that wagon. Whatever the reason, it’s pretty common just to accept that we won’t be meeting those goals for the year and try again next year.

What if we stop accepting failure, figure out what small steps we can make to get to our goal, and get started on it today. We don’t need to wait until the next Monday for a “fresh week,” the next month, or the next year. The longer we stay in our current habits, the harder it will be to change them. With that knowledge, what would it hurt to try to break apart our large goal for the year and see how we can make progress toward that. In fact, wouldn’t it feel better to know you’re making steps toward something instead of just wishing you were?

It’s easy to get caught up in the distorted thought that if we don’t do it the way we want or intend, we didn’t succeed. However, looking at these goals or intentions as something that need to be completed to perfection is likely to make our efforts feel like a failure. Let’s be honest; if we’re looking for perfection, we’re setting ourselves up for disappointment. Instead, it’s important to pursue progress and look at every single step, no matter how large or small, as movement in the right direction. Maybe this means, you declutter one item a day, get up 15 minutes earlier to stretch, add an extra scoop of vegetables, or intentionally put your phone away for 5 minutes each day. You can always use those steps as motivation to keep going and increase the difficulty of the task.

Where to start? Anywhere! That’s the amazing part about approaching our goals from this perspective! Anything that progresses you toward the change you’re trying to achieve is in the right direction. There’s no right or wrong way to progress on personal goals. But, if these goals align with what you value in life, then working toward them is the accomplishment. Even noticing that there are things you’d like to better about yourself is an accomplishment. The steps don’t have to be large at all, they just need to be steps. Let’s use a quick example; most parents want their child to walk, but they don’t have the expectation that they will try the first time and never fall down; instead the expectation is that they get up and try again and take small steps first. If we are able to think this way about the goals we have for other people, why wouldn’t we afford ourselves the same opportunity? It’s time to make those changes and allow ourselves room to make movement instead of staying stuck in the same place. Let’s remember that we’re trying to build new habits, learn new skills and make internal changes. Successful long-term changes take time and errors. The challenge to you is to let yourself try in a way you might not give up on when you make a misstep. Challenge, accepted!

Category: <span>Uncategorized</span>