A client recently shared with me a video of actor Will Smith talking about the fear that he felt before he was scheduled to go on a skydiving trip. That prompted a discussion around the difference between fear and anxiety.  To my way of thinking, fear is to anxiety as concrete is to imagined, actual is to forecast,  or today is to tomorrow . From a cognitive standpoint, fear pertains to a real, tangible, identifiable, and often immediate source of danger. For example, if a lion is standing in front of me, I will be afraid (not anxious!). If I am about to jump out of a plane, standing by the open door at 3,000 feet, I will be afraid (not anxious!). On the other hand, anxiety applies to situations where I perceive a potential for danger. I have not yet seen the lion, but I think that the lion may be lurking close by. Or coming for me at any time. Or just feeling hungry. I worry about something that has not happened yet and may never happen, But then, it could conceivably happen.  In psychotherapy, we may address both fears and anxiety using Cognitive Behavior Therapy. Problematic fears often come up in the context of phobias (e.g., fear of flying or driving across bridges). Clinically-relevant anxiety tends to manifest itself in the form of excessive worrying, tension, restlessness, over-sensitivity and hypervigilance.  Both feelings trigger our "fight or flight" response mechanism, which I will describe in more details in my next blog post.  The treatment of choice most often involves Exposure Therapy, an evidence-based intervention in which the client learns how to gradually expose themselves to stimuli that they fear, with a lot of support and guidance from the therapist. In the meantime, here is Will Smith talking about his "fears," which actually pertain to both anxiety and fear. Enjoy!

Negativity bias is a psychological phenomenon where negative experiences, thoughts, or emotions disproportionately influence our cognitive appraisals compared to positive ones. This bias, rooted in our evolutionary history, served an adaptive function by helping our ancestors respond quickly to threats. However, in modern life, it often skews our perceptions, leading to distorted thinking and unhelpful emotional responses. Cognitive appraisals refer to the way we evaluate situations, events, and experiences. They are central to how we interpret and respond to the world around us. When negativity bias infiltrates these appraisals, we tend to overemphasize negative aspects while underestimating or overlooking the positive. For instance, a person might receive glowing feedback from their boss but fixate on a minor critique, allowing it to overshadow the praise. This bias can have significant implications for mental health. It contributes to the development and maintenance of conditions like anxiety and depression, where negative thoughts dominate and create a cycle of negative appraisal. For example, someone with anxiety might perceive a minor mistake as catastrophic, leading to heightened stress and further negative thinking. Combating negativity bias involves becoming aware of this tendency and actively challenging it. Techniques from cognitive-behavioral therapy (CBT) can be particularly effective. One such technique is cognitive restructuring, where individuals learn to identify and reframe distorted thoughts. Instead of focusing solely on the negative, they are encouraged to consider the full picture, including positive or neutral aspects. Another strategy is practicing gratitude, which involves intentionally focusing on positive experiences and aspects of life. This can help counterbalance the negativity bias by training the mind to recognize and appreciate the good, even in challenging situations. Understanding and addressing negativity bias in cognitive appraisals can lead to more balanced thinking, improved emotional well-being, and healthier relationships. By challenging this bias, we can foster a more accurate and constructive view of ourselves and the world around us.

"Impostor syndrome" (also known as impostor phenomenon, fraud syndrome, or impostor experience) is a term initially coined in 1978 by psychologists Clance and Imes to describe describe high achieving individuals who, despite their objective accomplishments, persist in holding a belief that they are unworthy of their success and that others will eventually recognize them as a fraud . The early psychological literature on this topic (see original article ) proposed that the phenomenon was prevalent among women. Since then, dozens of studies have shown that it is equally common among men and particularly troublesome among minority groups.  Professionals with impostor syndrome tend to attribute their strong performance to external factors such as luck, support from others, or extreme effort, rather than internal factors such as talent, competence, and acumen. Setbacks, on the other hand, are viewed as proof of unshakable weaknesses. Indeed,  Clance described impostor syndrome as an “internal experience of intellectual phoniness in individuals who are highly successful and unable to internalize their success.” This unwarranted sense of insecurity can often result in distress, depressive feelings, anxiety, loneliness, and frustration.  A recent review of over 62 studies on the topic of Impostorism showed that the p revalence rates of impostor syndrome is hard to gauge. Depending on the screening questionnaire and cutoff points used, the research showed that 9 to 82%  of the participants would qualify for the label. It appears that age is negatively correlated with impostor Syndrome (i.e., it lowers as one ages). So...do you have Impostor Syndrome? Honestly, only you can answer that. If you're struggling with feelings of perfectionism, insecurity, and fear in spite of sustained academic and professional success, it is possible that you do hold beliefs that could be described as Impostorism. Many times, as hard as they might be, these feelings motivate you to keep striving and achieving, But at other times, they can stand in the way of you actually enjoying your life and the many contributions that you make to your organization. There are many ways to "treat" Impostor Syndrome.  if you look in the lay media, you will find many recommendations , ranging from  “own your accomplishments” to “comparing  notes with peers and mentors about shared impostor feelings” and "remind yourself that you are good at what you do." I am sure those are helpful and can alleviate the suffering momentarily. However, from a CBT perspective, Impostor Syndrome is more likely a reflection of core values, intermediate beliefs and automatic thoughts that pop up in many areas of your life. Getting to those is the key to long-lasting change. You can fight Impostor Syndrome with the help of a therapist by learning to be aware of your automatic thought patterns, recognize unhelpful thinking styles, and generate alternative appraisals that help you move forward in the direction of your values and your goals.

