The Huddle Blog

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

What is an anxiety disorder?

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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What is exposure and how does it relate to CBT?

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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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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The role of anticipatory anxiety

By maggie

As you learn to disarm anxiety, knowing its patterns is one of your best strategies. One part of the pattern of suffering that anxious people experience is anticipatory anxiety, which is the feeling of dread about an upcoming thought, feeling, sensation, or situation that might bring about the feared situation. Individuals with anxiety disorders typically have difficulty staying with the feeling long enough to recognize that it’s a feeling, not a fact or prediction. As I’ve discussed, the nature of your anxiety disorder is that your mind is experiencing your thoughts, feelings, memories, or sensations as unwanted and dangerous and is getting you away from them as soon as possible. Whether or not you have a formal self-monitoring practice, identifying and labeling dread when its happening is a powerful step because it is the opposite of avoidance. Here’s a suggestion of what to say to yourself: “What I’m experiencing right now is anticipatory anxiety. My dread is a feeling, not a fact or prediction. It’s an indication that I feel uncertain. The feeling of uncertainty does not mean something bad is about to happen. In fact, uncertain might indicate that something good is about to happen! This is just a …

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Tricked into listening to dread

By maggie

Let’s discuss what individuals with anxiety disorders often do instead of self-monitoring, identifying, labeling and allowing dread: Listening to dread by avoiding Because individuals with anxiety disorders characteristically avoid what they are thinking and feeling, they don’t recognize their dread as part of the pattern of anxiety. Rather it feels like information, as though whatever its saying is truth. Feeling dread, you may think, “I’m so nervous right now. What if my anxiety just gets worse and worse? What if something bad is going to happen? Maybe I shouldn’t do it. Maybe I should do it some other time when I don’t feel like this. Maybe I don’t actually want to do this because I feel so bad when I think about it.” Dread, when interpreted as information, triggers indecision and doubts; avoiding based on doubting thoughts causes more anxiety and more dread. Listening to dread and becoming depressed Dread can feel more like depression, and can hit you like a sudden lack of energy and motivation. If there are many thoughts, feelings, sensations, and situations that trigger your anxiety, you may feel a consistent and pervasive sense of dread that doesn’t feel like a passing feeling. Similarly, if you always …

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The relationship between dread and confidence

By maggie

Responding effectively to anxiety is a challenging skill that develops experientially with time and practice. Think of a challenging skill you’ve acquired in your life: riding a bike, learning to read, speaking a foreign language or learning a programming language, or playing a sport. You didn’t have trust in your ability to execute those skills — that is, you didn’t have confidence — until you had many experiences of practicing and succeeding. If the skill was important to you, you likely had feelings of anticipatory anxiety prior to experiences that would test your ability because you didn’t know what would happen. That’s perfect! That’s exactly how anticipatory anxiety works! It’s not alerting you that you can’t do something. It’s alerting you that you don’t know yet how you’ll do. For this reason, decreases in your anticipatory anxiety will be the last part of overcoming your anxiety disorder. For many people, the anticipatory anxiety is the worst part. They want it to go away now! Anticipatory anxiety is a clever trickster that causes people to avoid, become demoralized, self-criticize, and waver in their decision-making. Do not be fooled! Your mind is actually working adaptively. Like learning anything else, your body won’t …

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The attitude of active, willing acceptance

By maggie

So, how do you relate effectively to your unanswerable, catastrophic thoughts?  Your anxiety disorder will be cured 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.   When you feel anxious, here are your steps: #1 – Label it as anxiety #2 – Switch from content to process. #3 – Do the opposite of avoidance: Get unfused from your thoughts. Open up to sensations. #4 – Actively allow your anxiety. Make it worse. Ask for more of it. There will be other posts going into detail on each of these points. For now, let’s discuss how to help yourself learn how active, willing acceptance. There is a right way to self-monitor.  In order to practice the steps above, you’ll benefit from seeking out triggering situations and watching your experience. You want to observe the following aspects of your experience:  1) …

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Self-compassion precedes confidence

By maggie

It takes humility and courage to accurately assess where you are and commit to the next step. If you feel intense anxiety getting out of your house, the idea of obtaining and committing to a job on a daily basis might seem beyond what’s possible for you.  If you feel intense anxiety sending an introductory text message to a potential romantic partner, the ongoing vulnerability required to sustain a long-term relationship might seem overwhelming. Thinking about this, many individuals with anxiety disorders get so discouraged that they lose motivation to take the next step. It’s important to see this as part of the pattern of anxiety’s game. Anxiety (and his allies self-criticism and depression) will tell you: “What you’re currently doing isn’t good enough. This shouldn’t be hard for you. You shouldn’t have to practice this. You’ll never get where you want to be.” You need to be ready for this type of message and say back to it: “Every time I identify, label, and allow an uncomfortable thought, feeling, or sensation, you get less power. What I’m practicing is a new process; it’s not about my outcome in any given moment. It’s okay that this is where I am …

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Setting goals to gain confidence

By maggie

A helpful goal is specific, measurable, attainable, relevant, and time-bound. This is opposed to non-specific, vague, emotionally-driven, or unattainable goals. As an example, “I’d like to be more confident” is not a helpful goal, because it is not specific, measurable, attainable, or time-bound. It is vague and unmeasurable and unattainable. Sure, you could measure your level of confidence about a specific task one day and then measure your level of confidence using the same questionnaire at another time in the future. However, you would not actually be able to measure the nuances of confidence, because it is feeling state that changes over time. Just because you feel x amount of confidence on Monday at 4pm and y amount of confidence on Thursday at 10am, doesn’t mean that you’ve become more confident throughout every aspect of your life.  By unattainable, I don’t mean that you could never become more confident, but rather there is no objective binary cutoff where you could say either I am confident or I am not confident.  Other questions I have about this goal include: what does it mean to be more confident? Do you want to be more confident in every area of life or just …

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