Topic 8: Core Beliefs & Behavioral Exposure {by 3/18}

[Core Beliefs] – Watch MDD-18: Core Beliefs – Modifying 3 – Behavioral Experiment.  Practice a Behavioral Experiment on yourself.  Answer the following: (1) What was your behavioral experiment (only share what you are comfortable with)?  (2) In what ways was this behavioral experiment helpful in providing “evidence” for your new core belief?  (3) What challenges did you encounter?

 

[Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter).  For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress?  (2) What are some cautions to consider when implementing behavioral exposure interventions?

 

[Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns.  Answer the following: (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?  (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?

 

Your original post should be posted by 3/18.  Have your two replies posted no later than 3/20.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

67 Comments (+add yours?)

  1. Cassandra Miller
    Mar 15, 2021 @ 18:08:29

    1.
    My behavioral experiment had to do with keeping the plans that I had set in place no matter how I felt internally; since I have physically felt worse lately which has bred more negative automatic thoughts, linked to the core belief of helplessness (often causing me to withdraw more or procrastinate). The experiment also focused on vocalizing if I was feeling bad to the person I would be hanging out with, instead of pretending to go on as normal even though I was in significant discomfort (this is important for me since I often refrain from doing this because I feel like I may come off as a burden to others). I also wanted to go in with the intention of staying in the present, while also reminding myself in times of distress that I have felt good for a majority of my life and will not feel this bad (physically) forever. It will eventually go away whether that is in a short time span or a longer one (I can’t predict because most of it is out of my control, but I know I am not always experiencing this discomfort).
    This behavioral experiment helped provide evidence for my new core belief which essentially focused on my attitude/level of anxiety and what I could control. After performing this experiment and having it go successfully, I realized that I can handle things in a different manner that allows me to have a nice time and still do what is in my control to help the way I feel/process negative automatic thoughts. It also allowed me to see that doing social things during times of significant discomfort can actually be beneficial for me because it got my mind off of how I was feeling physically. One of the challenges I encountered had to do with my level of openness to this significant person in my life. Unless, I am in unbearable discomfort I would rather not say anything, as to avoid an uncomfortable conversation or feel like a burden on others. I still was more open with them, but really would like to work towards speaking my mind more often in regards to this issue. Also, I had felt a little better physically over the weekend which may have helped how I handled the situation. I am waiting to see how I follow through on this when I am experiencing more significant discomfort.
    2.
    Behavioral exposure is very effective for certain disorders/types of distress because it allows the individual to challenge their original perception of an event/situation in the same environment in which they had previously been overwhelmed. When an individual is exposed to an environment in which they had been avoidant or fearful (usually gradually) with the tools to manage their thoughts and behavioral responses, they are able to see that the outcome of this experience can be better than anticipated. It also helps them to feel more autonomous when exposed to these adverse experiences/situations/events. In addition, individuals with certain disorders/types of distress gain an understanding that they can be in control without needing to utilize their previous safety behaviors to “protect” them from or rather help them avoid directly confronting whatever it is (even though these safety behaviors may have been necessary in the past).
    Some cautions to consider when implementing behavioral exposure have to do with where the client is at in their therapy, how gradually they are exposed to these situations, and how the interventions are explained. A client’s maladaptive behavior patterns have been reinforced over time, so a clinician should usually start off very gradually in their approach when using behavioral exposure techniques. In addition, the client should have gone over their automatic thoughts, possible core beliefs, and how thoughts trigger emotions and behavioral responses, before introducing this. As a result, they will better understand certain techniques to overcome these patterns of thinking, as well as better interpret their physiological symptoms. Finally, they should understand the meaning and intention behind this behavioral exposure and what the clinician/they hope they gain from it. Therefore, they will better understand what they are looking for and how to approach this intervention. It is important to remember that just throwing a client into something can cause more harm than good, as it can enhance their fear and anxiety, as well as ruin your rapport with them.
    3.
    Lindsay’s primary negative automatic thoughts in response to the panic attack event in the grocery store had to do with her being a failure. She interpreted the outcome of this grocery store visit as a reflection of her own inability to incorporate the cognitive and behavioral techniques Dr. V had taught her. However, Dr. V did reassure her that just getting herself to go to the grocery store in general was evidence enough of her progress. This hope and motivation were not things that she demonstrated before therapy so Dr. V wanted her to recognize all that this experiment really did mean through a therapeutic lens. Thus, she was not a failure, but rather was brave and showing progress just by trying/going through with it. Her response to her associated automatic thoughts and physiological arousal was very interesting when looking back on her behavioral experiment. Her physiological symptoms seemed to start first with her feeling really hot, getting sweaty palms, having a tight chest, and feeling her heart pounding. She then began to look around and became overwhelmed by the thought that other people were noticing her symptoms, which in turn made her feel nauseous. The panic caused her to feel as though the grocery isles where too crowded to escape and wonder who would help her if she had a heart attack and fell down. As a result, she tried to think of strategies but ended up running to the car back to the safety behavior of being with her husband. She feels safe in his company and is comforted by the fact that he knows how to respond to her when she is in this state. However, Dr. V notes that she needs to phase the husband out in these interventions because he is providing short term relief, but is not helping her get better in the long run (as she is not fully confronting this behavior herself).

    Reply

    • Pawel Zawistowski
      Mar 17, 2021 @ 00:19:29

      Cassie,

      Thank you for sharing your behavioral experiment, your reflection was very thoughtful. It can sometimes be emotionally overwhelming and anxiety provoking committing to plans and meeting other’s expectations especially when we have a lot of other commitments and responsibilities in our lives. It is difficult to let someone down and manage your time so that all parts of your life are satisfied. I think it is interesting you point out that you are vocalizing how you truly feel instead of pretending things are normal when you are in distress. I am glad that this approach helped you overcome some of that discomfort.

      Reply

  2. Tayler Weathers
    Mar 16, 2021 @ 16:09:31

    [Core Beliefs] 1. My behavioral experiment was to sit in the anxiety of not doing something. 2. While I was working on it, I initially thought the evidence would be the reaction of others (e.g., getting mad, etc.), but while I was doing other things and not doing that behavior I realized that it wasn’t actually about what other people do/think but how I let that affect me – so the evidence for the old core belief started to not seem so strong. 3. The challenge was mostly just forcing myself to stew in the anxiety without letting it affect other elements of my day (which was the point). Since it was an “Experiment” I thought about it a lot more than I think I normally would have.

    [Behavioral Exposure] 1. Behavioral exposure is very effective for some disorders/types of distress because it functionally “reverses” the maladaptive behavior. As it says in the book, “in order to break the avoidance pattern, clients need to be exposed to what makes them anxious” (p. 260). This reversal happens as a result of using the conditioning principles against the maladaptive behavior: if the expected result no longer happens (e.g., if going to the grocery store doesn’t end in being hauled away in an ambulance), the learned behavior (avoiding the store) can be unlearned. 2. The primary cautions are in how the intervention is implemented: do you include relaxation or meditative techniques? How to avoid creating or reinforcing more safety behaviors? Importantly, the therapist must also consider how to keep the client from having such a negative experience that it ruins the entire process. This all requires careful information gathering and communication with the client, not just “well you’re afraid of snakes! Let’s go to the herpetarium!”

    [Behavioral Exposure] 1. Lindsey’s primary negative automatic thought was fear of the sensations, along with a fear of judgment. She mentioned “my body let me know I needed to get out,” because it seems like she believed the physical sensations more than the logical argument (“this isn’t a heart attack”). She was definitely catastrophizing her physical sensations, thinking she was having a heart attack and that something was wrong. She was sensitive about others’ perceptions/presence. 2. Her response was to just leave the store and see her husband, to just remove herself from the stressor altogether. Lindsey says she felt like she failed. The definite safety behavior was to have her husband in the parking lot, accessible if she needed him – that was good, because she did need him and it did help, but it might make it more difficult for her go into a store by herself or just with her therapist later on.

    Reply

    • Pawel Zawistowski
      Mar 17, 2021 @ 00:02:03

      Tayler,
      I think it is interesting that you point out that Lindsey is catastrophizing. I feel at odds with this claim because I am not sure if that minimizes what Lindsey is experiencing. But also, she is clearly overperceiving the threat in this situation and am not sure what is the appropriate cognitive distortion Lindsey is displaying. How would you explain to a client like Lindsey that she is catastrophizing, which I would imagine will only amplify a panic attack.

      Reply

    • Maya Lopez
      Mar 17, 2021 @ 19:10:07

      Tayler,
      Your behavioral experiment sounded like a great idea for you in that you truly felt distressed and were able to knock at the core belief a bit. I also agree that with the experiment, it makes us more aware of what we are doing, thinking, and feeling, knowing it is indeed an“experiment”. Addressing the next paragraph you wrote, I also wonder how to get clients to see the benefit in decreasing their safety behaviors because if it makes them feel more relaxed, it might be hard for them to see why they should decrease it and could be hesitant to take away their safety. Of course in time, clients will begin to understand that they can in fact keep themselves calm and will not need their past safety behaviors as they learn and implement more coping skills.

      Reply

  3. bibi
    Mar 16, 2021 @ 17:36:05

    [Core Beliefs]
    1. For my behavioral experiment, my goal was to walk down the aisles at Costco without holding onto my boyfriend. I have a lot of anxiety walking down these aisles because of an irrational fear that the shelves will fall and I will have a panic attack and no one will be able to help me.
    2. I think that the behavioral experiment was really helpful. I knew rationally that the shelves weren’t going to fall on me but it helped to be able to walk down the aisles and understand that I was ok. I want to eventually be able to go to Costco without my boyfriend and this was the first step in getting there. I feel like I have to cling to him when I am in the store and this experiment proved that it wasn’t absolutely necessary.
    3. I did have some anxiety at first walking down the aisles. I felt myself stop when I first approached the aisle and was really nervous because I couldn’t stop thinking that I was in danger. However, once I started walking, I started to feel better and realized that I didn’t have to be so scared and that other people walking down the aisles weren’t terrified.

    [Behavioral Exposure]
    1. Avoidance of anxiety provoking situations or escape in the face of anxiety is negatively reinforced. Clients avoid feeling anxious. Exposure therapy helps clients realize that there is nothing to be afraid of in the face of anxiety symptoms which helps change the meaning of the situation.
    2. There are a lot of challenges in implementing exposure therapy. The patient might have difficulty assessing specific aspects of anxious patterns or determining situations that cause anxiety. Additionally, clients might be hesitant to utilize the relaxation techniques or to try in vivo exposure because of a fear of experiencing the anxiety symptoms. Escape and avoidance in anxiety provoking situations is negatively reinforced which makes it a difficult pattern to break.
    [Behavioral Exposure]
    1. The clients primary negative automatic thought was what if I can’t escape if I have a panic attack right here in the middle of the aisle. She was already have anxious physiological symptoms and started to panic that help would be unavailable if she had a full blown panic attack.
    2. She attempted to utilize the behavioral exposure techniques from therapy. However, she was unable to use these techniques. Instead, she left the grocery store and went back to the safety of her husband and car outside the store. This could be considered an escape behavior.

    Reply

    • Beth Martin
      Mar 17, 2021 @ 05:45:35

      Hey Bibi,

      It’s great to hear that you were able to go down the aisles, and that you have set up a gradual modification for your exposure to hit your goals! I can completely sympathize with Costco-related anxiety; I get genuinely panicky when there’s too many people in an aisle, I feel trapped. I may try to employ something similar myself, as it sounds like you made some real progress.

      Thanks for posting!

      Reply

    • Cailee Norton
      Mar 17, 2021 @ 17:19:15

      Bibi,

      I think that you were able to recognize a safety behavior in your experiment of holding onto your boyfriend for comfort from your fears. I think you did an excellent job of pushing past the anxiety of your fear and walking down the aisles without the fear of something going wrong. Your goal of going to Costco without him is also a step for you to work towards, so I’m glad you’re almost planning ahead to move past this completely. I also wanted to mention that I think what your points about implementing exposure therapy are really important. Just because we give education about relaxation techniques does not mean they will be readily accepted nor used in stressful situations. This is a real process from turning those avoidance behaviors into positive experiences, and that can take time depending on the behaviors and the feared stimuli. Great job!

      Reply

    • Lilly Brochu
      Mar 18, 2021 @ 21:06:20

      Hi Bibi,

      Pat yourself on the back! 😊 That is such an accomplishment, and I am so happy that you were able to do that. Instead of turning away and giving into your distress, you were able to push through and conquer the fear. I can relate similarly to you because I get panicky in large crowds and tend to fear the worst to happen even when there is clear evidence that it is not possible. Thank you for sharing your experience!

      Reply

  4. Pawel Zawistowski
    Mar 16, 2021 @ 23:51:53

    Core Beliefs:
    1. My behavioral experiment consisted of giving out instructions in a professional setting to others and having them execute. At times I hold onto the core belief that others do not respect me, and will not follow through of what is asked of them and that will reflect poorly on my leadership. I often feel anxious when I have to take control of a situation and get different tasks accomplished. Additionally, I experience that instead of asking someone else to accomplish a task I will do it myself, which ends up creating further stress because I end up not having enough time to fulfill my own responsibilities. In this behavioral experiment I tried to take control more often and worked on different strategies of explaining expectations and providing more context for the certain things that we need to get done. I believe providing contexts helps the person understand the reason behind their actions instead of acting solely for the purpose that they are being commanded to do something. From repeated exposure to the stressor, I was able to become more experienced, modify my approach, and at certain times felt a bit less stressed. I hope that if I continue to do this the anxiety can subside and not interfere so much.
    2. This experiment was helpful in providing evidence for my new core belief because it showed me that people will follow through when I ask them to execute certain tasks and I have received pretty good results for the most part.
    3. At times I hesitate to take charge because I do not want to come across as bossy or too aggressive. I also do not want to offend anyone or ask for too much. When taking charge of a group it is important to consider how certain people may react and what is the most effective way of getting the message across. I think it is challenging at times because I feel like I am not sure how to approach the situation and it takes me a little bit of time to process the best way to handle it. I have learned that each time I put myself in a situation where I am leading people, I reflect and think of ways I can improve the next time I am in a similar situation.

