Anxiety can have a number of causes, such as genes, upbringing, trauma, lifestyle, and mental habits.

 The mental habit of worry can play a very big part in keeping anxiety going, regardless of the cause of your anxiety. 

Instead of letting you constructively “hope for the best but plan for the worst,” worry pointlessly repeats its fearful thoughts over and over again. 

Worry paints a picture of worst case, catastrophic scenarios that may or may not happen. In fact, they are usually not very likely to happen. 

Worry fans the flames of anxiety with misguided interpretations of whatever situation you are struggling with.

The catastrophic images of your worried thoughts cause you to react to the situation at hand as if it were the one you were imagining.

 Your body reacts to these images with the physical symptoms of anxiety. 

The good news is that worry is a habit that can be broken. Like other habits, it will take conscious, repeated efforts to do so. 

How to Break the Worry Habit

 You will need strategies to support you in your effort. You will need to use the strategies over and over again. 

There are many ways to break the worry habit. Here are 5 strategies you could try.  They are based on Cognitive Behavioral Therapy (CBT). 

CBT is based on changing your thoughts and behaviors in order to break habits or to reduce moods such as anxiety and depression. 

Strategy #1: Make a list of the benefits of worry. 

 People who worry constantly often think there are benefits to it.

 Their idea that worry is beneficial will often sabotage their efforts to reduce their amount of worrying. Often, the idea of benefits is not conscious.

 By bringing your ideas of the benefits of worry into the light and analyzing them, you will be better able to overcome worry. 

 One possible way you may think you benefit from worry is the idea that it is the responsible thing to do. Maybe you reason that not worrying would mean you are not concerned.

 Maybe you think that worrying helps you to keep track of all the things related to the problem that must be solved. That if you stop worrying, you will lose track of some important detail.

Maybe you think that worrying will keep you on your toes and motivate you to achieve your goals. You may think that you will lose your edge if you no longer worry. 

 In what ways does worry work for you? 

Strategy #2: Do a cost benefit analysis. 

Compare the benefits of worry to the downsides of worry.
Try listing the physical symptoms you get when you are anxious, and how constant worry fans the flames of anxiety. Think about how it might be hurting your overall health.

 Think about how worry affects your sleep, and how that may leave you not able to take constructive action if things do go wrong. 

Try listing missed opportunities that you were afraid to try because of worry. 

Think about how worry may keep you from being really present.

 Does worry keep you from connecting with others?

 Does it keep you from experiencing enjoyable moments, because you are mentally preoccupied and “not really there?”

These are just ideas to get you started. Write down your own ideas about the costs of worry. Then decide if it would be worthwhile to break the worry habit, or to at least  take it down a notch. 

 Some people decide that, “By worrying constantly, I am missing out on what is actually happening, moment by moment. It would be more responsible of me to live in the present, and deal with reality moment by moment, as it unfolds.”

 Some people may decide that “I probably won’t lose track of things anyway, if I stop worrying and constantly checking all the details. I can just write things down and make a list, to refer to as needed.”

  Some people decide “If I stop worrying so much, I will be able to sleep better and that would make me more able to deal with whatever comes up”..

 Some people decide that by getting out of their worried heads and having more enjoyable moments, they will feel better and cope better when things do go wrong. 

What will you decide about the benefits vs the cost of worry? 

If you decide to commit to breaking the habit of excessive worry, the following 3 strategies could help you. 

Strategy #3: Write down all your worried thoughts.

For each worried thought that you write down, also write a counter statement that is more calming, or at least more neutral, and less dramatic. 

 For example, “If I mess up this project, my career will be ruined forever!” could be countered by “I don’t really know how it will turn out. Maybe it will be a learning experience. Whatever happens, I can move on from there. I can deal with that.” 

Another example is, “If I mess up, I will look like a fool. I will never be able to show my face around here again!” could be countered by, “A lot of people look foolish sometimes. It is the risk I take in this venture. I don’t really know what people will think of me. Some may judge me, others may not. Some may even have sympathy for me and see me as more human.” 

Strategy #4: Schedule planned worry sessions.

By giving your worries a scheduled outlet, they may be more able to leave you alone when it is not their time. 

You might decide on five minutes, three times a day. You might choose one minute per hour. You might choose one hour at the end of the work day. Do what works for you.

 At the appointed time, let yourself worry as much as you can. You can even exaggerate your worried thoughts. Don’t try to not worry. Don’t try to come up with calming counter statements. 

 This is your scheduled worry time. You can refer your worries to these scheduled times when they try to annoy you at other times.

