Calming Breathing Technique

Sometimes when we’re attempting ERP, or just going about our daily lives, we can feel very anxious or panicky or distressed, and have the urge to engage in compulsions to try to make ourselves feel better. Here is a breathing exercise that can use instead, that helps calm anxiety, panic and distress.

Calming Breathing Technique

Breathing Technique Longer Version

Someone requested a longer version of this breathing exercise, so the video below is the same as above, but looped a few times.

If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Physical and Body Sensations and Anxiety

One of the most distressing aspects of feeling anxious can be the physiological, physical or body sensations that accompany anxiety. Whenever we notice these sensations, our anxiety tends to increase. And just like with the emotion anxiety, the best way to respond to the physiological aspect of anxiety is with acceptance. Not because we like feeling this way or having these sensations. But because the more we try to fight them, the more intense they tend to feel. But if we’re able to accept these physical sensations, we take away some of their fuel, and they usually start to become less intense.

Physical and Body Sensations and Anxiety

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Think about what it feels like to be sad or anxious or angry. How do you know that you’re experiencing a certain emotion? What is it that signals to you that you’re sad rather than happy or content? Or that you’re anxious or angry rather than calm or relaxed?

We generally experience our emotions through our bodies. And we often use the words emotions and feelings interchangeably. And talk about feeling sad feeling angry and so on. And that’s because we really do feel our emotions. There are actual physical feelings in our bodies that we associate with them. In my last video we learned how to regulate our emotions by naming validating and accepting them. In this video we’ll learn to regulate emotions through how we relate to the physical sensations in our bodies associated with our emotions.

There’s often a general physical feeling that accompanies an emotion. Our bodies feel heavy when we’re sad, jittery or tense when we’re nervous or anxious. We might feel hot if we’re angry or warm all over when we’re happy, and so on.

There’s also usually a sensation in a specific and localized part of our bodies that goes along with our emotions. We might feel a lump in our throats or broken-hearted if we’re sad. Or a tightness in our throats or chests, or heart palpitations or butterflies in our stomachs if we’re anxious. Or our heads might feel like they’re going to explode if we’re angry.

So because of this close relationship between our emotions and physical feelings in our bodies, if we’re able to calm the physical manifestations of our emotions and they start to subside, our emotions tend to calm down and feel less intense as well.

So in terms of a general feeling throughout your body associated with an emotion, if you’re feeling some sort of physiological arousal like with stress or anxiety or anger and your heart rate or blood pressure are elevated, or you have a lot of pent up energy and have trouble sitting still, in order to regulate your emotion you need to calm this physiological response.

One way to do this is by slowing down your breathing, and a good way to do this is to breathe in through your nostrils and then breathe out through pursed lips because the pressure of your lips forces your exhalation to be slower. And once you slow your breathing down for a couple of minutes your level of physiological arousal will naturally start to decrease.

And doing something a little active like going for a walk can also help, but a slow relaxing mindful walk not a frantic pacing back and forth. And perhaps tying your walking in with your slowed down breathing, so walking relatively slowly and then taking three or four steps per breath. So in, step, two, step, three, step. And out, step, two, step, three, step. And walking like this is a great way to decrease physiological arousal and calm yourself down.

Or in the case of feeling lethargic or a lack of energy that often accompanies sadness or depression, doing something a little more active can help lift the feeling of heaviness in your body. And i talk about this in more detail in my video on behavioral activation that you’ll find in the playlist that accompanies this video, in the description and pinned comment.

And now let’s look at the more localized physical sensations like a tightness in our throats or chests or, butterflies in our stomachs that often accompany our emotions. But first we’re going to do a quick exercise.

So in a moment I’m going to ask you to take a deep breath and hold it for as long as you can. And I’ll keep a timer on the screen, but try not to look at the timer until you’re done. And then make a note of how long you held your breath for. And I’ll keep talking about emotions while you’re holding your breath so you don’t get bored and go watch something else instead.

So I’ll count down from three and then take a deep breath and hold it for as long as you can. Three, two, one, go.

Now these localized physical sensations that we feel in our bodies that are related to our emotions can be very distressing. Sometimes they can be acute and come and go throughout the day and when we do become aware of them they can feel extremely intense. Other times they can be more chronic and we notice that feeling in our chests or throats or stomachs from the moment we wake up until the moment we go to bed and fall asleep. And if we wake up during the night it’s still right there.

And these sensations can be so distressing, not just because they’re so uncomfortable, but because they’re so persistent. We’re sure there’s a physical medical issue that’s causing them. And it’s not uncommon for people to make multiple trips to multiple doctors to try to figure out what’s wrong with them. And when the doctors can’t find any underlying medical issue it can be hard to believe that all of this physical discomfort can be caused by emotions and psychological distress.

So what can we do to try to calm these physical sensations, and as a result help calm our emotions as well. Like with all of our unpleasant internal experiences the first step is to accept them. Not because we like them, but because anything other than acceptance is only going to make things more unpleasant. And if you don’t know what we mean by acceptance in this context check out the videos i link to in the pinned comment and description.

Okay it’s been a while now so you’re probably not holding your breath anymore, so just make a note of how long you held it for and we’ll talk about why you just did this in a few minutes.

Unfortunately we can’t just make these body sensations go away because we don’t like them. And when we fight with our internal experiences like thoughts emotions and body sensations and try to ignore them shut them out, or force them to go away they only gain more strength.

Our bodies tense up as we strain to fight these feelings, which exacerbates the feelings of tension in our throats chests or stomachs. And any negative reactions we have to them like, damn it’s still there, why do i always feel this way, when is it going to end, it’s just going to make them more difficult to tolerate, because our subjective experience of them will be worse, because now we’re faced with not just the unpleasant physical sensation but with our negative thoughts about them as well.

And our negative thoughts have a negative effect on our mood and will tend to increase the intensity of our emotions, which in turn will make the physical sensations more intense as we get stuck in this vicious cycle. And that’s something i talk about more in my video on distress tolerance and the difference between pain and suffering. So once again we’re left with the problem of how do we accept these things that we find so unpleasant.

Well first we can try to adopt an attitude of acceptance through calming thoughts and statements that we say to ourselves such, as whatever’s here right now is okay. This is my experience right now. Whatever it is, is already here. There’s nothing i can do to keep it out. There’s no need to fight it or struggle with it or try to make it go away. And just allowing myself to be open to it.

And the more you stop resisting your unpleasant body sensations the less they have to fight to be acknowledged. And as a result the more likely they are to lessen a bit in intensity. Now this doesn’t mean they suddenly go away. Our emotions and corresponding body sensations are like waves. They may seem like a constant and monolithic force but when we start to pay attention to them we can start to notice their ebbs and flows.

They often come into our awareness when they’re at their peak, either because that’s why they’ve drawn our attention, or because when we check to see if they’re still there they tend to perk up like they know we’re talking about them and they start to swell a bit. But if we’re able to just allow them to be there, after the initial swell they tend to crest and then start to dissipate and trough. And then they’ll swell up again and then contract and continue like this to ebb and flow and wax and wane.

And so when you have an uncomfortable feeling in your body rather than fighting it, just allowing it to be there and noticing what’s going on in your body as you hold it in awareness. And tuning into any feelings of tension or tightness or discomfort, and then breathing into these sensations using your breath to bring your awareness to them on the in-breath, and then breathing out of these sensations and seeing if they soften or relax on the out breath. And just letting your experience of these sensations be whatever and however they are from moment to moment. And if you’d like to try a short guided meditation that incorporates some of what we’ve just talked about in the last section of the three-minute breathing space we practice breathing in and breathing out a physical sensations in our bodies.

