Anxiety can creep into our minds, bodies, and lives in the sneakiest of ways. From chronic bouts of anxious thoughts to full blown panic attacks, anxiety can wreak on our internal and external worlds. And although we often think that we should be able to conquer anxiety just by pushing it away or taking a prescription pill, I’ve found, as a clinical psychologist, that anxiety tends to get worse– often much worse–until we mindfully address the underlying issues. And when it comes to healing anxiety, research shows that CBT–cognitive behavioral therapy–yields top-notch results.

Join Dr. Carla and Dr. Joel Minden, leading psychotherapist, educator, and author, who offers expert advice on how to become the boss of your anxiety. Topics discussed include anxiety, CBT (cognitive behavioral therapy), obsessive thoughts, intrusive thoughts, betrayal, trust, affair, infidelity, cheating, romantic relationship, divorce, dating, avoidance, repetitive thoughts, adaptive behavior, cognitive flexibility, tolerance, panic attacks, fear, avoidance, compassion, self-compassion, understanding, thought distortions, distorted thinking, thinking errors, emotions, fight or flight response, hypervigilance, and anxiety treatment.

Please note that this episode contains sensitive material; listener discretion is advised.

Emergency Assistance Note: If you or someone you know needs immediate support, please call your emergency services. In the US, 24/7 help is available by calling “911,” “988” (Suicide and Crisis Hotline), or SAMSA (Substance Abuse and Mental Health Services Administration) at 1-800-662-HELP (4357). Support/informational links are in the show notes.

Books by Dr. Carla Manly:

Joy from Fear: https://www.amazon.com/Joy-Fear-Carla-Marie-Manly/dp/1641701218

Date Smart: https://www.amazon.com/Date-Smart-Transform-Relationships-Fearlessly/dp/1641704675

Aging Joyfully: https://www.amazon.com/Aging-Joyfully-Optimal-Relationships-Fulfillment/dp/1641701412

The Joy of Imperfect Love: https://www.amazon.com/Joy-Imperfect-Love-Creating-Relationships/dp/1641709057

Oracle decks by Dr. Carla Manly:

Etsy: https://www.etsy.com/listing/1757477615/imperfect-love-reflection-oracle-cards

Amazon: https://www.amazon.com/Imperfect-Love-Reflection-Oracle-Cards/dp/B0D1Z5M4YK

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Managing Anxiety, Obsessive Thoughts, and Panic Attacks Compassionately with Dr. Joel Minden

Simple Steps to Coping with Anxiety, Intrusive Thoughts, and Panic Attacks

Anxiety can creep into our minds, bodies, and lives in the sneakiest of ways. From chronic bouts of anxious thoughts to full-blown panic attacks, anxiety can wreak havoc on our internal and external worlds. Although we often think that we should be able to conquer anxiety just by pushing it away or taking a prescription pill, I’ve found, as a clinical psychologist, that anxiety tends to get worse, often much worse, until we mindfully address the underlying issues. When it comes to healing anxiety, research shows that CBT, Cognitive Behavioral Therapy, yields top-notch results. I’m joined by a leading CBT psychotherapist, educator, and author who offers expert advice on how to become the boss of your anxiety.

We’ll focus on this reader’s real-life question. “I divorced my husband three years ago, and I’m finally dating. Here’s some backstory. When I was married, I discovered that my husband was constantly lying to me and that he was also having serial affairs, one with a longtime ex of his. This triggered constant anxiety and a few panic attacks. I never had issues like this before. I thought the divorce would help me get back to normal, but if I get close to someone, I start having obsessive thoughts about them going back to an ex, cheating on me, that thing. I feel crazy. What can I do to get back to who I was before all of this happened?” With that question as the focus of our episode.

I am joined by a delightful guest, Dr. Joel Minden. Dr. Joel is a clinical psychologist. He’s the director of the Chico Center for Cognitive Behavioral Therapy, and he’s a lecturer in the Department of Psychology at California State University, Chico. Dr. Joel is also the author of Show Your Anxiety Who’s Boss: A Three-Step CBT Program to Help You Reduce Anxious Thoughts and Worry. Dr. Joel, welcome to the podcast. It’s such a delight to have you with us.

Thank you so much, Carla. I appreciate your inviting me, and I’m looking forward to talking with you.

We are going to have quite a lot of, let’s call it, fun with this very sad and serious real-life question. The reason I’m saying fun is because it’s not fun to be in a place of anxiety. Having been there. No, it doesn’t feel good, but we can make it, I’m hoping, fun and light by giving good tips and tools to help this reader and all of our readers who face anxiety or panic attacks. Give them some tools and then empowering, lighthearted way. What do you think about that?