Postponing worries until their planned time can help give you more control over the worry habit. 

 Strategy #5: Plan on “worry free” times. 

During these worry free times, you will make a conscious effort to practice breaking the worry habit. 
 For example, you may say, “For the next hour, I will focus on this project and not worry.” 

 You may say, “For the next twenty minutes I will enjoy this very beautiful sunset. No worries allowed here. I am focusing on the beautiful colors and the awe that I feel.”

 You may say, “For the next ten minutes, I will enjoy chatting with my coworker, without thinking about or talking about my worries.”

 Worries will try hard to interfere with these times. Do not judge yourself for this. Just tell them it is not their turn, and that they can wait until their scheduled time. 

 “Right now I am busy with this. You will have to wait your turn. If you can’t wait for your scheduled time, you must at least wait until I am finished with this.” 

 You will need to do this over and over again. That is just how it works, while breaking a habit. 


Take Your Next Step: 

If you are struggling with anxiety and excessive worry, and would like professional help, call me at (310) 658-3158 to discuss how we could work together. 

I offer in person Walk and Talk Therapy sessions in the Marina del Rey area. I offer therapy sessions by phone for all of California. 


Kate Boswell LMFT is a therapist in Marina del Rey, CA. She helps anxious young men and women become calmer and more confident. She helps adults of all ages who are struggling with stressful life changes. 


Nearby communities served are Playa del Rey, Playa Vista, Venice, Mar Vista, Del Rey, Culver City, and Westchester. 

Kate Boswell is licensed by the state of California as a Marriage and Family Therapist, License No. LMFT 20851. Contact Kate at (310) 658-3158.

Disclaimer/Terms of Use: This website and blog was authored by Kate Boswell LMFT for informational and educational purposes. It is not intended to replace any medical diagnoses or treatment. Nothing on these pages, or pages they link to, shall be construed to as medical advice. 

Introducing my Mom and a Monument in the Park

My Mom was a WWII veteran who lived a long life after the war.

There is a monument to fallen soldiers in Santa Monica which reminds me of her, even though she did not fight or die in the war.

In the Palisades Park in Santa Monica, CA there are four monuments, each dedicated to the fallen members of one of the four branches of the U.S. military.

The monument for the Coast Guard has this inscription:

"Dedicated to the members of the U.S. Coast Guard who have given their all so that others may live in freedom."
"Semper Paratus"

My Mom had a few fears which limited her life in some ways. She was also a habitual worry wort.

 My memories of her fears go all the way back to my childhood.

She was afraid of heights, afraid to go swimming, and was somewhat anxious socially and easily embarrassed.

When we kids were little, on beach trips she would stand near the edge of the water with us, ankle deep, having fun running from the approaching waves with us.

When we were old enough to go deeper into the water, it was Dad who would get in the water with us. Mom stayed on our picnic blanket watching, and most likely worrying.

On the rare occasions that Dad drove us to the mountains, Mom worried during the whole drive.

Her anxiety was expressed by a steady stream of, "Look out!" "Be careful!" "Keep your eye on the road."

She was easily embarrassed and avoided some social situations so she would not "die of embarrassment."

Mom in the Coast Guard during WW2

When my Mom was very young, WW2 broke out. She wanted nothing more than to join the Coast Guard and serve her country during the war effort.

The first step was to visit a recruiter, in spite of her shyness. Her efforts were rewarded by being laughed at and told to go home and put on some weight. Her petite size had disqualified her.

Determined to join the Coast Guard, she drank milk shakes every day and gained enough weight to qualify.

After joining the Coast Guard, the next step was boot camp.  As part of her training, she had to jump off the high dive and swim.

 She was terrified of both, but she managed to do both. Her goal was important to her. She forced herself to push through the fear and do what had to be done.

After boot camp, she was assigned to a job.

 One of her job assignments was to measure men’s chests to determine what size uniform they would need. That embarrassed her to no end. But she did it.

The monument in Santa Monica to the Coast Guard is dedicated to those who "gave their all."
 I reflect on the many ways that those who survived, like my Mom, gave their all.

I can only imagine what it took out of my shy young Mom to face the recruiter again, after having been laughed at.

 I can only imagine what it took out of her to jump off the high dive and swim, in spite of her fear of heights and fear of swimming.

I can only imagine what it took out of her to measure the men’s chests for their uniforms, in spite of her shyness and embarrassment.

I am quite sure that there were many more instances in her day to day life in the Coast Guard that required her to give her all.

Returning to the Comfort Zone

Mom did not have to jump off high dives or swim after the war ended. I wonder if life may have been more enjoyable, though, if she had continued to swim.