So let’s go back to the holding your breath exercise. We’re going to do it again now but this time with some guided instructions. While you’re holding your breath, and again there’ll be a counter on the screen but try not to look at the time until you’re done and then make a note of how long you held your breath for, so counting down from three, two, one, start holding your breath.

And now while you’re holding your breath, whenever you notice you’re having the urge to breathe, try to notice exactly where you’re feeling this urge in your body and whatever the body sensations associated with this urge to breathe are.

And then seeing if you can just allow these uncomfortable feelings to be here without taking a breath yet. And seeing what happens to this urge to breathe as you just open yourself up to it, allow it to be there, and allow yourself to experience it however it feels, without fighting it. And seeing if you can continue to hold your breath despite the uncomfortable feeling you’re having. And then when the urge to breathe starts to become overwhelming, take a breath and record how long you held your breath for. And I’ll just leave the timer up for a little bit longer in case you’re not done yet.

Now take a moment to think about any differences you noticed between the two times you held your breath both with respect to how long you were able to hold your breath for and what your experience was like while holding your breath.

Most people find that they hold their breath longer the second time, when they’re simply accepting of their experience for what it is allowing in that discomfort and urge to breathe and just watching it and letting it be there without resisting fighting or trying to change it or make it go away.

And so this exercise can help illustrate that the way we respond to discomfort and unpleasant feelings can change how we experience them. And that if we simply let them in and allow them to be there instead of engaging in our tendency to try to fight them or shut them out, they can become more tolerable and manageable.

And this is borne out by research into pain management that shows that responding to chronic physical pain with mindfulness and acceptance can reduce subjective pain intensity ratings by an average of forty percent. Now that’s a lot less than a hundred percent, so acceptance isn’t a magic cure that automatically makes discomfort go away, but a forty percent reduction is significantly better than nothing.

So when we don’t have the option to make our uncomfortable or unpleasant body sensations related to our emotions just disappear, why not try accepting them and make them significantly more tolerable and manageable? And the more we’re able to just accept these uncomfortable physical sensations, the more likely they are to lessen in intensity. And as a result we begin to experience a corresponding reduction in the intensity of the emotions associated with these sensations. So by learning to accept these uncomfortable physical sensations we learn to regulate our emotions as well and in the next video we’re going to look at the difference between emotion regulation and distress tolerance.

If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Distress Tolerance Strategies

Compulsions are also driven by feelings of distress. But if we can learn more effective ways to manage distress, then we can stop relying on compulsive behaviors and mental rituals.

Distress Tolerance Strategies

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Distress tolerance involves learning to tolerate and survive crises without making things worse. The two elements of distress tolerance are crisis survival skills and reality acceptance skills. And i have a couple of videos about acceptance that explain reality acceptance in a lot more detail, and you’ll find links to these in the pinned comment and description. But basically reality acceptance involves a willingness to accept reality as it is and by doing so we relieve any excess distress we cause ourselves when we try to fight against reality and struggle against things that are outside of our control.

Crisis survival skills are skills for tolerating painful events urges and emotions when we can’t make things better right away. A crisis often but not always starts with an external trigger like some interpersonal conflict, which could be an argument with your partner or falling out with a friend. Or some conflict at work. Or maybe you’re overwhelmed by stress at work, with your family, or a combination of things. Or there’s some distressing event like finding out you’ve lost your job a relationship ending, the death of a loved one, and so on.

And then this external situation triggers a number of distressing inner experiences like difficult and painful feelings and emotions, negative thoughts, and uncomfortable physical symptoms and sensations. And this inner distress can also arise without anything external to trigger it. And then when our emotions reach a boiling point and it all becomes too much we find ourselves in crisis

There are six basic crisis survival skills we’re going to look at, starting with techniques to help stop the crisis and allow you to take a step back from it. And then once you’ve been able to get some distance from the crisis, the skills focus on helping you recover from the aftermath and calm whatever after effects remain.

The first skill is called stop which is an acronym for stop, take a step back, observe and proceed mindfully. So when you stop you don’t react. You freeze. Don’t move a muscle. Your emotions may try to make you act without thinking, but stay in control.

And then take a step back from the situation. Take a break. Take a deep breath .and don’t let your feelings make you act impulsively.

And then observe. Notice what’s going on inside and outside you. What is the situation? What are your thoughts and feelings? And what are others saying or doing?

And then proceed mindfully. Act with awareness. In deciding what to do consider your thoughts and feelings, the situation, and other people’s thoughts and feelings/ think about your goals, and ask wise mind which actions will make it better or worse. And if you’re not sure what wise mind refers to check out the list of videos in the pinned comment and description.

So stop is basically an advanced form of time out. Sometimes stop alone is enough to calm the crisis. But it can also be a great first step before proceeding to another distress tolerance skill, like the next distress tolerance skill we’ll look at, pros and cons.

Now a pros and cons list is nothing new, but for distress tolerance we use a specific type. When we’re in a crisis we’re driven by our emotions, which creates urges for us to act impulsively often in ways we’ll later regret. So first we consider the pros and cons of acting on these impulsive urges and giving into them, giving up, or avoiding what needs to be done. So the pros might look something like this. It’s what we want to do right now based on what our emotions are telling us to do. It might release our pent-up energy and frustration, and it might make us feel better at least for a few moments. And it’s hard and takes a lot of effort to resist such a strong urge.

And then the cons of acting on these urges, such as it’s not strategic, it doesn’t help the situation, and there’s no regard for the consequences. It’s often self-destructive and leads us to do things we later regret. And it can damage our relationships and friendships.

And then we look at the pros of resisting our impulsive urges, of doing what needs to be done and not giving in or giving up. These can be things like, it allows us to make better choices and act strategically in ways that benefit us and have positive consequences. In the long run we’ll feel better about ourselves if we stay in control and don’t act impulsively. And it’ll improve our relationships with people we care about.

And finally the cons to this might be things like in the short term we continue to feel bad. We have to keep tolerating some distress and discomfort. And it can take all of our self-control to try to resist doing what our emotions are telling us to do.

And once you have all these pros and cons in front of you it can allow you to see that acting on your impulsive urges isn’t in your best interest, and help you resist regardless of how strong the urge is. And then instead of relying on your ability to come up with this list in the midst of a crisis when you’re probably not thinking very clearly, plan ahead and create a pros and cons list in advance. And then keep it with you perhaps in your phone. Because when we’re in a crisis and our emotions are driving our thoughts it can be hard to access the rational reasonable part of our minds that we need in order to be able to create something like a pros and cons list.

The next skill is tip which stands for: tip the temperature of your face with cold water, which is pretty self-explanatory. Splash some cold water on your face. Dunk your head in a sink of cold water, or hold some ice up to your face. You can even take a cold shower. These can all help shock you out of your emotional state of mind and help snap you out of a reactionary crisis mode long enough to be able to start acting a little more strategically.

And then intense exercise. A lot of times doing some intense exercise can give an outlet to the physical energy and adrenaline that’s been building up during a crisis and get it out of our system enough to calm some of our distress. Many people find that when their mind is racing and they’re feeling distressed exercise is the only thing that can clear their minds enough to allow them to start to calm down.

And then paced breathing so slowing down your breathing and a good way to do this is to breathe in through your nostrils and then breathe out through pursed lips because the pressure of your lips forces your exhalation to be slower and once you slow your breathing down for a couple of minutes your level of physiological arousal will naturally start to decrease.

Paired or progressive muscle relaxation, which is a relaxation exercise in which you move through your body tensing and relaxing each muscle group along the way. And for instructions on progressive muscle relaxation check out the link in the description.