Let's say you have an important work deadline coming up, or an important meeting, or a job interview. You'll likely be a bit stressed about it, right? That's understandable - and useful! A reasonable amount of stress shows that we care about these critical tasks and can actually help us prepare better for them. However, every now and then, that stress gets out of hand...instead of encouraging us to be ready for the challenge, the stress mounts so high that it makes that challenge seem completely unattainable. In the early 1900s, psychology researchers  Robert Yerkes and John Dodson developed an empirical curve that illustrates our performance levels on a task relative to the stress levels present in that situation, the "Yerkes-Dodson" law. It is easy to understand if you think about it in terms of a test at school. If there is no stress at all, we won't really prepare for the test, and might show up on the exam day without having done any studying. A good amount of worry and stress will encourage us to prepare for the test by reading the book chapters and doing the practice exercises, once...or maybe twice. An amount of stress beyond that might lead us to re-read all those chapters and re-do the practice exercises a few too many times, to the point where we may be too tired by the time the test comes along to get the best grades. And if we are really, really scared of the test, telling ourselves that it's way too difficult and we will never get a good grade on it, we may just throw our hands up in the air and not study for it at all. We may give up before we start, out of panic, exhaustion, and fear. So, some stress is good. Too little or too much may lead to subpar performance. The question is how to modulate the stress to get it to the level that is good for you. There are many answers there, ranging from relaxation exercises to worry break and mindfulness moments to  reappraising the importance and threat of the situations ahead. In TEAM-CBT , we have some great tools that can help with all of those!

Viktor Frankl, the renowned Austrian psychiatrist and Holocaust survivor pictured here, once said, " Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom."   This profound statement encapsulates the essence of human resilience and the potential for personal transformation. It also underscores the core principles of Cognitive Behavioral Therapy (CBT) in creating that crucial space between stimulus and response. In everyday life, we often react impulsively to various stimuli—whether they are external events or internal thoughts and emotions. However, Frankl's wisdom suggests that we have the ability to pause and consider our responses. This pause is where we can find empowerment and personal growth. It's in this space that CBT plays a crucial role. CBT as a therapeutic approach helps individuals recognize and challenge their automatic thought patterns and emotional reactions. By identifying and modifying these cognitive and emotional responses, CBT assists in creating the vital gap between stimulus and response. Through guided introspection and cognitive restructuring, individuals can develop more adaptive and rational responses to challenging situations. The practice of CBT equips individuals with the skills to choose healthier responses, fostering emotional resilience and personal growth. It allows us to shift from being reactive to proactive, ultimately leading to a more balanced and fulfilled life. Viktor Frankl's insight remains a powerful reminder that we possess the capacity to shape our responses to life's challenges, and CBT provides a practical toolkit to help us do just that.

In evidence-based psychotherapy, we most often depart from the premise that the client is unwell. We diagnose disorders based on set lists of symptoms and tailor treatment to particular presenting concerns. The goal is to eradicate the illness and restore the client's functioning to its previous, higher level. But what if we didn't have to get unwell to begin with? There is a whole field of psychology focused on that: Positive Psychology. Positive psychologists spend their days studying how we can make ourselves feel better and prevent the down periods in life. Live Happy Magazine  published a comprehensive summary of widely embraced ideas to help us all lead healthier emotional lives. While none of them are going to jump out as new and surprising, it is a god reminder to heed some age-old advice to live fully and sensibly. Positive Psychology recommends: Focus on the present, don't ruminate about the past Express gratitude often Use breathing and meditation to ward off excessive stress Be physically active Eat healthy Forgive Strive for good quality sleep Seek opportunities to laugh - a good, deep belly laugh! Practice self-compassion Balance work and play Slow down by doing things mindfully Savor small moments Easy, right?

