Anxiety Files

Afraid of Being Rejected?

Robert L. Leahy, Ph.D. — Mon, 19 Oct 2009 15:02:36 +0000

One of the central problems for you if you are anxious is your fear of making a mistake and your fear of being rejected. I don't know about you, but I sure have a long history of rejection---only because, I think, I have constantly been trying to be productive. When I was single I was rejected by girlfriends-but accepted by some. I have had book proposals and articles rejected. I view rejection as part of the cost of playing the game. You won't be able to win unless you can tolerate losing some.

If you wonder if other people have made mistakes, here is a list of authors and books that have been rejected by publishers when first submitted. The authors include James Joyce, Vladimir Nabokov, Sylvia Plath, Jack Kerouac, Jorge Luis Borges, Isaac Bashevis Singer (who won the Nobel Prize), Marcel Proust, Stephen King, Oscar Wilde, and George Orwell. Famous books that have been rejected include The Diary of Anne Frank, War and Peace, The Good Earth, Gone with the Wind, Dr. Seuss, To Kill a Mockingbird, The Rubaiyat of Omar Khayam, Watership Down, Lolita, Angela's Ashes, Harry Potter and The Hobbitt. The editor who rejected the classic book, Animal Farm, by George Orwell had this piece of wisdom: ‘It is impossible to sell animal stories in the USA'. Another brilliant observation-and a classic mistake- was the following: "Everything that can be invented has been invented", claimed the forgettable Charles Duell, Commissioner of the US Patent Office in 1899. Or consider this: "I think there is a world market for maybe five computers."(Thomas Watson, chairman of IBM, 1943). Or, one of my favorites: "We don't like their sound, and guitar music is on the way out" by Decca Recording Company when they rejected the Beatles in 1962.

Well, it's not just publishers and business people who make mistakes-we all do. Here's how you can find out. Ask every one of your friends about mistakes that they have made. If they are honest, they will reveal some great stories.

Mistakes are the pathway to success---if you persist and learn from them.

Time Urgency and Anxiety: The Seventh Step for the Final Week

Robert L. Leahy, Ph.D. — Fri, 07 Aug 2009 20:01:17 +0000

Our anxious brains were evolved to respond to a threat that was immediate. The tiger in the bush wasn't going to wait around for your ancestor to carry out probabilistic calculations about false alarms. Danger was imminent and your response-to escape-needed to be instantaneous. Reflection was the hallmark of the" soon to be eaten".

Time Urgency and Everyday Anxiety

So, how does this time urgency translate into your everyday anxieties?

You are stuck in traffic and you say to yourself, "I can't stand this. It's driving me crazy!" So you blow your horn, bang the dashboard, scream expletives. And you still can't move your car. But you feel a sense of urgency to get out of here. You feel trapped.

You start breathing rapidly. Your heart is racing. You are sweating. You are thinking that you will have a panic attack if you don't get the hell out of here immediately. But then you look around at your leather interior car with its Bose sound system and its luxurious air conditioned interior and you wonder, "What am I worried about?" The rational part of your brain knows that it's safe. But your amygdala is screaming, "Get out of here!"

Your panic seems to come on more strongly. This is the sense of "suffocation" that you have feared as you gasp for breath. Your brain keeps pounding away with the alarm, "You have to get out!" You think, "If only I could get out of the car and run like a madman, then I'd feel better." But you know that you would then think you are crazy.

You wake up in the middle of the night and you think, in your dreamy, somewhat intoxicated state, "Will I ever find the love of my life?" You look next to you-and that person is not the love of your life. And now you panic, "When will I find my true love?" You lie in bed, ruminating, twitching and turning, impatient. You've got to know right now. But you don't.

You notice a spot on your skin and it's Friday night and you think, "This could be cancer". But you also know that you can't see your doctor until next week. You have to know right now. So you Google skin cancer and drive yourself insane with worries until your next appointment.

Your brain tells you that you need to know right now. You can't stand waiting. You can't accept uncertainty. Like everyone who is anxious, you are plagued by time urgency.

Seven Steps to Putting Time on Your Side

Let's think this through for a few minutes. Take your time.

1. What is the disadvantage to you of time urgency? Doesn't it make you continually anxious and worried? Doesn't it deprive you of the ability to enjoy the present moment? Aren't you irritable and sometimes difficult to be around? Wouldn't you be better off with a cooler head and more patience?

