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.

Situational Avoidance

By maggie

Last week, we focused on how avoidance not only reinforces anxiety, but it also undermines your potential. As you commit to moving towards anxiety, uncertainty, and discomfort, there are several patterns that can undermine your best attempts at avoiding avoidance. Situational avoidance reinforces fear and creates demoralization. Experiential avoidance during situational anxiety creates habitual distance from the present moment and burnout. Cognitive avoidance creates habitual worry and rumination that reinforces catastrophic thinking and pervasive negative beliefs. Somatic avoidance creates habitual distance from the present moment and difficulty maintaining self-care. Emotional avoidance creates habitual distance from the present moment and difficulty experiencing intimacy and vulnerability. Emotion-driven behaviors are problematic avoidance behaviors such as addiction and fighting that create a new cycle of suffering. All of these options sound like a recipe for suffering to me! We’ll discuss these in detail through 2018. Let’s start with situational avoidance and experiential avoidance during situational anxiety. Situational avoidance If you don’t drive or fly because of the possibility of a panic attack or if you don’t eat a certain food or engage in certain activities because of OCD, you’re suffering from situational avoidance. If you could “just do it,” you wouldn’t be seeking help from …

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Cognitive Avoidance

By maggie

Cognitive avoidance occurs when you use problematic thinking to avoid feeling or to avoid effective thinking. I’m not referring to avoiding thinking altogether. In fact, your mind might be racing when you are engaged in cognitive avoidance. I’m referring to the types of problematic thinking (that is, unproductive worry, mental compulsions, and rumination) that create distance from feelings and prevents you from effective thinking (that is, problem-solving). Worry can occur when you have the feeling of uncertainty about an unanswerable question and you try to make the uncertainty dissipate by answering the question. Worry is productive when the question is answerable and the attempts to answer it result in problem-solving. Worry is unproductive when the question is unanswerable and the attempts to answer it create more questions, plus worry about worry (that is, “what if I can’t stop worrying?”). We’ll discuss this type of unproductive worry, called process-driven worry, as well as process-driven rumination and mental compulsions in greater detail during the weeks that focus on repetitive negative thinking. Functional cognitive avoidance (including unproductive worry, rumination, and mental compulsions) starts out as an attempt to answer uncertainty, to problem solve, or to understand something from the past when you experience uncomfortable feelings. Then, you get …

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Somatic Avoidance

By maggie

Last week in Community time, we focused on noticing, labeling, and staying with the emotions in your body rather than shooting up into your head and engaging in cognitive avoidance. When you shoot up into your head to figure something out or you distract or numb yourself out from what is happening in your body, you are engaging in somatic avoidance. (The  word somatic means relating to the body, especially as distinct from the mind.) You may have noticed that even if you identify as a person who is sensitive to emotions or someone who has been in psychotherapy for a long time, you still have trouble identifying and staying with your emotions. You might still be distant from your moment-by-moment bodily experience, your somatic experience. Two patterns are common here: 1) Individuals who are sensitive to emotions often learn and then reinforce behavioral patterns that make them experience their emotions more intensely. Sensitive individuals are often less able to identify and allow their emotions because of the intensity of their emotions and because of the way other people respond to them. We will discuss this theme in greater depth next week when we discuss emotion-driven behaviors. 2) Typical psychotherapy …

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Emotion-driven behaviors

By maggie

Emotion-driven behaviors are behaviors that increase the intensity of an emotion, despite their intention to decrease the emotion. Think anger and addiction and ineffective interpersonal strategies. As I mentioned last week, sensitive individuals are often less able to identify and allow their emotions because of the intensity of their emotions and because of the way other people respond to them. If you felt very strong, confusing feelings while growing up, due to trauma or your biological vulnerabilities, it was unlikely that you had the cognitive skills to understand what was happening and the emotional intelligence to regulate yourself. Many adults also don’t know how to regulate strong emotions effectively. The adults in your life may have tried to make your feelings go away by ignoring you or yelling at you. The urge to either over-control or under-control your feelings under these conditions is very common. Many people have a combination of both. Over-control of emotion includes suppression, withdrawal, compulsions, and perfectionistic control behaviors of your thoughts, feelings, and body (examples: compulsive exercise or restrictive diets). Under-control of emotion includes anger outbursts, self-medicating with alcohol and drug use, and problematic interpersonal strategies like passive aggression. For the last several weeks, we’ve been …

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Emotional Avoidance

By maggie

Over the last several we’ve discussed all the ways that we experientially avoid, including escape strategies and reassurance seeking, situational avoidance, somatic avoidance, cognitive avoidance, and emotion-driven behaviors. The last form of avoidance is emotional avoidance. Emotions are evolutionarily adaptive states that motivate behavior. Every emotion has or has had some utility in the evolutionary past. The sensations and thoughts associated with an emotion will peak and pass within 90 seconds if we don’t add anything to them. After the initial surge of emotion, you can choose whether you want to keep the thoughts associated with that feeling going. Your thoughts will retrigger the sensations to keep that emotion going. You only have the opportunity to choose whether you want to keep the emotion going if you are able to identify what’s happening. Many people do not have awareness of what’s happening to them when they are experiencing an emotion. The emotion feels like reality and the act to urge feels like the only option. It’s worth it to observe your emotional states and your urges to act in the presence of emotions so that you have the chance at more flexible behaviors. The opposite of emotional avoidance is staying with …