    Behavioral exposure:
    1. Behavioral exposure is especially an effective treatment for disorders such as anxiety disorders and phobias by repeated and gradual increase in severity of trigger and conditioning the individual that the trigger is not actually harmful.
    2. Some cautions to consider when implementing behavioral exposure interventions is to be careful how the trigger is exposed and not to cause further trauma. Too much exposure of the trigger too soon can cause a great fear response which will negatively reinforce avoidance behaviors and prevent the client from achieving treatment goals and even prevent them from attending therapy in the future.

    Behavioral Exposure
    1. Lindsey’s primary negative automatic thought and possible distortion is that she will experience a panic attack in the middle of a grocery store, that she will be judged by others and embarrassed, and that she will not be able to escape the situation.
    2. Lindsey’s response to her associated automatic thoughts and physiological arousal is that she began to further notice and concentrate on how she felt which led to an avoidance behavior of escaping the grocery store back to her husband for safety reasons. I think this is a perfect example of too much exposure to a trigger, and Lindsey needs to be very careful about such extreme exposure to her triggers and condition herself more gradually. However, I think Lindsey deserves some praise for taking the effort to overcome her fear.

    Reply

    • Beth Martin
      Mar 17, 2021 @ 05:43:01

      Hey Pawel,

      I completely agree with you in that the grocery store exposure may have been just a little too much for Lindsay, but that she definitely tried! It was evident that she was almost ready for this level of exposure, by her trying to engage in techniques to keep her anxiety at bay, but I think having her husband waiting in the carpark hints that she maybe didn’t feel like she’d be fully successful. It also sounds like you had success when it came to your behavioral experiment; I hope it continues to lessen your stress as you continue on with it!

      Thanks for posting!

      Reply

    • Cassandra Miller
      Mar 17, 2021 @ 10:23:16

      Hi Pawel,

      Thank you for sharing the core belief that you sometimes experience as I found some of the reasoning behind why you have it similar to my own core belief. It can be hard to be direct with others, especially when you are asking them to be understanding or to participate in something that is not preferred. I’m happy that you found that by vocalizing these instructions and tasks you found that others do actually respect you and that you were able to lower your own stress. It is often hard to put yourself in a position where you feel like you may be being a burden or an inconvenience on another individual. However, ultimately you are the one suffering in the end, so I really connect to this struggle and am glad you got the results you did!

      Reply

    • Tayler Weathers
      Mar 18, 2021 @ 12:32:32

      Hi Pawel! Thank you so much for your openness on your behavioral experiment. I’m curious, how did the obstacles play out? For me, I thought that looking at the obstacles to my behavior was the most confidence-building piece of it, and I’m wondering if you felt the same! I think clients might like the “plan ahead” feature of the behavioral experiment, though I do wonder if that could end up having a dark side (for example, over-planning everything and not doing well with unexpected derailments).

      Reply

  5. Beth Martin
    Mar 17, 2021 @ 05:39:36

    Core Beliefs

    1) My behavioral experiment was rooted in my perfectionism, that tends to cripple me to a state of simply not doing anything out of fear it won’t be perfect. I’ve been working on the “why”, and I believe it’s linked to a specific core belief I hold. My experiment was to go ahead and engage in something I usually overthink/work too much on, and to use coping skills to deal with the anxiety that resulted from it. I chose a smaller task to start with (one with very few possible poor outcomes); emailing a new colleague. Usually, I mull over the wording, leaving a 3-line email to take me more time than it should, but this time I wrote exactly what I wanted to say, spell-checked, and hit send. I was fairly anxious after, worried I’d come across negatively, but I stopped myself from checking the email and analyzing it. My email was received just fine, with no negative outcomes, so this experiment was helpful in providing evidence for my new core belief. Engaging in a task without spending a ridiculous amount of energy ended just fine, and therefore I do not need to be as concerned about my wording being absolutely perfect. I think this will help in the future, next time I’m hesitant to speak in class etc. – no one is likely to actually care about what I say, at the end of the day, so it doesn’t need to cause me as much anxiety as it does. I did find challenges in sticking to my experiment, as I was definitely anxious and wanted to engage in the self-soothing behaviors (or what I label self-soothing, but actually aren’t) like re-reading the email and guessing how things could be interpreted. But it encouraged me to go ahead and pick up another activity; I’ve started knitting, and found that helpful.

    Behavioral Exposure

    1) I believe that behavioral exposure is highly effective for certain disorders, such as anxiety or phobias, as it often helps an individual with exposure to a particular situation or stimuli in low-risk settings, and then gradually builds up tolerance/coping mechanisms. When it comes to specific phobias, for example, individuals are exposed and are not able to avoid said phobias, and this helps unlearn that behavior. As they are made to confront their trigger, they can start to learn coping mechanisms for anxiety in a safe environment, gradually increasing the level of exposure. Clients are able to get comfortable with each stage of exposure, so they do not feel shocked or startled, and I imagine this helps clients remain in therapy too.
    2) Some cautions that must be taken when employing behavioral exposure. Focusing on whether or not said exposure is reinforcing avoidance or safety behaviors that contribute to maladaptive functioning is important. Furthermore, clinicians need to be extremely mindful of whether or not behavioral exposure is right for their client at the current stage of therapy, taking into account any negative automatic thoughts and core beliefs, and how gradually they can ramp up said exposure. Clinicians also need to be cautious as to whether they are employing the correct relaxation/anxiety-soothing techniques for their client, and make sure that they’re on the same page with them regarding what behavioral exposure can achieve.

    Behavioral Exposure Part 2

    1) Lindsay’s primary negative automatic thought seemed to be centered around her being a failure, as she struggled to use techniques she’d learnt in therapy successfully. This could be tied to a possible cognitive distortion of “all or nothing”, and that if she was unable to use the tips and tricks Dr V. had given her in this one outing, that simply wasn’t able to at all, in a very black and white way of thinking. There was also potential catastrophizing when it came to her assessment of her physical anxiety symptoms, seen in her panicking about what would happen if this was a heart attack and she collapsed.
    2) Lindsay seemed to respond to her negative automatic thoughts by leaving the store, which could be an example of her engaging in a safety behavior. Her husband was waiting for her, and it wasn’t necessarily a bad thing in this particular instance, as she did not seem to be quite ready to put her skills to use. Having her husband in the parking lot in this instance likely brought a lot of comfort, especially when she was feeling like a failure after being unable to employ her strategies/techniques. Dr. V does note that she may need to stop using her husband as a short-term avoidance, which suggests that it’s something she definitely uses as a safety net.

    Reply

    • Cassandra Miller
      Mar 17, 2021 @ 10:33:34

      Hi Beth,

      I found your behavioral experiment to be very interesting. I find overthinking and trying to predict how others will receive ideas/messages to be a struggle that I deal with as well on a day-to-day basis. I found this experiment to be such a good idea because you started small and used a coping strategy of putting that anxious energy into another activity. Thus, you did not overly drain yourself on the first try and experienced a small success to build off of. I’m glad that you found this strategy helpful and that the message that you were concerned about was received well. This over-analyzing behavior can be so exhausting because simple tasks begin to take on so much energy and thus hinder all of the other activities that you are actually able to take on. I may actually try a similar strategy myself, so thanks again for sharing.

      Reply

    • Althea Hermitt- Mcpherson
      Mar 18, 2021 @ 01:07:31

      Hi Beth I can so relate to your behavioral experiment and the root cause since I do get that way at times. I am totally unable to engage in anything deemed important without overthinking and going crazy trying to perfect it. I really appreciate you sharing because I was a bit hesitant in sharing this aspect of myself. So thank you, I will take your advice about speaking in class that no one is likely to actually analyze and ruminate over what I say at the end of the day, so it doesn’t need to cause me any anxiety. These kinds of things will be challenging but relief comes in behavioral exposure and challenging those negative automatic thoughts. Best of luck and by the way you were amazing in your 711 presentation the other night.

      Reply

  6. Connor Belland
    Mar 17, 2021 @ 11:56:33

    My behavioral experiment was to go out and get my haircut and try to talk to at least three people while I was there. I have been confined to just work and my house a lot more lately which has really built up my social anxiety so I thought this would be a good exercise. I just wanted to get out of the house and talk to some new people and some old. I am still not completely sure what my core belief is for this but it is somewhere between fear of embarrassment or fear of the unknown when I am in public. I am usually ale to see different perspective of these thoughts though and rationalize it. I was nervous on the way their and once I got in there and saw the people that were there. While talking to the person cutting my hair though I had time to figure out how I would talk to more people. I ended u being fine and talked to a couple more people while I was there and had very pleasant conversations which reminded me that hey maybe this wasn’t such a bad thing to be nervous about after all.

    [Behavioral Exposure]
    Many types of stress or anxiety only occur or are extenuated by certain settings or situations so it is important to use behavior exposure in some cases. Things can be talked about in therapy but clients learn the best from actually doing in may cases. Exposing the person to the behavior will also give the therapist a better idea of the problems presenting in the client and can maybe begin to challenge these behaviors so that the client can work through them. The clinician has to be careful as to not expose the client to too much to quick or trigger them before they are ready to use their coping tools. The clinician needs to make sure the client is prepared for the exposure and may need to take gradual steps before exposing them all the way.
    [Behavioral Exposure]
    The main thought that was worrying the client was that she was having panic symptoms and she couldn’t escape it and thought she might have a heart attack and no one would be there to help her. She thought she could handle going into the grocery store alone but she wasn’t sure if she was totally ready for it and she wasn’t. She proceeded to exit the grocery store immediately and seek her husband in the car which brought her reassurance. She was ambitious and made great progress facing this fear but she needs a little bit more time before completing such a daunting task.

    Reply

    • Maya Lopez
      Mar 17, 2021 @ 18:59:16

      Connor,
      That was a fantastic idea for a behavioral experiment, It sounded like it went really well and you got a lot out of it. It’s great you are able to try to think critically about your own core beliefs even if just to speculate. I also agree that it is important to make sure the client is prepared for the exposure and is moderately overwhelmed but can still use the coping skills they learned in therapy. It is also, as you mentioned, a great way for the therapist to see how the client is progressing and to see how they can implement the skills they learned in the distressing moment.

      Reply

    • Tayler Weathers
      Mar 18, 2021 @ 12:32:17

      Hi Connor! I think your emphasis on the situation-dependent elements of stress or anxiety is spot on. Exposure works because it is so context dependent. I wonder, how would it work for an anxiety disorder like GAD, where there might not be a specific situation or location that triggers it, but situations in general?

      Reply

    • Lilly Brochu
      Mar 18, 2021 @ 21:29:08

      Hi Connor,

      It seemed like it went well, and that it was a beneficial experience that was much needed since you have not had many social interactions recently. Similarly, I had found that before I had my job right now, it was more difficult for me to socialize when I was cooped up in the house because of COVID-19. Taking small steps here on out will make a difference. Thank you for sharing your experience! 😊

      Reply

    • Laura Wheeler
      Apr 15, 2021 @ 23:03:18

      Hi Connor! Your experiment is one that I could definitely stand to try as well. Something about talking to strangers in public makes me so uncomfortable- as a matter of fact, many of the people closest to me are extremely outgoing and will talk to anyone, anywhere, and even witnessing that gives me second-hand uncomfortable feelings. I am pleased to know that it went well though, and I think you probably had the right idea to start with the barber since that is a pretty natural scenario for a conversation to get started. Hopefully as the world continues to open up these things will get more comfortable!

      Reply

  7. Christina DeMalia
    Mar 17, 2021 @ 14:17:31

    [Core Beliefs] (1) What was your behavioral experiment (only share what you are comfortable with)?
    I had previously identified a core belief centering around the idea that if I were to stop constantly helping people (family/friends) they would no longer like me. I’ve always been genuinely happy to help people in any way I can, but I have definitely let it reach the point of people pleasing. I often will put the needs of others far above my own needs and will constantly offer my friends and family help and support, putting them as a priority. Because I have always done this, I have formed the negative thought that maybe it is only my constant helping people that makes them want to keep me around. This seemed difficult to test at first because I’m definitely not at a point where I could imagine a friend or family asking me for help, and me turning them down. So instead I focused on the core belief of “ No one will like me unless I always put their needs above my own.” I tested this by waiting for a time when what I wanted was different from what my friends wanted, and putting my own wants first.
    Usually, whenever there is a disagreement or difference in opinion, I cave to the other side to avoid anyone being stuck with a difficult decision or having to debate over it. I do this to the extent that my friends rarely ever know if I disagree with something, and likely think I’m just always in agreement with them all of the time. However, I was planning a trip with a couple of close friends, and I disagreed with their choice for renting an Airbnb. They had picked a place that had bad reviews about the house being old, dirty, constantly losing power, none of the appliances working, and only pull out couches to sleep on. I had found a place that was much nicer and met our needs, and was only $10 more a person. I knew they were pushing for that option because it was the less expensive one, so I was really nervous to bring up that I didn’t agree with the decision. In fact, I agreed to the house they picked for an entire 24 hours. Then I thought about how we would tell a client to just give it a shot, so I messaged them again. I explained that I was concerned that our friend, who we were surprising with this trip for her birthday, would be disappointed if the place was run down. I also explained that I would feel much more comfortable spending the extra $10 to have a much nicer place where everyone would have a bed to sleep in and where the reviews were much higher.