2. What if you don't know right now? Why is that so bad? Are you thinking that if you don't know right now, then you will never know? Or, that things will turn out badly? Not knowing right now is exactly that-you might know later. In fact, you will know later. Just wait.

3. Is your body and mind keyed up to take action? Your adrenaline is shooting through you as you are prepared for immediate action. Turn down the adrenaline. Practice relaxing, let go of your breath. Surrender. Your brain may be telling you, "Don't surrender".

Let it go. You will find that nothing happens. No emergency.

4. How many times have you been wrong about needing to know right now? False alarms and emergencies constantly deprive you of your life. When you didn't know right now, was it always a bad outcome? Aren't you still here?

5. Set aside your worry until five hours later. Revisit the issue of urgency at that time. Does it now seem irrelevant? Why?

6. Get into a time machine. Go five years into the future. Eventually you will have the answer to your question. So why not simply enjoy the time in between?

7. What can you still do even if you don't know right now? Plan all of the positive and meaningful activities that you can do even if you don't have your answer right now. Fill your life with action and appreciation and you will crowd out the alarms.

Not knowing right now doesn't have to mean not living right now.

Practicing Your Obsessions: The Boredom Cure

Robert L. Leahy, Ph.D. — Mon, 13 Jul 2009 15:18:44 +0000

Have you ever read a book that seemed so dry, so repetitive that you just couldn't keep your eyes open? I remember a number of years ago saying to my wife, "I have this great book on the history of Russia. I can't wait to read it". Like most things dealing with Russia it was long, complicated and had a cast of characters that would leave the ordinary mind numb. I reclined on the couch, put my feet up and began to read. A few minutes later I was snoring. We call this "chest-reading" because the book is on my chest and I am happily dreaming about the Siberian winter.

There is nothing that will turn your anxiety around like sheer boredom. Anxiety is a readiness to run away-or, if necessary, to attack. Boredom is your readiness to-well---do nothing but fall asleep. Just writing about it makes me tired.

Can Obsessions be Boring?

OK. What does this have to do with obsessions? I've been saying that you have been repeatedly using the same failed techniques with those intrusive thoughts---you've been yelling at yourself to stop them, you've been neutralizing by washing your hands (repeating prayers, checking locks-whatever). You've been thinking -ruminating - about your obsessions: "Why me? Why am I thinking these things?" We've already seen why this never works in my previous blogs, How do Obsessive Compulsive People Think? and Those Damn Unwanted Thoughts!

Your strategy has been to get rid of those thoughts. They're "intrusive", barging in on you. "Throw them out", you say to yourself.

In my last blog I described the "Guest House" where you invite that intrusive thought in, show some kindness, make space to let it be--- Having a New Relationship to Your Obsessions: Welcome to the Guest House. I had one of my patients imagine that she was rollerblading with her intrusive thought. She pictured it as a funny clown-like figure on a skate-board zooming along with her. It was cool, she said, like she knew she wouldn't get rid of the thought, but she could take him along. These techniques allow you to make room, accept, take care of and share fun with your bothersome thoughts.

But there is another technique that you might try that allows you to inundate yourself with those miserable thoughts. Immerse yourself. Rather than reject them, you flood yourself.

This is the "boredom technique".

Imagine this. You are going to watch your favorite movie five times every day for the next week. I guarantee the outcome-if you are crazy enough to do this. You will be so bored you will either fall asleep the third time or you will start screaming. If you repeat something enough you just lose interest. Call it habituation, call it desensitization, call it defusing a thought from a feeling. Whatever. I call it "boredom".

I will never fall asleep

A technique I use for insomnia is to repeat "I will never fall asleep" hundreds of times---over and over. Try it right now. After you read this, close your eyes, repeat very, very slowly, "I will never fall asleep". Do this for ten minutes.

If you tried this, you might have noticed that your anxiety initially went up and then it gradually went down. If you stayed with it, you might have noticed your mind drifting away to other thoughts and concerns-even, "Will this really work?" or "Does this guy know what he is doing?" If you did this exercise you might have found yourself getting sleepy, having a hard time keeping a focus on those words---"I will never fall asleep". And you may have noticed yourself getting drowsy.

One patient of mine had the recurring thought that he feared, "Maybe I am gay". He wasn't, but the thought bothered him. He would avoid gay people because it triggered the thought that he might be gay. He would make himself feel macho by saying anti-gay things. But the thought kept coming back. So, I had him practice saying hundreds of times-like a zombie---"Maybe I am gay". He got bored.

