1. Rockland County Psychological Society May 19, 2013
Using Cognitive Behavioral Therapy to Treat Anxiety Disorders Presented by: Dr. Caren Baruch-Feldman drbaruchfeldman.com
Rockland County Psychological Society
May 19, 2013

2. GOALS FOR TODAY’S TALK
Increase Your Understanding of the Causes of Stress/Worry Faced by People Today.
2. Teach You Actual Cognitive Behavioral Strategies that Can Be Used to Treat Anxiety Disorders.

3. Is Stress and Worry Good, Bad, or Something In Between?

4. Why Are People So Stressed Today?
Pressure to Succeed.
Uncertainty in Society as a Whole that is Contagious (mirror neurons).
Internet/Media. We overestimate risk based on: accessibility, recency, powerful images, severity of outcome.
Fast Pace Life Increases the Need for Control.
People Can’t Just Sit with Their Feelings.

5. How Can We Help Individuals Turn Their Worry Into an Appropriate Level of Concern To Feel Better?
Psycho-Educational
(3) Changing One’s Behavior
(physiological and avoidance)
(2) Changing One’s Thoughts
No?
Yes!

6. Understanding Stress and Worry
Nervous Systems
Genetic Predisposition
Worry as a Bad Habit
Choose a Different Path by:
a. Identify productive and unproductive worry.
b. Accept reality and commit to change.
c. Challenge your worried thinking.
d. Change your behavior.
e. Use your emotions to help you rather than worry.
f. Keep it going and when failure occurs turn it into an opportunity.

7. Worry More Effectively
Rules for Productive Worry
Signs of Unproductive Worry
1. Figure out if the problem is plausible or reasonable. 2. Decide if you can do something about it right now or very soon. 3. Quickly move from worrying to problem solving.
1. You are worrying about unanswerable questions. 2. You are worrying about a chain reaction of events. 3. You reject a solution because it is not perfect. 4. You think you should worry until you feel less worried. 5. You think you should worry until you feel totally in control.

8. What Doesn’t Work!!!
1. Seeking Reassurance. 2. Trying to Stop Your Thoughts. 3. Checking and Checking. 4. Avoiding Discomfort. 5. Demanding Certainty. 6. Not Seeing Crazy Thoughts as Anxiety But Instead Thinking It’s True.

9. Changing One’s Thoughts
How One THINKS About A Situation Affects How One Feels.

10. Basics Principles of REBT
Albert Ellis .

11. Experiment 1
What Do You See? Look around the room and try to find all the examples of RED you can see.
What have you spotted?

12. Experiment 2
Picture yourself in the following situation: You are standing in line at the bank. There are about 50 people around. A robber enters and fires his weapon. You get shot in the arm, but no one is hurt.
Would you consider yourself lucky or unlucky?

13. Experiment 3 Florida Old Lonely Orange Bingo Conservative wrinkle
Worried
Florida
Old
Lonely
Orange
Bingo
Conservative
wrinkle
Taken together, these 3 slides demonstrate that what 1) you focus on shapes your view (experiment 1), that the situation alone does not dictate the emotional responses (experiment 2), and that on a very profound level, our thoughts affect our behavior (3rd experiment).

14. What Is the Thought Associated with Anxiety?
Expecting the Worst …
Seven Rules of Highly Worried People - R. Leahy (The Worry Cure)
1. If something bad could happen – then it’s your responsibility to worry about it.
2. Don’t accept uncertainty-you need to know for sure.
3. Treat all your negative feelings as if they are really true.
4. Anything bad that happens is a reflection of you as a person.
5. Failure is unacceptable.
6. Get rid of any negatively feelings immediately.
7. Treat everything like an emergency.
* Worry about your worry.

15. Changing Ones Thoughts
Step1: Identify Negative Thoughts.
Look for Expecting the Worst.
Step 2: Question and Challenge Thoughts.
Where is the Evidence?
Is it Helpful?
Step 3: Come Up With More Realistic and Optimistic Thoughts to Feel Better.
1)There is no evidence…
2) Worrying won’t help……

16. Step 1: Identifying Negative or Irrational Beliefs/Thinking Traps
Demandingness – SHOULDS/ MUSTS
Awfulizing – It Is Terrible!
Low Frustration Tolerance – I Can’t Stand It!
Global Rating of Self/Others. Self-Downing.

17. Core Irrational Beliefs/Thinking Traps Associated With Anxiety
It’s going to be terrible. From it will be 100 (fortune telling).
I can’t stand it (catastrophizing).
I shouldn’t feel this way (shoulds/musts).
I am a failure because I did poorly (personalizing).
I will fall apart if I feel uncomfortable (low frustration tolerance).
A disaster is definitely going to happen (overgeneralizing).
I have to get a 100 or do perfectly (all-or-nothing-thinking).
If I don’t do well on my chemistry test, I will fail the class. If I fail the class, I won’t get into medical school. Then everything will be terrible. (sliding down a slippery slope).