    (2) In what ways was this behavioral experiment helpful in providing “evidence” for your new core belief?
    In a way, this behavioral experiment was helpful because it gave me the push I needed to put myself first. Even though it might seem like a small task to voice my opinion, it is something I would usually never do. The fact that my friends response was simply to say that was fine and they didn’t mind going with the place I suggested instead helped me to de-catastrophize and realize that people wouldn’t stop being my friends just because I wanted to take my own wants and needs into consideration. It supported the new core belief that “my friends and family will still like me, even if I put myself first.”

    (3) What challenges did you encounter?
    One challenge to this was definitely my fear of my friends reaction to me disagreeing. I felt like they might be annoyed that I was being disagreeable and couldn’t just be okay with the other option. Even though they sounded completely fine with the idea of switching houses, I still had and have a lot of anxiety that they are actually annoyed that I asked to change it and will think that I was being too picky. This led to me failing at the experiment at first, until I revisited it and tried again the next day. Another challenge I saw, not in the execution but in the thoughts and feelings moving forward was how little this experiment helped to shift my core belief. I found myself thinking “Well they let it slide this time because it is such a rare occurrence for me. But if I became the person who started putting my own needs first or who stopped helping everyone else all the time, my friends and family may still not like me because of it.” This was useful, however, in helping me to realize why repeated behavioral experiments could be useful for modifying negative core beliefs.

    [Behavioral Exposure] (1) Why is behavioral exposure very effective for certain disorders/types of distress?
    Behavioral exposure can be so effective for people with anxiety disorders and panic attacks because it helps to build evidence against the negative automatic thoughts they are having surrounding the situations. If a person catastrophizes something and believes it will have a terrible result, it is understandable they will avoid it. However, if they always avoid it they will never be able to build up evidence against those thoughts. By slowly facing those situations with necessary coping skills in place, the person can experience their fears and realize that the worst case scenario they imagined didn’t happen. As this is repeated, it allows them to alter their belief about what the outcome of their feared situations will be.

    (2) What are some cautions to consider when implementing behavioral exposure interventions?
    Doing too much too quickly can definitely be problematic in behavioral exposure interventions. As we saw with Lindsey, if a person is pushed too far past their comfort zone, they could end up engaging in safety behaviors to eliminate their anxiety short term, while reinforcing more issues in the long term. Therapists should make sure the client has been thoroughly prepared for behavioral exposure exercises by going through psychoeducation on the different elements involved, and teaching some breathing or relaxation exercises the clients can use as a way to cope with the distress. Another thing to be cautious about is having the behavioral exposure be too small. A newer therapist may be worried about pushing their client too far. However, if the activity does not push the client far enough out of their comfort zone, it is unlikely that the exposure will be significant enough to make a change to something so deeply engrained.

    [Behavioral Exposure] (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?
    The client truly believed her automatic thoughts that she felt like she was going to have a heart attack, that she would likely have a panic attack in the store and others might see or judge her for it, and that her body was telling her that she had to get out of there.

    (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?
    Because she so strongly believed in these thoughts, she immediately wanted to engage in some of her safety behaviors. Leaving to avoid the arousal, such as when she has left class, is a common safety behavior of hers. It is also identified that rushing to her husband for emotional support is a safety behavior of hers as well. Because she immediately left the grocery store, went to her husband in the car, and drove home, her anxiety was reduced as a result. However, she also further reinforced the behaviors and thoughts connected to her anxiety.

    Reply

    • Cailee Norton
      Mar 17, 2021 @ 17:09:01

      Christina,

      It sounds like you made real progress in beginning to modify this core belief. I can sympathize as well with ideas of people pleasing, and I’m impressed at how you have tackled this belief! I think that your example of pushing an opposite position than your friends is one we can all relate to, especially in wishing not to cause a disturbance or upset others. Often (as your experiment turned out) it’s fine and people aren’t too concerned about it. I’m also one for catastrophizing situations, and unfortunately the very very few instances of those circumstances being worse than expected somehow solidified that core belief for the future. I think your experiment was a great way to begin the process of breaking such a wall down. Frankly, you made the right call $10 a head is worth the comfort and cleanliness in an Airbnb. Great job!

      Reply

  8. Cailee Norton
    Mar 17, 2021 @ 17:02:44

    Core Beliefs
    1. I worked on pushing myself to be more communicative towards my friends and really putting myself out there. With COVID it’s become impossible to really interact with friends and family besides virtually, and sometimes this can be really discouraging and for some people in similar experiments could lead to further withdrawing from friends and family. I wanted to show myself that I can still make those connections and build upon them. My core belief is something that will need continuous work, but I definitely see the benefit of working on these types of experiments to provide myself the evidence against them as well as building upon positive experiences.
    2. For me it really showed the distorted thinking that I have in regards to my core belief and how this can shape how I interact with others (or whether I withdraw). By pushing myself with my activities and seeing the best case scenario really play out I’m providing a basis for evidence to fight against the negative automatic thoughts that stem from my core beliefs. I think we often don’t challenge these thoughts, and that’s what I love this experiment does and how it provides the evidence both for and against the new core belief. This allows for some still negative possibilities (that may be entirely possible depending on the NAT) while providing evidence that really amplifies whatever it is your new core belief is.
    3. Some challenges I encountered were finding the right space to do my experiment as well as motivation. With COVID it is so limiting in finding new and exciting opportunities, which only inhibits motivation to go through with things sometimes. However I feel that I acknowledged this being true but really pushed through anyway and what resulted was a positive experience. The experiment for me was a success, and I want to continue to build off of that by continuing to experiment and push myself. Ultimately this mind frame is what we want for our clients, and this is what really begins to modify such rigid core beliefs.

    Behavioral Exposure 1
    1. I think that behavioral exposure can be really effective for certain disorders and types of distress because it’s pushing the individuals into facing what their fears are. Often our fears are either catastrophized through automatic thoughts, the risk of the stimulus is maximized, and we minimize our abilities to cope with it. This pattern of thinking and behavior results in the ultimate avoidance of the feared object/situation that’s causing us such distress and therefore reinforces the fear and arousal we get, creating a cycle of fear, avoidance, reinforcement. Some people even rely on safety mechanisms to deal with their fears or anxieties, so exposing clients to their fears takes away that safety and allows for the client to experience the situation entirely and see their conceptualization of it wasn’t exactly accurate. For a phobia like snakes, we are able to expose the individual to the stimulus through various methods, allowing for clinicians to guide clients through the experience and realize that they were catastrophizing the situation, and the risk that is really present in the situation isn’t really the absolute maximum, and we do have the ability to deal with the feared object if taught proper coping techniques.
    2. I would say that two cautions for implementing behavioral exposure in interventions is to be sure to have a strong therapeutic alliance. Going through with a behavioral exposure can be really difficult, and if the alliance is very new or doesn’t have the proper foundation for building up to such a challenge, this can cause the relationship to falter. Trust is very important with your client when they’re facing their fears because they have such strong reactions (emotionally, cognitively, and physiologically) to their stimulus. Another important point to mention is to ensure that your client has a few different relaxation techniques to do self-care both in therapy sessions but especially outside of therapy sessions. You’ll be assigning some of these things to be done on their own, and providing them all of the tools to succeed allows for our clients to be set up for success. If you don’t provide your client with some tools to calm themselves down, if they were to encounter the stimulus outside of the therapy session they may not be successful in exposing themselves to the experience and thus regress back into those anxieties.

    Behavioral Exposure 2
    1. After watching the video, the client’s primary negative automatic thought in response to the event was that she was a failure and that she was silly (almost letting on to her embarrassment of the ordeal especially in mentioning that others took notice of her struggling in the store itself). Ultimately she viewed the experience at the grocery store as a failure, instead of looking at it as you pointed out as a big step and a positive one in the direction of going to the store, completing the shopping, and going home. Instead her thoughts immediately go to how she was unable to complete the task (no matter how monumental it is). The physical symptoms also brought on feelings of judgment from those around her, but her primary negative automatic thought after the fact is her inability to complete a grocery trip.
    2. Her response to the thought was to go back to the car where her husband was waiting for her. I would definitely say that her husband going with her and just waiting in the car was a big safety behavior for her. She was able to leave the anxiety provoking situation and to go to the safety of her husband being there for her. It would have been a very different experience if this safety behavior was taken away and she was on her own taking on this task. Her response to the anxiety could have been much different had she not had that safety net in place. I would say that she did have a great response in leaving the situation, not going to the hospital, but instead going home and filling out the homework to talk about the situation in session with her clinician. This behavior while still needing the guidance of the clinician shows great progress in that: she didn’t go to the hospital (which seems to be her immediate reaction due to her strong physiological responses and panic symptoms), she instead attempted to reflect on the situation and how she felt about it and really process it. This may not be an autonomous step, but I think it shows the client moving in that direction.

    Reply

    • Anne Marie
      Mar 17, 2021 @ 22:15:23

      Cailee, Good for you for challenging yourself! I thought your blog made some great points about how easily fears can turn into catastrophizing thinking. Also, how people often use a safety mechanism to cope. I believe this can also become a crutch that needs to be slowly withdrawn in order for progress to be made. I had thought about the importance of rapport but neglected to include it in my response. I think you did a nice job recognizing how essential a trusting therapeutic alliance is in order to do this work.

      Reply

  9. Maya Lopez
    Mar 17, 2021 @ 17:54:01

    (1) What was your behavioral experiment (only share what you are comfortable with)?

    My behavioral experiment involved me trying to come to terms with my fear of death and lack of control over the situation. By forcing myself to watch death in animal shows, which I normally avoid doing, I saw over time it was all due to the circle of life and became easier to come to terms with. At first, my hands were sweating, I turned my head away, yelled out, and my heart rate increased as I got more and more worried about the impending doom. The behavior I was trying to change was not looking away or closing my eyes. Although this is sort of more of a behavioral exposure, it was the only thing I could come up with.

    (2) In what ways was this behavioral experiment helpful in providing “evidence” for your new core belief?

    I don’t believe my experiment contributed to any evidence for or against my core belief, as I said, I couldn’t think of an experiment to try so this was the best I could do.

    (3) What challenges did you encounter?

    Some challenges I faced were keeping my eyes on the screen and not looking at my phone, or turning away completely, another challenge was to not get too emotional because I have a real soft spot for animals getting killed on animal planet.

    (1) Why is behavioral exposure very effective for certain disorders/types of distress?

    Behavioral exposure seems very effective for anxiety disorders that prolong the avoidance of a feared experience or stimulus so by “forcing” a client to face said feared situation and begin to try to cope with the stress you are breaking the cycle that reinforces the avoidance and this is what needs to happen to decrease the fear and show the client they can actually do what they are scared of. This technique is very specific to those fear/ avoidant disordered thinking.

    (2) What are some cautions to consider when implementing behavioral exposure interventions?

    Some things to be wary of when doing behavioral exposure are to make sure the client knows your goal is to help them through the experience and not torture them, the therapeutic relationship must be strong enough, and most importantly to be cautious the experience does end on a less distressed rating so the experience does is not seen as contributing to the reinforcement of fear of the place, therapist, or experience of coping/ therapeutic techniques. It does seem very distressing for clients to be pushed to think more about how they are feeling and put their thoughts into words but if they leave when they are at their highest point of distress, it will reinforce the fear of the place and they may think they are correct to be scared of said experience or stimulus.

    (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?

    Her main automatic thought was that she was going to have a panic attack and everyone would see it. She also mentioned how crowded it felt and the anxiety coming from others perceiving her.

    (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?

    The client reported feeling a tightness in her chest, sweaty palms, and racing heart rate, she mentioned leaving and seeing her husband as a safety behavior and she did attempt to think rationally and remember what she discussed in therapy but her body did not believe it.

    Reply

    • Althea Hermitt- Mcpherson
      Mar 18, 2021 @ 01:21:40

      Hi Maya, I do agree with you that Lindsay’s main automatic thought was that she was going to have a panic attack and everyone would see it. She also had thoughts of losing control and not being able to escape due to the number of people in the aisle. Lindsay was also experiencing a catastrophizing cognitive distortion where she felt like everything was going to lead to an impending doom because she tends to assume the worst. I like that you spoke about Lindsays’ attempt to rationalize her feeling by thinking back to her conversations with DR. V in session to try to calm her physiological arousal. I’m also very impressed with the way DR.V was able to take a bad situation which could intensify or reinforce her negative automatic thoughts about the grocery store and turn it into a positive and a good start for Lindsay. When you say her body didn’t believe it, this just goes to show that our mind even though powerful our physiological arousal and sensation can be equally powerful.

      Reply

    • Abby Robinson
      Mar 18, 2021 @ 10:47:13

      Hi Maya,
      I really liked that in your description of cautions to be aware of during exposure is that your client should be well aware of the goal during the exposure and that this technique is to help them, not make them feel worse. This is a good thing to talk about before the actual exposure because if they didn’t realize the outcome will bring success, they may feel that the therapist is making them feel worse and they may feel defeated. Psycho-education helps the client realize that the therapist does certain techniques to help the client, even if it doesn’t seem that way to them at first.
      See you in class!