Another patient feared he had cancer. For years he was plagued with these thoughts, continually getting examinations that turned up nothing. We began with the feared thought, repeating "Maybe I have cancer". After a couple of weeks this got boring. So we replaced it with, "I definitely have cancer". This became boring. Now he was getting desperate to find something to fear. So he tried repeating, "I want to get cancer". After some initial spike in anxiety, this became boring. It was hopeless and boring. He complained, "Bob, I can't keep my mind on the words. It's so boring." Well, if you are bored you are not afraid. You're just tired of listening. You can't even pay attention to the fear. What a relief!!

I think it's time you took a nap, don't you?

To learn more about OCD and other anxiety disorders see my book, Anxiety Free: Unravel Your Fears Before they Unravel You.

Having a New Relationship to Your Obsessions: Welcome to the Guest House

Robert L. Leahy, Ph.D. — Fri, 10 Jul 2009 19:27:08 +0000

In my previous blog on OCD, Overcoming Your Obsessive Compulsive Disorder: Accepting and tolerating your obsessive thoughts, I suggested that you might think of allowing room for these bothersome and intrusive thoughts. You have been telling yourself that you have to get rid of these thoughts, so you yell "STOP THINKING THIS!" or you neutralize (perhaps you wash your hands or say, "No, I don't believe that").

You are continually trying to get rid of these thoughts.

One technique that can be helpful is to make friends with the thought. There's a wonderful poem by the 13th century Sufi poet called "Rumi". It's about the Guest House.

Imagine that your mind is a house in the woods, you are all alone and there is a guest that shows up uninvited. In the past you have been irritable with guests, angry that anyone would disturb your well-earned solitude. You have yelled at visitors to "GO AWAY" so that you can be alone. But visitors seem to pass on the road where you live. They ignore your no-trespassing sign.

One day this visitor knocks on the door. You don't know him. But you decide that rather than being angry, rather than push him away and pull the shades on the window, you have decided to show your hospitality.

Here are some lines from the Guest House:

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
Some momentary awareness comes
As an unexpected visitor.

And this time you let him in. He is a lonely visitor, only wants to stay for a while. Give him some tea, ask him to relax. Listen to his story. You do not have to obey him or fear him. Like you, he has been alone. Let him be with you for a moment and then he will leave.

Your intrusive thoughts are like this. They only want your company for a short time. When you hear an intrusive obsession do not fear it, do not run away, do not shut the door. Simply say to your thought, "Ah, you are back again. Welcome. Sit for a while and rest. I have my other things to do, but I know that you need to come in out of the cold".

As the thought chatters away, let it have some space. It's a big enough world. Room for all of us. Observe him, if you can, listening in the background as he repeats what you have heard many times before. He is afraid. But you can see that he is only a lonely soul lost in the woods and he has found some warmth, some friendship from you, some moment of kindness.

You are less angry, less afraid. The thought, your visitor, is sitting in the corner relaxing, happy to chat away about nothing in particular. Take some joy in the fact that he has a place to sit on his journey because he has a long way to travel and you have provided some kindness and hospitality for a brief moment in time. A brief moment in an infinite universe.

To learn more about OCD and other anxiety disorders see my book, Anxiety Free: Unravel Your Fears Before they Unravel You.

Overcoming Your Obsessive Compulsive Disorder

Robert L. Leahy, Ph.D. — Mon, 06 Jul 2009 15:02:03 +0000

If you are like millions of people with Obsessive Compulsive Disorder (OCD) you know how your OCD has created problems for you. You feel persecuted by your thoughts about making mistakes, contamination, harm, or losing control. Your OCD prevents you from living freely, including using public rest rooms, shaking hands, feeling comfortable and satisfied with your work, and having the feelings, thoughts and images that the rest of us don't worry about. You are constantly battling yourself. And you feel you are losing the battle.

What can you do?

In my previous blog How do Obsessive Compulsive People Think? I describe eleven characteristics of OCD thinking:

1. Triggers for your obsessions
2. "Odd" thoughts or images
3. Negative evaluation of thoughts
4. Self-monitoring
5. Demand for certainty
6. Thought-action fusion.
7. Thought-suppression
8. "I've lost control"
9. Compulsions
10. Felt sense of completion
11. Avoidance of triggers

You probably have seen a lot of your own thinking in this. But what can you do about this? In one of my blogs, Those Damn Unwanted Thoughts!, I describe your "failed strategies", and why they fail. Just as you can't run away from your hips, you can't get rid of your thoughts. Thought control and thought suppression don't work. Worse---they make you feel more hopeless.