Next we have distraction. Distraction is just temporary: you’re not completely ignoring problems or emotions. You’re just setting them aside for a while until they’re cool enough that you can handle them, just like they were a hot pan on the stove, and then once they’ve cooled down you can return to them if you need to and resolve any outstanding conflicts or issues. Or engage in some emotion regulation.

The complete list of distraction skills in dbt form the acronym accepts and some of these skills along with the ones in the next couple of sections will resonate with you and make sense and others probably won’t and that’s fine. The comfort level that people have with these techniques varies from person to person so just focus on the ones that feel right for you.

Distracting yourself with activities: this can be any sort of activity from chores around the house to watching TV or reading a book, to playing a video game to doing something with your friends. Just any activity to take your mind off what’s distressing you long enough for the most intense distress to start to calm down and become cool enough to touch.

Contributing: doing some volunteer work or helping a friend or family member or just doing something thoughtful for someone, which not only provides some distraction, but can help you feel better about yourself by doing something nice for someone else.

Comparisons: compare how you feel now to a time when you felt different think about people who are coping the same or less well than you. Compare yourself to those less fortunate.

Distracting yourself with different emotions: read an emotional book or story or watch an emotional film or TV show or listen to some emotional music. And be sure that what you’re doing creates a different emotion than the one that’s causing you distress.

With pushing away, push the situation away by leaving it for a while. Or leave the situation mentally or put your pain on a shelf box it up and put it away for a while.

With other thoughts: count to 10, repeat words to a song in your head, or work on a puzzle. Watch some TV or read.

And finally with other sensations: squeeze the rubber ball very hard. Listen to some really loud music or hold an ice cube in your hand or mouth. Go out in the rain or snow. Or take a hot or cold shower.

And starting from here the skills shift from focusing on getting some distance between yourself and the worst of the crisis to calming and soothing yourself in the aftermath. And the next skill is self-soothing with your senses. So looking at listening to or smelling something that gives you pleasure or that you find calming or relaxing. Or for taste eating some comfort food or having a soothing drink like a cup of tea or coffee or a smoother or treating yourself to something that you wouldn’t usually eat. And make sure to eat mindfully savoring the taste rather than just binging. And for touch doing something like taking a shower or long bath or soaking your feet getting a massage or feeling the warmth of the sun on your skin or a cool breeze on your face.

And finally improving the moment with the acronym improve. So improving the moment with imagery: imagining a relaxing scene. Remembering a happier time and imagining yourself in it indulging in some pleasant daydreams

With meaning: find purpose or meaning in a painful situation. Focus on any positive aspects of the situation that you can find any silver linings.

With prayer or spirituality: opening your heart to a supreme being or wherever you find meaning in the universe. Practicing some meditation opening yourself up to wise mind. Listen to or read about spiritual values.

With relaxing activities: taking a hot bath massaging your neck or scalp or practicing some yoga or other stretching. Or just doing some deep breathing.

Improving the moment with one thing in the moment. Focus all of your attention on just what you’re doing be mindful and keep yourself in the present moment.

Improving the moment with a brief vacation. Just give yourself a brief vacation get into bed and pull the covers over your head. Go to the beach or the woods for the day. Or turn off your phone go to the park and have a picnic.

And finally improving the moment with encouragement and rethinking the situation. Using some positive self-talk to encourage yourself. I’ll make it out of this. I’m doing the best that i can. Repeat to yourself that whatever this is i can stand it. This too shall pass. Everything’s going to be okay. It’s not going to last forever.

So when you find yourself in distress or in the midst of a crisis you can use these crisis survival skills to help calm things down enough to pull yourself out of emotion mind, step back from what’s distressing you, and get a little distance between yourself and the crisis.

And then once things have calmed down you can return to the situation and resolve things if necessary. Or attend to any emotions you’re still feeling in the aftermath by using some emotion regulation skills. Or just do whatever you need in terms of self-care to help yourself continue to recover from this crisis and the distress that you found yourself in.

So once you’ve become familiar with the skills and had a chance to try them and find out what works for you, come up with a crisis survival plan that lists the steps you want to take and the skills you want to remember to use when you find yourself in a crisis. And then keep this plan with you in your phone so it’s always there when you need. It for more on distress tolerance and how we can stave off a crisis by the way we react to things that have the potential to set one off check out my video on distress tolerance and how pain doesn’t have to lead to suffering.

If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Mindfulness and Acceptance of Emotions

With OCD, are obsessions cause anxiety or discomfort that we find difficult to tolerate. We then engage in compulsive behaviors or mental rituals in order to manage our anxiety or discomfort. But if we can learn better ways to manage and regulate our emotions and how we feel, then we no longer need to rely on compulsions. This video describes how we can regulate our emotions with mindfulness and acceptance.

Mindfulness and Acceptance of Emotions

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Emotion regulation refers to our ability to influence our emotions and how we feel. Part of emotion regulation involves increasing how often we experience positive emotions like happiness or decreasing how often we experience negative emotions like fear sadness and anger. But emotion regulation isn’t about blocking or avoiding so-called negative emotions. There’s nothing wrong with feeling fearful or sad or angry at times. And sometimes that’s exactly how we need to feel.

But emotion regulation helps us influence our emotions, either by reducing the strength or magnitude of these emotions and how intensely we feel them, which allows us to have emotions like fear and sadness and anger and even happiness without these emotions overwhelming us.

Or by transforming the emotion itself and changing how we feel either through modifying our actions and behavior, or our thoughts and you can learn how this works in my videos on opposite action, and reframing our thoughts and cognitive restructuring. And you’ll find links to these videos in the description and pinned comment along with my other videos related to emotion regulation.

So typically when we’re experiencing an emotion we don’t like we try to get rid of it. Either by problem solving it away, or trying to control how we feel, or by trying to suppress or block or avoid our emotion altogether.

Most of us learn from an early age how to think logically and solve problems rationally. And so it’s natural that we try to use thinking and logic to solve our emotional problems. Unfortunately emotions aren’t something we can rationalize and think our way out of. Emotions don’t conform to rational principles, they don’t listen to logic. We can’t think our feelings away convince our emotions through logic how they should feel. Or use rational arguments with our emotions to try to change them.

Trying to problem solve our emotions away tends to just make things worse because we end up stuck in our heads arguing with our feelings, even though our feelings have no interest in what we’re trying to tell them. And in the end the emotions we were trying to problem-solve away are still there, and now our minds are racing and we’re thinking in circles, ruminating and dwelling on things, which is just creating more stress, and anxiety for ourselves, and making our emotions even more intense.

So when we can’t problem solve our emotions away we try to control them. But fighting against our emotions to try to control how we feel is a battle we just can’t win. We can influence how we feel by modifying our thoughts and behavior. But we can’t change how we feel by sheer will or brute force. No matter how much we try we cannot make ourselves feel a certain way because our emotions just don’t listen to our attempts to try to control them.

Perhaps you can recall an occasion when someone tried to tell you how you should feel. Maybe you were upset and they told you to just calm down. Or you were anxious and they told you there’s nothing to be afraid of and stop worrying so much. Or you were feeling sad and they told you to cheer up. Now if something like that’s ever happened to you, how well did it work? When we tell someone else how we think they should feel it usually makes them feel worse.

Well the same thing happens when we try to control our own emotions by telling ourselves how we should feel. When we try to control our emotions they resist and fight back and generally become more intense.

In the mindfulness and acceptance workbook for anxiety john forsythe and george eiford explain why controlling our emotions doesn’t work:

Emotions differ in important ways from other problems in life that can be controlled quite effectively. Situations that are controllable tend to involve objects in the world outside your skin. Changing things in the world around you is often possible and works well. So it only makes sense that you’d want to apply it to manage emotional pain.

