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.

Alternatively, you may want to coach your loved one through the problem. That strategy actually works sometimes, but it’s very tricky and we recommend professional guidance for both yourself and your loved ones if you want to become their coach.

Coaching, like reassurance, can easily backfire, cause arguments, or be perceived as criticism by people you’re trying to help.

Perhaps you’re tempted to try a confrontation or so-called “intervention” in which you and other family members tell the person how badly she needs help. That too is at least as likely to backfire as it is to help. Confrontations usually cause defensiveness and often, anger.

Instead, consider fully and unconditionally accepting your loved one and all of his problems with anxiety. After all, you likely fell in love with this person as a whole package that included issues with anxiety. And you probably have a few flaws and struggles yourself. Who doesn’t? So instead of forcing the issue to a head, consider embracing and loving the one you care about “as is.”

Acceptance delivers a positive message that may allow you and your loved one to actually become closer. When you drop pressuring people to change, it sometimes actually frees them up to make changes. When you convey the message that you’ll care about someone no matter what, it can actually enable them to start taking risks which is one of the things they’ll have to do if they want to overcome their anxiety.

In fact, change always requires being able to take risks, be vulnerable, and make mistakes. When people feel safe, they can do these things more easily. So, try letting go of your need to see your loved one make changes. Realize that whether the one you care about changes isn’t really about you anyway. Acceptance just may take you further than you think, but changing your loved one shouldn’t be your goal. Let go of that need and it just “may” happen a little more easily.

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My goals for today are modest, sort through the recycles, do a few loads of laundry, and write a blog. I’m trying not to get a cold so I’m drinking lots of juice and I am spending most of the afternoon reading, one dog sleeping below me and the other curled up on the couch. It’s a bit chilly so I cover myself with an afghan that my mother knitted years ago. Pretty cozy.

The afternoon has passed. I have finished a delightful mystery by Louise Penny. I’m feeling pretty rejuvenated so I can actually sit down at the computer and write the blog that has been rattling around in my head over the past week.

About 10 days ago, I went to the local bookstore. The same bookstore as the other 700 across the country that look just about the same as this bookstore. I go to this book store because the other two stores that I used to shop at went out of business. I walked in, and there was a visual change.

What happened to the jammed shelves? There seems to be more open space. I understand that the e-readers are here to stay, but what’s with the big sections for toys and games?

What happened to all of the books? Honestly, like all authors, I secretly, discretely (and of course just once or twice) scurried down the aisles of bookstores all over the world counting how many copies of books with my name on them were in the store. Having co-authored 9 books in 10 years with Chuck Elliott (who is usually with me on these covert operations), those numbers would range from a couple to more than a dozen. Well, recently, like many authors, our trips to bookstores have decreased. Shelves are curiously stocked with fewer books and fewer copies.

It was not a coincidence that last Sunday’s New York Times Business section featured a piece by Julie Bosman titled “The Bookstore’s Last Stand,” an interesting, timely, and frankly scary article. I admit I own device to which I can download books. I have enjoyed the convenience of easy, instant, and lightweight media. However, I have spent many hours in libraries and bookstores, wandering among the shelves picking something up, reading a bit and then putting it back or not. Will online stores really give us that same freedom or will we be filtered to material that seems to fit our online profile?

I feel very blessed that I had a very small place in the book business. The business of writing takes hard work, determination, perseverance, and in return, has been loads of fun. I have met many interesting people, enjoyed taking risks, and done many things that I would not have done as a psychologist. I hope if they close the bookstores, that something will take the place of the bookstore. But, I don’t know what so I grieve about books. Meanwhile, how about I download that next mystery?

The “reinforcement” part of the term means that negative reinforcement is a strategy that tends to “reinforce” or increase the likelihood that a behavior will happen again. In other words, negative reinforcement strengthens behaviors to which it is applied and makes them more likely to occur again. By contrast, punishment involves delivering an unpleasant consequence to behaviors in the hopes that the problem behaviors will decrease.

Negative reinforcement occurs whenever a behavior manages to eliminate or rid you of a distressing, unpleasant event or feeling. And I can tell you, negative reinforcement can have amazing power. Our dog Murphy knows this principle very, very well even though she’s never read a single psychology book (that I know of anyway—I’ll have to ask her to be sure).