      Reply

  10. Brianna Walls
    Mar 17, 2021 @ 20:33:43

    Core Beliefs
    1. My behavioral experiment was to go out in public wearing a shirt that was tightfitting. I typically wear sweatshirts and baggy shirts to cover myself up because I do not like the way I look, specifically I do not like how much I weigh. So, I stepped out of my comfort zone and I went to dinner with my boyfriend. I wore jeans and a tightfitting shirt that showed the figure of my body/stomach. I was super uncomfortable the whole dinner but I got through it.
    2. My core belief was “I am overweight and I don’t look good in fitted clothes.” My new core belief is “I may be overweight and uncomfortable wearing tight fitted clothes but this is something I can change and it is not permeant.” This behavioral experiment was helpful in providing evidence for this new core belief because I was able to wear tight fitted clothes in public, even though I felt uncomfortable I was still able to get through the night because in the back of my head I thought of my new core belief and how I can change my weight. Also, I realized that no one cared that I was wearing tight-fitted clothes, no one came up to me and told me I looked bad in them, I actually got a compliment from my boyfriend.
    3. I experienced a few challenges, one is trying to find an outfit to wear. I was very indecisive and was super cautious not to wear anything too “eye-catching,” After I finally found something to wear I was very anxious to get in the car and leave the house. My boyfriend encouraged me and reassured me that everything would be okay and my anxiety went down a little. Also during dinner, I found myself trying to cover up myself with my jacket, even though I wasn’t cold.
    Behavioral Exposure
    1. Behavioral exposure is very effective for certain disorders/types of distress for a few reasons. One reason is that for individuals with anxiety and/or phobias behavioral exposure allows the individual to be exposed to a certain stimuli/situation. The individual isn’t thrown into a certain situation right away but rather they are gradually exposed. For instance, they will start off by confronting their anxiety/fear, they will then move towards creating a hierarchy of their feared situations, the individual will then move towards imaginal exposure where they will just imagine their feared situation or stimuli, and lastly, they will move towards Vivo exposure where the individual will confront their most feared situations. As they move through these stages they can start to learn coping mechanisms for their anxiety all while gradually increasing the level of exposure.
    2. Some cautions to consider when implementing behavioral exposure interventions are making sure you “push” your clients to the point that they are feeling challenged and they feel like they are becoming successful but you as the therapist want to make sure you aren’t pushing them too much. You don’t want your client to feel frustrated and feel like a failure. Also, the therapist should not be present too much during Vivo exposure because they may end up being a safety behavior. It is important that the therapist uses their own clinical judgment in deciding when to and when not to be present.
    1. I believe Lindsey’s primary negative automatic thought in response to her having a panic attack at the grocery store was that she had failed herself. She told Dr. V that this panic attack was unexpected, she was so sure that she wasn’t going to have one while at the grocery store by herself. She also mentioned to Dr. V that she had failed to use the techniques Dr. V had taught her during therapy which she seemed very disappointed about.
    2. The client’s response to her associated automatic thoughts and physiological arousal was to leave the store and head back to the car to see her husband. However, this further reinforced the behaviors and thoughts connected to her anxiety. In the future, her husband should not go to the grocery store and wait for her in the car because she uses him as a safety behavior. This was a good start to her Vivo exposure.

    Reply

    • Anne Marie
      Mar 17, 2021 @ 22:09:02

      I thought you had some good points about the importance of gradual exposure of behavioral activation. I think it was smart to mention the importance of using imagery to start and building up to in vivo experiences. I agree that is a balance to challenge a client while also being supportive and not overwhelming them with too much too fast.

      Reply

  11. Anne Marie
    Mar 17, 2021 @ 22:02:41

    My behavioral experiment was to complete a task before moving on to another task. It was more challenging than I anticipated. It prompted me to explore what core belief is maintaining this behavior. In predicting problems/obstacles I was able to be proactive in meeting my goal. For example, I recognized that I often get bored with an activity. Yet, using music as an accommodation helped me overcome that. I also frequently get interrupted while attempting to complete a task. Therefore, I set more realistic time frames on how long I could attend to something. I also recognized that I set unrealistic goals for any given day. I needed to reappraise my expectations to better reflect a more realistic view. I also need to give myself more positive praise for what has been accomplished versus only focusing on what still needs to get done. I found it difficult to meet the goal, as I have been half finishing tasks for a long time and it has become habitual. It takes effort to become mindful or cognisant to behaviors and act with intention. I believe it will take time and practice to have this new behavior feel less foreign.

    Action is essential for change to occur. This is why behavioral exposure is essential and effective for certain disorders, especially anxiety. Thinking, feeling, and acting are reciprocal and intertwined. However, when clients engage in adaptive behaviors more frequently they are able to activate more adaptive thinking and feelings as a result. It also allows them to know what steps to take to become more independent in reaching and maintaining their goals. Clients should be aware that they are not seeking out an unattainable goal of happiness but instead that life is full of challenges. They will certainly face them and it is only through accepting that fact and learning to think about circumstances in a flexible manner that long term change can occur. However, if this is done too quickly it can not have the intended effects.

    Lindsay’s primary negative automatic thought or possible cognitive distortion was that she “couldn’t escape”, or “couldn’t get out”. She stated that she felt that she was “losing control” and began to think of the threat of having a heart attack and not being able to access help. She was creating a sense of danger or threat where there wasn’t one which triggered the physiological sympathetic response (ex. rapid heart beat). Her initial response was to intellectualize her emotions but the physiological response was too intense for her to be able to cognitively reason her way out of it. Therefore, she escaped the cause of her distress (the grocery store).

    Reply

    • Yen Pham
      Mar 18, 2021 @ 06:09:11

      Hi Anne,
      Thank you for your posting!
      I like the points that you made in the process of changing your old beliefs. You have a belief that you frequently get interrupted while attempting to complete a task. I agree with you time and more practice is a good way to help us have a new core belief. I am glad that you find some ways that help you to challenge your old beliefs like listening to music and making positive self-praise for what you have been accomplished. My hope is that you will soon achieve your goal.

      Reply

    • Connor Belland
      Mar 18, 2021 @ 08:32:30

      Hi Anne Marie,
      I really like what you did for your behavioral experiment. I often find myself not completing activities or getting distracted as well. Setting daily expectations are always hard to be accurate because you can never predict exactly what’s going to happen on a given day, but I commend you for trying. I find it very hard to break habits like that, but making gradual changes and praising yourself more for completing them like you said, can be very helpful when trying to modify a unwanted behavior.

      Reply

    • Abby Robinson
      Mar 18, 2021 @ 10:42:10

      Hi Anne Marie!
      I think that it’s so important you brought up that behavioral exposures can help make a client become more independent. I think that this is important to note because the overall goal through-out CBT is so that the client becomes more autonomous and needs their therapist less and less and eventually not at all. Doing gradual exposure helps the client think about their goals in attainable ways that will be challenging but will also set them up for success in the future when they are faced with a challenge on their own.
      See you in class!

      Reply

    • Laura Wheeler
      Apr 15, 2021 @ 23:08:57

      Hi Anne Marie! I love what you tried for the experiment- I am definitely going to challenge myself to do the same thing. In regard to work and homework I VERY often start an important task, then get distracted by something that feels either equally or more important, and then the original task gets pushed to the side (sometimes even pushed to the bottom of the pile) which ultimately results in two projects not getting completed and more stress added to the situation. I know that one completed task is always better than two half-completed tasks, but it can be a real challenge. I like how you incorporated music to try and keep yourself on track, great idea!

      Reply

  12. Michelle McClure
    Mar 17, 2021 @ 22:37:02

    Core Beliefs
    My behavioral experiment was trying not to filter what I say to people to make what I say more pleasing to them or more of what they want to hear. I have been trying for years to overcome my habit of people pleasing. I decided to try just expressing myself honestly and I tried not to filter what I said. This behavioral experiment was helpful and did go well. After a lot of effort I decided that my negative core belief was that I was unlovable unless I was perfect, my new core belief that I am working toward is that no one is perfect and I can be imperfectly me and still be loved. I surprised a few people who are not used to me being so expressive, but to my surprise even though I know I did and said several things that people in my life would not be thrilled with, no one left me and it even lead to some good discussions. The challenge was it was hard to do at first, I saw that the person I was talking to was unhappy with what I was saying and I had to fight the urge to stop the experiment and let him off the hook, but I did not and I dealt with the discomfort of knowing he was not happy but I did not back down and eventually he was fine. In another instance I allowed myself to have a strong emotional reaction to something that I would normally have internalized and dealt with myself. The look of shock on my partner’s face was almost comical, but he did not leave me and it lead to a great conversation. It is really hard to change deeply ingrained beliefs and behaviors, even understanding how maladaptive they are in the long term to my relationships, because in the short term they seem to make everything run smoothly but at the expense of genuine relating and intimacy. Conflict takes me out of my comfort zone and I usually choose to avoid conflict to give myself a false sense of safety but I have realized it is just that a false sense of safety. I imagine if I struggled as hard as I have with core beliefs even with all my background and knowledge that clients that do not have a psychological based background would struggle just as much if not more first trying to find the core beliefs and then trying to change their core beliefs and their behaviors to match.

    Behavioral Exposure
    1. Behavioral exposure is very effective for disorders that involve anxious and fearful patterns, from phobias to anxious distress in certain situation. The idea is that by slowly exposing a client to situations and stimuli that produce various amounts of psychological distress that they start to cope with the distressing situation instead of avoiding it and over time have less and less of an anxious reaction to previously distressing stimuli.
    2. When using behavioral exposure with a client it is important to watch for “safety behaviors” which are more maladaptive coping strategies, including avoidance tactics, sometimes well-meaning friends and family can unintentionally increase anxious thoughts and behavioral reactions by reinforcing the client’s avoidance of the aversive stimuli. Safety behaviors can interfere with behavioral exposure effectiveness and it is good practice to become knowledgeable of your client’s maladaptive and adaptive coping skills and how their coping skills will affect the behavioral exposure.
    Behavioral Exposure
    1. Lindsey’s primary automatic thought seemed to be around losing control and that she could not escape. Lindsey was also seemed to be worried she was having a heart attack. Lindsey panic attack continued to get worse until she fled the store to the safety of her husband who was waiting in the car.
    2. 2. Lindsey response to her physiological arousal in the food store by leaving the store and running out to her husband who was waiting in the car. Lindsey talked about her husband like he was a safety person, safety net, coping skill, maybe all of the above and she seems to get some reinforcement from the comfort she feels with her husband, the feeling that everything is going to be ok. Lindsey seems to use her husband’s emotional support as a safety behavior and even though that is wonderful that she has a positive relationship with her husband, but that can affect her treatment and behavioral exposure attempts.

    Reply

    • Yen Pham
      Mar 18, 2021 @ 05:45:05

      Hi Michelle,
      Thanks for your posting!
      I’m interested in how you mention the reasons and considerations that we should take when using behavioral exposure. Like you I find this approach to be effective for clients with disorders and distress because it offers the client an opportunity to face these disorders directly rather than by avoiding them. This exposure over time will help clients control their thoughts and actions. They will suffer less and live happier. I also agree with you, clinicians should ensure the safety of clients when consider do not put them to act when they are not ready for that. However, I also think that it is necessary to train clinicians well before using this therapy because otherwise it will be harmful to clients in some way.

      Reply

  13. Althea Hermitt- Mcpherson
    Mar 18, 2021 @ 00:46:23

    Watch MDD-18: Core Beliefs – Modifying 3 – Behavioral Experiment. Practice a Behavioral Experiment on yourself. Answer the following: (1) What was your behavioral experiment (only share what you are comfortable with)? (2) In what ways was this behavioral experiment helpful in providing “evidence” for your new core belief? (3) What challenges did you encounter?

    The old core belief was rooted in the area of competence. So my behavioral experiment involved completing a presentation without feeling nervous or freaking out about it due to the anxiety associated with people realizing I’m a nervous mess or the presentation not being good enough. The behavioral experiment was helpful as it provided a lot of positive evidence for my new core belief that I am competent. This is a work in progress, the presentation went well so that gave some positive feedback to the new core belief. I also utilized a few coping skills that were helpful. The major challenge I encountered was ruminating about the content of the presentation and every possible situation that could go wrong. The overall challenge was that I wasn’t able to do anything else until it was over and done with. So I spent days working to perfect it even though it was fine. My thoughts and feelings moving forward are that social anxiety and physiological arousals can be seen as a form of anticipatory excitement for doing a great job and not pending doom.

    [Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter). For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress? (2) What are some cautions to consider when implementing behavioral exposure interventions?
    (1) Why is behavioral exposure very effective for certain disorders/types of distress?
    Behavioral exposure is very effective for treating anxiety disorders such as (GAD, PTSD, Social anxiety disorder, OCD, Panic disorder, and specific phobias. Fear and anxiety can cause a lot of distress in individuals. Therefore individuals avoid sources of distress to decrease physiological arousal which reduces their anxiety and allows them to feel safe. This continuous cycle of avoidance generally works in the moment however it does cause debilitating effects in the long run as the individual does not learn to use adaptive coping skills to manage their fear and anxiety. So behavioral exposure is a great tool to use as it exposes the client to the fear and anxiety-provoking object, situation, or event which will help to decrease the cycle of avoidance. This will allow the client to function optimally.

    (2) What are some cautions to consider when implementing behavioral exposure interventions?
    The biggest caution is to ensure that the therapist teaches relaxation techniques, modification of fear or anxiety-related automatic thoughts, engagement in graded exposure( in vivo, imaginary) to build up the client to eventual engagement in direct exposure. Therefore direct exposure too soon can lead to unintentional reinforcement of the feared and anxiety situation. Another caution is moving too fast too soon, ensure and assess for client’s readiness. It is important to remember that avoidance has been working for these individuals for a long time so relearning how to navigate a feared and anxious situation will also take time. Hence gradual exposure is key because too much exposure can be too intense for the client which can be detrimental.

    [Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns. Answer the following: (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event? (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?

    1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event?
    While in the grocery store Lindsay’s negative automatic thoughts were losing control, needing to escape, and having a heart attack. Based on these thoughts and the feelings that Lindsay explained heart racing, tightness in the chest, sweaty palms, feeling hot it is safe to say that Lindsay was experiencing a cognitive distortion known as catastrophizing where her distorted type of thinking leads her to have feelings of dread and assume the worst will happen when face with feared situations. Ordinary worries like too many people in this aisle, quickly escalate for Lindsay causing her to run out of the grocery store.

    (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?
    Lindsay allowed her automatic thought to take over her arousal state. Lindsay’s automatic thoughts resulted in numerous physiological arousal such as heart racing, tightness in the chest, sweaty palms, feeling hot, choking sensations, nausea, and a feeling of dread that people are noticing her symptoms. Her ultimate response to her automatic thought was running away or escaping. I think that her taking her husband with her to the grocery store was a safety behavior and the fact that she started to feel better once she got out of the store and saw her husband solidified that.

