The Anxious Moment & How to Manage It
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- Marybeth Rose
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1 The Anxious Moment & How to Manage It Brief Therapy Conference December 7, 2018 Chapel Hill, NC Reid Wilson, Ph.D. Anxiety Disorders Treatment Center 421 Bennett Orchard Trail Chapel Hill, NC [919] NoiseInYourHead.com 1
2 The Moment Whenever I notice 3 Intrusive Distressing Unhelpful Noisy worry That shows up as Memory Fearful anticipation My bias 4 All therapeutic work should manifest moment-by-moment NoiseInYourHead.com 2
3 The beginning of Objective 1 5 to defend logically the therapeutic benefits of embracing doubt & discomfort How do we get to embrace? 6 while feeling doubt & discomfort elevate above their immediate fear & apply new response based on provocative frame of reference and therein lay the benefits NoiseInYourHead.com 3
4 7 If they need to understand the way things are, don't give them a map They don't need directions, they need to see the big picture 8 Asbestos is none of your business! NoiseInYourHead.com 4
5 Strategic Principles 9 The Moment The beginning of Objective 3 10 to persuade an anxious client of the benefits of seeking out distressing moments while simultaneously holding an incompatible point of view NoiseInYourHead.com 5
6 Strategic Principles 11 The Moment Rate of change in inertia is proportional to force causing change 12 hands to become hard surface that quickly punches ball up over net Disrupting speed & direction NoiseInYourHead.com 6
7 13 A sudden, hard push in a new direction 14 one pin? ten pins at once? NoiseInYourHead.com 7
8 Strategic Principles 15 The Moment I WANT THIS! * * Seeking out Forcefully I know why Disruptive Attitude 16 The Moment If I have to take what you re dishing out, then give me 2 servings, now NoiseInYourHead.com 8
9 This is Explosure-Plus 17 Don t step forward Step forward with attitude Be aggressive Push into the Disorder s territory The Attitude Shift 18 NoiseInYourHead.com 9
10 Protect & Defend Step Forward & Risk If they do this Get them to do this Negative emotions narrow our thinking 20 I can t do this Tomorrow s going to be just like yesterday what s the point ) Positive emotions broaden our thinking So NoiseInYourHead.com 10
11 Arousal congruence 21 Move valence of distressing uncertainty from negative to positive Make anxiety & doubt ego-syntonic 22 Only do what you want to do And if you want to get stronger, you have to want to do the hard stuff NoiseInYourHead.com 11
12 Strategic Principles 23 The Moment Pair stepping into threat with outcome picture 24 The Moment NOW they get directions/the map NoiseInYourHead.com 12
13 NOW they get the map 26 The Moment Train your amygdala NoiseInYourHead.com 13
14 The amygdala 27 I got this & I want this NoiseInYourHead.com 14
15 Objective 2 29 to explain how to engage the working memory in service of therapeutically managing the anxious moment NOW they get the map 30 The Moment Engage your working memory NoiseInYourHead.com 15
16 Working Memory Roughly 4 thoughts, images or feelings at one time Central Executive pushes away distractions 31 NoiseInYourHead.com 16
17 Self-talk DIRECTS Working Memory Therefore, apply strategy 33 When you re anxious ask for exactly what you re experiencing now But you have to ask for it signals working memory to retrieve resource of acceptance from past NoiseInYourHead.com 17
18 The APP -- Anxietychallenger.com 35 NOW they get the map 36 The Moment Develop your Self-talk NoiseInYourHead.com 18
19 Messages of motivation 37 Good opportunity to practice I can take this hit I can handle this I want to be uncertain I want to be clumsy I gotta risk something here Self-instructions/commands 38 Leave the room now! Stop washing Call someone Take a risk Keep moving; don t pull over Don t figure it out NoiseInYourHead.com 19
20 39 Honest Stance toward symptoms/worry/uncertainty 40 Purposely, voluntarily, choose I want it If it lasts, I want it to last If it gets strong, I want it to be strong NoiseInYourHead.com 20
21 Self-Talk 41 Infuse it into treatment It should represent Attitude Apply strategy Attach self-messages to exposure 42 Keep repeating process Your long-term working memory will link it all together NoiseInYourHead.com 21