When Murphy wants to be petted (which is rather often), she goes up to any human that’s around and starts to scratch that person’s knee. Her scratch is pretty annoying, if not painful at times. Of course, Murphy knows that people realize what she wants—to be petted. And most folks start petting her immediately because they know the scratching will stop if they do. In other words, Murphy removes the unpleasant feeling of being scratched once people start doing what she wants. Sometimes people start petting her before the scratching even starts because she has trained them so well with her negative reinforcement technique.

Trust me; it’s really difficult not to be affected by negative reinforcement even when you know it’s going on. My wife and I recognize Murphy’s tactics, yet find it almost irresistible to ignore her scratching, and inevitably cave in to her demands. But negative reinforcement can impact lots of behaviors that may be more important than petting your dog. Here are two common examples; perhaps you can think of more.

1. People with OCD often experience obsessional thoughts that make them feel distress and anxiety (such as “perhaps that doorknob I touched was laden with MRSA germs that could kill me”). When they have thoughts like that, they engage in a compulsion in order to reduce their worry or distress (such as washing their hands excessively). The compulsion briefly reduces their distress, but it also powerfully reinforces the obsessional worry that led to the compulsion. An ever worsening cycle ensues. Sometimes these folks gradually increase their hand washing to the point that they do it for hours every day. All because of the power of negative reinforcement.
2. Anxious kids often express worry and frustration to their parents. The parents find their kids’ anxiety and worry distressing so they try to reassure their kids. The reassurance usually makes the kids feel better for a little while, but it too reinforces the very insecurity that led to the reassurance seeking. This problem also quickly turns into an ever worsening negative cycle. The kids express worry and frustration more often and the parents find themselves powerfully motivated to eliminate their kids’ distress even if it’s only temporary. These parents usually don’t understand that they are actually making the problem worse.

Well, I didn’t plan on making this blog a pitch for our books. However, if you want to learn even more about this issue, we discuss it in more detail in Overcoming Anxiety For Dummies as well as Obsessive Compulsive Disorder For Dummies.

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I suppose I should be concerned about all of this hoopla over optimism. You see, as my wife will readily verify, I rather often take a different approach. It’s something that Dr. Julie Norem calls “defensive pessimism.” Sounds sort of awful doesn’t it? Does this mean that I walk around morose and glum and project nothing but doom and gloom? Not at all.

However, I do frequently imagine “worst case scenarios.” I run various “what if” scenarios through my mind such as:

• What if the publisher hates our latest book proposal?

• What if the stock market tanks our 401K retirement account?

• What if the audience hates our workshop?

You get the idea. You may think that this sort of thinking could be ruinous and cause me to feel horribly anxious, if not depressed. Au contraire! I find it quite useful to ponder pessimistic possibilities. But when I do so, I also carefully work through how I would cope with each and every one of them. In other words, I end up feeling much better by realizing I could actually cope with just about anything bad that could happen. I also inwardly realize that these worst case scenarios aren’t particularly likely to happen.

So to all of you optimists out there: I’m glad you’re optimistic and that you find it helpful. Just don’t tell me that I should be more optimistic; it feels annoying when you do. And be careful that you don’t let your optimism run wild into unrealistic territory—you’re likely to encounter trouble and make poor decisions if you do.

And to pessimists everywhere: Don’t feel defensive about your pessimism! Just be sure that you don’t overdo it and use it productively. Dwelling on possible negative outcomes can be useful, but only if you productively problem-solve what your mind comes up with.

On the other hand, perhaps my wife has a point. Expressing a little more of the optimism that I have stored inside would probably feel better to her. So maybe I’ll try it out and see…

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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.

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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.

Well, after that thought you might be pretty anxious.

On the other hand, what if you have these thoughts? “Oh no, I forgot my iPad. What an idiot I am. How can I be so stupid? I should have checked to see that I had everything before I left. Why do I always have to be so stupid?”

Having those thoughts might lead to feeling pretty depressed.

Same situation but different thoughts: “Oh no, I forgot my iPad. Oh well, I’ll survive and if it’s a big deal I can always check with the people I work with to find out what’s scheduled. Or I can call home and get my wife to read me my schedule.”

Those thoughts would likely keep you calm.

Distorted thinking can be recognized and replaced with more realistic thinking. The first task is to recognize the distortions. In the above examples, there are some common thinking errors such as:

• Awfulizing: this distortion involves making a mountain out of a molehill. In other words, thinking that a situation is far worse than it really is.

• Negative predicting: people who use this distortion predict horrible events that haven’t and may never happen.

• Mind reading: this involves believing that people are thinking certain (usually negative) thoughts without checking out the truth.