    Reply

    • Connor Belland
      Mar 18, 2021 @ 09:51:40

      Hi Althea,
      Your Behavioral experiment was definitely a tough one to do but good for you to try and not be anxious about a presentation. I think its important you give yourself more credit for completing projects and try to be more confident in your skills! I agree with you that clinicians have to be very careful with behavioral exposure and make sure their client has been properly prepared and taken gradual steps before throwing them into an environment that causes them stress so that they dont have a bad reaction or panic attack.

      Reply

  14. Yen Pham
    Mar 18, 2021 @ 05:27:15

    [Core Beliefs]

    My behavioral experiment was to call my parents and shared with them my challenges of studying abroad. I was happy because I have done it last week. I have a core beliefs that whenever I was sad or got worries in life. I did not want my parent worry about me, so I tried to hide my true emotions. I believe that as an adult I must responsible for my life. I did not want to be a burden for my parents. This behavioral experiment was helpful for me because I begin to change my behaviors, I also notice that my original negative core belief continue to weaken while my new core beliefs strengthen. This result is in a continually reinforcing process for my new/adaptive cognitive and behavioral processes. I found a new core beliefs that I would not be less self-esteem and I did not make my parent worry if I shared with them my life’s anxious because my parent feel they are important in my life and so do I. They were happy because I shared with them my true feelings. However, before did this behavioral experiment I was tempted not to tell my parents my anxious. My core beliefs reminded me not to make mom worry, and just have fun talking with them. But it’s good that I finally decided to share my anxious with my parents. They did not worry too much as I imagined, they encouraged me and made me laugh by their sense of humor.

    [Behavioral Exposure] Volungis –Chapter 1

    1.Behavioral exposure very effective for certain disorders/types of distress because of its effectiveness such as it reduced sensitivity to previously distressing situations. It decreased fear of associations with the stimuli as well as increased ability to tolerate fear. It helped to recognizing one’s power to overcome challenges. It improved functioning, social skills, and mental stability. In particular, people with PTDS, the behavioral exposure is considered a behavioral treatment .This therapy works by helping clients approach trauma-related thoughts, feelings, and situations that they have been avoiding due to the distress they cause. Repeated exposure to these thoughts, feelings, and situations helps reduce the power they have to cause distress. In addition, behavioral exposure can be an effective treatment for anxiety disorders; clients will have exposure to a situation or stimulus that triggers feelings of fear or panic for them. Over time, controlled exposure to these fears in a safe space can help reduce their feelings of anxiety and distress.

    2. There are some cautions to consider when implementing behavioral exposure interventions. According to the available evidence, exposure is not inherently harmful. Exposure-based treatments are arguably the most efficacious and successful psychological treatments for anxiety disorders. Although exposure is safe, it may in fact place patients at more risk compared to traditional talk therapies if clinicians lack of training and supervision in exposure techniques. They are little confidence or trust in administering exposure and minimal knowledge in understanding the mechanisms of change involved in implementing exposure based therapies. Thus, training well before using this intervention is important thing. In addition, clinicians should realize the amount and what kinds of behavioral exposure will be the best for clients. Avoiding to put clients to do a variety of “uncomfortable” exercises when they are not ready for that. At this point, I think clinicians should build up a good relationship with clients first, then guiding them and do the behavioral exposure.

    [Behavioral Exposure] Volungis-Chapter 9

    1. In the case of Lindsey, I think her primary negative automatic thought was having the feelings of choking and then just felt like she was losing control. She thought that “what happens if I have a heart attack right there in the middle of the aisle? How am I going to get help and those people were there”. She thought that she needed to get out the grocery so she would be fine.

    2. Lindsey’s response to her associated automatic thoughts and physiological arousal was. She like ran to the parking lot and as soon as she saw her husband sitting in the car. She started to feel way more relieved and ready to go home. She just needed to get away from the grocery and back home. She was relaxed and calm at home.

    Reply

    • Christina DeMalia
      Mar 19, 2021 @ 12:44:17

      Hi Yen,

      It sounds like this process worked really well for you! I completely understand how it can be difficult to feel like a burden, and to want to avoid worrying anyone else. It is easy to get stuck on the idea that once you’re an adult you shouldn’t need help and you should be able to do things on your own. However, as you realized with this experiment, there is nothing wrong with reaching out to family for help. I’m sure they love to hear from you and are happy to be a support system. I think it is so interesting how through these experiments we are able to notice and change things about ourselves we might not otherwise have thought to do. It really is helpful in understanding how our clients will feel.

      Reply

  15. Abby Robinson
    Mar 18, 2021 @ 10:37:04

    [Core Beliefs]
    1. My behavioral experiment was to work on going to sleep earlier to help me stay on schedule throughout the next day, without feeling tired. I tend to sit on my phone at night and it keeps me up too late, which then I can’t get up early enough to get done everything I have planned. This has caused a lot of anxiety, guilt and feeling like I can’t get it completely together.
    2. This experiment helped me provide more evidence for my new core belief because I was able to have a more fruitful day of accomplishing tasks, when before I was feeling so guilty for not accomplishing much during the day.
    3. It was challenging because it is hard to change a sleep schedule overnight, so when I didn’t stick to the exact time schedule at first, I felt totally defeated. But then the more I stuck with it over a few days I was able to go to sleep at a reasonable time and put my phone down to really shut my mind off.
    [Behavioral Exposure]
    1. Behavioral exposure is very effective for disorders such as anxiety, phobias and agoriphoba. Once the patterns of anxiety are found, exposure is important to break that pattern of anxiety because this technique goes beyond the anxiety that is currently present during the exposure. Exposure is helpful because it labels the patterns that seem to stimulate the anxiety or fear, which is then how the exposure plan can start. By focusing on those big triggers, you are able to target some of the major anxiety and stress in the client’s life which would be the most helpful to work on. Then the therapist can focus on the client’s NAT with the anxiety and how it creates uncomfortable feelings or behaviors. This is a great way to tackle a client’s anxiety by taking steps to first label it, understand what thoughts are associated with this stressor, the physiological response and then the anxiety. It is also a good way to see what avoidance behaviors are associated with the event so the therapist can properly plan gradually exposing the client.
    2. Some cautions to consider when implementing an exposure therapy plan is to be aware that there has to be enough challenge to this plan in order for success but not so much that the client will fail. As well as the opposite, if the plan is too easy, there won’t be much takeaway or benefit from an exposure session that was too easy. It is also important that the client can do these exposures without a safety behavior or relying on a relaxation technique too much (for disorders such as panic disorders). The best way to create an appropriate plan that isn’t too hard or too easy is the do the exposure gradually and possibly repeat steps if there wasn’t much success with a certain exposure technique.
    [Behavioral Exposure]
    1. Going to the grocery store triggered some NAT, which seemed to be that she was going to have a heart attack and die in the middle of the grocery store and no one be there to give her help. This thought pattern seems to be a cognitive distortion of catastrophizing. This was during the event. After the event, she felt that she was a failure because going to the store shouldn’t be “that hard” in her words but she wasn’t able to accomplish that task without having a panic attack.
    2. Lindsey felt upset about her NAT because she knew that she wasn’t going to have a heart attack and die in the grocery store but she wasn’t able to modify that thought enough to get through the store successfully and had to leave. During this time of the NAT she had tightening in her chest, trembling hands, and feelings of choking. Then she was aware that other people were noticing these behaviors, which made her feel worse. These physiological arousals were enough to make her leave the store in order to see her husband who was waiting in the car for her. Her husband seems to be her safety behavior because once she was able to be with him again, the sensations started to slow down and she was feeling calmer. Also, when Dr. V mentions Lindsey doing the exposure without her husband present (eventually) she says she doesn’t like that idea, showing that she feels he needs to be there as a safety behavior.

    Reply

    • Alexa Berry
      Mar 18, 2021 @ 14:49:58

      Hi Abby,

      Your post caught my attention because I had to do this behavioral experiment in the past too! I’m glad you ended up having a mostly positive experience with it. It’s definitely difficult to change a sleep schedule and incorporate the new sleep schedule into your routine, so I encourage you to stick with it! I remember times where I would spend hours on tik tok and not even realize what time it was, which would sometimes lead to me cancelling plans or going into work late the next morning. I still get caught up in my phone every now and then when I’m trying to go to sleep, but overall, it has contributed positively to my ability to get things done during the day. Something else that helped me was limiting my screen time by setting time limits. So if I had set myself a limit of 2 hours a day on a certain app, once I reached this limit the app would lock and I couldn’t use it anymore.

      I agree with the points you made about Lindsey’s NAT during her trip to the grocery store. Something else that stood out to me about her thoughts surrounding having a heart attack in the grocery store was even though she thought no one would be able to help her, this typically occurred when she was surrounded by other people. This definitely stood out as a cognitive distortion because if a lot of people are around, ideally that means there is more help available.

      Reply

  16. Lilly Brochu
    Mar 18, 2021 @ 12:34:15

    [Core Beliefs]

    (1) What was your behavioral experiment (only share what you are comfortable with)? (2) In what ways was this behavioral experiment helpful in providing “evidence” for your new core belief? (3) What challenges did you encounter?

    A lot of my own negative thoughts and behaviors stem from a lack of confidence in myself or the skills that I have. I tend to believe that I am not good enough in several aspects of my life, such as school or work. My behavioral experiment was to use words of affirmation (e.g., “you are enough”, “you are doing the best you can”) to begin my day or when I felt a sense of anxiety about myself or other responsibilities that I hold highly rigid expectations for.

    This behavioral experiment was helpful because words of affirmation did help to ground me in a more positive and healthier mindset about myself. My “old” core belief was, “I am not good enough for others” and my “new” core belief was, “I am enough for myself and that is what matters the most”. I tend to rely on praise from others to make me feel better about myself and my abilities rather than truly believing that I have what it takes to succeed on my own. After using words of affirmation daily, it allowed me to take a step back from some of my reoccurring anxious thoughts and behaviors. It helped to center me in what was true rather than focusing on unrealistic expectations of myself, and helped me to take a more realistic approach. For example, prior to an interview that I was very anxious about, I looked in the mirror for a few minutes before the interview took place, and kept telling myself that “I can do this”, “I am capable of anything”, I am good enough for this position”, etc. and I found this to be very helpful and quite motivating for me. It sounds sort of silly, but it did help to compose myself and my negative thoughts. Following this, the interview turned out better than I expected, and I was offered a internship position right away. This experience showed that I am more in my head about how I feel about myself because the outcome proved my negative automatic thoughts otherwise.

    As for challenges I faced, it was easy for the automatic negative thoughts to take over more often than I wished they would. Additionally, I found myself easily shutting down and withdrawing from people, responsibilities, or things that bring me joy when these negative thoughts began popping up. Personally, it has always been easier for me to become hyper focused on the negatives about myself rather than the positives. When I get to the point of withdrawal, I notice that my “not being good enough” core belief applies to anything and everything in my life, and I shy away from a lot of things that do make me feel happy. It was tough to stick to the daily words of affirmations, but I was able to push through because of how much better I knew I would feel afterwards.

    [Behavioral Exposure]

    (1) Why is behavioral exposure very effective for certain disorders/types of distress? (2) What are some cautions to consider when implementing behavioral exposure interventions?

    Behavioral exposure can be very effective for certain disorders or different types of distress because they challenge the individual to confront the very situations that are being avoided that are triggers for them. By continuing to avoid the source of anxiety or distress, the individual may feel relieved of their distress but are also inhibiting their own growth by learning and adapting to the feelings of relief and safety without addressing the root of their anxiety or distress. To break the cycle of these avoidance patterns and behaviors, clients need to be exposed to what is making them anxious/distressed as well as identifying and addressing any associated negative automatic thoughts with the avoidance. Once the client confronts the source of distress, and is exposed to it time and time again, they will be able to learn coping and relaxation skills that will assist in providing them long-term anxiety relief when they are faced with it.

    It should be noted that implementing behavioral exposure interventions should be utilized when the client seems to have grown to a point that exposure will be beneficial to progressing them further in therapy. If the client is not ready for this type of intervention, it could easily overwhelm or retraumatize them, could possibly hinder their therapeutic process and gains, or set their progress back a bit. Additionally, it is important to consider the type of behavioral exposure intervention that is the most effective type of exposure tactic for them and their presenting problem or disorder.

    [Behavioral Exposure (cont.)]

    (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event? (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?

    Lindsay’s primary negative automatic thought of being a failure seemed to derive from her lack of progress in therapy and the use of techniques Dr. V has given her to cope while in distress. This thought occurred because she was not able to successfully shop in the grocery store without feeling strong physical sensations of panic and as if she were going to have a heart attack. However, Dr. V was able to reframe Lindsay’s black-and-white thinking, and was able to have her recognize that being able to follow through with driving to the store and being in the store was still a huge step and that this attempt should be recognized as an achievement. As for Lindsay’s response to her negative thoughts and physical arousal, she left the cart and ran out of the grocery store back to her car and her husband. Lindsay states that her husband makes her feel supported, safe, and that her symptoms tend to subside when she is around him. Dr. V points out that her husband is what she clings to for relief, and that eventually, she will learn how to do these things on her own because her husband’s presence will only provide short-term relief and will not provide her the long-term relief she needs to adaptively function in her life.