22 43 Then call up message cue working memory retrieves internal resources associated with message Your work becomes easier over time! Teaching children to dive Brain water is solid object Urge to protect! Picks up head as diving Coach creates strategy! chin tucked; hands flat, one on top of other Repeat sitting, kneeling, standing dive... Builds working memory to master diving for life 44 NoiseInYourHead.com 22
23 Run hills hard 45 Step 1: Create Strategy 1) get body forward by dropping head & raising arms 2) apply energy to task 3) push forward & up 4) get faster turnover of legs 46 Step 2: Generate Commands Look 5-6 feet ahead Raise arms Shorten stride Swing arms Pick up tempo NoiseInYourHead.com 23
24 Step 1: Create Strategy Act as though the content is irrelevant 2. Accept the worry/obsession when it pops up 3. Seek out uncertainty 4. Seek out anxiety 5. Create rules if you need them Step 2: Generate Motivations or Commands Dr. Barb Frederickson [- narrows ( I can t); + broadens ( maybe )] If you will pull up a positive emotion on the heels of these negative feelings, you can literally dismantle all that mental and physical preparation to run Actively generate a positive meaning for why you are letting yourself generate feelings of threat Then step forward, voluntarily, because you know why you are stepping forward because you can see it in the broader context of your life s goals Then your intentions can transform your experience 48 NoiseInYourHead.com 24
25 Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broadenand-build theory of positive emotions. American Psychologist, 56, Fredrickson, B. L., Mancuso, R. A., Branigan, C., & Tugade, M. M. (2000). The undoing effect of positive emotions. Motivation & Emotion, 24, Dr. Les Greenberg 50 Transform your fear reaction: Let yourself become afraid, then call up a competing emotion NOT by thinking or reasoning, or allowing the feeling, or letting go of the feeling, or facing the feeling. NOT by exposure or extinction or habituation But by activating a competing emotion that expresses a competing point of view How? Elevate your willingness to embrace doubt and discomfort while you re feeling afraid NoiseInYourHead.com 25
26 Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment by moment process. New York, NY: Guilford. Greenberg, L. S. (2010). Emotion-focused therapy. Washington, DC: American Psychological Association. Greenberg, L. S. (2012). Emotions, the great captains of our lives: Their role in the process of change in psychotherapy. American Psychologist, 67(8), Why we are important They need to TRUST US during anticipatory dread without experience 52 NoiseInYourHead.com 26
27 Sandra 53 OCD 21 years Rabies, other contaminations, ordering 1 bottle Champagne per night Session 4 (5 weeks) CLIP 1 (30 sec.) her response to improving CLIP 2 (2:45) Essential placebo & rapport: I finally met someone who knows what I m talking 54 Generating 2 nd voice (NOT dominant yet): I wanted to be optimistic, but I was very pessimist 21 years is too deep. I ve tried over and over, and I have failed every time. Watch her light up. What you put on the board! That s what you did! That s what you do! Self-talk that manifests principles: how I need to feel anxious and distressed for prolonged time. I had that memorize, and I still say that. NoiseInYourHead.com 27
28 2 nd voice becomes dominant: I just made myself do it. I said, I m going to do it. 55 The biggest thing was Self-talk: It s going to work. It can work me, too. Self-talk: I d touch them, and I kept saying to myself, You re going to have to feel anxious. TRUST! I said that over and over, I hope that good doctor knows what he s talking about. Learning thru behavioral experiment: Some of the things, within 15 minutes, I just moved on... Act as though 56 I want to take actions right now as though everything is OK just the way it is unfolding this is exactly what needs to be happening right now I have enough skills The content of my obsession is irrelevant NoiseInYourHead.com 28
29 Get big! Change who is in charge Bad dog! 57 NoiseInYourHead.com Free, short videos How Anxiety Uses Basic Human Nature againstyou (5 min.) WhyYou Should Step AWAY fromyourworries (5 min.) WhyYou DON T Need to Relax to Get Control (6 min.) How to Transform Fear (6 min.) NoiseInYourHead.com 29
30 NoiseInYourHead.com/free-video-series Thank you NoiseInYourHead.com 30
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