Emotions such as great upset, distress, anger, and despair are quite typical and frankly, normal at these times. It’s also pretty typical to find yourself railing about the unfairness of it all and the fact that you don’t deserve what’s happened. When these thoughts and feelings occur, generally the person will take on a new role in life—that of a patient or even a victim. And friends, healthcare providers, therapists, and family generally pick up the appropriate role of helpers.

Good helpers feel motivated to help. They usually feel sympathy and concern and they provide support as needed. They often believe it’s largely up to them to create improvement and healing for the patient or victim. And they rarely see the patient as to blame for their dilemma.

Society has created the roles of patient, victim, and helpers for good reasons. These roles facilitate the provision of help when something bad happens to people. And almost everyone we know has occupied the role of victim, patient, or helper from time to time. We actually see that as a good thing. At least in the short run.

However, occasionaly the roles of victim or patient evolve over time to the point that they become completely entrenched in the mind, almost chiseled in granite. As the belief in one’s status as a victim or a patient takes hold, sometimes people start focusing and dwelling on how unfairly life has treated them. They may begin to complain and feel enraged much of the time. They start to feel helpless and hopeless. They may feel that not enough is being done for them.

If you find yourself sliding down the slippery slope into entrenched victimhood, we suggest therapy for helping you learn a new, more productive role—that of a coper or perhaps even a rehabilitation patient. As is the case with patients and victims, both copers and rehab patients have had difficult things happen to them that they didn’t deserve. But at some point, they learn how to let go of their anger and rage and reach deep inside of themselves to find ways for productively dealing with what’s happened and put themselves on a path for improving their situation. At times, they may not find much they can do about their illness or horrific event, but they can usually find ways of coping better and finding meaning in their lives in spite of what’s happened to them.

Please also try to realize that letting go of your rage and focusing on coping by no means diminishes the importance or the horribleness of what may have happened to you. Rather, you can find new meanings from your efforts to cope. This shift from victim or patient to coper is rarely easy, but you’re likely to find it useful. And again, getting therapy to help you with the process is usually a very good idea.

Well, yes and no. Of course most therapists would love for you to be able to feel calm, relaxed, and peaceful all of the time. However, that goal isn’t possible for anybody. Life is full of unpredictable, often random, dangers, hassles, and perils. Therefore, if you have the goal of eliminating these things, you will almost certainly fail.

So, I first recommend that you give up on the unrealistic goal of purging distress from your life. But then, I have something far more radical to suggest: Welcome anxiety, uncertainty, doubts, and distress into your life! Walk right up to anxiety and let it know that you’re ready to take it on. Seek every single opportunity you can to actually feel and experience anxiety!

What, you say? Have I lost my mind? Am I failing to understand how horrible anxiety is for you?

Actually, I think I do understand how uncomfortable anxiety can be. And I know how much those with anxiety wish to be rid of it. But the only sure fire way to master anxiety is through a process known as habituation. Habituation occurs whenever you encounter a feared situation, event, or object over and over and over again. Ever so slowly, but just as surely, your distress decreases as you go through this process. And it does so by gradually increasing your exposure to your fears.

The key term here is “gradually.” Take a simple case of someone who gravely fears spiders to the extent that she avoids going outside, has her apartment sprayed with toxic chemicals every week, and sprays insecticide around her desk every day. Clearly, her spider phobia is costing her dearly—her health may suffer; she likely annoys her coworkers, and she suffers miserably from worries and anxiety about spiders.

The treatment for spider phobics is much the same as it is for other anxiety problems. I would have this patient ever so gradually expose herself to small spiders (at first encased in a cage) and then move on to looking at pictures of fearsome spiders, then deal with small spiders at a short distance, and so on. Eventually, most people who go through graduated exposure find themselves no longer controlled and dominated by their anxiety. But this improvement comes from their willingness to actively confront their fears one step at a time.

If you have mild problems with anxiety, you may wish to try this approach on your own. Break your fears into a series of gradual steps and then start confronting them one at a time. Remain in contact with each step until your anxiety drops some. We discuss this process in Overcoming Anxiety For Dummies (2^nd Edition) in great detail, but you can also find a lot of information about the approach by Googling.

Make a game out of confronting your anxieties. Rate every fear and anxiety on a scale of 1 to 100 and then go out and rack up as many points as you can. Welcome anxiety! Embrace it. Tell it to give you its best shot. Go into the ring and confront your anxiety. You can’t win by running away—that just makes things worse.

Finally, If your anxiety problems are serious, seek a professional for help and guidance with this approach.

Young man in park photo available from Shutterstock.

In my early training, I considered myself a radical behaviorist. I still do pretty much. I believe that the words we use and the thoughts we think can be considered verbal behavior. But, those beliefs are much more complex than what I wish to discuss today.