The problem is that what works well in the external world just doesn’t work well when applied to things going on inside you. You might try to deal with your thoughts and feelings in the same way you deal with clothes you don’t like. Can you give away or throw out your unpleasant thoughts and feelings? Can you replace a painful emotion you don’t like with a new one? Have you ever been able to do that?

The take home message here is that you can’t win a fight against yourself. And as much as you may wish to throw out your painful emotions there’s simply no way to take them in your hands and out of the room.

So since we can’t control our emotions and just get rid of the ones we don’t like why not just suppress these emotions and ignore or avoid them all together. Well unfortunately this doesn’t work either. Maybe we can avoid our emotions for a while. But they keep coming back/ they’re like a child craving attention. Our emotions won’t leave us alone until we acknowledge them and give them what they need. And each time we try to just ignore them or send them away they come back louder than ever demanding our attention.

And so because we can’t avoid our feelings we’re left with one option for emotional control. And that is to avoid any situation or circumstance we think could trigger the emotions we’re trying to avoid. But this type of avoidance winds up seriously limiting how we live our lives. If you’re depressed and start avoiding situations that may trigger more distressing thoughts or feelings you wind up isolating yourself and not taking part in things that could actually help you feel better. And as a result you end up feeling even more depressed.

If you’re experiencing anxiety you might start avoiding anything that could provoke your anxiety, like certain social situations, travel, furthering your career and so on. And as a result your quality of life begins to suffer. Once you start avoiding some things it’s easy to keep finding other things you need to avoid, until eventually your life becomes so restricted that you can no longer take part in the things that are most important to you. So for these reasons in acceptance and commitment therapy emotional avoidance is regarded as one of the main factors that contributes to anxiety and depression.

So since we can’t problem solve our emotions away or control or avoid our emotions what can we do when we’re experiencing difficult or painful emotions? We’re left with two options. To continue to struggle with them in a fight we can’t win that only gives them more strength. Or find a way to accept how we’re feeling accept whatever emotions we’re experiencing even if they’re uncomfortable or painful and we don’t like how they make us feel.

Because accepting how we feel is the first step in being able to regulate our emotions, and as soon as we stop fighting them and start accepting them they tend to start to lose some of their intensity, or at least stop escalating and becoming overwhelming.

So how do we accept our emotions., and if you’re not sure what we mean by acceptance in this context check out the videos i link to in the pinned comment in description. So one thing we can do is to name and acknowledge and validate our emotions. A lot of times we feel bad but we don’t know exactly what it is that feels bad. So we need to start by identifying the emotion we’re experiencing and putting a name to how we’re feeling.

All we need to do is to say to ourselves i feel sad. I’m feeling anxious. Or I’m angry right now. And just this simple act of naming our emotions helps us acknowledge how we’re feeling. And just this alone can help calm our emotions and stop them from escalating.

And then once we’ve acknowledged our emotions we can validate how we’re feeling. Have you ever noticed yourself saying things like i shouldn’t feel this way. There’s no reason to feel sad. Or why can’t i just get over this? When you do find yourself judging your emotions like this how does it make you feel?

Judging our emotions is the opposite of validating them. And it’s similar to trying to control our emotions and it probably makes you feel worse. So how do we validate our emotions?

As sherry van dyke says in the dialectical behavior therapy skills workbook:

Validating your emotion basically just means giving yourself permission to have them. It doesn’t mean that you like to feel that way, or that you don’t want the feeling to change. It simply means acknowledging the presence of the emotion and allowing yourself to have it.

And this is precisely what we mean by accepting our emotions. So instead of saying things to yourself like why am i always so sad, i shouldn’t feel this way, try to validate the way you’re feeling. Tell yourself that even though it’s not pleasant to feel sad or anxious, these are natural human emotions. And everyone feels them sometimes.

You might prefer to feel differently—who wants to feel sad or be anxious?— but there’s nothing unusual or wrong with feeling sad or anxious or angry or however you’re feeling. And just because you’re feeling that way right now doesn’t mean you’re always gonna have to feel that way. Emotions come and go all of the time without us ever having to do anything. In fact the more we try to do something about an emotion other than just accepting it, the longer it sticks around and the more intense it tends to become.

Now another aspect to accepting our emotions is learning to accept the physical sensations that go along with them. And that’s the topic of my next video.

If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Exposure Therapy

This video describes exposure therapy in general, which is the basis for ERP. It goes into more detail about how exposure works then we covered in the ERP video. It can be helpful for understanding ERP, but you can also just skip it without missing out on much.

Exposure Therapy for Anxiety

This transcription was auto-generated by YouTube and edited with ChatGPT

Exposure therapy is a type of behavior therapy that’s an important component in treating many types of anxiety as well as PTSD.

When we fear something or something causes us anxiety, our natural inclination is to want to avoid it. And avoidance can provide some short-term relief. As long as we can avoid whatever we’re afraid of, there’s nothing to feel anxious about. But in the long term, avoidance only increases our fear and anxiety because each time we avoid something that we’re anxious about, we’re reinforcing the idea that this thing is scary and dangerous. So we begin to fear it even more, and it causes us even more anxiety.

Avoiding things we’re anxious about deprives us of the opportunity to have new experiences and new learning that teach us that these things aren’t as threatening or dangerous as we fear. And that even if we do have some anxiety while we’re in these situations, it’s okay to have some anxiety. It’s uncomfortable, but anxiety itself isn’t dangerous, and we’ll get through it. We don’t need to avoid things just because we’re going to feel anxious while we’re in those situations.

Now the opposite of avoidance is exposure. Instead of avoiding the things that make us anxious, we expose ourselves to them. Put ourselves in those situations, and as we do this, they start to cause us less fear and anxiety.

There are a couple of ways of doing exposure therapy that we’re going to look at in this video. The traditional method involves what’s known as graded or graduated exposure. We make a list of about eight to ten situations related to what we fear or are anxious about, and then rank them into a fear hierarchy or ladder based on how much fear, anxiety, or distress they each cause us. Then we gradually expose ourselves to our fears by starting with a situation that causes us the least amount of anxiety and working our way up the list.

Now most of you watching this video aren’t going to set up experimental exposures to practice putting yourselves in situations that cause fear and anxiety. But these situations arise naturally in our lives, and we can still apply the things we’ll learn in this video, especially with regards to the second type of exposure therapy we’ll be talking about to everyday situations to help decrease the amount of fear and anxiety they cause us over time.

So each exposure exercise involves putting ourselves in one of the situations from our exposure list and then staying in that situation until our fear begins to subside and we experience some level of reduction in anxiety. And we repeat each exposure situation until it no longer causes us significant fear or anxiety, and then we move on to the next item in the list.

This is known as habituation-based exposure, and habituation is the process through which we experience a decrease in our fear or anxiety responses as a result of repeated exposure to a situation or stimulus. As we become less sensitive to it, we get used to it.

And there are three types of exposure. In Vivo, we simply put ourselves in real-life situations that cause us fear or anxiety. If we have a fear of dogs, we put ourselves in a situation where there is a dog.

Now, with imaginal exposure, we don’t actually put ourselves in a situation. We imagine the situation. This is common in treating PTSD. Imaginal exposure helps us process traumatic experiences in a safe and controlled environment, revisiting the traumatic event in our minds and imagining it in detail. This helps us gradually reduce the distress and anxiety associated with traumatic memories.

