The Huddle Blog

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

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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How is a healthy lifestyle related to my sense of wellbeing?

By maggie

In the search for wellbeing, many people try all kinds of interventions to help themselves feel better before seeking psychotherapy. They or their friends and family see they aren’t acting like themselves, that they are sleeping, eating, drinking, and exercising differently. They are tense and irritable or withdrawn and isolating themselves more often. People try committing to exercise, eating better, drinking and smoking less, sleeping regularly, meditating, putting “boundaries” around work. Sometimes this brings relief and restores a person’s sense of well-being. I am not against any of these healthy lifestyle behaviors.  I want to talk about what’s occurring when healthy lifestyle behavior changes don’t “work.” Let’s discuss what’s happening when no matter how healthy a person’s lifestyle is, he or she still doesn’t have a sense of well-being. Or, no matter how much a person wants to commit to certain behaviors, he or she can’t seem to commit on a regular basis. Suffering or wellbeing occur based on how you relate to your mind and body, not from what you do. It’s not what you do, but how you do it.  People who relate to their thoughts, feelings, and sensations with openness, compassion, and courage do not have the …

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What are the different ways to think about relating to your thoughts?

By maggie

Throughout the brief history of psychology, there have been many schools of thought regarding how thoughts relate to wellbeing. Below is a very brief summary of the beliefs about thoughts that the various theoretical orientations assume. Every theoretical orientation starts from a complex understanding of human experience and skilled clinicians of every modality effectively use their theory to direct their interventions. I refer here to the clinical distinction of what the major theoretical orientations assume about the nature of thought and how it influences their interventions:  Psychoanalytic/psychodynamic – Analyze your thoughts, bringing awareness to what they are, what they’re connected to, and why you have them. As you bring insight and awareness to your thoughts, you become more connected to yourself, work through your feelings, and experience greater wellbeing. Behaviorism – Change your behavior. Regardless of your thoughts, your change in behavior will result in an increase in wellbeing.  Cognitive behaviorism – Change your thoughts in order to change your behavior. Change in thoughts from this perspective occurs from bringing insight and awareness to your thoughts and then challenging the irrational thoughts that lead to maladaptive behavior. More effective behavioral options occur as an individual challenges their irrational thoughts. They experience …

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What is an anxiety state?

By maggie

As we think more about achieving wellbeing, let’s discuss the most common feeling with which people have trouble: Anxiety is a normal, healthy emotion that includes thoughts, sensations, and the urge to behave in specific ways. It occurs after your fear circuitry is triggered in the presence of ongoing uncertainty.  Our fear circuitry is a highly perceptive, adaptive, and primitive part of our brain that kept us alive as a species and is up against different challenges in the modern world. When fear is triggered, there is a pattern of sensations, thoughts, and urges that come with it that are adaptive. Specifically:  Sensations present during fear (aka fight-or-flight response): Heart races, blood pressure increases, pupils dilate, sweating, shortness of breath, and digestion rapidly decreases.  Thoughts present during fear: Catastrophic, worst-case scenarios are generated. Thoughts are experienced as “sticky” or as if the presence of the thoughts means that they are actually occurring. This is called thought-action fusion (TAF). Although thought-action fusion is also “irrational,” it is important to recognize that thought-action fusion in the presence of real danger is very adaptive. Pulling your hand away at the same time (or even before) you have the thought “my hand is touching …

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The spectrum of responses to anxiety

By maggie

Your response to an anxiety state depends on your interpretation of the meaning of that state. The meaning that you could give an anxiety state ranges from danger on one side to opportunity on the other.  People who believe “anxiety = danger” avoid internal and external situations that make them anxious.  This is the primary misinterpretation that you are making if you have an anxiety disorder. It is true that the fear response (including sensations, thoughts, and an urge to problem solve or avoid) is triggered when there is a perceived threat, but the presence of the fear response does not equate to danger.  What’s more, if, through learned behavior, you start believing that the fear response itself is dangerous, you will avoid more and more until your world is very small. For example, if you fear that your sensations will lead to a panic attack you will avoid anything internally or externally that might lead to a panic attack. Or, if you fear having certain thoughts, you will avoid internal or external situations that might trigger those thoughts or perform physical or mental compulsions to make the thoughts go away when they inevitably occur. In both cases, you are …

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The adaptive nature of anxiety

By maggie

Let’s think about what it would have been like to be a cave person in order to understand the evolutionary utility of the anxiety response.  You and me, cave people, are sitting next to each around a fire, discussing our recent drawings on our cave. The fire is warm and the conversation is calm, yet engaging. The feeling we both have is one of calm and ease.  Suddenly, there’s a loud sound just 20 yards away!  Both of our limbic systems immediately respond. Our hearts start pumping, our blood pressure increases, our pupils dilate, we stop digesting. Sweating, we’re now ready for action. These physiological sensations occur before we’re thinking and as our minds catch up, both due to the noise and due to the increase physiological sensations, our minds start generating all kinds of catastrophic possibilities.  “Is it a tiger? Is it a bear? Where are our children and are they safe?”  We’re both on our feet, starting to search for the source of the noise and prepare to take action or run away depending on the threat.  Step out of this imaginary scene for a second… what do you think about the response you and me, as cave people, …

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