What I’d like to convey in today’s blog is that many people think that rewards, encouragement, planned ignoring, and sometimes small punishments are the simple answers to getting people to do what you want them to do. Well, it’s not so simple. We don’t always have the full deck to play with when it comes to behavior modification.

When I work with kids, parents, and teachers, I work from a Cognitive Behavioral Model. Yet, I can’t always tell teachers or parents to reward one behavior or ignore another and get the results that I expect. Sometimes, there are other aspects of a child’s environment that strongly influences his or her behavior. It could be a sibling, a friend, a parent, or a strong belief that the child has that no one has really uncovered. Those other influences can be tough to figure out.

I like to tell stories to illustrate my points. When my twins were 2 years old, I really wanted them to stop throwing food at each other (and on the floor, the high chairs, the counters and sometimes me). So, I decided to ignore them. That principle is called extinction. If a parent stops giving a child attention for misbehavior, the behavior should first get worse, and then gradually fade over time. When I implemented this procedure for my twins, I expected the throwing to increase—a last ditch effort to get mom’s attention. And it did, I was strong—tried not to laugh (not always so easy to do by the way). But after a few days, I noticed that the ignoring was having absolutely no effect. The girls were still hurling food and giggling away. Eventually, I realized that I had nothing to do with it.

You see, I was not the chief reinforcer—my kids were reinforcing each other. There was not much to be done about that other than separate them or punish them. I chose not to separate or punish them. Eventually, throwing food became less fun. My kids are now adults; and guess what? I rarely (actually never) see them throw food at each other—but they can still make each other laugh—more so than anyone else in the world. And when I hear them laugh today and get a little silly, I remember the lesson they taught me about behavior modification and I smile.

You might wonder why that would be the case. After all, if you have a problem, you should venture out and do something about it, right?

I’d like to suggest that if you’ve had significant problems with anxiety or OCD, yet avoided getting treatment for years, you’ve probably done so for some pretty good reasons. And it makes more sense to take a look at your reasons for not seeking treatment than to beat yourself up for not having done something about your problem. There are six major reasons or beliefs we’ve heard people give for avoiding treatment. See if any of these apply to you:

1. I fear trying to tackle my problems and not making progress. If that happened I’d feel worse than if I’d done nothing at all—in fact, I’d feel like a complete failure.
2. I know that you can’t really change feelings. They are what they are. You’re just fooling yourself if you think you can actually do something about them.
3. I wouldn’t know who I was if it weren’t for my OCD or my anxiety. They define who I am.
4. People never really change. I’ve been this way my whole life; if I haven’t changed by now, I probably never will.
5. My anxiety feels too overwhelming to do anything about it. I’ve heard that treatment make you feel anxious. It’s safer to just let things stay as they are.
6. I’m too busy to go to treatment. Therapy takes time and that’s something I simply don’t have.

So does one or more of these beliefs explain why you’ve avoided treatment? Perhaps you can come up with other reasons—expense, hassle, whatever. I recommend that you write all of the reasons you have for avoiding treatment down.  Take a good hard look at them. You likely haven’t been staying away from treatment just out of laziness. Rather, you’ve had some pretty powerful reasons for staying stuck.

What you ask? Am I actually going to tell you to just live with your problems and not do anything about them? Au contraire. Treatment is usually a very good idea if anxiety or OCD are significantly interfering with your life. But you’re not likely to do anything about your problems until you’ve taken a close look at the reasons you’ve been delaying taking action.

Once you know what those reasons are, you can do something about them. Stay tuned. Our next blog gives you advice on that topic.

Anxious man photo available from Shutterstock.

True panic attacks of this sort involve anxiety and fear of stunning intensity. The actual attacks usually peak within ten minutes and slowly fade, but it’s common for people to actually think they could die during one of these attacks. Common symptoms of these attacks include:

• Profuse sweating
• Rapid, irregular heartbeat
• Shortness of breath or sense of suffocation
• A sense of unreality or detachment
• Fear of impending death without any real basis
• Nausea
• Fear of losing control or “going insane”
• Trembling and shaking
• Chills and hot flashes
• Dizziness

When such attacks reoccur, the person worries about future attacks, has considerable concerns about the meaning of the attacks, or changes his or her behavior in order to avoid attacks, the odds are that a Panic Disorder is in play. Frequently, but not always, people with Panic Disorder also have Agoraphobia (fears of being in places that would be difficult or highly embarrassing to leave or escape from), but that’s a topic for another blog.

Trust me; if you’ve never had a panic attack, you don’t want to. But if you have such attacks from time to time or if you worry a lot about getting them, what can you do? Well, there’s a reason we titled our blog Anxiety and OCD Exposed. The term “exposed” or “exposure,” forms the foundation for most treatments of anxiety.