    Reply

  17. Carly Moris
    Mar 18, 2021 @ 13:57:03

    Core beliefs
    1.
    My old core belief is centered around feelings of worthlessness and that I am not good enough. That I need to help other people in order for them to like me, and I shouldn’t burden them with any of my stuff. This has lead me to always be the one doing things for other people and not for myself. This is something that I have been trying to work on because it has lead to some unhealthy relationships in the past, but I still find myself having negative automatic thoughts related to it. For my behavioral experiment I asked my boyfriend if he would be okay going out to dinner for two of the three nights that he is coming to visit. I felt really guilty about doing this because he is also in grad school and living in a dorm. I also know it has been awhile since he has had a home cooked meal, and he really likes my cooking. Normally when he comes over I try to make a nicer meal with multiple sides, that will take me a few hours to prepare and complete. But, I’ve been feeling pretty burnt out and the idea of planning and executing dinner all three nights was really stressful. Especially because he is coming over next Thursday so I would need to try to cook between my two classes. So I asked him about getting takeout or going out Thursday and Friday night and he was perfectly okay with it. I actually started it off with an apology about not cooking and he said that he loves my cooking, but that I’ve cooked for him a lot in the past and he knows I will more in the future, so he really doesn’t mind going out to eat because he’s just excited to see me and we could get food all three nights if I wanted.
    2.
    This experiment was helpful in providing evidence for my new core belief that I have value even if I am not doing things for other people. Logically I know that my boyfriend values me as a person and he has shown it multiple times. We wouldn’t have been dating this long if he didn’t. But, I still feel really guilty at times like this and like I will be letting him down. This experiment helped me to move past those feelings of guilt and realize that they were really misplaced. That my boyfriend wouldn’t be disappointed that I wasn’t cooking the meals that I had originally planned. It felt like such a relief after we had this conversation because I didn’t realize how stressed I was about cooking, and now I feel like I can just look forward to spending time with him. He was also so kind and understanding about it. He even took the time to reassure some of the insecurities and feelings of guilt that I brought up. Overall this behavioral experiment ended up really making me feel more secure about myself and my relationship.
    3.
    One of the challenges was my fear that my boyfriend would be disappointed I wasn’t cooking. I really dislike and feel uncomfortable with he idea of disappointing or letting down the people close to me and that they will think less of me for it. I realized before hand that this was an invalid thought and that my boyfriend would not think less of me for not this time cooking. But I was still nervous he would be disappointed. I would say that another challenge of this behavioral experiment was that due to Covid there are really not other people I could have done this behavioral experiment with. In the end I’m glad I did it with my boyfriend because it helped to confirm that these thoughts were invalid. But I also realize that my boyfriend was a safer option to do this behavioral experiment with because we do have a close relationship.
    Behavioral exposure 1
    1.
    Behavioral exposure is very effective for relieving anxiety related distress and helping individuals cope with life stressors. When an individual is anxious they are likely to avoid the situation or thing that is causing the distress. This avoidance will cause the individual short term relief from their distress. But it can cause long term issues because it will negatively reinforce the avoidance behavior. The individual will continue to feel distressed when they are confronted with the triggering situation or thing. Which will lead to more avoidance behaviors, which can significantly impair their daily functioning. Behavioral exposure is effective for relieving this anxiety because it helps to break the avoidance pattern by exposing the individual to the situation or thing that causes them distress. At first this will cause the individual increased distress because they are confronting the previously avoided stimulus. But, over time after repeated exposures the clients distress should decrease as they learn the situation or thing is not a threat. This process can also help individuals develop coping skills to help deal with future distress.
    2.
    Before attempting behavioral exposure counselors should make sure that they have a strong therapeutic relationship with the client. They are asking the client to participate in something that is extremely distressing to them. The client needs to trust that the counselor knows what they are doing, that they have their best interest in mind, and that they are not in danger. If this is not the case the client may be unwilling to try behavioral exposure, or they may not return after it is attempted. Counselors also need to be cautious about pushing clients to far to quickly with behavioral exposure, because it may cause the client more distress then they are able to handle. Which may end up reinforcing the distress and hurting the therapeutic relationship. This is one of the reasons it is important to make a hierarchy of fears and work your way from bottom to top, at a pace you know the client can handle.
    Behavioral exposure 2

    1
    Lindsay’s primary negative automatic thoughts seems to be be in relation to the physiological arousal that she experiences with her panic attacks and being able to escape when she experiences them. She is afraid that she will not be able to leave the situation and get help if she is actually experiencing a medical emergancy. Her panic attack was triggered at the grocery store when the isle began to be crowded with people and she thought how would she be able to get past all of these people and get help, and that she would drop to the floor there due to a heart attack and be unable to get help. This shows that Lindsay has cognitive distortions related to catastrophizing, she was predicting the worst case outcome for this situation. Even when she told herself that she wasn’t having a heart attack she still had to escape from the situation. She was also afraid that if she had a heart attack she would drop to the floor and not be able to get help, disregarding the fact that if she were to drop to the floor the people in the isle would most likely try to help her and call for an ambulance. Lindsay tends to have negative automatic thoughts about her physiological arousal that lead her to catastrophizing situations that produce them.

    2.
    When Lindsay began to experience negative automatic thoughts and physiological arousal her response was escape from the situation. She ended up leaving the store and going to the car were her husband was waiting for her. She started to feel better when she was with her husband and the two of then ended up going home instead of the hospital, like Lindsay normally would when she experienced a panic attack this severe. Having her husband wait for her in the car would be considered a safety behavior because he helps her feel less anxious, instead of her using coping strategies to deal with the anxiety. Though in this situation it was probably a good thing that he was there because as she stated she was a bit overly ambitious, and she ended up having a panic attack that would have otherwise caused her to go to the hospital if he was not there. Later when she was home she felt disappointed in herself and like she had failed at this task because she ended up having to leave without buying groceries. She also said that she felt silly about her response because she should have been able to do this. However, like Dr. V pointed out she should be commended for trying to do this on her own because it was a big step for her to attempt something like this.

    Reply

    • Zoe DiPinto
      Mar 18, 2021 @ 15:57:45

      Hi Carly,

      I agree that something that stuck with me was Dr V’s response to Lindsey feeling like she had failed. He was quick to gently point out this all-or-nothing thinking that was contributing to her frustration. After this, she felt much better about the progress that she had made and we could see the advancement of the therapeutic relationship. Positive reinforcement is extremely important especially in these behavioral experiments to maintain trust while clinicians ask clients to do things that cause them extreme distress.

      Reply

    • Lina Boothby-Zapata
      Mar 20, 2021 @ 15:33:25

      Hi Carly,
      I think it is a great point to think about building rapport with the client and making sure that the alliance between therapist-client is strong enough to begin this process of behavioral exposure, otherwise the client may no return next session. Also, I agreed with you that this will provide an opportunity for the client to strengthen the therapeutic relationship. The way that I observed this point was that we need to be vigilant in assessing the client’s process in terms of checking in if the client learned the appropriate coping skills such as relaxation and catastrophizing negative automatic thoughts. Another element was to make sure the client doesn’t have any medical condition related to heart illnesses or clients with high levels of anxiety.

      Reply

  18. Elizabeth Baker
    Mar 18, 2021 @ 14:06:17

    [Core Belief]
    (1) My behavioral experiment was trying to separate myself from schoolwork and actually enjoy doing various activities (e.g., painting rocks, watching movies with my family, working out). I tend to stress about the amount of homework I have to complete, and I find that I am just stressfully going through activities that are unrelated to school if I allow myself to take meaningful breaks. It is extremely frustrating to be in this tense and anxious state when I am trying to relax, and negative automatic thoughts like, “I’m lazy,” “I’m not using my time productively,” and feeds into my negative core belief of feeling inadequate. These thoughts tend to pop up even when I am working on homework and going to bed, as I feel that I could use the time to continue working on homework and produce higher quality work. I thought I owed it to myself to practice taking true breaks from schoolwork and clear my head and the tension from my body, and tell myself that this break will also make me more motivated to complete my homework.
    (2) Even though it was still difficult not to think about school, I was able to spend the majority of my day almost completely enjoying my relaxing activities. I spent about three to four hours painting rocks and I was having fun singing songs and delving into my creative world. I had stayed away from my phone during this time as well, which also helped me fall into my relaxing and positive state. I finished the day by spending time with my family and felt that I was in a more positive mood. When the next day came, I started to work on my classwork again and found that I worked more efficiently and was not feeling as overwhelmed or drained from the amount of work I had to complete. I also completed this work with more interest and focus, and it was truly pleasant to tackle these assignments without feeling weighed and slowed down by my tense and anxious state.
    (3) Some challenges that I encountered were that even though I was trying hard to completely detach from my schoolwork, I still worked on assignments for a couple of minutes, repeatedly glanced at my agenda, checked school emails, skimmed over my classes syllabus’, and still felt anxious and slightly overwhelmed with all I had to complete. I have already created a to-do’s list, so I did have a plan for the following day, but it was still difficult to completely detach myself from school and enjoy my creative and relaxing activities. I am going to keep setting aside time each day, or one day out of the week, to practicing completely detaching myself from the task/situation that is causing me distress. That way, I can effectively enjoy these activities and return to the initial stressful task/situation with a clear mind.

    [Behavioral Exposure]
    (1) Behavioral exposure has many benefits as it can slowly decrease the distress clients feel or have felt during unexpected or avoided situations. I think behavioral exposure is a great strategy to increase client’s self-efficacy when coping with the distress they feel when they encounter the initially avoided situation with a partner and finally once s/he encounters the situation alone. Hopefully, this exposure, in the long run, will also increase clients’ adaptive response and confidence when encountering future distressing situations, and be able to take on the challenge independently. This carefully executed exposure also allows clients to understand that their physiological response to these initially avoided encounters are natural and that everyone experiences varying levels of physiological arousal when exposed to an immensely distressing situation. Additionally, it allows clients to learn that it is okay to lean on others (e.g., romantic partner, close friends, family members) to support them through the process and physiological response of being exposed to the provoking situation.
    (2) A caution to consider is that the client may be resistant to be involved in the exposure process, even though they truly want to overcome this obstacle. It is also helpful to remind the client that progress takes time and to not beat themselves down or rush the process. Just like in Lindsay’s case, although she felt ready and confident that she could successfully go to the supermarket alone, she was upset that she did not achieve that successful outcome. Other clients may also have this reaction if they do not successfully get through the exposure process. It is important to reassure the client, telling them that it is okay to feel disappointed, but it is also important to remind them that progress is progress, no matter how “small” it may feel.

    [Behavioral Exposure]
    (1) Lindsey may have had the negative automatic thought of “I will never be able to do this alone,” after her attempt to go inside the supermarket alone. She seemed to also disqualify the positive after processing her attempt in the supermarket; although the experience did not go as well as she thought, she still made great progress. She was able to walk into the supermarket alone and wander around for a couple of minutes before her experience in one of the aisles overwhelmed her and evoked symptoms of a beginning panic attack.
    (2) She started experiencing physiological symptoms like sweaty palms, racing heart, and feeling hot once more and more shoppers filed into her aisle. Thankfully she had her husband there with her, waiting for her in the car, and was able to comfort and support her through her panic attack. It was very clear how grateful Lindsey was to have her husband there once she exited the supermarket. Another safety behavior seemed to be her using relaxation techniques to continue calming her down as she and her husband were on their way back home. Although this was briefly stated before the vignette ended, it seemed that Lindsey was still motivated to practice these breathing techniques to help her cope with the physiological arousal that accompanies her encounter during a distressing event.

    Reply

    • Alexa Berry
      Mar 18, 2021 @ 15:29:49

      Hi Elizabeth,
      Thank you for sharing your experience! It sounds like you really challenged yourself but got some rewarding results. It can be really difficult to put schoolwork out of mind to enjoy other things especially when we truly do have a lot of work, and it is not just perceived to be too much work. It seems like being remote has only increased school related stress because all communications are virtual, so it makes sense to constantly be checking emails for updates, when this really just adds to stress levels. Something I noticed in your response about behavioral exposure is you highlighted how it can be beneficial for someone to feel like they have support from loved ones. While this is definitely an important factor, I would encourage clients to keep an eye on this, so they are not only able to cope with stress when a loved one helps them through it. It seems like this occurred in Lindsey’s case. Although her husband was able to comfort and help her, having him go with her is a safety behavior. Additionally, I’m not sure if I would consider relaxation techniques safety behaviors because this is an adaptive coping mechanism for facing stressors.

      Reply

      • Elizabeth Baker
        Mar 18, 2021 @ 16:46:16

        Hello Alexa!

        Thank you for your response and for pointing out the misinformation/misinterpretation in my post. I am definitely guilty of leaving out some information, unintentionally of course. I left out explaining how although Lindsey’s husband is able to decrease the intensity of her symptoms, it is important to work on increasing her self-reliance so she uses her own coping strategies to decrease her distress during similar situations like in the supermarket (I instead just listed her safety behavior of using her husband as a sense of comfort and the benefits of that). Even so, you are absolutely right in encouraging and educating clients to cope with their distress using their own adaptive coping techniques. I completely agree that breathing exercises/techniques are more of an adaptive coping technique, I am not sure why I listed it as a safety behavior. Thank you again for your close observation! I apologize for the misinformation, my goodness I really need to be careful to not do that again.

        Reply

    • Christina DeMalia
      Mar 19, 2021 @ 12:51:29

      Hi Elizabeth,

      Hearing about your behavioral experience definitely stuck out to me, because I find myself caught in that same mindset all of the time. I feel like if I am not being productive all of the time, then I am wasting my time. Then when I do try to relax, I feel stressed because of those automatic thoughts. What I found really interesting is the difference between when I schedule my days and when I don’t plan them out ahead. Similar to the daily activity schedule, I often plan my days out in advance, down to the hour or sometimes even 15 minute period. I don’t necessarily think this is a process that would work for everyone. However, the really interesting thing I noticed is how much more accomplished I felt when I scheduled things out. Without a schedule, I would flee like watching Netflix or playing video games was a waste of my time. But, when I planned my day with mostly work and then hour long periods of TV or other relaxing things in-between, I still felt accomplished when I did them. I understood that I would work and function better if I had relaxation time in between, and I found good times to take those breaks. This way I got to cross it off my list once I was done, and feel accomplished because even if the activity was lazy, I knew it served the purpose of making me more relaxed and focus when I went back to working.