In my new book, Anxiety Free: Unravel Your Fears Before They Unravel You, I help you understand that OCD is largely a problematic theory of your own mind. Your perfectionistic theory of your mind is that you should only have pure thoughts, pure feelings, certainty in what you think, comfortable feelings, and control over what you imagine. You also have a problematic theory of how to make things better. All of your failed strategies to control your thinking and eliminate "unwanted" or "odd" thoughts and images are because of your theory of your mind.

I lay out a number of ways of changing the way that you relate to your thinking. Rather than view your thinking as the "enemy", you can try the following:

1. Prove that thought suppression doesn't work. Example: Try not to think of white bears for the next thirty minutes. Oops. There's another white bear. It won't work.

2. Prove that thoughts don't control reality. Example: If you think that Satan will possess you, beg him to possess you. It won't work.

3. Modify your image of the obsession. Example: You may imagine your obsession as some ominous, powerful, dark, large, all-encompassing cloud that engulfs you. Change the image to one of a silly looking clown. It's less frightening. Imagine he has a high-squeaky voice. He's silly.

4. Float your obsession. Example: Rather than trying to get rid of your obsession, imagine it is a tiny piece of wood floating ever-so-gently down a stream. Watch it in your mind's eye. Imagine yourself breathing out as it floats away. Let it return and float past once again and breathe it away. (I'm imagining that if you do this enough you will get sleepy.)

5. Bore yourself. Example: Repeat your obsessive thought very, very slowly. Imagine that you are a zombie. "I am contaminated". Repeat it as if you are slowed down and you are watching the words go by. Over and over. Hundreds of times. Boring.

In future blogs we will look at how you can change your relationship to your obsessive thoughts-rather than trying to suppress them, we will see how you can "make space" for them. It's like a relative at a big picnic--- you can tolerate him without feeling like he occupies your entire mind.

How Do Obsessive Compulsive People Think?

Robert L. Leahy, Ph.D. — Fri, 19 Jun 2009 15:19:45 +0000

In a previous post Those Damn Unwanted Thoughts I indicated how your anxiety often is a result of your fear of your thoughts and sensations. Let's say that you are obsessive and you have the recurring thought, "Maybe I have cancer". But you don't. You've seen the doctor, she tells you that you are fine, you go home and begin thinking again, "Maybe she's wrong. Maybe I have cancer". Then you think, "The fact that I'm thinking that must mean that there is something to worry about. I need to know for sure. I need to do something." So you Google endlessly every possible cancer and expect to see your pretty face appear on the screen.

People with Obsessive Compulsive Disorder have intrusive thoughts (or images) that bother them. These can be thoughts about making mistakes, harming someone, contamination, disease, religious preoccupation, fears of impulses or desires, or just about anything that you might consider dangerous, disgusting or dirty. Examples of obsessions are, "I made a mistake at work and it will blow up on me", "I touched the chair and it's contaminated", "I had a violent fantasy and now I will lose control", "I left the gas on (the doors unlocked, the cat in the washing machine)" or "I did something that God will punish me for". Once you have the intrusive thought you begin looking for more examples of these thoughts. "Oh God! I just had that thought again." You now are watching yourself, totally self-conscious, fearing every possible thought or intrusion that does not reflect a pure and good mind. Your theory of your mind is that you should only have certain thoughts. Everything else is bad or dangerous.

So what do you do when you have these unwanted intrusive thoughts? Do you shout at yourself, STOP? Do you try to get reassurance from someone, "Does this look like cancer to you?" Perhaps you pray for peace, or you have a drink, or you binge eat. Or maybe you ruminate, thinking over and over, "Why am I having these damn thoughts? Am I going crazy?"

How to Understand Your OCD

The diagram below (which, I admit, is a little obsessive itself) is from my book, Anxiety Free: Unravel Your Fears Before they Unravel You. It lays out a detailed schematic on the nature of OCD. Let's take a look at each step.

1. Triggers: These are the events or stimuli that set you off. It could be touching something (contamination), leaving the house (something is unlocked, the gas is on), driving at night (I ran over something), thinking of sex (God will punish me, I will lose control).

2. Odd thoughts or images: You have some thoughts or sensations that you don't like. "Why am I having those bizarre, sick, disgusting, unwanted thoughts?"