 It might have made family trips to the beach more fun for her if she had been able to get in the water.

However, she only went back to her comfort zone in certain areas, such as avoiding heights, swimming, and some social situations.

New Challenges to Face Courageously (and Anxiously)

Adult life continued to bring many challenges and fears to be faced. She kept pushing through her fears, when necessary, to do what needed to be done.

It must not have been easy to be a Mom and a worry wort at the same time. I can think of many situations that must have taken all she had to get through.

It could not have been that easy for a shy person to go to school open houses and parent conferences.

It could not have been easy to allow her children to do all the daring things that kids and teenagers do, in spite of her worries.

To a large degree, she gave her all so that we could live in freedom. The freedom to be kids. The freedom to explore.

Maybe You, Too, are Courageous (and Anxious) Like My Mom

What about you?

Are there things you are afraid to do which keep you from reaching your goals?

If so, maybe you have forced yourself to do what had to be done to reach your goals.

Maybe you then went back into your comfort zone after your immediate goal was met.

Do you give yourself credit for the challenges you do face in spite of your fears?  To not be defined by the few limitations you do allow yourself?

Many people live a full life while avoiding some specific situations.

For example, someone who is afraid of snakes will simply avoid going on a hike. Their life does not feel limited because of this. There are plenty of other fun things to do.

If you fear something that keeps you from reaching an important goal, then it would make sense to find ways to overcome that fear.

Pushing through is one way. If you do something often enough, the anxiety and fear often wear themselves out.

It Could Be Easier, With Help

Pushing through is not always the easiest way to go. It can sometimes be too scary.

There are more gradual ways to get used to a scary situation. There are also mental planning strategies that can be done with the help of a therapist.

If your fears and anxieties are keeping you from what you want to do in life, you can work with a therapist who specializes in anxiety.

I am available in my private practice in Marina del Rey, Ca. 90292

Call me at (310) 658-3158 for a free 15 minute phone consult to discuss how we could work together.

​Kate Boswell is a therapist in Marina del Rey, CA. She helps anxious young men and women become calmer and more confident. She helps adults of all ages who are struggling with stressful life changes. From her Marina del Rey office, she serves the communities of Playa del Rey, Playa Vista, Culver City, Del Rey, Mar Vista, Westchester, and Venice, California.  Kate is licensed by the state of California as a Marriage and Family Therapist, License No. MFC 20851. Contact Kate at (310) 658-3158 or through the contact page on her website at www.2bstressfree.com

​​Do you worry that you would die of embarrassment if you had a panic attack in front of other people?

​Panic attacks can seem to come out of the blue. When and where the next panic attack might strike can be unpredictable.

Understandably, you fear that it could happen in public, and that it would be extremely embarrassing for you. 

The fear of being embarrassed could be even more frightening than the fear of the panic attack itself.

This fear might cause you to limit your activities, staying home more and more, or only getting out in situations where you feel very safe.

Going this route can become a slippery slope toward agoraphobia. Your life would become more and more closed in. You would miss out on so much of what life has to offer. 

It doesn't have to be this way. I specialize in helping people with anxiety and panic.

Here I will share a few tips on getting over embarrassment. These tips could give you ideas for getting out more, in spite of your anxious fears. 

Change How You Think About Panic and Being Embarrassed

• ​Fretting over "what if" scenarios, the mind can go into overdrive, imagining worse case scenarios that may not ever happen.
• It may be helpful to simply ask yourself, "How likely is that to happen?" and "If it did, could I find a way to deal with it?"
  
• This is the number one tip that is most helpful in planning for all situations. 

​Following are a few scenarios that some people fear a panic attack could happen in, and their fear of how it could embarrass them. Each example will include a coping strategy or two, for that situation. 

Fear of Having  a Panic Attack While Walking Down the Street

​"What if I am walking down the street and have a panic attack? What if I get lightheaded and my legs get all rubbery, and I feel like I will pass out? I will have to sit down, and everyone will stare at me. I couldn't stand to have all those people staring at me, like I am some kind of weirdo."

Coping Strategy #1  Shift How You Think About It

• ​You could ask yourself how likely it would be that you would have a panic attack, and how likely it would be that everyone would stare at you.
• You could ask yourself if you could somehow deal with everyone staring at you, if indeed, they did.
• ​You could ask yourself, if you are such a mind reader, if you know for a fact that they would think you are weird.
• Is it possible they would feel concerned, and  would watch to make sure you are able to get back up on your own, before they offer help?