I agree with that. Empowering and lighthearted. I think with anxiety, it’s a very scary emotion for a lot of folks, and it’s hard to know what to do with it. Often, the things that we want to do, like try to get away from the feeling or control the feeling, backfire. I think a lot of the stuff that really helps in terms of anxiety management is counterintuitive. Empowering, I think it’s important to do things that give you a sense of personal control.

I can address this challenge, I can deal with difficult thoughts and feelings, I can handle this. The lighthearted thing, I think, is really important as well. Sometimes it’s helpful to change our relationship to anxiety. Maybe we can relax our standards, allow ourselves to feel that way. Sometimes things get scary and difficult, and maybe we can see it for what it is. Sometimes even have fun with it, laugh about it a little bit. I think being really flexible in the way we understand anxiety and respond to it is so important.

Psychotherapist, Educator, And Author Dr. Joel Minden

It’s interesting. Sometimes a guest is saying something, and my heart goes, “This feels good. This feels soothing. That felt good and soothing because it felt like a very friendly approach to anxiety.” Before we get any deeper into the topic, can you tell our readers just a little bit about what makes you, you?

Good question and a tough question to answer. One thing that makes me me is I’ve always seen myself professionally and in my personal life as someone who likes to explore the middle ground between science and practice or applied work. My hobbies, my professional work, I’m always thinking about the scientific foundation for whatever it is I’m doing, but also how to live in the world, how to operate in an authentic way, in a practical way. Finding that middle ground between science and practice, I think, is one way to describe me in the way that I typically operate.

I’m getting a sense of an intellectual, and it crossed with the surfer vibe, but maybe not.

Something like that, except I don’t surf.

You don’t surf. What’s your favorite form of exercise?

Lifting weights.

There is a surfer-like quality to lifting weights, because if you get into that flow state, I’m not a weightlifter. I can lift little weights, but I’m not a weightlifter. There is something beautiful and very flow about doing weightlifting in a few times I’ve done it.

I think the repetitive nature of it is very calming. Keeps you centered, grounded, focused.

Understanding Cognitive Behavioral Therapy (CBT)

It is a form of exercise that does feel really empowering because you can feel your muscles working. You can see them working. Instant gratification as well. Now, let’s give our readers. I don’t ever like to assume that anyone reading understands what we’re talking about when we’re using technical terms that might be familiar to us, such as CBT. Could you give a brief description about CBT and why it’s so effective?

CBT, if you think about the name cognitive behavioral therapy, we’re looking at cognition, how people think, and what they think. Behavior, what people do. I guess left out of that acronym is the emotional element. When CBT, we’re looking at the interplay of thoughts, feelings, and behaviors. In my experience, especially with anxiety, but you could say this about almost any difficult emotion. When people are struggling with their feelings, usually their go-to is that they’re scrambling or looking for a way to stop the feeling or get a better handle on what’s going on emotionally.

What I like about CBT is that it’s a pragmatic way of looking in different directions to understand the problem or to try to help people find a productive solution. Sometimes that involves cognitive work, maybe looking at how people think about themselves or their relationships or the future. I say sometimes, I think we all fall into this trap. People get stuck in these biases. There’s certain patterns of thinking that are very realistic, maybe overly negative, very biased ways of thinking, not reality-based. If you believe these things to be true, it can really create an obstacle.

It can impact the development of difficult emotions. It can impact behavior. When we get stuck in these thinking traps or in CBT, we call them cognitive distortions. It’s really easy to struggle emotionally and behaviorally. We want to help people understand. How do you think? Would there be any value to modifying your perspective to be more realistic and useful? That’s the cognitive element of CBT. The behavioral element, in my opinion, I think is the most important part of the work. Let’s take anxiety.

Typically, when people struggle with anxiety, they develop a pattern of behavior that involves a lot of avoidance. It makes sense. If we’re in a challenging situation or we think something bad is going to happen, of course, we’re going to have that urge or that impulse to pull away from the potential threat or the bad thing. That can feel good in the moment. We get that reinforcing experience where anxiety declines, maybe a little bit or temporarily.

It feels like, “Maybe I’m on the right track by pulling away from things that are scary or difficult.” In the long run, that’s really problematic because then we become dependent on this pattern of avoidance. It’s really hard to live a meaningful life if you just keep avoiding. Behaviorally and especially with anxiety treatment, we want to focus on how we can help people move toward important challenges in their life, even if things get scary, how do they work through the anxiety and still engage in activities or behaviors that bring fulfillment, meaning, and purpose, a sense of accomplishment.