3. Negative evaluation of thoughts: You think there is something wrong with your thinking-as if you should only have pure and good thoughts and feelings. You have a lot of "shoulds" about the way you should think and feel. You think that now that you have the thought, you have a responsibility to get reassurance, get control or get rid of it. Having the thought is equivalent to being SENT ON A MISSION. You have become THE THOUGHT POLICE.

4. Self-monitoring: You watch yourself like a hawk-looking for those thoughts. Of course, simply because you have to think about what you are looking for ("I am looking for that disgusting and dangerous thought"), you always have to find it. It's like holding up a mirror to yourself and saying, "I am looking for a mirror. OH MY GOD! THERE IT IS!!!!"

5. Demand for certainty: You think you should know for sure whether you will act out, lose control, or are contaminated. Nothing short of perfection and certainty will suffice.

6. Thought-action fusion: You equate having a thought with committing an action. "If I think I will get violent, I will". Or, a thought is the same thing as reality. "If I think I have cancer, then I must be a dead man". Thoughts, actions and reality are all one. All in your mind.

7. Thought-suppression: Your first line of "defense" is to try to stop having these thoughts. You tell yourself, "Don't think that". It works, for three minutes. But your failure to permanently suppress these thoughts leads you to believe

8. "I've lost control": You now equate control in your life to eliminating unwanted thoughts. Now you feel more out of control as you desperately try to control your thoughts more and more. It's like slapping the water and drowning.

9. Compulsions: You now perform some neutralizing ritual. Perhaps you wash your hands excessively, pray, repeat "No", walk a certain way, wash a certain way, arrange things, go back and check, check again. You find yourself frenetically doing these things until you have a

10. Felt sense of completion: You say, "I can stop now because I feel I have done enough. This felt sense of completion now becomes your new rulebook for rituals. "I need to do them until I feel I did enough". You are hooked on your rituals.

11. Avoidance of triggers. You remind yourself, I wouldn't have any of these thoughts if I simply avoided the triggers. So you avoid touching things, avoid public restrooms, avoid shaking hands, avoid movies with Satan, avoid people that make you have feelings that are bad and disgusting feelings. Avoid, avoid and avoid. You are running away from the world.

This is how you think. All in the name of being responsible, conscientious---all in the name of avoiding losing control, going crazy or becoming irresponsible. All because you need to be in control. And it doesn't work. Take a look at the schematic and let us know where you see yourself. In a later post, we will discuss what you can do.

But the first step is understanding how your OCD makes "sense" to you.

From: Anxiety Free: Unravel Your Fears Before They Unravel You by Robert L. Leahy, Ph.D.

To see a bigger image of the chart, please click here.

None of these techniques will help for very long. So what can you do?

In my recent book, Anxiety Free: Unravel Your Fears Before they Unravel You, I lay out a number of things that you can do when you have obsessive thoughts.

Constructive Discomfort: How to do what you really don’t want to do

Robert L. Leahy, Ph.D. — Mon, 08 Jun 2009 14:55:04 +0000

If you are like a lot of us, there are a number of things that you know you should do, but you simply can't get yourself to do them. You know you should exercise, you should cut down on calories, you should spend less time on Facebook, and you should save more of your meager income. You know you should call up that friend who left a message and you know you should take out the garbage-now. But there is a little voice in your little head that says, "I DON'T WANT TO".

I don't want to!!!!!

Your implicit rule for your life is, "If I don't want to do it, then I won't do it". Or, you might even take a position-on principle--- "I shouldn't have to do it". You take pride in your autonomy as your self-discipline has evaporated. You fold your arms across your chest in defiance and then wonder, "Why haven't I gotten anything done?"

OK. I could say, "GROW UP!" But that might sound a little less empathic than you would care for. So, I will put it in a different way: "If you only do what you want to do, then you won't get what you want to get." It's that simple.

What is constructive discomfort? Well, think of it this way, my friend. It's really simple.

What do you want?
What do you have to do to get it?
Are you willing to do it?

OK. Let's take most people. I want to lose ten pounds. What do I have to do? Eat less, exercise more. Am I willing to do it? Hmmmmmm.

You probably noticed, I didn't ask what you wanted to do, I didn't ask about your motivation, and I didn't ask you about what your mother said to you when you were five years old. Why? Because none of that is relevant.

What is relevant is setting goals, committing to behavior, and practicing discomfort.