Coping Strategy#2  Do Something Embarrassing, On Purpose, and See What Happens

• ​Is it possible that nobody would stare? Is it possible that people are going about their business and don't really notice or think it unusual that someone would sit down?
•  To test this out, you could go  for a walk in public and see if there are places to sit down.
• You could  try sitting down for a little bit to see if anyone notices.
• This could  help stop your worry that it would be embarrassing.
• Chelsea tried that one time.  She went into a downtown area and simply sat down on the curb. Nobody seemed to notice, as far as she could tell. If anyone did look at her out of the corner of their eye, she did not notice. 
• After that little experiment, Chelsea was able to go downtown regularly, to shop, eat, or go to the movies. She didn't have any panic attacks downtown. 

​I experimented with this myself once, quite by accident! A friend and I were walking in an upscale downtown area, where nobody sits on the sidewalk.

While crossing the street, I tripped over a pothole and landed on my knee. It was very painful.  I let out a little scream, and  hobbled back to the sidewalk. My friend and I sat down in the grass just in front of the sidewalk. I was crying.

A young woman appeared with a bag of ice for my knee. She had seen it happen from a few doors down, and asked the staff at a nearby restaurant for ice for me.

Nobody else seemed to notice me sitting there crying! People went about their business as though I were not there.

Fear of Having a Panic Attack on an Airplane

​"What if I have a panic attack on the plane, and my seat mate notices? They will think I am crazy!"

Coping Strategy#1 Observe Your Thoughts and Consider Shifting Them

• ​You could ask yourself what your particular type of panic attacks look like and how likely it is that your seat mate would notice.
• You may feel like you are going crazy and that anyone could see that. But maybe your private suffering is not even noticeable to others.
• They may not notice your heart racing, or your hands trembling, or that you are breathing faster.
• If they do, maybe they just figure you are anxious about flying, like a lot of people. 

Coping Strategy#2 Ask for Support

• ​Some people who struggle with anxiety and panic will tell their seat mate up front that they get nervous about flying.
• Maybe that could work for you too.  Then it will be out in the open, and you will find out what your seat mate thinks.
• ​Chances are, they might become a helpful ally, who could distract you with conversation, if that is what you want.
• They may offer understanding, and tell you that someone they know also struggles with anxiety when they fly.

​Fear of Having a Panic Attack While In a Restaurant with Friends

​"What if I have a panic attack in the restaurant, and have to leave, or it causes a scene? I couldn't stand all that attention, with everyone staring at me."

Coping Strategy#1 Ask for Support

• ​You could tell your friends ahead of time that you worry about having a panic attack in the restaurant.
• That could lead to your friends expressing concern and support, and asking how they could help, if it did happen.
• ​That in itself could dispel the fear of embarrassment, and take the edge off the anxiety.
• It could lead to a more relaxed dinner over all, and make a panic attack less likely to happen.

Coping Strategy#2 Have a Plan for Calming Yourself Privately

• Know that you  are not trapped at the table, and that it is okay to leave the table for a little while, for a private moment of calming yourself.
• You might plan to get up and go to the restroom, just to get a little break from the situation. Then you could do some calming breaths, or do a little stretching to relax your self. 
• Your calming plan could include a very important call on your cell phone, that you notice just at the moment that you need a break. Then you can step outside for a few minutes for a change of scenery and perspective. 

Coping Strategy#3 Have an Exit Plan

• You could give yourself  permission to leave if you need to,  telling your  friends you are suddenly ill.
• This is a plan of last resort, if all else fails.
• Having that plan could make it easier for you to go to the restaurant with friends, instead of staying safe and sound at home. 

In Conclusion

​I hope these few tips will get you thinking about ways to be able to keep getting out there, and not becoming a shut in over fear of embarrassing yourself.

​So no matter what worse case scenario you imagine, ask yourself if this fear really justifies cancelling your plans and staying home.

Hopefully your answer would be, "Being embarrassed won't kill me. Being embarrassed is something I am willing to risk, in order to get out there and do things."

Take the Next Step

If you struggle with anxiety and panic, take the next step now. Call me at (310) 658-3158 to discuss how we could work together. 

​Panic attacks are very treatable. This article is not meant to replace therapy. It is meant to give some hope and some ideas about how others have overcome their fear of embarrassment over possible panic attacks in public.

​Kate Boswell MFT is a therapist in Marina del Rey, CA. 90292. She helps anxious young men and women become calmer and more confident. She helps adults of all ages who are struggling with stressful life situations. Kate is a licensed Marriage and Family Therapist, Lic.# MFC20851. Nearby communities served are Playa del Rey, Playa Vista, Del Rey, Mar Vista, Culver City, Venice, and Westchester. Kate may be reached at (310) 658-3158.