      Reply

  19. Alexa Berry
    Mar 18, 2021 @ 14:12:33

    The behavioral experiment I used to challenge my old core belief was related to the Socratic technique of examining the evidence. In using the downward arrow technique last week and discovering some new information about a core belief of mine, I thought it would be beneficial for me to continue to think deeply about this before jumping into any other techniques. My specific behavioral experiment involved not participating in behaviors that I typically engage in when my old negative core belief was triggered (i.e. if I was feeling sad because a friend did something without me, I would assume it was because they did not want to spend time with me). I found that it was helpful to share with loved ones who may have been implicated in my behavioral experiment what I was working on. I thought that this was helpful in providing evidence for my new core belief because I was unable to resort to my typical response of believing my negative core belief without giving an opportunity to see contradictory evidence. It appears that I majorly overlook contradictory evidence or discount it, so even giving attention to contradictory evidence helped to strengthen my new core belief. It is always challenging to change old behaviors, especially those that are engrained in you. Old habits die hard, so a major challenge for me was actively focusing on what I was trying to work on. It is much easier to resort to what we know, since change can be uncomfortable. Despite these challenges, I found behavioral experiments to be beneficial to actually challenging old core beliefs, instead of kind of abstractly thinking about changing them.

    Behavioral exposure is very effective for anxiety disorders, especially those that result in patterns of behavioral avoidance. Anxiety-related disorders like agoraphobia, panic disorder, PTSD, and social phobia are some disorders which behavioral exposure can be effective for. Behavioral exposure is effective in cases where individuals avoid the source of their distress. Although this reduces their anxiety in the short term, in the long term this leads to patterns of avoidance and inability to cope with distress. Through behavioral exposure, individuals learn they can face their source of distress, and the more they are exposed to it without engaging in safety behaviors like fleeing, their associated anxiety will decrease after repeated exposure. In the long term, clients see that the source of distress is no longer threatening, which results in long term anxiety relief and coping skills for facing future stressors. When implementing these interventions, it is important to consider that sometimes you will first need to work on associated negative automatic thoughts, because they can initiate and reinforce maladaptive behaviors.

    In observing this client’s session, I noted various automatic thoughts, but it appears the primary one is associated with her ability to carry out actions that trigger her panic disorder (i.e. if she can’t finish grocery shopping she is a failure). It seemed like she was measuring her success with the set goal of finishing shopping. However, it also appeared that the client was not yet ready for this step. In this case, she had negative automatic thoughts about her inability to complete the task. The clinician helped the client work through this and see that although she did not finish her shopping, this was a very big step for her and could still be viewed positively. Another prominent automatic thought I observed was the client’s thought about her inability to get help while in the grocery store if she were to have a heart attack. The client repeatedly states that the grocery store or particular aisles being busy are a major stressor for her. So, if she is in a busy aisle and has panic symptoms that she interprets as a heart attack, even if she were to have a heart attack, there would be plenty of people around to help. Lindsey engaged in two main safety behaviors of fleeing from her source of distress (i.e. leaving the grocery store), and having her husband come with her for comfort.

    Reply

    • Zoe DiPinto
      Mar 18, 2021 @ 15:54:21

      Hi Alexa!
      You raised a good point that was mentioned in the PDA-6 video about Lindsey not being ready for the behavioral exposure in the grocery store. I remember Dr V also mentioning this directly in the video. It makes me wonder if there could have been a slightly different intervention that would have acted as a midway point between extreme exposures. Now that we know this activity leads her to having a severe panic attack, what would a less intense exposure experiment be for Lindsey? Perhaps walking into a post office and asking for stamps. Maybe borrowing a book from the library. As I brainstorm, I wonder how important crowds are to individuals with agoraphobia. I believe getting Lindsey to go to places with more and more people would be a good way to build her up to feeling calm in a grocery store.

      Reply

  20. Laura Wheeler
    Mar 18, 2021 @ 14:24:34

    [Core Beliefs] – Watch MDD-18: Core Beliefs – Modifying 3 – Behavioral Experiment. Practice a Behavioral Experiment on yourself. Answer the following: (1) What was your behavioral experiment (only share what you are comfortable with)? (2) In what ways was this behavioral experiment helpful in providing “evidence” for your new core belief? (3) What challenges did you encounter?

    For my behavioral experiment, I chose something that I was not very motivated to do. I discovered that setting a plan or “experiment” to push myself to do something that maybe felt a little more difficult or undesirable helped me to actually achieve progress towards modifying the identified core belief and therefore the areas of my life that it impacts. I felt that because I consciously set the expectation for myself, even with pretty low recorded motivation, I didn’t have any trouble completing it because I wanted to meet the goal. This definitely helped provide me with evidence that when I make a plan or set a goal, I complete it. I found in the days afterwards that I could be equally successful in continuing to set an expectation for myself and being successful in meeting that expectation. Again, while it was something I thought was going to be particularly difficult or uncomfortable, I realized after that the anticipation was really the worst of it- once I made the leap to start, everything went fine. I have been using the experience in the last couple days to try and relate it to other areas of my life and weed out the things that are truly challenging or distressing for me from the things that just seem difficult.

    [Behavioral Exposure] – There is one reading due this week (Volungis – 1 Chapter). For this discussion, share at least two main thoughts: (1) Why is behavioral exposure very effective for certain disorders/types of distress? (2) What are some cautions to consider when implementing behavioral exposure interventions?

    Behavioral exposure can be very effective for certain disorders, especially anxiety and phobias. Part of this is that increasing exposure in increments helps build up tolerance and minimize symptoms experienced. Regarding anxiety, for example, if an individual has a great deal of anxiety about attending a dental appointment for fear that something catastrophic will happen, behavioral exposure could help tremendously to minimize the experience of symptoms. With behavioral exposure, the goal is that the client will eventually be able to attend an appointment successfully and will ultimately leave that appointment with the evidence that nothing catastrophic happened, despite their anxiety. The hope then, is that the individual will be able to use this evidence going forward to eliminate their anxiety about future appointments- proving to themselves that they can attend dental appointments without anything terrible happening, proving that their fear is irrational.

    When considering behavioral exposure interventions, caution should be taken. First, the therapeutic relationship needs to be strong enough that the clinician can challenge the client while maintaining the clients feeling of trust. If the client feels as though the clinician is setting them up for failure or for something traumatic to happen, the process will not be successful. Further, the clinician needs to challenge the client in appropriate increments to help them grow and achieve success, but also needs to be very careful to not push them too much. The clinician needs to be cautious to only challenge the client to participate in exercises they have the skills to manage and be successful in.

    [Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns. Answer the following: (1) What was the client’s primary negative automatic thought (possible cognitive distortion?) in response to this event? (2) What was the client’s response to her associated automatic thoughts and physiological arousal (any safety behaviors?)?

    The clients primary negative automatic thought was feeling like she was going to lose control. The client started the experience feeling okay then quickly started to become consumed and felt overwhelmed, like she needed to escape. The client reported rapidly feeling hot, having sweaty palms, a tight feeling in her chest, her heart pounding, and nausea. The client said that although she felt okay on the drive to the store and initially upon entering the aisle, once the aisle started to begin getting crowded she started to spiral. Upon feeling the physiological symptoms of her panic attack, she felt like she needed to run away; leaving her cart and all her groceries and immediately escaping the situation. During the session, the client and clinician discussed the possibility that her husband is sort of taking on the role of a safety behavior. The client reported feeling unconditionally supported and comforted by her husband, but the clinician pushed back that perhaps his role in the situation was nearing on being unhealthy and almost like a crutch. The client knew that as soon as she started to experience panic, she could escape the situation and her husband would facilitate that. It seems to be a tricky line to walk, though, because a client having positive supports is very important, this particular client just needs to ensure that her husbands involvement in her treatment is healthy and productive.

    Reply

    • Tim Cody
      Mar 19, 2021 @ 16:31:32

      Hi Laura,

      I agree with your comment on the level of trust the client should have for the behavioral exposure. While the therapeutic relationship is important throughout each session, it is in these experiments that their trust is most important. Putting the client outside of their comfort zone and doing something that is anxiety provoking is nerve racking. However, with the right amount of trust, level of psychoeducation provided for the client, and a great leap of faith, the client can thrive in these exposure techniques, whether they be imaginative or in vivo.

      Reply

    • Elizabeth Baker
      Mar 20, 2021 @ 14:58:15

      Hello Laura,

      I enjoyed reading your post! It sounds like you had a positive experience with your behavioral experiment. I should use this as inspiration to step out of my comfort zone as well, as uncomfortable as it might feel, but with time it may become less uncomfortable and more beneficial than we initially expected!
      Also, the cautions that you mentioned when going through behavioral exposure with clients is very important. As said in class, it is important as a clinician to work up the ladder of fears, starting with the client’s least distressing fear. That way the client can overcome fears at their own pace and put more trust in the behavioral exposure process as they eventual work on their most distressing fears. Great post!

      Reply

    • Lina Boothby-Zapata
      Mar 20, 2021 @ 15:49:12

      Hi Laura,

      I agreed with you that one of her cognitive distortions was losing control. However, I think that in Lindsay the idea that she feels silly and this is something that she should be doing alone without any support makes her feel that she fails. This thought is strong enough that it can be seen in the next video where Dr.V. the PDA 9 Behavioral Techniques-Modifying Anxious Thoughts, Lindsey provided us with the following information; she is convinced that she will fail her class, fail the program, and lose her job or no getting her promotion. Dr.V works with her in catastrophizing automatic thoughts. This is one of the main goals, the process of decatastrophizing Automatic Thoughts in order for her to apply in her behavioral exposure technique at the market when Dr.V reminds her “Remember that research shows that these physiological arousal symptoms will pass and you will no die.”

      Reply

  21. Zoe DiPinto
    Mar 18, 2021 @ 15:43:41

    My behavioral experiment was drinking a caffeinated tea. Caffeine makes me feel anxious and panic-y because it increases my heart rate and makes me hyper aware of bodily sensations. I don’t think this experiment provided much evidence towards a core belief (or if it did, I need to do more work in uncovering what core belief this is) however, I do believe it helped gather evidence against an automatic thought. When my body feels too hyper, I believe I have automatic thoughts that lead me to believe my body is doing something that it shouldn’t and my life is in danger. Exposing myself to a caffeinated beverage did not result in any direct anxiety. The challenge I faced was getting a good night’s sleep afterwards! I believe feelings of anxiety came from a worry of not getting enough sleep rather than feeling in danger.
    Behavioral exposure may be extremely helpful in cases of anxiety and phobias. Clients are able to confront their fears and gather new evidence that breaks their catastrophic fears. Breaking these associations is the key to creating healthier patterns. Caution should also be taken in cases with behavioral exposure. Moving too fast may reinforce the fear and move the client backwards. We should also be careful not to reinforce unhelpful coping strategies. At the same time, clinicians should kindly push to challenge the client to do the thing they do not want to do.
    Lindsey’s primary negative automatic thought was feeling stuck and unable to escape a public space. She also has a fear that she is going to have a heart attack in the isle around people. Her response to this automatic thought was pushing back with some logic saying to herself “I know I’m not going to have a heart attack.” She also reported having some frustration at herself for “failing” the assignment that should be easy. She said she felt her body get hot right before the panic attack followed by sweaty palms, chest tightness, tenseness, racing heart, paranoia, nausea, choking sensations, and feeling out of control. Her safety behavior was having her husband in the car waiting outside.

    Reply

    • Brianna Walls
      Mar 18, 2021 @ 19:26:04

      Hi Zoe! I agree, moving too fast with exposure therapy may reinforce fear within the client and may cause the client to move backwards in therapy. It is also important that the therapist be careful not to reinforce unhelpful coping strategies such as Lindsey’s husband waiting for her in the car while she went into the grocery store.

      Reply

  22. Tim Cody
    Mar 18, 2021 @ 15:49:53

    [Core Beliefs] – Watch MDD-18: Core Beliefs – Modifying 3 – Behavioral Experiment
    (1) My behavioral experiment was to sit next to one of my co-worker’s that I particularly do not get along with, and have a genuine conversation with them. I usually tense up when I am around this particular individual, owing to the core belief that I have that he does not respect me as a Staff member but is still attempting to treat me like an undergraduate he needs to minister to.
    (2) I found this experiment to be helpful because I am trying to let go of the prejudice and judgment I hold over this coworker. I want to be able to respect my colleagues and those I am in direct contact with, but I have had difficulties getting along with this individual in the past. I found him to be interfering and extremely invasive of my privacy. However, after reaching out to him myself and sitting and chatting with him, I found that I was letting go of my anger and my new core belief solidifying: he respects me not only as a colleague, but as a friend. I still need time to analyze and accept this new found friendship, but I think this experiment was a step in the right direction.
    (3) I found my physiological cues to be a challenge. Usually when I am around this individual, I tend to tense up and hold in my breath. I think this anxiety provoking symptoms, for I do not normally get along with this individual and avoid being around him if I can. However, I held myself together, allowed myself to breathe and carry on the conversation until it ended at a natural point.

    [Behavioral Exposure]
    (1) Certain disorders such as anxiety or agoraphobia are so prevailing that clients tend to avoid what makes them so significantly distressed. They may feel physiological sensations that disrupt their daily routines and functioning. Behavioral exposure along with relaxation techniques can assist one with high levels of anxiety and related symptoms. Many people tend to avoid their anxiety or phobias, but this only provides temporary satisfaction. This avoidance is what reinforces the heightened senses of fear and anxiety. If one is to truly combat their anxiety, they must confront it, learn from their therapist the psychoeducation to their anxiety, normalize their symptoms, and allow them to pass.
    (2) Clients and therapists should take caution to their safety behaviors when they are implementing behavioral exposure interventions. These are the situations, events, and thoughts that the client has been using thus far in order to “get through” what is causing their anxiety. These are temporary avoidant behaviors that only provide short-term satisfaction and do nothing to tackle the anxious situation. These should be avoided at all cost if the client wishes to be exposed to their anxiety head on.