Think about discomfort as a means to an end. It's a tool.

Building Mental Muscle

In my book, ANXIETY FREE: UNRAVEL YOUR FEARS BEFORE THEY UNRAVEL YOU, I ask you to think about discomfort as a means to an end.

Here are some simple exercises that you can do to build up your discomfort tolerance.

Take a discomfort history---"What are some things you've done that were uncomfortable, but you did them anyway?"
Relate discomfort to pride-"What have you felt proud about? Was there some discomfort involved?"
Assign yourself some discomfort-"Keep track of things that you do that are uncomfortable. See if they are linked to getting things done."
Recognize that discomfort is temporary-" All discomfort is temporary. It won't kill you. In fact, it will make you stronger. Dancers say, ‘It was a good work out. It hurt good.'"
If you are not doing something that is uncomfortable every day, then you are not making progress.

You can use your discomfort as an investment-to do what needs to be done so you can get what you really want.

Practicing discomfort is like building mental muscle.

I asked a young man who graduated from West Point , "What is the most important thing that you got out of your training?" "Sir" (I liked that he said that). "Sir, I learned I was able to do things that I never thought I'd be able to do".

That's called self-discipline.

Discomfort is temporary. Pride is forever.

Those Damn Unwanted Thoughts!

Robert L. Leahy, Ph.D. — Mon, 01 Jun 2009 14:17:11 +0000

Have you ever felt plagued by thoughts and images that you just couldn't stand? Perhaps it's the nagging thought, "I made a mistake" or "I think I have cancer" or "I'm going to lose control". These thoughts seem to intrude on your mind and you try to block them out. You think about your thought and you say (to yourself) something like the following:

I'm having that thought again.
What's wrong with me that I'm thinking that?
It must mean something-about me.
I have to do something--- make sure it doesn't become a reality
I have to stop having that thought.

You have begun noticing that thought and you are interpreting it over and over as something really significant-something about you. Maybe it "means" you are going crazy, you're evil, you're going to have a panic attack, you're going to attack someone. You are running around thinking your mind is your enemy. You feel out of control and wonder, "Why am I having these crazy thoughts?"

You are battling your mind. You think, "Normal people don't have these thoughts". You are afraid of the thought, embarrassed, and you think that the thought predicts something about the future. Maybe the thought means you are dangerous or be punished by God.

Welcome to the world of "intrusive thoughts". Cognitive therapy can help you. Your problem is not that you have having intrusive thoughts. Your problem is how you are evaluating them, how you are trying to suppress them and how you avoid situations that evoke them. The problem is not the thought-it's what you try to do about the thought.

Thinking about your thoughts

Three rules are important.

1. Everyone has crazy and disgusting thoughts
2. Thoughts are not the same thing as reality
3. Thought-suppression doesn't work.

Research on people without anxiety disorders shows that almost 90% of them have "bizarre" thoughts---thoughts about contamination, harm, religious impropriety, losing control, sexual "perversion"---you name it, we all have thought about it before. So, your "weird" thoughts might mean nothing about you. Join the crowd. We are all a little weird. I like to think of this as "we all have an imagination".

Thoughts and reality are not the same. If they were, you'd be rich. Try to think about a pot of gold. Think about it all day. Wish for it. Pray for it. At the end of the day, all you will have are a lot of thoughts. You can't take your thoughts to the bank.

Your idea that thoughts=reality is what Jack Rachman of the University of British Columbia called "thought-action fusion". People with obsessive compulsive disorder think, "If I think I will lose control, I will" or "If I think that Satan might possess me, he will". Sorry, it's just a thought.

Also, thought suppression doesn't work. Perhaps someone told you, "Snap a rubber band on your wrist every time you have that (BAD) thought". It doesn't work. The thought keeps coming back. Leon Tolstoy described a game he played when he was a kid in Russia. They would stand in a corner and try not to think about a white bear. Years later, Harvard psychologist Dan Wegner showed that people instructed not to think about a white bear were more likely to think about white bears. Thought suppression leads to thought rebound.

Cognitive therapists have been interested in how we evaluate our intrusive thoughts. For example, Canadian psychologists Christine Purdon and David Clark have reviewed the research on intrusive thoughts. They find that evaluations and thought-control strategies for intrusive thoughts and images are a core feature of all of the anxiety disorders. People with OCD try to suppress and neutralize thoughts and images---often with compulsive rituals. People with social anxiety disorder treat their intrusive thoughts about "appearing anxious" as the equivalent of being humiliated. And people with PTSD treat their intrusive images and sensations as evidence that the trauma is happening now. It's like we are running away from our minds.