Should medical marijuana be used for the treatment of anxiety? Is it a healing herb for anxiety, or is the whole idea a hoax?

I treat young men and women with anxiety issues. Not surprisingly, this is a topic that comes up frequently. 

Whether medical marijuana is a healing herb for anxiety, or a hoax, is a question I wrestle with from time to time. Just when I have it figured out, a new wrinkle is brought to my attention. 

• My current short answer is "I don't know." My current more complicated answer is "It depends." 
• Some people experience marijuana as a healing herb for anxiety. Some people have experienced severe side effects, such as paranoia or extreme anxiety and panic. 
• The reason I entertain the idea of medical marijuana for anxiety as a hoax, is that the medical status is often used as a legal way to get marijuana for recreational use. 
• In my therapy practice, some who have had medical marijuana cards see it as a joke. They have said that it is too easy to get the card, and their use of marijuana is not monitored medically.
• Some states have legalized recreational pot, and a number of other states seem to be heading in that direction.
• If and when recreational use becomes legal, and there is no longer a need for a medical marijuana card, there will still be things to consider before deciding whether or not to use it as self treatment for anxiety.  

Following are some of the reasons people give for using medical marijuana for anxiety, and my thoughts, pros and cons, on each one:

"It is a natural herb, and is not dangerous like the drugs pushed by Big Pharma." 

• I understand the reasoning behind this. Big Pharma has probably caused a lot of harm to a lot of people. It is very understandable that people would want to seek out more natural remedies. 
• I am not a big fan of Big Pharma either. There are plenty of drug free strategies for overcoming anxiety. Too often, doctors prescribe anti-anxiety medications instead of referring to a therapist for assessment for drug free solutions. 
• Many people do self medicate with marijuana. The results I have observed have been mixed. Some people find it helpful, while some find it brings new problems.
• Unfortunately, in my position, I have become aware of too many instances of it not working very well. It has caused paranoia, and, paradoxically, more severe anxiety and panic. 
• "Big Pharma" drugs, on the other hand, are standardized and  available by prescription only. They are monitored by the prescribing physician, who can make changes to deal with side effects or other problems that may develop. They can also monitor withdrawal symptoms if a person decides to stop the drug. 
• Doctors cannot write prescriptions for marijuana, because of the federal government's classification of it. They can only authorize a medical marijuana card.
• The consumer then is allowed to possess marijuana, up to the amount within the state's legal limit. They are left to figure out dosages and frequency on their own. Their use is not monitored by the doctor, and there is no need for the doctor to approve a "refill." 
• Research on medical marijuana has been severely limited, due to the federal government's restrictions on accessing it for studies. It is still in the same classification as drugs such as heroin, considered dangerous and without any medical benefits. 
• Unless and until the government changes the classification of marijuana, there is no definitive data available to support that it is safe and helpful in the treatment of anxiety. 

"It helps me socialize better. I can put my shyness and awkwardness aside and enjoy getting to know new people."

• This is a common reason for using marijuana for anxiety. It is similar to the idea of alcohol being a "social lubricant." 
• The trouble with marijuana, alcohol, and the prescribed fast acting anxiety drugs, is that they can be said to "work too well." Many people become dependent on them for socializing. 
• They may attribute their social enjoyment to the action of the drug, rather than to their own efforts. 
• Most people struggling with anxiety do not realize that there are strategies to help them face their fears and overcome them. When a drug is depended on to take the edge off social awkwardness, the person may never develop their own abilities to do so. 
• There are psychotherapists who specialize in treating anxiety. They can help people build skills and their own inner strengths. This can greatly increase a person's self confidence and pride in their accomplishments.
• There are also some great self help books out there. That is another way to  learn skills for dealing with social anxiety, without the use of drugs. 

"It helps me stay focused and stop worrying about the past and the future." 

• This is another common benefit reported by people who use marijuana for anxiety. Artists and others involved in creative works are able to immerse themselves in their projects and be fully present with what they are doing. 
• Unfortunately, this can foster dependence on a drug, as discussed above as it relates to social awkwardness. Often people will slide into using too much too often. New problems arise, such as lethargy, loss of motivation, and loss of focus. 
• Another sad effect is sometimes seen after a profound experience, while high, of being immersed in a great work. Once the high wears off, and the artist takes another look at their work, they see it as not only not profound, but not even very good. 