Interceptive exposure involves exposing ourselves to physical sensations in our bodies that cause us fear and anxiety. Usually, these are sensations that lead us to start panicking. So we might do some exercise that increases our heart rates and leaves us short of breath to help us learn the symptoms we have when we’re feeling anxious, like a racing heart or shortness of breath. This teaches us that these symptoms don’t necessarily mean we’re having a heart attack. Or we might spin around until we’re feeling dizzy to teach us that feelings of dizziness don’t mean that we’re having a stroke or about to pass out.

But if you’re not sure that your physical symptoms are the result of anxiety and are concerned there may be an underlying medical condition, then please consult a medical professional before trying interceptive exposure.

Recent research suggests that habituation isn’t the most effective or reliable way to reduce anxiety through exposure, and there’s been a shift towards what’s known as inhibitory learning-based exposure. Inhibitory learning involves new learning that takes place during the exposure that inhibits or suppresses our previously learned fear or anxiety response in that situation. Our goal isn’t to experience a reduction in anxiety during the exposure, although that may happen. Instead, there are two main things we want to accomplish: we want to violate our expectations about what we fear is going to happen, which leads to new inhibitory learning that inhibits or suppresses our previously learned fear and anxiety responses to these situations that stem from our beliefs that these situations are threatening or dangerous. And we want to learn that we can still do things even if they cause us some fear or anxiety.

We can apply this inhibitory learning-based approach to fear and anxiety-provoking situations that arise naturally in our lives to help learn new ways of thinking about these situations that lead to a reduction in our fear and anxiety responses. So keep that in mind as we look at the formal process of inhibitory learning-based exposure therapy.

So let’s look at how this works in practice using social anxiety as an example. First, we come up with a list of exposure exercises related to our social anxiety. With traditional exposure therapy, we would rank these situations based on how much distress they cause us and then start from the one that causes us the least amount of distress and then work our way up the list in order. But now it seems to be more effective if we go through the list in a quasi-random order.

We can still start with the situation that causes us the least amount of anxiety if that makes it easier for us to get started, or we can prioritize situations that seem most important or relevant to us. So, if we’ve been criticized at work for not speaking up enough at meetings, we might prioritize doing an exposure exercise related to this, even though it may cause us a great deal of anxiety compared to some of the other items on our list, like talking to a cashier, which may not seem like a particularly valuable situation for us to prioritize.

So now, let’s go through some examples of inhibitory learning based exposure for social anxiety, and you can download a copy of an exposure therapy worksheet that guides you through this process from the link in the description. Let’s say our anxiety prevents us from attending a lot of social events that we’d like to go to because we’re just too uncomfortable being around people we don’t know, and we decide that talking to someone we don’t know in a social setting would be a useful exposure exercise to prioritize, even though the thought of it causes us a lot of anxiety.

So first, we need to set a specific and measurable goal for the exposure, not just something like, “next time I’m at a social event, I’m going to try to talk to people I don’t know,” but something like, “at Mia’s party this weekend, I’m going to talk to two people I don’t know for at least five minutes each.” We want to make sure that the goal is something we expect is going to be challenging because we want to give ourselves a chance to violate our expectations about what’s going to happen as much as possible because that’s going to lead to the greatest amount of learning.

So, something like, “I’m going to say hi to someone I don’t know, and then if I’m feeling uncomfortable, I can excuse myself to go to the restroom,” isn’t going to be that productive. First, because we don’t expect that anything that bad is going to happen, so there’s not that much opportunity for inhibitory learning to take place. Second, we’re getting out of the situation as soon as we start to feel uncomfortable, so we’re depriving ourselves of the opportunity to learn that it’s okay to have some anxiety in these situations, that we can tolerate this anxiety, and it’s not something we need to avoid.

Then we predict what’s going to happen and write down our expectations and the feared outcome or outcomes we’re most worried about, and the feelings and emotions we’re worried that we won’t be able to tolerate. “I’m going to feel so anxious it’s going to be difficult for me to speak properly,” “My anxiety will be so bad I’ll start having a panic attack,” “I’m not going to have anything to talk about, and the other person is going to get so bored they’ll make an excuse to get away from me before the five minutes are up.” Then we rate on a scale from zero to a hundred how much we expect that these outcomes will actually happen.

Then we do the exposure, and afterwards, we compare our expectations of what we thought was going to happen with what actually happened. The first conversation went on for a couple of minutes, and then someone they knew joined us, and I felt a little awkward and didn’t have much to say after that, but they didn’t abandon me or seem to mind that I was still there. The second person I talked to turned out to have some friends in common with me, and so we talked about them for a while, and after some initial anxiety, I felt pretty comfortable once we started talking.

And were we able to tolerate the distress? I felt anxious but not so anxious that it was hard to speak. I did feel pretty anxious a couple of times but never close to panicking.

And how was this outcome different from what we expected? I felt anxious but not as anxious as I thought I would, and my anxiety never made it difficult for me to get my words out. Once we started talking, the other person was really friendly and easier to talk to than I feared.

And what did we learn from this experience? Even when anxious, I’m able to carry on a conversation with someone I don’t know, and once we start talking, I start to feel more comfortable. I didn’t really need anything that interesting to talk about; we just talked about random stuff, and it was fine. So through this exposure, we’ve experienced quite a bit of discrepancy between the bad things we feared and expected were going to happen and what actually occurred. This learning will help inhibit our fear and anxiety responses in similar situations in the future. We can apply this process to situations that arise naturally in our lives: look at what we expected was going to happen in a situation we were having some fear or anxiety about and how that was different from what actually happened, and then ask ourselves what we can learn from this result that can help reduce our fear and anxiety in similar situations in the future.

And here’s an example from an article I’ll link to in the description that has examples and case studies of how to use exposure therapy to treat a wide range of issues, and also covers everything we talk about in this video in much more detail. I like this example because it demonstrates the type of exposure exercise that might not occur to us on our own to help test the hypothesis that the emotions we’d experience in certain types of situations would be intolerable and therefore need to be avoided at all costs. In this case, the emotion being embarrassment or humiliation in public. So the goal of the exposure is to ride the elevator at the local mall for 30 minutes, calling out the number of each floor in a loud voice.

What are we worried will happen? People will look at me angrily and ask, “What’s wrong with you?” I’ll feel so humiliated and embarrassed I’ll start crying and have to run out of the elevator.

And then we do the exposure, and afterwards we look at what actually happened. When I called out the floor numbers, some people looked over at me with a confused look on their face, but nobody seemed angry, and most people just kept their heads down and ignored me. I did feel really embarrassed and humiliated, but not to the point of crying, and I was able to stay in the elevator the whole time.

How is this different than what I’d expected? Well, people seem more confused than angry, and nobody said anything to me, and most people just ignored me altogether. And even though it was really humiliating to embarrass myself like that, and I did feel really uncomfortable, I was able to tolerate these feelings and stay in the elevator until the end of the exercise.

And what did I learn as a result of this exposure? Even if I do something really embarrassing in public and humiliate myself, it’s not the end of the world. And this exercise seems way more embarrassing and humiliating than anything that would actually happen in real life. So if I can get through this, I can get through whatever embarrassment or humiliation I may experience in the course of any sort of typical real-life situation.

So as a result of this exposure exercise, we’ve experienced new learning about the effects of feeling embarrassed or humiliated in public, which has taught us that these experiences are actually tolerable. So in the future, if we find ourselves in situations in which we fear we may be embarrassed or humiliated, or if we do in fact embarrass or humiliate ourselves, this new learning will help inhibit or suppress our previously learned fear or anxiety responses regarding these types of situations or these emotional responses.

