The Huddle Blog

Sharing thoughts on a cognitive-based understanding of anxiety and how online individual and group therapy can help us get better, together.

The ordinary nature of wellbeing

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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A short history of how the profession of psychology understands wellbeing

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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A description of the 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 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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A description of anxiety disorders

By maggie

An anxiety state becomes an anxiety disorder when the individual adds an interpretation of danger and responds accordingly. Individuals with anxiety disorders believe their catastrophic thoughts and attempt to problem solve or avoid their thoughts, feelings, and sensations. Although there are other characteristics of each disorder, one way to think about the specific anxiety disorders is by understanding what the individual misinterprets as dangerous.  Put simply,  Panic disorder – Fear of sensations and avoidance of external or internal stimuli that may trigger those sensations Generalized anxiety disorder – Fear of thoughts; hypersensitivity to uncertainty; problematic beliefs about the utility of worry Obsessive compulsive disorder – Fear of thoughts; hypersensitivity to uncertainty, guilt, and disgust Social anxiety disorder – Fear of sensations and thoughts; fear of positive evaluation and negative evaluation due to hypersensitivity to the possibility of rejection and perceived judgment Sensitivity to anxious sensations occurs in all of the anxiety disorders. This trait is called anxiety sensitivity and it is a biological predisposition that runs in families and is passed down through social interactions.  The fight-or-flight response is inherently neutral; it isn’t good or bad. It’s just happening. A performer who frames the way that his heart races before going on …

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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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Avoidance creates, maintains, and intensifies anxiety

By maggie

As explained in the spectrum of responses to anxiety post, the spectrum of responses to anxiety an individual could display ranges from avoidance to exposure. The belief of a person who avoids is that he or she is in danger. In contrast, the belief of a person who exposes herself to the anxiety on purpose is that the anxiety is an opportunity to learn. Exposure is the willing act of putting oneself in psychological and physical situations that induce fear and anxiety.  Willing exposure is challenging in the moment of anxiety, but in the long-term it decreases anxiety.  One theory of why exposure works is habituation. This theory understands the fear response to be similar to other senses. For instance, if you were to enter a room that smelled distinctly, if you stayed there, after a little while, your sense of smell would adapt to the smell in the room and stop notifying you of the smell. If, one the other hand, you left the room and reentered repeatedly, you’d notice the smell anew each time. In the first situation you are habituating. In the second situation you are not.  As it relates to anxiety, the theory is that you …

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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.

Exposure is a lifestyle, not a technique

By maggie

Cognitive behavioral therapy is known for its techniques, including self-monitoring, cognitive restructuring, exposure, and relaxation training. The original theory was that a skilled clinician can apply techniques to get her client to think differently and the consequence of thinking differently would be behavior change and provide relief from suffering. From this perspective, although the clinician acknowledged the impact of the relationship, she was functioning a lot like a physical therapist. That is, the physical therapist knows more about the body than the client and can teach the client to manipulate her body through practice in ways that will provide relief. Similarly, a cognitive behavioral therapist knows more about the mind and its interactions with the body than the client, and the therapist can teach a client to practice thinking and behaving in ways that will provide them relief. For many interventions related to behavior change, this parallel continues to be accurate.  Exposure, however, needs to be understood as a a way of being, not as a technique to apply. My post about exposure described what it is and how it relates to CBT. Willing exposure requires an attitude shift. It requires the person who has previously experienced his anxious thoughts, sensations, …

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Frequent misunderstandings about exposure

By maggie

Just do it. Exposure has to be done the right way, meaning that the individual engaging in exposure has to have the right perspective. If you decide to “just do it,” it is true that the task will be achieved and for some people in some circumstances that in and of itself is important. However, just facing the fear does not mean that you are willing to experience the thoughts, sensations, and behavioral urges that accompany the fear. If you continue to resist against those thoughts, sensations, and urges, whatever task you are attempting will feel very burdensome. Fighting against the urge to avoid and trying to ignore feared sensations and catastrophic thoughts will be exhausting.  The right attitude to embrace during exposure is one where catastrophic thoughts, uncomfortable sensations, and the urge to avoid are all expected and understood as part of the process. They are not signs and they don’t have meaning. When they arrive, you don’t fight to make sure they don’t get worse. Rather the attitude towards your thoughts, feelings, and sensations is something like, “Oh. It’s cool that you’re here. I was expecting you. I’m going to continue doing what I was doing.”  I already …

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