The Huddle Blog

Sharing thoughts on cognitive-based therapy and how online group therapy can help us get better, together.

Fear of positive evaluation and the imposter syndrome

By maggie

Imposter syndrome occurs when there is a discrepancy between your performance and your beliefs about your performance. I differentiate between two types of imposter syndrome: anxiety-driven imposter syndrome and developmental imposter syndrome. Anxiety-driven imposter syndrome occurs when you have the skills to perform at the level that is expected of you, but you feel anxious about your skills anyway. Developmental imposter syndrome occurs when you have the potential to perform at the level that is expected of you, and you feel anxious about the process of reaching that potential. Both fear of positive evaluation and fear of negative evaluation can show up in both types of imposter syndromes. We’ll talk about anxiety-driven imposter syndrome and fear of positive evaluation this week and developmental imposter syndrome and fear of negative evaluation next week. Assuming you have the appropriate skills, fear of positive evaluation can be maintained by the pressure to maintain high performance, by the belief that confidence is synonymous with arrogance and dissonance between your belief about your worthiness and the evidence of positive evaluation. Let’s get curious about these patterns! Pressure to maintain high performance As we’ve discussed, consistent high performance (in any area of life) is a paradox. If you fear …

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Emotional perfectionism and the paradox of checking on your recovery

By maggie

Anxiety and OCD treatment is a paradox. You must become more anxious before you can become less anxious and you must become more anxious in the right way. The answer to anxiety is curiosity and compassion. Mental illness is the only type of illness where you go to the doctor to get relief from a symptom and your doctor prescribes you more of that symptom. It doesn’t make sense. It’s reasonable for you to be confused and frustrated about your treatment plan and your treatment progress. Let’s talk more about this paradox. You typically see a medical professional for structural disorders caused by pathology or injury. You need penicillin for an infection and a cast when you break your arm. Your eye doctor will prescribe you glasses as your eye sight declines; your dentist will give you a root canal for a decaying tooth. You are vulnerable to the effectiveness of your doctor, because something is wrong and someone else needs to fix it. Mental health treatment involves some important differences. The first difference is that the experience of anxiety is not a structural problem caused by pathology. You don’t have an infection that we can treat with medication. In fact, medication that completely sedates …

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Clinical perfectionism: a problem of strategy, not outcome

By maggie

Clinical perfectionism is a problem of strategy, not outcome. Perfectionists have high standards and expectations for themselves and others. This value can be a strength, as long as perfectionistic strategies aren’t compulsively used to control thoughts and feelings. Adaptive perfectionism is a healthy, ego-syntonic way of approaching tasks that leads to a good outcome. Clinical perfectionism occurs when anxiety and OCD hijack your values and bully you into approaching goals in a way that undermines your performance. Some of the characteristics of clinical perfectionism include: Rigidly following rules (“I should or must do things this way.”) Every task is equally important. Mistakes are catastrophic. Repetition until it feels/looks/sounds “right.” Missing deadlines due to procrastination. To shift clinical perfectionism into adaptive perfectionism: Prioritize based on values. Experiment and take risks. Notice when your efforts result in diminishing returns. Fight procrastination. Identify conscientious people as models. Self-talk that reduces Clinical Perfectionism includes: “It’s okay for me to have high ideals. In any given moment, it’s also okay to be uncertain or make a mistake.” “Any progress is better than no progress.” “I’m willing to take a risk or make a mistake in this instance, in light of my values.” Behavior that reduces Clinical Perfectionism includes: …

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Intolerance of uncertainty and exposure to uncertainty as an opportunity

By maggie

I described the nature of intolerance of uncertainty in my last post. Let’s talk more about shifting your interpretation of uncertainty to opportunity, rather than fear. When you’re feeling very anxious, it’s normal to attend to your anxious sensations, uncomfortable feelings, and catastrophic thoughts over everything else. You are not being selfish or going crazy. The nature of the anxious response is such that your mind fixes your attention on potential threat in order to help you survive. Some part of you knows that you aren’t running from a tiger and it would be okay to stop scanning the environment for danger. Another part of you does not know whether or not you are in danger. That part of you is uncertain. It’s okay. You’re not doing it on purpose, it isn’t your fault that it’s happening, and you aren’t doomed to feel this way forever. You just need to be more strategic. Let’s first honor evolution. Way to go fellow homo sapien! We made it! Your response to fear was adaptive the first time it happened. If you are in danger and you avoid, you survive. If you are not in danger and you avoid, you will develop an intolerance of …

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The role of intolerance of uncertainty in all anxiety disorders

By maggie

Intolerance of uncertainty is the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events. There are two beliefs that maintain Intolerance of Uncertainty 1) Uncertainty has negative behavioral implications for me and means something bad. 2) Uncertainty is unfair and spoils everything. I shouldn’t feel uncertain. There are two types of Intolerance of Uncertainty 1) Fearful anticipation of uncertainty often leads to avoidance. 2) Inhibitory anxiety in the face of uncertainty often leads to difficulty thinking, talking, making decisions, and taking action. Self-talk that reduces Intolerance of Uncertainty includes: “It’s okay to feel uncertain. Feeling uncertainty doesn’t mean I’ve done something wrong.” “Anticipatory anxiety is a feeling, not a fact or prediction. That is, it predicts my past, not my future.” “Uncertainty signals opportunity. I don’t know if something will go poorly, but I also don’t know what could go well.” “It’s okay for me to take the next small step in the presence of uncertainty.” Behavior that reduces Intolerance of Uncertainty includes: Commit to valued behavior to reduce indecisiveness. Practice guessing at the smallest next step. Live in your decision, including taking responsibility for the consequences of those decisions. Bring up an attitude of curiosity …