It's like trying to run away from your hips. No matter how fast you run, they're always there.

Listen to a Lecture on How to Handle Your Worries

Robert L. Leahy, Ph.D. — Wed, 13 May 2009 13:32:32 +0000

Last October I gave a series of lectures and workshops at the University of Louisville Medical School's Depression Center. One of these talks was on how to handle your worries. I thought that some of you might find it of interest to hear this talk which is now available on-line for free. You can access the several "sections" of the lecture audio at the following hyperlinks:

"Dr. Robert Leahy, the author of The Worry Cure"

Introduction - About Worry Underlying processes of worry.
Steps 1 and 2 - Productive and Unproductive Worry. Acceptance and Change
Step 3 - Challenging your worried thinking.
Steps 4 and 5 - Deeper Threat. Fear of Failure.
Steps 5 (continued) and 6 - How to Handle Failure. Use your emotions rather than worry about them.
Step 7 - Put time on your side.

As you listen to the various steps in dealing with your worry you might ask yourself which specific techniques seem the most relevant to you. I have found that some people find it immensely helpful to distinguish between productive and unproductive worry-and to turn to immediate problem solving if there is a problem to address today. Others find it helpful to accept uncertainty or limitations. Some people find that simply setting aside worry time helps them compartmentalize the experience of worry that has pervaded their day. Still others find that challenging their pessimistic ideas and their catastrophic thinking is helpful. In any case, there are dozens of techniques, strategies and ways of looking at things that can be helpful.

When I wrote The Worry Cure, I wanted to avoid the tendency that some psychologists have that only one approach-their approach-will work. I have been impressed with the work of many of my colleagues in North America and the United Kingdom who have advanced our understanding of why worry persists and how we can change it. So, when you listen to the lecture-or read the book--- you will find that your particular process of worry is amenable with some techniques, but maybe not with other techniques. The key thing is to find what works for you.

Turning Panic Disorder on Its Head

Robert L. Leahy, Ph.D. — Mon, 11 May 2009 15:03:12 +0000

If you have ever suffered from panic attacks then you know how terrifying they can be. Your first panic attack came out of nowhere-you suddenly found yourself shaking, trembling with fear, short of breath, feeling like you are going to collapse and then you thought that the end was coming. In my last blog on panic disorder-- Do You Have Panic Disorder?-- I described the process of developing panic disorder and agoraphobia. In this blog I will describe the steps to reversing this process so that you can live your life free from the fear of panic attacks.

What are the rules for having panic disorder?

In my new book, Anxiety Free: Unravel Your Fears before they Unravel You, I describe each anxiety disorder as a set of rules that you follow implicitly. For example, the general rules for developing panic disorder are the following:

1. Detect Danger - You focus on your sensations as a sign of danger
2. Catastrophize Danger - You interpret sensations as life-threatening
3. Control the Situation - You try to control your breathing or you use safety behaviors
4. Avoid or Escape - You avoid situations that make you anxious-or you escape

So, let's imagine that you begin breathing rapidly when you are anxious and you find yourself short of breath. You now become quite frightened that in the future you will become short of breath, so you begin watching your breathing to see if you are "losing your breath". You may also begin focusing on your heart-rate. When you notice your breathing has become more rapid you begin to think that you will stop breathing-and that you will collapse, have a heart attack or die. You then shift into "control" mode and try to catch your breath-perhaps by taking deep breaths-which makes you more short of breath. Or you use safety behaviors-for example, you slow down your pace of walking or you hold onto the side of a building so you won't collapse. And, if you have the chance, you will avoid exercise (which increases your breathing) or you avoid situations that "make you anxious"-such as sitting in a crowded theater. Now you have panic disorder and agoraphobia.

In Anxiety Free I give you the specific rules for your panic disorder. Do any of the following make sense to you?

The Panic Disorder and Agoraphobia Rule Book

Focus on any sensations that don’t seem “normal.”
Interpret these sensations as a sign of a catastrophe about to happen.
Anticipate any situation where you might have these sensations.
Avoid these situations if you can.
But, if you can’t—then do something to make yourself feel safe.
If you survive the situation, attribute your survival to your safety behaviors.