    [Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns
    (1) It seemed like the primary negative thought that Lindsay was facing was, “I can’t escape.” She thought she was able to face going to the grocery store on her own, and wanted to be exposed to that fear as she had not been the grocery store in a few months, but she found that the longer she was in the store, the harder the situation was for her.
    (2) Her immediate reaction was to run away from the situation. she felt many physiological arousals (e.g., felt hot, anxious, claustrophobic), and wanted to find her husband who was waiting for her in the car. Fortunately, her husband was there for her, her panic symptoms subdued after sometime, and they decided to not go to the hospital.

    Reply

  23. Anna Lindgren
    Mar 18, 2021 @ 15:58:32

    [Core Beliefs]
    1. Since the pandemic began, I’ve been struggling with catastrophizing thoughts around going out in public and being in crowded spaces. Since my partner went back to working in-person, he has been doing most of the grocery shopping and errands outside of the home. As grateful as I am for that, I realized that it was contributing to a cycle of avoidance for me and that I was feeling more anxious whenever I did go to the store. As luck would have it, I was able to get an appointment for my first COVID shot earlier today, which meant going to the mass vaccine clinic at Gillette stadium. I felt like that would be a great behavioral experiment for me, and the vaccine itself was a great incentive to go for it.
    2. The experience at Gillette was straightforward and quick. The staff were really good at making sure everyone was maintaining distance and wearing masks. I was in and out in about 20 minutes. Being able to complete this task that brought on a lot of anxiety leading up to it felt great because it was a reminder that even though I haven’t been doing much outside of my home this last year, I am still capable of the kinds of activities that I did before (although getting a shot in a football stadium was a first!). It also reminded me that going out in public is not as overwhelming as I’ve been thinking it is recently. And then, of course, there was the accomplished feeling of getting the vaccine! I already feel less anxious knowing that once I get the second shot next month, I will be more protected against the virus and hopefully this will lead to less anxiety around being in public spaces.
    3. I got to the stadium about 20 minutes early and sitting in my car waiting to go in heightened my feelings of anxiety a bit, but once I was inside and moving quickly through the line, I felt myself calm down.
    [Behavioral Exposure]
    1. Behavioral exposure is a great intervention for anxiety disorders that are future-focused because clients are able to confront the situations that they are anxious about and see that the outcome they are anxious about will not necessarily happen. It discontinues the cycle of negative reinforcement that avoidance behaviors give to those struggling with anxiety (e.g., avoiding going out in public leads to a sense of relief from anxiety symptoms, makes it more likely that the individual will continue to avoid going out).
    2. When implementing behavioral exposure, it’s important to communicate with your client to make sure that they are ready to attempt this experiment, that they have at least some confidence that it will go well, and they understand and are comfortable with the plan. Assigning a behavior exposure that a client is not ready for could have the opposite desired effect and make them more anxious about future attempts.
    [Behavioral Exposure]
    1. Lindsay’s trip to the grocery store started out well, but she started to notice herself feeling hot and this first physiological symptom gave way to many others, resulting in a panic attack. She was very concerned about who would help her if she had a heart attack (i.e., catastrophizing the event), and became aware of the other people in the aisle noticing her, which could be interpreted as a personalization cognitive distortion.
    2. Lindsay’s panic attack led her to abandon the behavior experiment and seek out the safety and security of her husband, who was waiting in the car outside to take her home. As Dr. V pointed out in the video, this safety behavior of seeking out her husband can be useful when she is in distress, but it could also be holding her back from being able to complete the task independently. Moving forward, the experiments will involve her husband less and less until she is able to go to the store on her own using the coping techniques she learns in therapy.

    Reply

    • Lina Boothby-Zapata
      Mar 18, 2021 @ 16:06:45

      [Core Beliefs]

      (1) I can share that my core belief is “Unloveability” and I am not sure, but I think it in the categories of “I will be eventually be rejected.” For the experiment, I decided not to do something too extreme but introduce some behaviors to test and see the reactions and outcomes. For example, I choose to make jokes about a “highly sensitive theme” with my husband the outcome was that he was surprised about it and we laughed together, it was positive and the “theme” lost a little bit of weight, kind of decatastrophizing. I also encouraged him to go out with his friends to play poker and allow him to arrive on time to his game. I have another experiment to do (pending), which is to communicate my feelings without waiting for days but this part is tricky.

      (2) In my personal experience is not about finding evidence to support my new “core belief”. It is more about “particular situations” that trigger my emotions, negative automatic thoughts, and behaviors. I guess I am so upset at the moment that I forgot about the evidence. But I think that new evidence has the role of reassuring and strengthen the new core belief.

      (3) One of the challenges is that when I tried to identify the plan/experiment, I struggled a little bit to identify the experiment because reflecting about “old core belief and “new core belief” is more subjective and doesn’t come from a concrete situation. Contrary to the NATR exercise, it was easier to identify a specific situation and then breakdown the problem BEFORE and AFTER between, Negative Automatic Thoughts, Emotions, Behavioral Response, and Outcome. The Downward-Arrow technique focused on digging in the Automatic Thought throughout Socratic questions until the Core Belief emerges and the client can identify.

      [Behavioral Exposure] –

      (1) When clients avoid the source of stress, they have a short-term relief, this avoidance is known as a negative reinforcement response. However, a long term it is not the best plan because the source of distress is being maintained and could probably increase. Furthermore, the person is not learning to cope with his distress. The Behavioral Exposure experiences what offers is to confront the source of stress, in order to break the avoidance pattern, it is necessary that the client is being confronted with the source of anxiety/distress. The benefits of confronting the source of stress are that the avoidance patterns that maintain avoid/flee behavior will be broken. The client will have the opportunity to learn new behaviors and cognitions to resolve or dissolve the source of the stress.

      (2) It is important to consider that while the client is initially being exposed to the situation, the client will have momentums of arousal and a panic attack. However, as Dr. V illustrates, we don’t throw the client to the distress’s source. What the counselor needs to do before this exposure is to prepare the client with relaxation coping skills, new cognitions based on the catastrophizing techniques, and having support for the therapist. These conditions will guarantee a different outcome. Hence, the expectation is that the client will learn that the situation is no longer threatening, and these new coping skills will allow them to manage future distress. The counselor needs to be cautious about it to make sure that the client learned these new strategies to expose him in the field, especially for those who have high levels of anxiety because end it up being self-defeating.
      It is important to consider that exposing the client to the source of anxiety the physiological arousal such as hyperventilation leads to shortness of breather, light-headedness, dizziness, rapid heartbeat, and chest tightness/pain. These symptoms are not deadly; however, as a precaution, it is important to know if the client has preexisting heart conditions such as heart disease.

      [Behavioral Exposure] – Watch PDA-6: Behavioral Techniques – Assessment of Anxious Patterns.

      1. There are some ideas/cognitions that Lindsay expressed. She stated that “She feels silly because it is an activity that it should be easier to do, and she fails”. We can assume that she has cognitive distortions related to failing and if these distortions are strong enough will lead us to the core belief of worthlessness. In the next video about the PDA 9 Behavioral Techniques-Modifying Anxious Thoughts, Lindsey provided us with the following information; she is convinced that she will fail her class, fail the program, and lose her job or no getting her promotion. These are Catastrophizing Automatic Thoughts.

      (2) One of the Lindsay Safety Behaviors is that she supports her husband and she goes out to the grocery store with him. She stated that he drives with her and takes her to the market. Lindsey went inside and she had an unexpected panic attack, she thought she was ready. She left the store unexpectedly and left the carriage. Lindsey went to the car and when she sees her husband, she feels relief and thought that she is fine and safe. Safety Behaviors provide a “moment of relief” to the client; however, they are problematic because they work as a negative reinforcement, which means Lindsey will continue avoiding going to the stores and expanding to other settings like her class at school. Hence, the Behavioral Exposure goal is to break those patterns and cycle and encourage the client to learn new responses to the situation without ending it up in a Panic Attack.

      Reply

      • Brianna Walls
        Mar 18, 2021 @ 19:56:51

        Hi Lina! Safety behaviors are important to notice within your client. They work as a negative reinforcement which provides the client with a moment of relief. Her safety behaviors will lead her not to progress in therapy. For instance, if her husband goes to the grocery store with her every time, she will know in the back of her head that she can leave the grocery store at any time and find relief with her husband. It is important that once she can successfully go into the grocery store by herself she should move towards not having her husband standing by in case she does have a panic attack.

        Reply

    • Tim Cody
      Mar 19, 2021 @ 15:18:38

      Hi Anna,
      Congrats on getting the COVID Vaccine! I hope that experience eases your mind and anxiety as to being out in public. These are challenging times, so your anxiety and negative thoughts towards the pandemic are definitely justified. Hopefully when you as well as the public are more accustomed to the effects of the vaccine, we can return to a new normal and have less anxious thoughts.

      Reply

  24. Nicole Giannetto
    Mar 20, 2021 @ 13:09:21

    [Core Beliefs]

    1)
    One core belief I identified after completing the downward arrow technique was, “I am weak.” In this example, I was processing through my experience with having to make announcements to a large room of people during work. As a mental health counselor at a residential setting, part of my job is to speak to the room at large to share announcements or redirect patients. Before group time, some counselors call out, “Group is starting everyone!”. Typically, I go to people’s doors individually to let them know group is starting. As I thought about why I do this I think of 2 explanations: 1) I want each pt to be informed because there is a better chance they will attend group I believe when someone comes to tell them specifically; 2) I am too shy to announce down hallways that group is starting. I think it’s out of a fear that people won’t listen to me or hear me. When I go individually to each room I feel more comfortable. My goal for my behavioral experiment was to try my hand at announcing that group was starting down the halls during the shift.

    2)
    I was able to try my hand at this a few times during shift, and, yes, people did hear me and a handful did head down to the group. My main takeaway from the experience was that I can do this and that people will hear me (one of my main fears was that people wouldn’t hear me/want to listen). By seeing the result of my behavior that I was hoping for, it challenged my core belief that “I am weak”, and showed me that pushing myself to step out of my comfort zone can help to break down this belief and turn it into something positive, like “I am strong” or “I am heard”. In a way, each shift is a bit like a behavioral experiment, because I am constantly pushing myself out of my comfort zone.

    3)
    Challenges in this experiment were really just working up the courage to make the announcements. I found myself rehearsing what I was planning on saying which is helpful, but this can also increase my feelings of anxiety before I start .

    [Behavioral Exposure]
    1)
    Behavioral exposure can be effective in treating certain disorders or types of distress such as, anxiety and phobias, because it forces a person to sit with the discomfort as the main way to overcome their fears/NATs. Exposing oneself to the stimuli that triggers anxiety or panic can help the clinican and client deepen their understanding of the experience and the underlying factors and patterns that are associated.

    2)
    Behavioral exposure should consist of a gradual chain of events that increasingly moves closer to the actual experience that is causing dread/avoidance in the patient. By moving through the hierarchy of fears, the client and clinician can move at a pace that both pushes the client to work while also being considerate of what they are ready for.

    [Behavioral Exposure]
    1)
    Lindsey’s primary automatic thought was around losing control over herself and not being able to escape, and that she was going to have a heart attack. In addition to these thoughts, Lindsey experiences physiological symptoms such as racing heart, sweaty palms, feeling overly hot, and a tightness in the chest. These primary negative automatic thoughts are cognitive distortions AEB the way that Lindsey catastrophizes situations that typically would not elicit distress in most people, but which lead her to assume the worst possible outcome (heart attack, losing control, inability to escape).
    2)
    Lindsey responded to her associated automatic thoughts and physiological arousal by fleeing the situation. She left the grocery store and met back with her husband at the car. This provided some immediate relief, but once she returned home, Lindsey also returned to a much more relaxed state. One of Lindsey’s safety behaviors does seem to be seeking out her husband for comfort after fleeing distressing stimuli, so future sessions may want to look at how Lindsey can practice behavioral exposure without having her husband will be outside to retreat to.

    Reply

    • Elizabeth Baker
      Mar 20, 2021 @ 15:18:25

      Hello Nicole,

      I really enjoyed reading about your behavioral exposure! I am glad you went through with the exercise, as I also feel anxious (almost avoidant) when I have to talk to a big group of individuals out of fear of not being heard/listened to. Getting out of our comfort zone is such a huge task, and you definitely succeeded in doing so! Of course, we can not control how people respond to our words, but fortunately, it sounds like clients acknowledged your announcement! I can definitely relate to this fear. I tend to keep quiet and listen to everyone else during group meetings (for school), even when I have much to say. My fear is that I will say something unhelpful, incorrect, or ignorant, so that tends to hold me back from adding to the conversation. I am working on this though because I want to speak my mind and contribute to group meetings. I think my next behavioral exposure challenge will be to jot down my ideas before a group meeting and bring up at least 3 of them during the meeting. Thank you for telling us about your behavioral exposure!

      Reply

      • Nicole Giannetto
        Mar 21, 2021 @ 11:20:46

        Hi Elizabeth! Thanks for your response. It does feel comforting knowing other people have had similar experiences. I like the idea of jotting down things you want to say on paper before you begin whatever it is you’re taking part in. I do that for various things all the way from interviews to calling a restaurant for take-out, and it’s so helpful! Now that I am thinking about it, it may also serve as a safety behavior (lol). So, eventually, maybe it would be good to try my hand at those tasks alone. I would still try to implement that technique for my work because I think it would serve as a way to push myself to interact in ways that I haven’t and would boost my confidence! Thank you again for your response and suggestion, I really enjoyed reading it. Have a great day!

        Reply

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Adam M. Volungis, PhD, LMHC

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