Exposure is an important component in treating many types of anxiety, as well as PTSD, because it gives us the opportunity to learn that the bad things that we fear or expect or predict are going to happen in certain situations usually don’t actually happen or aren’t as bad as we’d worried they’d be, which helps inhibit and suppress our fear and anxiety responses in these situations. And we learn that we can still do things even if they cause us some fear or anxiety, and so we don’t need to avoid things, especially things that are important to us, just because they provoke fear or anxiety.

Here’s a great article that goes in to a lot more derail about inhibitory learning based exposure along with a number of case studies, and you can download the Exposure Therapy Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd ed.). The Guilford Press.

Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5–27.

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.

Posted in OCD

Reduce Obsessions with a Worry Record

When we’re anxious and worrying, we tend to:

  • worry bad things will happen
  • worry over “what if” hypothetical negative outcomes
  • overestimate the likelihood something bad will happen
  • overestimate how bad things will be, and focus on the worst case scenario
  • underestimate our ability to cope if something bad does happen

The worry record is a CBT worksheet that helps us reduce anxiety and worrying with cognitive restructuring. We modify or replace our anxious thoughts and worrying with less negatively biased and more realistic thinking. It allows us to see things from a less catastrophic perspective. And this lets us come up with more likely scenarios than the worst-case scenario. And as a result our levels of anxiety decrease and we worry less.

Reduce Anxiety and Worrying with a Worry Record

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In this video we’re going to learn how to reduce anxiety and worry with a worksheet from cognitive behavioral therapy called a worry record. I’ve made a few videos about worry recently where we’ve looked at the difference between productive and unproductive worry; and how we can turn productive worrying into problem solving; and how to just let our unproductive worries go or postpone our worry and use a worry period later in the day. And then when we do look at our worries, a worry record is a great tool to find different ways of looking at situations that are causing us anxiety and as a result experience less anxiety and have less reason to worry.

If you’ve seen my other videos you’ve probably heard me talk about the close relationship between our thoughts and our feelings. When we feel anxious we tend to have anxious thoughts and worry a lot. And these thoughts and worries feed back into our anxiety, making us even more anxious; which leads to even more worrying, and so on. But if we’re able to change the thoughts that we’re having about the situation that’s making us anxious, we can decrease the amount of anxiety we’re feeling.

And then as we decrease our levels of anxiety our thoughts will naturally become less anxious, and we’ll start to worry les; which leads to a further reduction in anxiety; which leaves our thoughts less anxious; and reduces how much we worry.

Now when we’re anxious and worrying our thoughts tend to follow a certain pattern. First, we worry that something bad or unpleasant is going to happen. And this can take the form of predicting a negative outcome like, i’m not going to be able to get everything done on time; i’m going to let everyone down.

Or i think they’re mad at me, they probably don’t like me anymore. Or instead of an actual prediction our worries can take the form of a what if statement. What if i can’t get everything done on time? What if i let everyone down? What if they’re mad at me? What if they don’t like me anymore?

And second, we overestimate the likelihood that this bad outcome will occur. I’m sure i’ll never be able to get this done on time. I know i’m going to let everyone down. They must be mad at me.

And then we overestimate just how bad things will be: i’m going to get fired; they’re going to break up with me. And we underestimate our ability to cope with that negative outcome if it does arise: i don’t know what i’m going to do; i’m not going to be able to deal with it.

So the worry record is a type of thought record that focuses specifically on anxious thoughts and worry, and helps us challenge these worries and: either modify them so that they’re more accurate and less negatively and catastrophically biased; or we replace these worried thoughts with new thoughts that more accurately reflect the reality of our situations. And in both cases these modified or new thoughts lead to a reduction in our anxiety because of this close connection between our thoughts and how we feel.

So now let’s look at how the worry record helps us do this. So in part one of the worry record we start off by describing the situation we’re anxious or worried about. So for example an important project we have at work. And then we write down our feelings and emotions, describing them with single words like anxious, worried, nervous.

And we also write down any physiological symptoms or physical sensations we’re experiencing, because these can be such a big part of anxiety. So maybe there’s some tightness in our throats and our stomachs feel really tense. And then we rate the intensity of these emotions and sensations on a scale from zero to a hundred.

And then we write down what we’re worried about, what we’re thinking or saying to ourselves, or just whatever’s going through our minds. It’s too much work, i’m never going to get it all done. Or i’m going to have to rush everything and do a really bad job.

And then we write down what we predict is going to happen. I’m not going to get it all done. Or if i do it’s not going to be very good and i’m going to let everyone down and i’m going to get in trouble with my boss. And then we rate how likely we think it is this prediction will come true on a scale from zero to a hundred percent.

And so these last couple of sections relate to our tendency to overestimate the likelihood that something bad will happen, and also overestimate how bad it will be. And so as the worksheet continues we’ll generate more accurate estimations in both of these areas. And then in part two we challenge and modify our worries and predictions.

So we start by writing down all of the evidence that supports our prediction and all of the evidence that doesn’t support our prediction. So maybe the evidence for is something like: i do have so much work to do; i don’t have very much time; i know that when i’m anxious i’m not able to work as effectively as i usually do so i can’t even get as much work done as normal; when i’m rushed i never do my best quality work; and i know how important this project is for my boss and my colleagues.

And then the evidence that doesn’t support our prediction could be things: like i’ve never missed a deadline before; no one’s ever complained about the quality of my work; i often feel stressed at first but i always manage to make it work in the end; even if i didn’t do as good a job as i could it’s still probably going to be good enough; and even if i do let people down i’ve worked here long enough with good enough results that i’m not going to get fired over this one thing.

And if we get stuck trying to come up with evidence that doesn’t support our predictions we’re stuck on any of the questions coming up at the bottom of the worksheet there are series of prompt questions we can use to help us with our responses.

And now we ask ourselves what’s the worst that could happen. Well the worst case scenario is probably, i could lose my job over this. And then we ask ourselves if the worst case did happen, what could we do to help ourselves cope. And this helps address our tendency to underestimate our ability to cope if something bad were to happen. Well i guess i could live off my savings for a while while i look for another job, and if i run out of money i could even live with my parents for a while until i’m working again. And obviously these aren’t great options—nobody wants to be unemployed or have to move back in with their parents—but remember we’re looking at the worst case scenario here, which probably isn’t going to happen. But even if it does, at least there are some things we can do, even if none of them are ideal. And just knowing this can help reduce our anxiety a little bit.

And then we ask ourselves what’s the best that could happen. And this question is important because when we’re feeling anxious and worrying we have such a tendency to fixate on only the worst case scenario, which is going to leave us feeling as anxious as possible. So we need to remind ourselves that the worst case scenario isn’t the only scenario. And in the best case scenario probably nothing that bad happens. And then we’re going to look at the most likely scenario.

So maybe the best case scenario is, i get everything done on time and it turns out pretty well. And maybe the most likely scenario is, i’m really stressed for a few days and struggle to finish on time, but in the end i do get everything done, and even though it’s not my best work it’s perfectly fine.

And then we ask ourselves what are the consequences of continuing to worry about this. Well worrying makes me feel like i’m doing something, but really i’d be much better off spending my time actually working on the project rather than worrying about it. And the more i worry, the more difficult it is for me to focus when i’m trying to work, the more stressed i get, and the harder it is for me to get to sleep at night. And when i’m stressed and tired i can’t get as much work done and the quality of my work suffers.

So now based on our answers from the last section we come up with modified and alternative ways of viewing the situation and predicting what’s going to happen that don’t cause us so much anxiety and give us less reason to worry. If i’m able to focus on work and not worry so much i probably will be able to get it all done. And i might have to work late or even on the weekend or ask for some help, but one way or another i’m gonna get it finished.