• Self-tagging: labels are useful on food items in the grocery store; they are less useful when applied to a person. Self-tagging involves calling yourself negative names like stupid, idiot, ugly, or so on.

• Shoulding: I should have known better or I should have done something differently. These statements are not really useful and often involve self-scolding.

If you find yourself feeling upset about something, stand back and take a look at how you are interpreting or thinking about what happened. If you can come up with a more reasonable thought, you just might find yourself calming down.

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I think it’s also wise to take one more important step. Specifically, I’d like you first to consider accepting where you’re at, problems and all. That’s right; evaluate yourself as acceptable and OK as you are.

Realize that you didn’t ask to have problems with anxiety and OCD. Rather, you have these problems for lots of good reasons. You may have had genes that tilted you in this direction. Or perhaps you experienced one or more traumas. Maybe your parents were overly critical and overbearing. On the other hand, maybe they couldn’t provide the structure you needed as a child. Perhaps you grew up in an unsafe neighborhood. People acquire anxiety and OCD for these reasons and many more. They pretty much never become anxious because they “wanted” to have these problems.

Yet, many clients judge and evaluate themselves very harshly just because they have some problems that they didn’t ask for in the first place. They see themselves as weak, incompetent, and horribly flawed. Thus, they tell themselves that they absolutely MUST overcome their problems. In addition, they should do so quickly and completely.

Can you see a problem in that line of thinking? I hope so. If your thoughts go in that twisted direction, you’ll merely compound your problems by adding huge amounts of stress and pressure to your treatment efforts. That pressure is likely to cause you to stall out before you get very far.

I frequently tell my patients to think of treatment as an endurance race. When you realize you’re not yet near the finish line, it’s important to merely keep putting one foot in front of the other. But if you judge that your progress is unacceptable and that you haven’t gotten as far as you think you should, you might as well take out a hammer and start beating yourself over the head! That’s not exactly going to get you there faster. Rather, you’re likely to collapse in an exhausted heap.

Therefore, I recommend that you stop judging yourself. Accept that you have anxiety or OCD. You may not “like it,” but try to accept yourself and your problems. You don’t even “have” to change them. Yes, you’ll probably feel better if you do engage in treatment, but don’t make it into an absolute “must.”

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Here are six ideas for overcoming such obstacles to change:

1. Money. Many people lack the financial resources for getting help. Some people can’t afford therapy at all, others have medical insurance that doesn’t cover mental health in a comprehensive way.

   Try contacting the nearest college or university. Most colleges have psychology clinics that have well supervised upper level students or graduate students work with clients in order to gain experience. Costs for such services are often modest and most use a sliding scale. Community mental health agencies also use sliding scales to charge for services.

2. Access. One reader mentioned that in her area therapists are not trained in the use of cognitive or behavioral therapies. That’s a tough one. Today, most programs in psychology or social work provide training in CBT, so ask around. If no one in your area uses these approaches, you might offer to bring in materials for your local therapist to use with you.

   Almost all problems have self-help books that outline the procedures for helping people through a cognitive behavioral approach. You can borrow these books at a local library or purchase used copies on line. Many therapists are at least somewhat familiar with cbt to the extent that they would be willing to work with you on self-help materials.

3. Too stressed out to face your troubles. People with emotional problems are often frightened of getting help. They believe that facing their troubles will make things worse. That’s just not true. Most people feel relieved to finally talk about and do something about what is bothering them. Therapy helps.
4. What if I try to get better and fail? People worry that if they try and fail they’ll just feel worse than ever. Again, most people find that when they admit they have a problem and go seek help, they will get better. Maybe not perfect (pretty impossible) but definitely better. I believe there’s almost no such thing as out and out failure in therapy—you almost always at least learn a few things.
5. Too busy. Aren’t we all? But the reality is that feeling too much anxiety or depression actually makes people less efficient. When people are worried or depressed, they don’t think clearly. They tend to make careless errors, forget things, and find it hard to keep focused. The time consumed by therapy will be more than made up by increased productivity in most cases.
6. Too hopeless. Some people believe that their anxiety or depression is a part of their lives and that no amount of help will make them feel better. Feelings of hopelessness are common in those with emotional troubles. Try to set aside those feelings and take a chance on getting better with help.

If you struggle with emotional problems, read about other people and their struggles on psychcentral, look for some suggestions or ideas that other people have tried out. People care and want to help. Good luck and take care!

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