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

2. www.drbrianott.net Audience Participation

3. www.drbrianott.net What just happened?

4. www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Body ResponseBody Response Behavioral ResponseBehavioral Response BeliefsBeliefs

5. www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Body ResponseBody Response Behavioral ResponseBehavioral Response BeliefsBeliefs

6. www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Body ResponseBody Response Behavioral ResponseBehavioral Response BeliefsBeliefs

7. www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Were you feeling anxiety or fear?

8. www.drbrianott.net Anxiety or Fear? Fear helps you stay alive in an immediately dangerous situation.

9. www.drbrianott.net Anxiety or Fear? Anxiety gets you ready for an immediately dangerous situation…

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

11. www.drbrianott.net Anxiety or Fear? …interferes with living your life.

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

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

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

15. www.drbrianott.net Johnny and Max

16. www.drbrianott.net Johnny and Max

17. www.drbrianott.net Johnny and Max

18. www.drbrianott.net “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?”

19. www.drbrianott.net Phobias Answer:

20. Phobias

22. Johnny and Max

23. www.drbrianott.net Johnny and Max TriggerBody’sEmergencyResponseSystem

24. www.drbrianott.net “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?”

25. www.drbrianott.net Phobias So how do we help Johnny?

26. www.drbrianott.net Phobias So how do we help Johnny? How do we stop pooch drooling?

27. www.drbrianott.net Phobias So how do we help Johnny? How do we stop pooch drooling? How do we stop Brian Ott drooling?

28. www.drbrianott.net Phobias Talk some sense into me!

29. www.drbrianott.net Phobias Solution: Hide the meat and ring that bell.

30. www.drbrianott.net

31. Johnny and Max

32. www.drbrianott.net

33. Phobias

34. Phobias

35. Problem:

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

40. www.drbrianott.net Phobias Solution:

41. 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.

42. www.drbrianott.net Johnny and Max

43. www.drbrianott.net Panic Disorder What is a Panic Attack? What’s the difference between a Phobia and a Panic Attack?

44. www.drbrianott.net Panic Disorder

45. www.drbrianott.net Panic Disorder Involves one of three concerns Losing control (usually in public) Going crazy Dying

46. www.drbrianott.net Panic Disorder Seems perfectly reasonable.

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

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

49. www.drbrianott.net 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.”

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

51. www.drbrianott.net Social Phobia

52. www.drbrianott.net Social Phobia Can have BOTH Conditioned Responses AND Anxiety Triggering Thoughts

53. www.drbrianott.net Social Phobia

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

55. www.drbrianott.net Social Phobia

56. www.drbrianott.net 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

57. www.drbrianott.net 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?

58. www.drbrianott.net 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.

59. www.drbrianott.net Take Home Messages When anxious: First ask: how much Body conditioning and how much Beliefs?

60. www.drbrianott.net 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

61. www.drbrianott.net 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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