And then we write down our new prediction about what we think will happen, which could be the most likely scenario we identified above, or it could be something slightly different like, i’m going to be really stressed and struggle to finish on time, but in the end it’ll get done even if it’s not my best work. And we rate the likelihood that our new prediction will come true on a scale from zero to a hundred percent.

And then we ask ourselves how much do i believe my original prediction now, and we re-rate how likely we think it is that prediction will come true. And then we go back and re-rate the intensity of the emotions and physiological symptoms and physical sensations that we identified in the first part, and write down any new emotions or physical sensations we’re feeling now.

And now with these new ways of thinking about the situation a new prediction about what will happen that’s not so catastrophic, our levels of anxiety will decrease and we’ll have less reason to worry. And you can download a worry record worksheet from my site where you’ll also find my complete self-help course for anxiety.

Now let’s go through another example. So let’s say the situation is, we got in an argument with our partners this morning and they haven’t been responding to our texts or calls all day. And we’re feeling anxious and sad and impatient, and we notice some tightness in our chests.

So what am i worrying about thinking or saying to myself? What if they keep ignoring me? What if they’re really mad at me? What if we get into a big fight over this? What if they want to break up with me? And then we write down what we predict is going to happen. We’re going to have a big fight about this tonight and maybe we’re even gonna break up. And then we rate how much we believe this prediction.

And now in part two we look for the evidence that supports and that doesn’t support our prediction. They were upset this morning they haven’t answered my texts all day. They’ve seemed kind of distant lately and we’ve been arguing a lot. This is exactly how my last relationship ended.

And now we look at the evidence against our prediction. I can’t read their mind and so i don’t know what they’re thinking. Maybe they’re just too busy to respond right now. And i know they don’t like arguing over text so maybe they’re just waiting until we can talk about this in person. This relationship is so much different than my last one, there’s no point trying to compare the two. We’ve had plenty of arguments before and we’ve always worked things out.

And what’s the worst that could happen? Well the worst that could happen is that we break up. And if the worst did happen how would i be able to cope with it? I’ve had relationships end in the past and i’ve always gotten over it. I’ve got some close friends that would be there for me and i’d be miserable for a while but eventually i’d be okay. And again this isn’t great but remember we’re looking at the absolute worst case scenario, which is probably not going to happen. But even if it does at least we know that we’ve been in similar situations before and found a way to manage.

And now what’s the best thing that could happen? They’re just busy right now and they’ll text or call us back as soon as they have time. And what’s the most likely thing that could happen? Well we’ll talk about things tonight and probably even argue over them, and in the end we’ll resolve things and make up like we always do. And what are the consequences of continuing to worry about this? Well it’s just going to make me feel bad all day. I’m going to have trouble focusing on anything else. And i’m going to be in a bad mood when we do talk about things.

So what’s a more balanced or alternative way of thinking about this situation? I don’t know why they’re not responding to me. Maybe they’re just busy or maybe they’re just waiting until they get home so we can talk in person. And even if we do end up in a big argument, we’ll probably work things out and make up just like we always do.

And then we ask ourselves, what am i now predicting will happen? We’ll talk things over tonight and maybe we’ll even fight a bit, but in the end we’ll figure things out and it’ll be okay. And we rate how much we believe this new prediction. And we go back and re-rate how likely we think it is our original prediction comes true. And then we re-rate the intensity of the emotions and physical symptoms we identified in part one, and write down any new emotions or physical sensations we’re experiencing now.

So whenever we’re not able to problem solve what we’re worried about, or just let our unproductive worries go, the worry record is a great tool to help change our anxious thoughts, which then reduces our anxiety, and gives us less to worry about.

You can download the Worry Record worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Modifying Obsessive Thoughts

OCD is associated with obsessive anxious thoughts in which we overestimate the likelihood and and exaggerate the severity of potential negative consequences or outcomes. Cognitive restructuring helps us modify our thoughts to make them more accurate and realistic, which in turn reduces our anxiety. The video below covers anxiety in general, but includes concepts that can help reduce obsessions.

CBT for Anxiety and Cognitive Restructuring

Cognitive restructuring is important in CBT because it helps us change how we’re thinking. And in CBT, changing our thoughts is one of the main ways we change how we feel. If we’re able to modify our worries and anxious thoughts in order to:

  • more accurately estimate a situation’s level of threat and danger
  • consider outcomes other than the worst case scenario
  • feel more confident in our abilities to cope with negative outcomes

then we’ll start to reduce our anxiety.

The questions in the Cognitive Restructuring for Anxiety Worksheet [download PDF] or [download Word] can help with cognitive restructuring of worries and anxious thoughts.

Next we’ll learn how to complete a worry record, that guides us through the process of cognitive restructuring for anxiety. If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Mindfulness of Sounds and Thoughts

It can be difficult to stay mindful of our thoughts. When we try to pay attention to our thoughts, our thoughts often carry our minds away. And this is the opposite of mindfulness. The Mindfulness of Sounds and Thoughts exercise mentioned in the previous video is a guided meditation that leads us through a few ways we can practice being mindful of our thoughts.

In the Mindfulness of Sounds and Thoughts meditation, we begin with a period of mindful hearing, and then we turn our attention to our thinking, relating to our thoughts the same way we did to sound. Rather than paying attention to the content of our thoughts and what they mean, we simply notice thoughts arising, and sustaining, and passing through the thoughtscape of our minds, watching them coming and going like clouds passing through the sky.

In this meditation, after mindfully following sounds for a while, we then turn our attention to our thoughts and practice relating to them in a similar fashion. Rather than engaging with the thoughts we’re having and getting caught up in them or thinking about them, we simply notice what thoughts are present, and just treat them as mental events moving through our field of awareness.

Mindfulness of Sounds and Thoughts Guided Meditation

Mindfulness of Sounds and Thoughts (Extended Version)

If you’d like to learn more about mindfulness, please check out my Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Meditation courses. If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Mindfulness of Thoughts

This videos overlaps a little with the last two, and goes in to how we can be mindful of our thoughts in a little more detail.

Mindfulness of Thoughts

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

My first video on mindfulness and dbt was an overview of the goals of mindfulness and six of the core mindfulness skills. In this video we’re going to go into more detail about how we can practice mindfulness, and especially how we can be mindful of our thoughts.

One way to practice mindfulness is through meditation. In a mindfulness meditation we’re noticing, paying attention to, and observing whatever we’re experiencing in the present moment, focusing on our inner experiences: our breath, our thoughts, our feelings and emotions, and the physical sensations in our bodies. And then whenever we get distracted and our minds start to wander, we simply acknowledge whatever’s distracted us, and then as best we can we let it go and redirect our attention back to what we’re trying to pay attention to, which is usually our breath. And if you’d like to learn how to practice mindfulness meditation check out the videos that i link to in the pinned comment and description.

But the fact is most people aren’t going to practice mindfulness meditation on a regular basis. But all of the things we do in a mindfulness meditation, we can also do as we go about our daily lives. We just need to focus our attention on whatever we’re doing in the present moment. If we’re working, we’re focused on our work: what we’re doing, and thoughts related to what we’re working on. And we’re aware of other thoughts and feelings and emotions and body sensations that arise while we’re focused on our work, but we just observe these thoughts, feelings and sensations. We don’t allow them to carry our minds away. We acknowledge them, and then as best we can we let them go and redirect our attention back to whatever it is we’re trying to pay attention to.

Now the two main ways that we practice mindfulness in dbt are by observing, and describing and labeling. So as we go about our daily lives, we’re being mindful when we’re able to take a step back from what we’re doing, stay in the present moment, and observe what’s going on with our thoughts, feelings and emotions, and body sensations.