18. Step 2: Question and Challenge Thoughts
Where is the evidence that what I am expecting will happen?
Is it helpful how I am thinking?
What are the cost and benefits to my thinking?
Would I think the same way if a friend presented this issue?

19. Step 3: Develop Rational Beliefs/Thoughts
Wishes/ Preferences
Living in the Gray
I Can Stand It
Total Self Acceptance

20. Irrational vs. Rational
RATIONAL BELIEFS
Preferences
Living in the Gray
Realizing That They Can Stand It
Not Judging Themselves
Self Acceptance
IRRATIONAL BELIEFS
Demandingness – SHOULDS/MUSTS
Awfulizing – It Is Terrible!
Low Frustration Tolerance –
I Can’t Stand It!
Global Rating of Self/Others - Self Worth Tied to 1 Behavior or Action. Self-Downing

21. EXAMPLE: Mom, I’m Worried!
Test Anxiety
Expecting the Worst
I am going to fail!
It is going to be terrible!
I will need to repeat the grade.
If I fail I am a bad person!
The test shouldn’t be this hard!

22. EXAMPLE: Mom- I’m Confident!
Confident Test Taker
Realistic and Positive Thoughts
There is no evidence that I will fail. I haven’t failed previous tests.
Even if I fail, I am exaggerating how bad the results will be. Nobody gets left back in 7th grade because of one test.
Worrying is a waste of energy. It is really the worst thing I can do. Since when I worry, I am not paying attention fully to the test.

23. Let’s Practice
Step 1: Identify Negative Thoughts. Step 2: Question and Challenge Those Thoughts. Step 3: Come Up With More Realistic and Optimistic Thoughts to Feel Better.

24. Rational Emotive Imagery
Picture a bad event clearly. One that has either already happened or that you believe likely to happen. Take your time. Fill in the details. Visualize the people involved, hear them talk, describe the environment, let the situation happen in your mind. Feel the emotions; you can do it. Keep imagining until the emotions are as disturbed as you can get them.
After a minute or two, change your emotions from disturbed to merely unpleasant. Did you change your thinking? Was your thinking more realistic? It’s the thinking that causes the emotional response.

25. Changing Behavior: Your Emotions Are Your Friends
Be A Detective
Rather than think of fear as a signal to RETREAT, consider it a CUE to go forward.

26. Changing Behavior: Physical Sensations
Spell Your Name with Belly Breaths
Deep Muscle Relaxation
Guided Imagery
Meditation
Change Your Breath

27. Changing Behavior: Don’t Avoid
Facing One’s Fear or Stress
Manageable and Hierarchical Manner
Success Breeds Success

28. Coping Cat by Kendall- FEAR Plan
F = Feeling Frightened?
E = Expecting Bad Things to Happen?
A = Attitudes and Actions that can Help.
R = Results and Rewards
FEAR Ladder or Situation Cards

29. What Else Can You Do
Possibility vs. Probability. Determine How Likely It Will Happen.
Give Worry a Name.
Living in the Here and Now, Not the Future. Appreciate the Moment.
Worry Tape. Flood Yourself with Uncertainty.
Embrace Discomfort. You Can Stand It.
Set Aside a Worry Time.
What’s the Best, Worst, Most Likely Outcome.
Write Down a Story With a Better Outcome.
Separate Thinking from Action. I am simply having the thought….
Describe What Is in Front of You. Don’t Jump to Conclusions.
Can’t Tell Someone to Relax/Calm Down. The Person Needs to Get There Him/Herself.
Positive Psychology: Grateful Activity, Journal the Positive, Random Acts of Kindness.
Exercising, Eating, and Sleeping Right .

30. A Few More Facts/SUMMARY
People are actually less worried when they are worrying. In fact, worriers fear emotions and do not process the meaning of events because they are too much in their heads.
Intolerance for uncertainty is the most important aspect in worrying.
Be a long-term hedonist vs. a short term one.
Turn failure into opportunity (I didn’t fail, my behavior did. Failure is not fatal).

31. From Challenge to Opportunity
After SANDY
Seeing it as an OPPORTUNITY

32. CBT Sheet by Caren Baruch- Feldman
What is the Situation?
What Is the Feeling Associated With That Situation?
What Are Your Thoughts About The Situation?
Challenging Those Thoughts.
Alternative Way Of Thinking About the Situation.
New Feeling.