How do we get people back into living behaviorally? Anyway, long story short, in CBT, we’re focusing primarily on the cognitive element, the behavioral element. I guess the final thing I want to say is, in terms of the emotional aspect, instead of working so hard to try to control emotions, maybe we shift the focus a little bit more to how I understand my emotions and how do I respond to them? Sometimes difficult emotions get in our way, and it’s important to be flexible in the way we make sense of them and the things that we do with them. That’s an overview of at least CBT, the way I practice it.

It is a very thorough for the situation overview. I appreciate how you broke it down into understandable portions. I’m going to throw something back to you, and please help me shift it if it needs some shifting, so that our listeners can see how it’s very practical. If somebody is afraid, they often say, “I’m conflict avoidant. I’m afraid of having discussions with my partner or my boss or my parent, or my child.” They don’t have the discussion.

They respond to the anxiety and they say, “I’m not going to have this discussion. I’m just going to close down.” The issue doesn’t go away. They’ve avoided it. The anxiety signals to stay awake. Even sometimes the anxiety is lying to you. Sometimes, if that person’s not going to be horrible to you or harm you or be emotionally abusive, that anxiety is often lying to you based on an earlier life experience. In the here and now, they think I’ll just avoid it. They don’t go through the discussion, the back and forth that would be needed to resolve the issue.

It gets harder and harder to have conversations. Now the anxiety is controlling their ability to have honest or deep, or meaningful conversations with other people. You would take that simple situation and help that person understand, wait, yes, you’re experiencing anxiety, your brain, your cognitions are telling you it’s not safe, but we can shift this and make it realistic. Is this person safe? Will they listen to you? Now we’re doing it in a realistic way, and then have them practice it so that they stop avoiding something that could actually be empowering for them. How does that work as an example, just to bring it down?

Great example. It’s so relatable. I think most of us have to have difficult conversations with people, and it’s a really hard thing to do. One nuance that I want to bring up here because I talk to folks about stuff like this a lot. Sometimes I’ll hear comments like, I have to have this difficult conversation and I’m really scared that it’s going to lead to an argument. I’ll hear a follow-up statement like, “I know that’s irrational, but,” and I guess my reaction to that is maybe it’s not irrational because maybe you’re bringing up something that could be touchy.

Can be sensitive. Maybe the other person will have an issue with it. Maybe you don’t handle it very well. It seems accusatory rather than productive. Instead of being even more self-critical and judgy, like I’m irrational in my thinking, I look at it more like there’s a chance that things could really backfire here, and you could try to have this conversation, and things might really fall apart. That’s where I try to move things more toward useful thinking. What could you do that would be helpful here? Maybe write down some talking points.

Maybe you try to deliver the message in a really soft way. Maybe you try to do it in the moment, when a problem comes up, kind of acknowledging it and trying to work through it rather than saying to your partner or whomever, “We’ve got a problem. Let’s sit down and talk about this.” It becomes a big event. There may be a lot of strategies that people can use to think in very useful ways about how do I approach this really difficult conversation. The actionable part, how can I take that first step toward doing this in a way that’s going to minimize the risk and increase the likelihood that things go well, that I’m effective?

I really appreciate that because so often, especially with the issue we’re talking about, somebody who’s afraid of having discussions or conflict that the tips you offered just there help really ground the person. You first honor that, yeah, it can go bad. Sometimes, when we really look at that, honestly, it could go bad. Let’s prepare and see how well we can do as you’re saying, take some steps, maybe make some notes in advance, maybe practice in the bathroom mirror, a few ways of bringing up the topic that sound kind, and use I messages.

I found that for me personally, if I’m talking with someone where there’s some anxiety on their end as well, which I often will feel on my end, I’ll just say, “I’m feeling really anxious about this, or I’m feeling a little unsettled about this, but I really believe we can have a productive conversation about this.” Sometimes, just honoring our anxiety and saying it’s there, we don’t have to pretend it’s not there. We just need to not go into fight or flight because it’s there.

I love that point. I’m so glad you brought that up. It’s important to acknowledge to ourselves that I am anxious. This is hard. When we acknowledge that to someone else, that can be empowering. I’m anxious and I’m still talking to you and self-validating, but also maybe a little easier for the other person to drop their defenses a little bit and go, “This is hard and it’s a big step for you to bring this up. It must be important. Let’s see if we can talk about this in a productive way, a respectful way.” I love that idea of just saying, “I’m anxious about this, important to bring up. Let’s see what we can do here.”