"Having a medical marijuana card keeps me out of legal trouble."

• To a degree, this is probably usually true. This in itself probably goes a long way in reducing anxiety for those who use marijuana for recreation or for self medication. 
• One should keep in mind that a medical marijuana card authorizes possession only under the state law, and within the legal limit of that state. The card cannot protect someone who happens to be in the wrong place at the wrong time.
• One possibility is being  at the marijuana dispensary when it is raided by federal agents. Another situation that comes to mind is being swept up in a bust, when socializing at someone's home, and unbeknownst to you, the host is a dope dealer. 

Conclusion:

Is medical marijuana for anxiety a good idea or not? It may or may not be, depending on your unique situation. 

I generally do not recommend medication as a first line of defense against anxiety. 

I do recommend seeing a therapist who specializes in anxiety.  Together you would come up with a plan to treat your anxiety. 

Your individual plan might include shifting how you think about anxiety, and becoming more accepting of your feelings. It might include getting some exercise and better nutrition. It might include adding a calming practice to your daily routine. 

If it turns out that medication is needed, you could explore with your therapist and your doctor whether marijuana could be the right medicine for you. 

I will leave you with a book recommendation:

"Stoned: A Doctor's Case for Medical Marijuana" by David Casarett, M.D. is a book which I highly recommend in your own exploration of whether medical marijuana may be right for you.

The author is a hospice doctor. He spent a year researching the benefits and risks of medical marijuana.

He interviewed patients, other doctors, and even posed as a patient when visiting marijuana doctors and marijuana dispensaries. His findings were very interesting and enlightening.  

Take the Next Step:

If you are struggling with anxiety, call me at (310) 658-3158 to discuss how we could work together. 


Peace, 
Kate

Kate Boswell MFT is a therapist in Marina del Rey, Ca. She helps anxious young men and women become calmer and more confident. Nearby communities served are Playa del Rey, Playa Vista, Venice, Culver City, and Westchester. Kate can be reached at (310) 658-3158. 

​​Does anxiety ever keep you from doing what you want to do or need to do? You are not alone. Many people are bullied by anxiety.

​Anxiety may be keeping you from speaking up at work, saying "hi" to a potential new friend, asking the boss for a raise, or getting in an elevator.

​There are many more examples that may apply to you. In short, anxiety can paralyze you, making you too afraid to go after your goals.

​You can break free from the tyranny of anxiety by changing two things--your thoughts and your actions.

This is simple but not easy.

​You may not be aware that some of your thoughts are "anxiety friendly," or how to change them. It may be scary to break ingrained habits and try new ways of doing things.

​There are powerful strategies from Cognitive Behavioral Therapy (CBT) that can help you.

These strategies can help you change how you think about things you fear, and find the courage to change your habit of avoiding them.

Changing your thoughts and actions can be broken down into 3 simple steps. 

1. Observe and Record Your Anxious Thoughts 

​To change your thoughts, you first need to know which thoughts need changing.

One strategy is to notice, and write down, all the thoughts that come up when you are feeling anxious about something.

​For example:

• "People won't like what I have to say"
• "I will look foolish"
• "My mind will go blank"
• "I will get stuck in an elevator if it breaks down, and that would be a major catastrophe."

2. How to Change Your Thoughts to Reduce Anxiety

​You can ask yourself if your anxious thoughts are 100% true.

Most likely, there are shades of gray to the situation, and it is not all black or white.

​Try replacing each of these thoughts with a more realistic thought that is believable to you.

The new thoughts do not have to be 100% positive. They just need to be more realistic thoughts that you can believe in. 

These replacement thoughts can lower your anxiety, and act as a bridge toward more positive experiences and hopeful expectations.

​Some possible replacement thoughts are:

• "Some people won't like it but maybe some will; I can't expect to please all people all of the time"
• "Some will think I look foolish, some won't; besides, looking foolish does not make me a fool"
• "Sure, my mind could go blank; I could rehearse a Plan B, just in case"
• "People have gotten stuck in elevators and lived to tell of it; I hope it never happens to me, but if it does, I would get through it somehow."
• 
  

Write your own replacement thoughts down, and refer to them often. 

 3. How to Change Your Actions to Reduce Anxiety

​To overcome anxiety and build confidence, it is essential that you  do the very thing that you are afraid to do (assuming it is not something that is truly dangerous).

​Confidence comes from practice, over and over again. Only then will your anxiety level go down.

Waiting to feel confident does not help. You must act, even though you feel anxious.

​CBT refers to this strategy as exposure.