Life throws its fair share of curveballs. Difficult emotions, stressful situations, and intrusive thoughts can leave us feeling overwhelmed and lost at sea. Acceptance and Commitment Therapy (ACT) offers a powerful technique called ACE (Acknowledge, Connect with your Body, Engage) , also known as "dropping anchor," to help us navigate these stormy waters and find our inner calm. Why We Struggle: Our natural tendency is to avoid or fight unpleasant emotions. We might try to distract ourselves, numb out with unhealthy habits, or ruminate on negative thoughts. However, these strategies often backfire, leading to increased anxiety and a feeling of being stuck. The Power of the ACE Technique: ACE provides an alternative approach, helping us develop psychological flexibility. Here's how it works: Acknowledge (A): The first step is acknowledging your thoughts and feelings without judgment. Simply observe them – "I'm feeling anxious" or "That was a critical thought." This creates space for them to exist without fueling them further. Connect with your Body (C): When emotions run high, we often disconnect from our physical sensations. Focus on your breath, how your feet feel on the ground, or any physical tension. This grounding technique brings you back to the present moment. Engage (E): Instead of getting caught up in your thoughts and feelings, shift your focus to what truly matters. Engage in the present activity, be it a conversation, a task at hand, or simply observing your surroundings. Benefits of Dropping Anchor: Reduced emotional intensity: By acknowledging emotions without judgment, we lessen their power over us. Increased mindfulness: Focusing on the body brings us back to the present, where we can make conscious choices. Greater clarity: Stepping away from unhelpful thoughts allows for more rational decision-making. When to Drop Anchor with the ACE technique: Anxiety or panic attacks: Use ACE to acknowledge your anxious thoughts and feelings, ground yourself in your body, and focus on your breath or calming techniques. Rumination: When caught in a cycle of negative thoughts, use ACE to acknowledge them, refocus on your body and surroundings, and engage in a different activity. Stressful situations: Practice ACE to manage overwhelming emotions, stay present, and navigate the situation effectively. Dropping anchor is a skill that takes practice, but it can be a powerful tool for managing difficult emotions and living a more mindful life. The next time life throws you a curveball, remember to ACE your way through the storm and find your inner peace. Here is your map!

In Cognitive Behavioral Therapy (CBT), core beliefs are the deepest level of negative thinking patterns. These are the most fundamental assumptions we hold about ourselves, the world, and others. They are formed early in life and tend to be rigid and unquestioned. Core beliefs are central to CBT because they influence everything from our automatic thoughts (fleeting negative ideas) to our emotions and behaviors. Here's a closer look at core beliefs in CBT: Characteristics of Core Beliefs: Deeply Held: Core beliefs are ingrained and often unconscious. We might not even realize we hold them. Global and Overarching: They are broad generalizations applied to many situations, not specific to one event. Difficult to Change: They are resistant to change due to being deeply ingrained and reinforced by experiences. Impact of Core Beliefs: Filter for Perception: Core beliefs act as a lens through which we interpret events. They can distort our perception of reality. Fuel Negative Thoughts: Core beliefs can trigger automatic negative thoughts, leading to emotional distress and unhealthy behaviors. Self-Fulfilling Prophecies: When we believe something strongly (even if untrue), it can influence our behavior in ways that confirm that belief. Examples of Core Beliefs: I am worthless . (Leads to feelings of worthlessness, social withdrawal) The world is a dangerous place. (Leads to anxiety, avoidance of new experiences) I can't trust anyone . (Leads to isolation, difficulty forming relationships) How CBT Addresses Core Beliefs: While directly targeting core beliefs can be challenging, CBT helps individuals: Identify Core Beliefs: Through exercises and therapy sessions, individuals can uncover their core beliefs. Challenge Their Validity: Examining the evidence for and against the core belief can help weaken its hold. Develop More Balanced Beliefs: CBT helps replace negative core beliefs with more realistic and empowering ones. Changing core beliefs takes time and consistent effort. However, by working with a therapist, individuals can loosen the grip of these negative beliefs and experience significant improvements in their mental and emotional well-being.

