Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School of Professional Psychology

Audience Participation

What just happened?

Anxiety: Body, Behavior, and Beliefs Body ResponseBody Response Behavioral ResponseBehavioral Response BeliefsBeliefs

Anxiety: Body, Behavior, and Beliefs Body ResponseBody Response Behavioral ResponseBehavioral Response BeliefsBeliefs

Anxiety: Body, Behavior, and Beliefs Body ResponseBody Response Behavioral ResponseBehavioral Response BeliefsBeliefs

Anxiety: Body, Behavior, and Beliefs Were you feeling anxiety or fear?

Anxiety or Fear? Fear helps you stay alive in an immediately dangerous situation.

Anxiety or Fear? Anxiety gets you ready for an immediately dangerous situation…

Anxiety or Fear? that may not be as likely to happen or dangerous as you think. And…

Anxiety or Fear? …interferes with living your life.

Anxiety: Body, Behavior, and Beliefs same kind of response but fear helps us move through life anxiety gets in our way

Anxiety: Body, Behavior, and Beliefs “Lots-O-Labels”Phobia Panic Disorder Generalized Anxiety Disorder Post Traumatic Stress Disorder Obsessive Compulsive Disorder

Anxiety: Body, Behavior, and Beliefs “Lots-O-Labels”Phobia Panic Disorder Generalized Anxiety Disorder Post Traumatic Stress Disorder Obsessive Compulsive Disorder

Johnny and Max

Johnny and Max

Johnny and Max

“It doesn’t make sense.” “It’s just a fence, a bell, a building.” “Nothing bad about them, but I can’t stop the feeling.” “Why can’t I talk myself out of this?”

Phobias Answer:

Phobias

Johnny and Max

Johnny and Max TriggerBody’sEmergencyResponseSystem

“It doesn’t make sense.” “It’s just a fence, a bell, a building.” “Nothing bad about them, but I can’t stop the feeling.” “Why can’t I talk myself out of this?”

Phobias So how do we help Johnny?

Phobias So how do we help Johnny? How do we stop pooch drooling?

Phobias So how do we help Johnny? How do we stop pooch drooling? How do we stop Brian Ott drooling?

Phobias Talk some sense into me!

Phobias Solution: Hide the meat and ring that bell.

Johnny and Max

Phobias

Phobias

Problem:

Phobias More you avoid, the more you will avoid. The more you avoid, the less chance of conditioned response extinction.

Phobias Solution:

Phobias What have we learned so far? Part of anxiety has to do with a learned physical “reflex” - the BODY on Automatic Conditioned body reactions have to be reduced by a change in BEHAVIOR – “All action, no talk.” Need to move in small steps towards the situation starting at a middle level of anxiety.

Johnny and Max

Panic Disorder What is a Panic Attack? What’s the difference between a Phobia and a Panic Attack?

Panic Disorder

Panic Disorder Involves one of three concerns Losing control (usually in public) Going crazy Dying

Panic Disorder Seems perfectly reasonable.

Panic Disorder Trigger I can’t control this. Fail! Try to Stop EmergencyReaction Sensation

Panic Disorder Trigger I can’t control this. Fail! Try to Stop EmergencyReaction Sensation Panic Attack

Panic Disorder What to do with a Panic Attack? Can’t Overcome a Strong Rush of Adrenaline Distraction and Relaxation often make things worse. (note: do relaxation techniques when feeling good) “Can’t beat them, join them.”

Panic Disorder Trigger I can’t control this. Fail! Try to Stop EmergencyReaction Sensation Panic Attack

Social Phobia

Social Phobia Can have BOTH Conditioned Responses AND Anxiety Triggering Thoughts

Social Phobia

Social Phobia BELIEFS can trigger a false alarm of the bodies emergency system when expectations don’t match experience

Social Phobia

Social Phobia When predicting a catastrophe, ask yourself: Am I being a good bookie and a good actuary In my experience is the likelihood of the emergency Is the damage estimate correct

Social Phobia If I look at MY personal experience, what are the odds a catastrophe will occur? If the catastrophe does occur, how bad will it be for me?

Social Phobia If the belief is accurate – find a way to cope with a bad situation. But If the belief is inaccurate – time to create a new belief about the situation that better matches your experience.

Take Home Messages When anxious: First ask: how much Body conditioning and how much Beliefs?

Social Phobia For Body conditioning: Build a staircaseBuild a staircase Ring the bellRing the bell Keep ringing the bell until calm downKeep ringing the bell until calm down Then go a bit farther up the staircaseThen go a bit farther up the staircase

Social Phobia For beliefs, the thinking part: Think about the horse race and hurricanesThink about the horse race and hurricanes Ask self is what expecting match what I know has happened in the past?Ask self is what expecting match what I know has happened in the past? If yes, use your coping skillsIf yes, use your coping skills If no, build a new Belief based on experienceIf no, build a new Belief based on experience

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