Dealing With Recurring Unwanted And Intrusive Thoughts

It makes it so much more human, so much more, “We’re all imperfect. We all get anxiety. We all have issues. Let’s just see if we can meet. Just meet somewhere on this and talk.” Thank you for all that background. Now, for our readers’ question. It’s a really complicated one. It sounds as I recap it in my mind, this individual has been divorced for three years, now out dating, never suffered from anxiety or panic attacks.

Found out the husband was cheating with different people, now has recurring obsessive, unwanted thoughts, intrusive thoughts maybe about that are related to it seems that they get triggered because the husband cheated on her, lied to her. Now, when this individual is dating and getting close to someone, some sirens are going off saying, “No, they might be cheating. They might be bad. They might be with an ex.” Walk us through this little minefield, please.

There’s so much to talk about here. If I’m too focused on one thing or another, bring me back. I guess the first thing I’m thinking here is, again, validating the concerns. Here’s somebody who went through a situation where there was a problem of infidelity, and maybe they trusted their partner. They thought things were safe and okay.

They found out things are not okay. Going into dating, new relationships, it makes sense that she would be aware of the possibility that maybe some people are not going to be trustworthy. This is going to cross her mind. That seems like a very normal thing to be concerned about. Also, if I heard something like that, I would think that’s pretty adaptive. Imagine if you didn’t think about this at all. You thought, “Great. I’ll just move on to the next person, and I’ll trust whoever I’m with.”

That doesn’t seem like a good move based on past experiences. Who knows. When you’re meeting someone new, you don’t know a lot about them. Good to play it safe, or at least to some degree, in the early stages of dating. I think an important first step is to acknowledge that there’s some value to thinking this way. Even if you don’t buy into that, it’s understandable that she would think this way. I guess that’s probably the first thing that I would focus on.

Can I pause here? That was so sweet. That was so kind. I’m going to repeat a few words you said, that when there’s trust that was broken, there was adaptive behavior as a result of infidelity, and that this behavior is understandable. I’m hearing you say, this poor soul is not crazy. She’s not broken. Her brain is a bit wired now to be aware of indicators that somebody might break her heart. They might betray her, they might be unfaithful.

I often say to clients, your brain learns that a red berry is bad because there was a person who got poisoned by the red berry. Now it’s saying, “There’s no difference between a strawberry and a raspberry and these poisonous berries, but it’s seeing red berries and it’s saying be really careful.” There is a highly adaptive quality to that. Thank you for just giving us that dose of tender loving care. Next step.

Just one more thing I want to say about that is you were saying, adaptive behavior. I think about cognition as behavior. The way that we think is private behavior. This thinking is a private behavioral reaction. I may not be able to trust this person. Looking at that as a learned response, an automatic thing that’s going to happen based on past experiences, that might be pretty freeing for somebody who sounds like in the example, she’s being pretty tough on herself for thinking this way. It sounds like it’s an automatic thing. It’s just happening. Maybe she can give herself a break for having these thoughts. Next, as I was saying earlier, figure out “What am I going to do about this? How do I move forward?”

Thank you again. It’s a really beautiful way to look at as with most anxiety, or repetitive thoughts, intrusive thoughts. There’s a warning quality to them. Once we see that we’re not broken, that the brain is just sometimes a little hyperactive, it’s a little hypervigilant. What’s next?

Next, maybe this is more buildup than you’re looking for, you were touching on this, I think, sometimes the anxiety we have, it’s telling us something important. Sometimes it’s like a false alarm. It’s like a learned response. Next, I would focus on the appraisal of the thoughts and the anxiety. By that, I mean, here she is thinking a certain way and feeling anxious.

It sounds like she’s looking at that as a problem. I shouldn’t think this way, or maybe I’m going too far with this, or the anxiety is a problem. How do I get a handle on this? Focusing on being flexible in the way she understands these inner experiences, these thoughts, and feelings. If I were working with a client like this, I would probably work with her on making sense of this. Why is this happening? What does it mean to you? What does it indicate?

Is the anxiety a threat? I’m guessing that probably is part of the appraisal, because you mentioned panic attacks. Talk about that a little bit. Is it a threat appraisal? “I’m in danger because I’m thinking and feeling this way.” Is it possible that, as I said a few times that her mind is just going to go there and she’s going to have these feelings because she’s had these past experiences, and there are a lot of unknowns. There’s a lot of uncertainty in dating, and it’s just part of the deal as she moves forward in her life.