Often times, thoughts that are largely accurate or even innocuous at the surface level can lead to intense sadness, anxiety or anger. For example, telling myself that “this meat tastes bad” or “I fumbled that word” or “she is not paying attention” can quickly result in a drastic mood change. In CBT, the downward arrow technique is a way of working through these automatic thoughts to find the irrational beliefs at their base that are triggering the strong emotions. These beliefs may not be immediately obvious to us, so we need to ask the same questions repeatedly until we get to the bottom of it: “what does that mean about me?” and “why is it upsetting to me?”. ​When we get to the end of the chain, we will find a deep-seated – and mostly unhelpful – belief that explains where these intense feelings are coming from. That is called a “core belief” or “schema” and commonly builds on themes of incompetence or failure, abandonment or unlovability, and helplessness. Once these schemas are identified, we can challenge them using CBT techniques similar to the ones applied to automatic negative thoughts. Examples of Downward Arrow technique: 1)  This meat tastes bad And if that were true, what would that mean about you? Why is it upsetting to you? --> I am a terrible cook And if that were true, what would that mean about you? Why is it upsetting to you? --> I am a bad mother And if that were true, what would that mean about you? Why is it upsetting to you? --> I am a complete failure   2) I fumbled that word And if that were true, what would that mean about you? Why is it upsetting to you? --> I didn’t do everything perfectly And if that were true, what would that mean about you? Why is it upsetting to you? --> People will be disappointed in me And if that were true, what would that mean about you? Why is it upsetting to you? --> I will be alone forever And if that were true, what would that mean about you? Why is it upsetting to you? --> I am unlovable 3) She is not paying attention And if that were true, what would that mean about you? Why is it upsetting to you? --> She doesn’t care about me And if that were true, what would that mean about you? Why is it upsetting to you? --> Nothing I do can make things better And if that were true, what would that mean about you? Why is it upsetting to you? --> I am helpless With good CBT techniques, you can identify your schemas and change them over time.

I recently re-read a classic article by Dr. Albert Ellis, inventor of Rational Emotive Therapy (RET) and one of the early practitioners of cognitive therapy, that presents a valuable take on the causes of emotional suffering. I’ll save you a dozen pages of technical reading and summarize it here. All of emotional suffering in the human race comes from us conflating ‘needs’ vs ‘wants.’ Let me explain. Each of us has a series of goals for ourselves and our lives. Ironically, as social beings, they are not that different across people. Generally, we want safety, approval, achievement, efficacy, comfort, and happiness. These are laudable desires: they help us survive, thrive, and procreate. When faced with situations where we fall short of these goals, it is natural to feel disappointed, upset, sad, or frustrated. These appropriate negative feelings help us cope with life and direct our energy towards change. They do not keep us stuck. However, consciously or unconsciously, many of us often escalate these ‘wants’ into ‘needs.’ Beyond wanting safety, we may start expecting that under all conditions and at all times, so we don’t suffer discomfort, pain, or handicaps. We may not only want approval, we may require agreement, admiration, and love by all our significant others. Rather than merely wanting achievement, we may start believing that we need to be notable, celebrated, and special. Naturally, when those rigid ‘needs’ are not met, we suffer. But this suffering is more acute and persistent, because it is violating an existential condition (mind you, one that we invented ourselves). Worse, when we notice that we are stressed, anxious or depressed in response to certain events where our ‘needs’ are unmet, more suffering ensues as we continue to judge the situation as unbearable or ourselves as incorrigible. That keeps us stuck. For example, let’s say that I want achievement. Through a process of illogical thinking, I escalate that into the irrational belief that I must have success and happiness in my life at most times. As a nice bonus, that will guarantee that I am worthwhile. Then an outside event that I cannot control happens that leads to failure and an understandable state of sadness. Because this threatens my ‘need’ (and my worthwhileness), the sadness grows into despair and into depression. And then, when I realize that I am depressed (and unworthy), I feel depressed about my depression. I may even feel depressed for feeling depressed about my depression, as all of those things violate my achievement and happiness ‘needs.’ In contrast, if I can stay in a space where I am thinking logically about my desires and longings, I can interpret my setbacks for what they are: unlucky, unforeseeable, or unfavorable steps in a long journey. Ellis suggests that I tell myself something along these lines: “I don't like failing or experiencing losses. I wish that my life was richer and more comfortable. But if I am thwarted, do fail, get rejected, and am uncomfortable at Point A, that is unfortunate but hardly the end of the world. I can still lead a fairly happy life. Now let me go back to the immediate events and try to improve or deal with them so that I can get more of my goals fulfilled at Point B." That’s neat, isn’t it? As you can see, Ellis was laying the groundwork for much of the Cognitive Therapy fundamentals that followed him.  With the help of a good CBT book or an individual therapist, you can learn to identify which of your ‘wants’ has serendipitously morphed into a ‘need’ that may be keeping you stuck right now.