When you feel your anxious arousal increasing you may have some of these thoughts:

I'm going to throw up.
I'm about to pass out.
I must have a brain tumor.
I'm about to have a heart attack.
I'm going to have a stroke.
I'm about to choke to death.
I'm going blind.
I'm losing control of myself.
I'm acting foolish.
I may hurt someone.
I may hurt myself.
I'm going to scream.
I'm too scared to move.
I'm going crazy.

Take Away Your Catastrophic Thinking

The hallmark of your panic disorder is your belief that your physical sensations are dangerous. Anyone with panic disorder should have a full medical checkup before commencing with any cognitive behavioral therapy. But you can stand back and look at your sensations more rationally. Here are some more reasonable interpretations:

Rapid heartbeat, shortness of breath

Panicky thought: I am having a heart attack.
Rational response: I've just seen a doctor who's told me my heart is fine. I've had these sensations before and been none the worse. My brain is sending me a false alarm, telling me I'm in danger when I'm not. My reaction is simply the body's normal physical response to an alarm.

Dizziness, weakness, disorientation

Panicky thought: I'm about to collapse or pass out.
Rational response: This is a temporary phenomenon caused by the fact that my blood is circulating to different parts of my body away from my brain. If I sit quietly and breathe normally I'll return to a state of calm.

Racing mind, tension, shaking

Panicky thought: I'm going to start screaming and lose control.
Rational response: There's nothing to scream about. I have no clear idea of what "losing control" means. I can allow my mind to race without any danger; I can simply watch my thoughts and see where they go.

Rise in intensity of physical symptoms.

Panicky thought: My panic is going through the roof. If it doesn't stop, I'll go insane.
Rational response: Panic attacks are self-limiting. They eventually subside on their own. They are simply the result of arousal and pose no danger to me.

Eliminate Safety Behaviors

Research on anxiety disorders shows that you are probably doing something that you think "makes you safer". If you have panic disorder you may be using some of the following safety behaviors that superstitiously maintain your belief that panic is dangerous and needs to be controlled. Here are some typical safety behaviors: sitting near exits, having someone accompany you, walking slowly or rigidly, trying to catch your breath, holding onto the side of a building or a support, wearing sunglasses, having a drink or using an anti-anxiety medication, seeking reassurance, etc. You may also find yourself repeating self-assuring statements or praying. The problem with relying on safety-behaviors is that you can still do exposure to your feared situations, but believe that the reason you survived is that you relied on this magical thinking and behavior. Try to catch yourself and begin to give them up. Then notice if the world falls apart. Once you give up the training wheels you can ride the bike on your own.

Panic induction

In my book I spell out a number of ways that you can actually intentionally cause yourself to have the panic symptoms so that you can learn that they are not dangerous. Keep in mind that you should check with your physician before doing any of this. Be sure that you don't have a serious respiratory complication, asthma, or cardiovascular complications. Talk to your doctor if you are pregnant. However, your therapist can help you intentionally induce shortness of breath by breathing rapidly or induce a sense of derealization by staring into a light. You can spin around in a chair to learn to feel dizzy. Once you have induced the symptoms, under supervision, stand back and observe yourself and recognize that sensations go up and down in intensity. Breathe normally, relax your shoulders, sit and observe and describe to yourself what is happening. Notice that you become safe when you give up control.

Practice exposure

As with any anxiety disorder you should make a list of the situations that you fear and begin practicing exposure. You can begin with practicing the image of the feared situation. So, if you fear exercising practice the visual image of yourself on a treadmill getting your heart rate up. Then practice walking on the treadmill until your anxiety increases and then decreases. Gradually with more time increase the intensity and length of exposure. Watch for any safety behaviors and relinquish them.

Remember the rational, de-catastrophizing interpretations of arousal that I described above. Sensations are simply arousal, thoughts are often false alarms. Think of yourself as watching a movie-but you are not in it. It's simply a fiction, a make-believe. And nothing terrible is happening. The movie will come to an end.

Practice Discomfort

One of the concepts that I have used is "constructive discomfort"-that is, practicing doing things that are uncomfortable so that you can get things done that you need to do. You may already be doing this-for example, exercise and work may be uncomfortable, but you do them anyway. I suggest to my anxious and depressed patients to keep track of the constructive behaviors that are uncomfortable so that they can be proud of facing their fears and doing what is difficult to do. Much of anxiety involves attempts to avoid discomfort. Taking pride in tolerating discomfort is a way to empower yourself.