First, as with most emotional problems, you should see a physician to rule out physical problems that could be causing your anxiety. Try to avoid the temptation, however, of going to the doctor over and over and over again. In all but the rarest exceptions, a thorough physical once a year should be sufficient for moving ahead with exposure therapies.

Second, look for a cognitive behaviorally trained therapist who has expertise in treating Panic Disorder with Exposure techniques. That therapist will work with you on developing a hierarchy of items that tend to trigger your concerns about having panic attacks. You will gradually work your way through the easiest items, up to the most difficult.

In addition, your therapist may suggest exposure to the actual sensations of panic attacks themselves. This task is accomplished by intentionally bringing on these sensations by engaging in various tasks such as:

Breathing through a straw: You’ll usually breathe this way for about a minute each time. You feel like you aren’t getting enough air, your heart may race, and you may have feelings of choking, all of which mimic some types of panic for many people.

Spinning yourself around: This strategy induces dizziness and lightheadedness as well as an increased heart rate. Generally, sixty seconds or so works for this technique as well.

Hyperventilation: You breathe in and out very rapidly for about a minute which often induces feelings of shortness of breath, dizziness, of a racing heart.

There are various additional techniques for creating similar sensations. By repeating these exercises over and over again, you gradually learn that you won’t go crazy; you’re not going to die, and most importantly, that you can cope with anxious feelings. That knowledge allows you to quit worrying about having panic attacks which usually helps them fade from the scene.

Panicked woman photo available at Shutterstock

I was alert and aware of the snake behind us. I distinctly heard a rattle as we moved quickly and silently away. I was not thinking, only acting.

When your body responds to a dangerous situation like a snake in your path, you’re preparing to fight or flee. In the case of a snake, getting away makes more sense than making a stand to fight. The response to danger is hard wired and immediate. The brain responds to a perceived threat by releasing chemicals that surge to all parts of the body. These chemicals help protect you in the face of danger. You instantly become stronger and faster; your senses are all in hyperarousal; your focus intensifies. The body also responds when the danger is gone and the chemicals subside. After danger passes, there is usually a feeling of relaxation or fatigue.

The chemicals released during times of anxiety surge through the whole body. That’s why people who experience high levels of anxiety often have lots of physical symptoms. Anxious people can get cold or hot, have trouble getting enough air, or breathe too quickly, they may have muscle aches, or muscle weakness, upset stomachs, headaches, diarrhea, or constipation. These physical sensations can be frightening in and of themselves.

The fear of anxiety is the basis of panic disorder. People who develop panic disorder are first plagued by the physical symptoms of anxiety. When those symptoms are intense, people fear they might lose control, die, or embarrass themselves. The first step to treating panic is the understanding that panic attacks involve high levels of physiological symptoms in response to a perceived dangerous situation. More about actual panic attacks and Panic Disorder in a couple of days. Stay tuned.

Rattlesnake photo available from Shutterstock

Many millions of parents, with good intentions, have said to their scared kids, “Don’t worry, there’s nothing to be afraid of.”

Most scared kids willingly accept their parents’ reassurance. They might get an extra hug or a night light or one more bed time story. Gradually, they outgrow their fears. But some kids don’t easily grow out of their fears. They may just be prone to anxiety or sometimes they get too much attention from their caring parents.

These kids’ fears may get them extended routines of reassurance such as long rigid rituals that must be performed each night before they sleep. And many exhausted parents give up and extend an invitation to their frightened children to sleep with them in their beds.

And some of those kids whose parents have succumbed to their pleas eventually outgrow their fears as well. But, a small number of children get worse. Their fears grow. And as their weary parents lose patience, these kids feel intense anxiety. So, what began as a small bit of worry about separating from mom or dad at bed time becomes a monster of emotion. The child, once stretching out the bedtime routine with small requests, now screeches with desperation. Fear looks like anger and the child rages– now seemingly out of control.

These nighttime tantrums can turn a household upside down. Other family members can lose sleep, the child whose tantrums disrupt others in the family can be thought of as a trouble maker, and the sleep deprived family often becomes irritable and less productive at school or at work.

What can families do when fear morphs into anger? First, stop blaming each other. Parents and kids, for the most part, do the best they can do. Take a look at what happens when a fearful child throws a temper tantrum. Does the tantrum get the child what he or she wants? These patterns of behavior can be pretty tough to sort out and may require the help of a cognitive behavioral therapist.

However, the good news and the bottom line: These problems are pretty easy to solve if you get that help early. Do it now.

Image available from Shutterstock.com.

Children and teens with social phobia don’t answer questions in school even when they know the right answer. They don’t want to seek attention and can seem distant, unfriendly, and sometimes even arrogant to others. As adults, they may avoid speaking up at work, making presentations, being socially interactive, and being assertive. It’s understandable that those with social phobia are often underachievers—at school, at work, and in relationships.