If you expose yourself to a feared event, in spite of starting off anxious, you can desensitize yourself to the event, so it no longer causes you anxiety.

You can expose yourself to the feared, avoided situation by either wading in gradually, or jumping right in.

Both ways work, for different people and in different situations.

The idea is to approach the situation that makes you anxious, and suffer through the anxiety until it wears itself out, to desensitize yourself to the situation.  

Examples of Exposure to Reduce Anxiety in 3 Situations

For each example, I will give 2 examples: one for exposure through wading in, and one for exposure through jumping in. 

1. Approaching a Potential New Friend

• ​Exposure through wading in: You could say "hi" to a potential new friend, and then excusing yourself after a very short conversation. You could say "hi" again another time, and talk a little more, gradually building toward getting to know the person better.
• Exposure through jumping in: You could approach  your potential new friend and attempt a long and meaningful conversation.  It could work for some people, depending on the situation. It could backfire by making you, and maybe the other person, feel overwhelmed, awkward, and anxious. 

2. Going to a Party

• ​Exposure through jumping in: You could go to a party and force yourself to talk to everyone. That could be overwhelming. It could trigger such anxiety that you, understandably, might be afraid to go out again. Then again, for another person in another situation, it could be fun and exciting, and the anxiety would wear itself out after a while.
• ​Exposure through wading in: You could go to the party, planning to leave after twenty minutes. During those twenty minutes, you could say "hi" to the host and two other people. Then you could excuse yourself in a friendly way, saying, "I am really busy, but I wanted to at least stop by." This way, you could gradually get used to similar situations.

3. Asking Your Boss for a Raise

• ​Exposure through jumping in: You could just go  up to your boss and ask for a raise. It  may not be very effective, as it would put your boss on the spot. It could certainly be anxiety provoking for you to even think about.
• ​Exposure through wading in: You could start a friendly conversation with your boss. That could lead to ongoing "mini" conversations with your boss, helping to build up a rapport between you. This could gradually lead up to inquiries about their expectations of you, how they think you are doing, and  how to merit a raise.  

Self Help Books I Recommend
You can learn more about CBT through self help books. I recommend these 3:

• The Feeling Good Handbook by David Burns, M.D.
• Stopping the Noise in Your Head by Reid Wilson, Ph.D.
• Mind Over Mood by Christine Padesky, Ph.D and Dennis Greenberger, Ph.D.

How Therapy Can Help

A therapist can help you to implement these ideas in these ways:

•  support you in looking at your automatic thoughts and possible replacement thoughts
• support you in personalizing your plan for exposure to feared events
• point our your successes and strengths that you may not have noticed

In Conclusion
​I hope this article about CBT strategies for reducing anxiety is helpful to you.
This article is not intended to diagnose or treat a mental health condition.
It is intended as an introduction to CBT, and to present a few examples of how CBT strategies can help lower anxiety.

Take Your Next Step

Call me at (310) 658-3158 to discuss how we could work together. 

​

Peace,
Kate

​Kate Boswell MFT is a Los Angeles based therapist in Marina del Rey, CA. She helps anxious young men and women become more confident and brave in going after their goals. Nearby communities served are Playa del Rey, Playa Vista, Del Rey, Mar Vista, Venice, Culver City, and Westchester. Kate can be reached at (310) 658-3158.

Does your anxiety skyrocket during the Holiday stress time of year? You are not alone. Many people become anxious and stressed during the Holidays. 


A couple years ago, my friend and colleague, Michelle E. Vasquez, LPC, interviewed me on her Blog Talk Radio show to talk about coping with anxiety during the Holidays. 


What follows are excerpts from the interview.  


What is it about the Holidays that gets us so stressed out? 
A few things. It is not always the happy time it is cracked up to be. We think something is wrong with us if our holidays are not fitting the image we have of everyone else's holiday. We may be traveling to see family and dealing with crowded airports, or the stress of preparing to be off on vacation from work. Going back to see family may trigger old hurts. We are busier than usual, with shopping and getting together with others. We pressure ourselves to buy the perfect presents, host the perfect party, or bring the perfect potluck item. 


Does Holiday stress affect some people more than others? 
Yes. People who have had recent losses... of a loved one, a job, their health...Single people who are not comfortable being single, and wish they had that special someone to enjoy the holidays with. People who are struggling financially and feeling pressured to buy presents for everyone. People who tend to become depressed or anxious can become more vulnerable to an episode of depression or panic during this stressful time. People who are naturally shy or introverted. 