Emotions are an integral part of our lives, influencing our thoughts, behaviors, and overall well-being. However, for many of us, managing intense emotions can be a challenging task. Dialectical Behavior Therapy (DBT), developed originally by Dr. Marsha Linehan , offers a comprehensive set of skills to help individuals regulate their emotions effectively. One of these essential skills is TIPP, an acronym that stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation. How do TIPP DBT skills work? TIPP skills work by changing your body's physical response to stress. When you are feeling stressed or overwhelmed, your body goes into " fight or flight " mode. This is a natural response that helps you to deal with danger, but it can also be uncomfortable and make it difficult to think clearly. TIPP skills can help to calm your body down and bring it back to a more relaxed state. This can make it easier to manage your emotions and cope with the situation at hand. How to use TIPP DBT skills Temperature One of the easiest ways to use TIPP skills is to change your body temperature. This can be done by splashing cold water on your face, holding an ice pack to your neck, or taking a cold shower. Changing your body temperature can help to activate the parasympathetic nervous system, which is responsible for the "rest and digest" response. Intense exercise Another way to use TIPP skills is to do some form of intense exercise. This could be anything from running or biking to doing jumping jacks or push-ups. Intense exercise releases endorphins, which have mood-boosting effects. It can also help to burn off excess energy and tension. Paced breathing Paced breathing is a simple but effective way to calm down your body and mind. To do paced breathing, simply sit or lie down in a comfortable position and focus on your breath. Breathe in slowly and deeply through your nose, and exhale slowly through your mouth. Try to keep your breathing even and regular. Progressive muscle relaxation Progressive muscle relaxation is a technique that involves tensing and relaxing different muscle groups in your body. This can help to release tension and promote relaxation. To do progressive muscle relaxation, start by tensing and relaxing the muscles in your toes. Then, move up your body, tensing and relaxing the muscles in your legs, stomach, chest, arms, neck, and face. How to use TIPP DBT skills in everyday life TIPP skills can be used in a variety of situations, including: When you are feeling stressed or overwhelmed When you are having a panic attack When you are feeling angry or upset When you are trying to cope with a difficult situation It is important to practice using TIPP skills when you are not feeling stressed so that you can use them effectively when you need them. Here are some tips for using TIPP DBT skills in everyday life: Identify your triggers . What are the things that typically make you feel stressed or overwhelmed? Once you know your triggers, you can start to practice using TIPP skills when you are exposed to them. Have a plan.  Decide which TIPP skills you are going to use in different situations. For example, you might decide to splash cold water on your face if you start to feel anxious in a social situation. Be patient.  It takes time and practice to learn how to use TIPP skills effectively. Don't get discouraged if you don't see results immediately. Just keep practicing and you will eventually get the hang of it. If you are struggling to use TIPP skills on your own, consider working with a therapist who is trained in evidence-based therapies. They can help you to learn how to use TIPP skills effectively and develop a distress tolerance plan.

In TEAM-CBT, when patients are looking to improve their interpersonal relationships, we first spend some time analyzing the nature of the conflict that they're facing before jumping in to solve it. Even though there are as many different flavors of interpersonal conflict as there are people in the planet, if we look closer, we can find a few broad patterns of common relationship issues. If you are having problems with someone close to you (romantic partner, family member, boss, co-worker, etc), odds are that the issue will fall into one of these three categories: 1- Character Issues:  they don't see themselves! These are problems where you firmly believe that the person with whom you are in conflict is just flawed. They may be self-centered, dumb, histrionic, unfair, needy, controlling, unreasonable...and a lot more! For example: "He is mean and stubborn!" 2- Appreciation Issues:  they don't see me! These are problems where you feel under-appreciated in the relationship. You firmly believe that the person with whom you are in conflict doesn't see you for everything that you do. They may frequently criticize, blame,  disrespect, ignore, or belittle you. All said, they either don't value you, don't value your needs, or don't value the relationship. For example: "They never recognize how much I do for them!" 3- Give-and-take issues: they don't see us! These are problems where you find a fundamental imbalance in the relationship in terms of the give-and-take. It can be that the other party just doesn't listen, no matter how hard you try to communicate with them. Or they just don't share, regardless of your valiant efforts to engage them. Or it can be that they don't reciprocate when you do something nice for the relationship. For example: "They ignore my advice!"   There are naturally many other ways of understanding relationship issues. This is just one of them. But the goal here is to recognize that the first step in solving a problem is defining it! If you are suffering because the relationships in your life are not intimate, respectful, and fulfilling, cognitive-behavioral therapy can help.