But often instead of just observing what we’re experiencing, we start getting pulled into our experiences. Rather than simply observing our thoughts, we get stuck in our heads, our minds racing, and we can get completely caught up in our thoughts. Or our emotions and body sensations can become so strong that they begin to overwhelm and subsume us. One way to stay mindful in the face of strong uncomfortable feelings emotions and body sensations is to practice radical acceptance, and we can also use various emotion regulation skills and i have videos that go into more details about these topics that i link to in the description and pinned comment. And in the remainder of this video we’re going to look at how to stay mindful of our thoughts by observing and describing or labeling them.

There are always lots of thoughts passing into and out of our minds. And while we can’t control what thoughts come into our minds at any given time, we do have the ability to choose which thoughts we want to pay attention to. When we’re being mindful we’re aware of and observing the thoughts that come into our minds. And then when we notice ourselves having a thought that’s not related to what we want to be paying attention to at the time, we’re mindful of this thought, we notice we’re having it, but that’s all we do with. It we don’t engage with it. We don’t think about it. We just acknowledge that we’re having that thought. And then as best we can let it go and redirect our attention back to what we’re trying to pay attention, to without allowing that thought to distract us and carry our minds away.

And the best way to explain how we practice being mindful of our thoughts is to use some metaphors. One way we can be mindful of our extraneous thoughts that aren’t related to what we’re doing at the time is to treat them as if they were just sounds going on in the background. We generally don’t pay attention to these sounds or think about them very much, and we just allow them to pass in one ear and write out the other. And we can do the same sort of thing with our thoughts: not give them any undue attention and think about them or try to figure out what they mean, and just treat them like mental noise in the background, allow them to pass into our mind and then right out again.

Another metaphor for this way of relating to our thoughts is to simply treat our thoughts as if they were clouds passing through the sky: noticing as a cloud or a thought passes into our field of awareness, sticks around for a while, and then continues to float through the sky or through our minds until it passes away.

Or sitting back and observing our thoughts as if we were at the movies and watching our thoughts being projected on the screen in front of us. Not actively participating or getting caught up in the action on the screen that is our thoughts, and just sitting back and watching them as they unfold. And remember that the thoughts that we’re trying to simply watch and observe and allow to pass from our minds without interacting with them aren’t the thoughts related to what we’re doing at the time, but extraneous thoughts that act as distractions that can pull us away from what we’re trying to focus on. And if you’d like to try an exercise that leads you through these metaphors with a guided audio file, please check out the link in the description and pinned comment.

But often it’s not that easy to just sit back and watch our thoughts. And so if we find ourselves getting caught up in our thoughts rather than just observing them, describing or labeling our thoughts is a great way to take a step back. When we’re describing our thoughts we’re observing our thoughts and simply describing to ourselves what’s going on in our minds.

So instead of just observing the thought, i hate my life, describing what’s going on in your mind: first that you’re having a thought, and then noting what you’re thinking about. I’m having the thought, i hate my life. Instead of just observing the thought ,what if i can’t get this done on time, describing what’s going on in your mind. I’m worrying, what if i can’t get this done on time? Or I’m wondering, why haven’t they emailed me back yet? Or I’m having the thought, how could he do that to me?

Now instead of describing the content of our thoughts we can simply label our thoughts with a couple of words or a short phrase that labels what’s going on in our minds so merely noting that we’re thinking thinking; or worrying about work; or I’m obsessing; or I’m dwelling on an argument. When we label our thoughts, we’re shifting our focus away from the content of what we’re thinking about, and merely observe that we’re engaged in the act of thinking or worrying, or obsessing, or dwelling, and the content of our thoughts loses its power.

If we’re observing ourselves having the thought, i hate my life, or why haven’t they emailed me back yet, those thoughts generate an emotional reaction that makes them more difficult to let go. But if instead we describe our thoughts with a simple label like thinking or worrying, there’s really no emotional pull to that label. So labeling helps us become aware of and acknowledge our extraneous thoughts, while making it less likely that these thoughts end up carrying our minds away from what we’re trying to pay attention to.

So even if you don’t practice mindfulness meditation there are lots of ways that you can learn to be more mindful of your thoughts. And remember that being mindful takes practice, so try to use these strategies on a regular basis to build up your mindfulness skills, so if you’re feeling overwhelmed or a crisis arises they’ll be ingrained enough that you can rely on them to help you through it. And if you missed my first video on dbt and mindfulness please check out the link in the description and pinned comment, where you’ll also find a link to my guided mindfulness of thoughts exercise.

The next post contains the Mindfulness of Sounds and Thoughts exercise mentioned in this video. If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD

Obsessions and Cognitive Defusion

Cognitive defusion is a key concept from Acceptance and Commitment Therapy (ACT). When we practice cognitive defusion, we let go of our thoughts without allowing ourselves to become “fused” with them. Or, if we’re already stuck in our heads and “fused” with our thoughts, cognitive defusion helps us de-fuse. Cognitive defusion is a great antidote for obsessing.

Cognitive Defusion

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

There’s a type of mindfulness based therapy called acceptance and commitment therapy. And an important concept in acceptance and commitment therapy is the idea of cognitive fusion and defusion.

Cognitive fusion describes those times when we’re so tightly stuck to our thoughts that we become fused with them. We can’t separate ourselves from our thoughts and so our thoughts become our reality. And when we’re in a state of cognitive fusion we can feel removed from the world outside our thoughts, and from what we’re doing, and from the people around us, and it can be hard to pay attention to anything outside our head.

The opposite of cognitive fusion is cognitive defusion. Cognitive defusion involves taking a step back from what’s going on inside our minds, and detaching ourselves from our thoughts. In this state of defusion we can observe our thoughts without getting caught up in or lost in them. And we can just allow them in and accept them and let them be and let go of them if we want.

One way we can practice cognitive defusion is to label your thoughts. Anytime you notice that you’re starting to become fused with your thoughts, you can simply take a step back from your thoughts by labeling them as thinking, or daydreaming, or worrying, or ruminating or planning—just labeling whatever type of thought you’re having with a one or two word description.

And doing this helps you take a step back from the thought and focus less on the content of your thought and more on just the fact that you’re thinking, or worrying, or daydreaming, or whatever the nature of your thought is. And this makes it less likely that you’ll get sucked in by those thoughts, or carried away by them, or become fused with them.

Or you can say to yourself: I’m just thinking, just worrying. And putting the qualifier just in front of the thought helps take away some of the power of that thought and makes it easier to let go. Or you can label the content of your thought as being “just a thought.” So if you’re thinking, “i can’t do anything right,” you can reframe this as “I’m just having the thought i can’t do anything right.”

Or if you’re thinking “this is going to be terrible” you can reframe that as “I’m just having the thought that this is going to be terrible.” Instead of “,nothing ever goes my way,” “I’m just having the thought that nothing ever goes my way.” And by prefacing our thoughts with the disclaimer that this is just a thought, we reinforce the idea that our thoughts are not facts. And every time we remind ourselves of this we take away some of the power that our thoughts have over us.

Or if you’re having trouble letting go of your thoughts you can imagine yourself writing down each thought on a balloon, and then releasing that balloon up into the air and just allowing that thought to float from your mind as the balloon floats away.

Now sometimes instead of just letting go of our thoughts, it can be helpful to look at the content of our thoughts, and just get a sense of how accurate or how biased that thought may be, and see if there may be a different way of looking at things and thinking about them that’s more helpful to you, which is something we’ll explore in the next video about reframing your thoughts and cognitive restructuring.

This is the final post about thoughts. Next we’ll look at the “B” in CBT: behavior. If you have any questions or comments, please leave them on the YouTube video page.

Posted in OCD