People with social phobia usually don’t seek treatment for their condition. That makes sense, because they tend to avoid attention of any kind and rarely ask for help. They don’t want to make a call to a mental health professional or seek a referral from their medical provider. Those with social phobia may lead restricted, lonely lives because of their condition.

The suffering caused by social phobia is particularly sad because when recognized, social phobia can be treated by a mental health professional that has training in cognitive behavioral therapy. Therapy involves establishing a trusting relationship with a client and slowly expanding their exposure to the activities that the client fears.

Teachers, parents, and other adults should watch for signs of social phobia and make referrals. Adults with social phobia should make those difficult phone calls to find a professional who has CBT training (ABCT.org has a list of therapists as does Psychology Today).

Normally, I don’t like telling people what they “should” do. But I’m making an exception this time. Living with the pain of a social phobia simply isn’t something you have to put up with. This condition substantially lowers life satisfaction and it’s so treatable. So yes, you SHOULD call for help for yourself or your child now!

Photo by Timothy Tsui, available under a Creative Commons attribution license.

Children and people with mild autism sometimes appear to others as self-contained and aloof. Others may assume that those with autism are pretty calm, cool, and collected. However, they are likely very wrong.

Those with autism may suffer increased levels of anxiety and stress because of interpersonal isolation. They feel different from other people and worry that they may be disliked or misunderstood. This may lead the child or adult with autism to withdraw or avoid. This lack of contact with others can lead to more awkwardness and lack of opportunities to practice social interactions.

Those with autism frequently report hypersensitivity to loud noises, touch, lights or other forms of sensation. When in situations that involve these areas of oversensitivity, they may also experience periods of stress and discomfort. Stress may again result in avoidance of places in which over-stimulation may occur.

Furthermore, people with autism may have trouble understanding the perspective of others. They may misinterpret communications and subtle interpersonal cues. These misunderstanding can lead to anxiety, worry, and difficulties in relationships. Withdrawal, rejection, or avoidance are natural reactions.

In previous blogs, we have described the way that fear and worry can become worse. First there is something feared which results in distress. Avoidance temporarily brings down the feelings of distress and thus feels good. This good feeling is rewarding and results in more avoidance. The next time fear is experienced, there is a strong desire for avoidance. Thus fear grows and avoidance is the natural pathway.

People with anxiety and autism can learn to slowly become exposed to what they fear, just like those with generalized anxiety disorder, panic disorder, or obsessive compulsive disorder. They need a large dose of cognitive behavior therapy given by a patient, understanding therapist.

Photo by Leonid Mamchenkov, available under a Creative Commons attribution license.

Maybe you’re feeling a bit stressed and someone says, “Those are interesting shoes.”

Pretty benign comment right, but the shoes you are wearing are sort of weird and you’re feeling a bit off. So whether or not the comment was meant to be positive or neutral, suddenly you’re filled with feelings about your now ugly shoes. You might spend the rest of the day trying to hide your feet from others and you’re distracted with thoughts about what sorts of shoes would be “less interesting.”

Perhaps you are basically doing okay financially (how lucky is that?) but you got your property tax bill which went up but your house value went down; the same day you got your electric bill and your rate has skyrocketed, and the stock market just seems to be spiraling down, out of control. Well, maybe that one day your mind fills with thoughts about eventually running out of money, then losing your house, and possibly affording a studio apartment, or maybe nothing at all and you’ll be sleeping on the street begging to work for food.

Another day could start out just fine until you open the paper and read about the 3 people who have died eating cantaloupes. Just last week you had cantaloupe. You start to search where the cantaloupes came from and realized it was your area. It’s possible that you could have eaten one of those cantaloupes. Symptoms include headache, muscle aches, and diarrhea. You’re starting to feel a bit sick. Could these symptoms be the sign of something horrible? Should you call the doctor or go to the ER?

Okay, three examples of people taking a bit of information that starts out pretty neutral and takes it to the extreme. They begin a negative spiral of thoughts and end up feeling pretty bad-either anxious or depressed. Well, since most people don’t have a therapist following them around to help them rethink negative thoughts here are a few suggestions simply using water to calm yourself down.

• Get a glass of very cold water. Sit in a quiet area and drink it slowly. Think of past good times.

• Go to a sink and rinse your hands and wrists with warm water think of this as a bit of a purification ceremony. Let your worries run down the drain.

• Take an ice cube and rub it on your wrist or hand. If someone asks you what you are doing, you can say you’ve hurt yourself (which is true, you hurt yourself with your negative thoughts).

• When emotions are really out of control, use lots of ice. Don’t do this one in public, but it works. Fill a bowl of water and ice. Put your face in the bowl. This will calm you down—come up when you need to breathe, but repeat until you feel better. For those who wear mascara, be sure to wash your face after this one!

Photo by J E Theriot, available under a Creative Commons attribution license.