Since the Holiday season is just over a month long or so, starting with Thanksgiving and ending with the New Year, why not just ride the wave and recuperate afterward? Why get stressed out about the stress? 
The idea isn't to get stressed out about the stress, but to get informed about how it affects us, and make choices to lessen it. Stress, if not dealt with, can affect our immune systems, not a good idea during a season that coincides with cold and flu season. Stress can make us irritable, and thus wreak havoc with our relationships. It can leave us feeling too tired or uptight to enjoy the holidays. If we have a tendency toward anxiety or depression, stress can cause more depression, more anxiety. Stress can lead us to eat or drink more than we wanted to, further weakening our immune systems and our moods. 


What are some ways we can lessen stress during the Holidays? 
There are three main ways:
We can change our thinking, we can choose different behaviors, and we can make lifestyle changes to reduce stress. 


What are some ways we can change our thinking?
We can interpret things in a more positive, or at least more realistic, way. Not to deny that we feel unhappy about things, but to choose a perspective toward reducing stress. 


For example, if money is the challenge, we can welcome the opportunity to scale down and enjoy simpler things. We can be glad we don't have to go to the crowded and noisy malls to buy presents! We can enjoy being creative, finding meaningful ways to celebrate and share with the people who matter. 


If we are thinking everyone else is having fun except us, we might decide to realize that all we really know is what people present. They may look happy in their family letter and pictures, or in their Facebook posts. But who really knows? Everyone has problems of some type, and some are better than others at presenting a happy image to the world. 


If we are feeling lonely and miserable without a special someone, we can reinterpret this as an opportunity to get to know ourselves better, and find ways to enjoy life without a mate. We can look around at couples who don't seem to be enjoying themselves so much, and realize that having someone is no guarantee of happiness. We could still look forward to hopefully having a special someone in the future, while deciding not to be miserable with ourselves in the meantime. 


If visiting our nutty families is what stresses us out, we can decide to stop expecting that it will be different this time, and just take things as they are. After all, why should they be different this visit than on past visits? Would it be realistic to think so?  Much disappointment can be avoided by not having that expectation. 


What are some of the behaviors we can choose, to lower stress? 
This would go along with changing our thinking, our perspective, and choosing not to react in a knee jerk way. Not assuming the worst, but reframing something first, and responding accordingly. 


For example, if you have decided to take a break from pining away for a special someone, you may decide to go to some get togethers alone to enjoy socializing, or take a trip with a group such as the Sierra Club or some local group you know of. You never know, you could meet that special someone that way. Just don't pressure yourself to make that the goal of socializing. Better to go in with an open, curious mind, ready to enjoy the activity and the people. 


If you decided to scale back and not spend money you don't have, then you would act on that by brainstorming and discovering affordable ways to give gifts. 


If you decided to lower stress by being less busy, you would then choose behaviors to support that. You may decide to do all your shopping online, or give gifts from one favorite store, such as a bookstore. You may decide to pick up that potluck item at a deli on the way, rather than preparing that perfect but time consuming dish. 


What are some lifestyle choices we can make to lower stress? 
We can eat a reasonably balanced diet most of the time, enjoying the special treats in moderation. 


We can exercise regularly, even if just a daily walk around the block. That is a proven stress buster and mood lifter. 


We can choose not to overindulge in alcohol, sweets, or caffeine. 


We can practice some form of relaxation exercise, most days, if not daily. 


What are some examples of relaxation exercises? 
Simple breathing exercises, especially abdominal breathing. 


Mindfulness exercises, such as paying focused attention to one activity at a time, gently bringing your attention back when it wanders. 


Walking peacefully in nature, or even in a park or tree lined street, noticing your surroundings. 


Sitting quietly and having a pleasant daydream, about some lovely place, indoors or outdoors, that you have visited, or created in your imagination. This can be your "safe space" when you are feeling frazzled and just nee a little break. 


Where would someone learn these relaxation exercises? 
There are many good self help books. I like The Miracle of Mindfulness by Thich Nhat Hanh, and The Anxiety and Phobia Workbook by Edmund J. Bourne. 


Some communities have various meditation, yoga, or Tai chi classes available. 


Some therapists, such as myself, will teach relaxation exercises to their clients as part of their therapy, or offer stress and anxiety management groups. 


How can listeners get more training on this from you? 
If they are in the Los Angeles area, they can come to one of my Anxiety and Stress Management Training Workshops in Marina del Rey. They can also schedule a one on one session with me. 


They can call me at (310) 658-3158 to sign up for a workshop or schedule an individual session. I also do phone sessions with people who are too far away from my Marina del Rey office for in-person sessions.