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Anxiety sensitivity as fear of all strong affects

By maggie

Anxiety sensitivity as fear of all strong affects In my last post, I explained that anxiety sensitivity is the fear of arousal-related sensations, arising from beliefs that the sensations will have adverse consequences such as death, insanity, or social rejection. Fear of fear is common when you are in a neurologically vulnerable state, including being hungry, tired, angry, lonely, and stressed. We discussed how to make a plan to prevent and manage your sensitized states. Let’s focus on other thoughts, feelings, memories, and situations that contribute to sensitization. We can try to predict and prevent sensitization, but triggers happen. The paradox of introspection is that when you are very triggered and sensitized, all the thinking you engage in to try to “figure out” why you’re upset will likely make you more upset. It isn’t your fault. Your amygdala is doing its job searching through your memories and fears in an attempt to figure out why it’s happening, how to get out, and how to prevent it again in the future. Most people get caught in this attempt to figure it out and their rumination and worry make them feel worse. Even if you gain insight every once in a while, the …

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The biological basis of anxiety sensitivity

By maggie

Anxiety sensitivity is the fear of arousal-related sensations, arising from beliefs that the sensations will have adverse consequences such as death, insanity, or social rejection. You can think about it as second fear. Whereas first fear is the automatic fight-or-flight reaction that arrives in response to a perceived threat, second fear is the interpretation that the sensations themselves are a threat. Anxiety sensitivity amplifies the automatic anxiety reaction. The tendency to respond to arousal-related sensations with terror is heritable. Sensitivity runs in families and the thinking patterns that perpetuate terror are socialized. Taking responsibility for your anxiety disorder requires that you learn what sensitizes you and make a plan for those situations.The best way to disarm anxiety sensitivity is to get accurate information about your sensations. Pay attention to the sensations that scare you and ask about them in group. Here are some common sensitizing situations and what you can say to yourself when they happen: Hungry – “My mind might be sticky because I’m hungry. I should have a snack before I fuel or act on these thoughts.” Angry – “My mind is building a case, so I probably feel angry. In the presence of anger, rather than fueling my case, I …

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What would you do if you didn’t feel anxious?

By maggie

You will have recovered from your anxiety disorder when you overcome your anxiety sensitivity, or second fear. Anxiety treatment can’t and shouldn’t mean that you’ll never be anxious again. Becoming anxious is a normal, healthy adaptive reaction to doing challenging things with uncertain outcomes. I would never want to take the capacity to become anxious away from you. Instead, I want to teach you to respond to anxiety in a way that helps you rather than hurts you. You overcome fear of fear by inviting in fear when it shows up and choosing to see it as an opportunity, not a threat. This week I also asked several members, to ask themselves, “If I didn’t feel anxious, what would I do?” and “If I am feeling more than just anxiety, what else do I feel?” These two questions seem simple, but they target two very important concepts: “If I didn’t feel anxious, what would I do?” targets values driven behavior. We’re trying to wade through the anxiety to the values underneath it and act according to that value, rather than according to what our anxiety urgently tells us we must do. “If I felt more than just anxiety, what else do I feel?” increases …

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What is Acceptance and Commitment Therapy?

By maggie

Acceptance-based cognitive behavioral therapy is based on a theory of psychological science that studies the relationship between thoughts, feelings, and behaviors. The idea is that feelings influence thinking, thinking influences behavior, and behavior influences feelings. Regardless of why you are thinking, feeling, or behaving a certain way, you can learn to observe it and choose to respond differently. Flexibility in how you think, feel, and behave creates opportunity for the experience of wellbeing. Psychological flexibility is the opposite of psychological rigidity, which is marked by experiential avoidance and rigid thinking. You can increase your psychological flexibility through accurate education about how your mind works, flexible practice getting distance from your unhelpful thoughts and opening up to what you feel, and by building motivation through focus on what you care about. Learning to relate effectively to anxiety by increasing values-based action and increasing your willingness to tolerate distress and uncertainty increases your psychological flexibility. We’re going to find opportunities to increase psychological flexibility by observing moments where you get stuck.

What is wellbeing and how is it achieved?

By maggie

Many people seek psychotherapy because they just don’t feel good. They say they feel stuck or that they don’t feel like themselves. They feel tense and keyed up. They can’t stop worrying about work, money, or their relationships. Many say they’ve been sleeping too much or waking up throughout the night. They’ve started drinking or smoking more often. They’ve started eating less healthfully and they never exercise. They have no sense of energy when they wake up in the morning and instead feel dread and fear about what’s coming next. Some people can articulate that they feel lonely, sad, disappointed, confused, anxious. Many others just feel a vague sense of numbness and fatigue. They just don’t feel well. Sometimes there are external circumstances, like the death of a loved one, a divorce, or a stressful transition, that triggered their change in thoughts, feelings, and behaviors. It is just as likely that there is no external circumstance that explains the change.  Modern evidenced-based psychological theory understands psychological suffering to be the result of the individual’s experience of herself, including internal thoughts, sensations, feelings and urges, as she responses to external circumstances. Put simply:  Psychological suffering = physical or psychological pain + …

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