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Repetitive Negative Thinking (RNT)

By maggie

At the end of last year, we discussed experiential avoidance including escape strategies and reassurance seeking, situational avoidance, somatic avoidance, cognitive avoidance, emotional avoidance and emotion-driven behaviors. For the next several weeks, we will shift to another type of response mechanism that creates, maintains, and intensifies psychological suffering: repetitive negative thinking. Repetitive negative thinking is the broad category of habits of mind that occur when you are stuck in a rigid cognitive loop. It is a behavior, not an automatic process. Those with anxiety and mood disorders are vulnerable to experiencing thinking patterns (that is, vulnerability mechanisms) that make repetitive negative thinking more likely, but the repetitive negative thinking itself is a behavior. We discussed the thinking patterns that make repetitive negative thinking more likely throughout the fall. Specifically, anxiety sensitivity, intolerance of uncertainty, clinical perfectionism, fear of evaluation, inflated responsibility, and pervasive negative beliefs are thinking patterns that trigger the urge to worry, ruminate, or engage in post-event processing. In my academic study of ACT and transdiagnostic mechanisms and in my application of these theories in clinical work, I’ve noticed 5 types of RNT that can be understood on 5 dimensions. That is, I’ve noticed that very few people only …

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An explanation of worry

By maggie

Worry is a two-part process including an uncertain question and an attempt to answer it. Whether the attempt to answer it occurs via analysis, problem-solving, distracting, or getting reassurance, the attempt to answer is always problematic because it can never “solve” an unanswerable question and it makes the original uncertainty feel more threatening.  We typically say that you have generalized anxiety if you struggle against thoughts that are ego-syntonic— meaning consistent with your sense of what is important. You have obsessive-compulsive disorder if you struggle against thoughts that are ego-dystonic— meaning inconsistent with your sense of what is important. Many anxious people have both. As an example, the person with generalized anxiety fears: “what if my child doesn’t get into college?” and, in thought and action, attempts to answer that uncertain, unanswerable question. The person with obsessive-compulsive disorder fears: “what if my child is in the freezer?” and also, in thought and action, tries to be certain about this uncertain thought. Where worrying about your child’s future seems reasonable to most people, worrying about your child being in the freezer seems “irrational” or “unreasonable” to most people, so they have an added layer of confusion, frustration, and shame about why they …

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Functional Worry

By maggie

I’ve decided to organize the categories of repetitive negative thinking into types so that I can also organize interventions that will be most helpful for each type. You won’t find this in any textbook, scholarly articles, or elsewhere on the internet. I’m using these types for us to have shared language without unhelpful interpretations that come with the current label of each type of thinking pattern. (For instance, “I have anxiety, not OCD,” which may or may not be true in any given person.) Refer back to my previous post for a review of the dimensions. Type 1 – Functional worry Ego-orientation: Ego-syntonic, meaning that worries seem reasonable to worrier. Time orientation: Past and future Content: Can be anything Beliefs that maintain it: “I don’t feel as upset by everything when I worry.” “I worry because I care.” “Worrying helps me problem solve.” The function that maintains it:  Suppresses all feelings (examples: uncertainty, not-just-right  feeling, guilt, disgust, embarrassment) Worry as a function is a cognitive form of experiential avoidance, similar to thought control or thought suppression. In thought control and thought suppression, individuals make active attempts to stop thinking about the stimulating topic and distract themselves. When worrying as a cognitive avoidance, …

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Worry as a process

By maggie

Your process for any task is your series of steps to achieve your end. Your process for brushing your teeth or cleaning your kitchen may seem to you like “that’s just how you do it,” but if you surveyed the next 10 people you encounter it is very likely that their process for those tasks are not as similar as you were expecting. For worriers, the mental process of worrying might otherwise be described as thinking. Where does your worry end and your thinking start? To sort this one out, first off, bring attention to and get control over any functional worry that you experience. Read more about worry that functions as an emotional suppressant here. We’ll also discuss mental compulsions, rumination, and post-event processing over the next several weeks. These are triggered thinking patterns. There are external circumstances or internal thoughts, feelings, and sensations that make these responses more likely in your thinking. To overcome mental compulsions, rumination, and post-event processing, observe what triggers it, what keeps you fused to the content when it arrives, and what you feel. We can work together to challenge the beliefs that keep you fused to the content and to stay present to the …

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Mental compulsions

By maggie

The nature of obsessive thoughts is that they are unwanted and intrusive. They arrive with a spike of anxiety or uncertainty and the urge to do something that makes them stop. Behavior that you feel compelled to perform, against your conscious wishes, with the sole intention of ending a thought, feeling or sensation is a compulsion. Let’s discuss the nature of compulsions in greater detail so that we have shared language to understand mental compulsions. Here is a list of common physical compulsions:  Excessive hand washing or bathing Checking locks or appliances Checking that you haven’t made a mistake Checking that you did not or will not harm yourself or others Checking your body for sensations or your mind for thoughts and feelings Rereading or rewriting Repeating routine activities like moving a chair up and down Counting Excessive list making Needing to tell, ask, or confess what you are thinking Needing to touch or tap Needing to arrange or order objects Hand washing and all other behaviors listed above becomes excessive and problematic when the function of the behavior transitions from problem-solving to anxiety reduction. When your hands are visibly dirty or your body is sweaty or smelly, washing is …

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