Why Threat Appraisal Happens

Could you say a little bit more, please, about the threat appraisal and why that threat appraisal is happening, and how it benefits this individual or anyone in a similar type of situation, and how it works against them.

The threat appraisal might be really helpful because if she’s dating someone and they say great and right off the bat, she just thinks this person’s wonderful, and I’m ready to go into a serious relationship with them. It’s probably not a good move. Probably good to take things slow. If she starts thinking this way and feeling anxious, she thinks, “Be careful.” “I don’t want to find myself in a situation that I was in before, and I cannot completely eliminate the possibility of a bad outcome.” Maybe these thoughts and feelings are telling me, “Be careful. You may be in trouble if you move too quickly here.”

That threat appraisal, to me, seems pretty helpful. Sometimes people can go too far with the threat appraisal. They might think, “If I’m thinking and feeling this way, this person is not right for me, or I’m not ready for dating. There’s no hope, and I’d better just give it up.” That’s maybe taking the threat appraisal too seriously. Again, turning to that avoidance tactic to try to get away from difficult situations and the thoughts and feelings themselves.

In some cases, if this person, so break it down a little more. If this is a good reflection back to you. If she’s dating someone and they are maybe showing through looking at other people all the time or hiding texts, then her threat appraisal is really working for her. Saying this person, even though you’re falling for him, “Look, there are some serious red flags.” In that case, it’s working for her. However, if she’s dating someone who’s there, not showing any signs of being an unfaithful person or having this mask of being one way when he’s with her and another way when she’s not looking. If this person seems honest and genuine after several dates or many dates, and she’s still having these behaviors, then it’s working against her. Pretty basic?

Yeah, although as an aside, if we think about anxiety disorders, it was my opinion. My opinion is that all anxiety disorders have a common element, and that’s an intolerance of uncertainty. What you’re saying is if she’s thinking, “Things are going well.” I don’t really see any evidence to suggest that things are dangerous or problematic here. Maybe I shouldn’t listen to this threat appraisal, or maybe it doesn’t mean anything.

When somebody has an anxiety disorder, they want to know for sure, 100%. “Am I safe? Is everything good? Is everything going to work out?” Of course, we cannot get that we can never get that complete certainty. Somebody who’s struggling with uncertainty they may get tripped up even more in situations like this, because it’s a real threat or a false alarm? It’s “I don’t like uncertainty, and no matter what I experience or what happens here, I’m going to be considering the possibility that things might really fall apart.”

That’s another dimension in terms of understanding anxiety and anxiety treatment, really paying attention to that uncertainty piece because for some people, they struggle to figure out “When am I in a situation where I just don’t have enough information to know how to proceed? When am I in a situation where the uncertainty is just doing a number on me, and I don’t know what to do with that?”

As you’re explaining it, I’m feeling so much compassion for this individual and for all individuals who, at some time or another, or maybe chronically suffer from anxiety. Certainly, at the other end of the continuum, mild anxiety over here and then full-on panic attacks over here. It goes beyond uncomfortable to excruciating. I’ve had clients end up in the emergency room, and that’s how they come to find me because they think they’re dying.

I don’t take my first book, Joy from Fear, all about anxiety, all about fear, all about how very non-CBT. I shouldn’t say it’s non-CBT, it’s just my own approach, a Jungian-oriented approach to cognitive behavioral therapy. I am in accord with you. I truly love that so many people think cognitive behavioral therapy lacks empathy lacks compassion. You are bringing such a blanket of warmth and gentleness and understanding. It’s just so beautiful.

Thank you.

Bringing Empathy To The CBT Process

Now you’ve written a book on this topic. I imagine your book is infused with the same type of energy because it seems just part of who you are.

Thank you. Very nice of you to say. That science and practice thing. I tried to write the book. Really pragmatic and to the point, and a lot of applied info in there, but also I think it’s important to bring some warmth here. Trying to understand the human experience. We all experience anxiety. It’s a

tough emotion. It’s confusing. I think so many people just get down on themselves for feeling this way. Other people say, “Calm down, relax, get over it. It’s so unhelpful.”

I think step one is to go easy on yourself, be self-compassionate, and understand that anxiety is tough for everybody. It may be tough for you in certain situations, and you don’t need to be harder on yourself just because you’re struggling with an emotion you cannot control. Be authentic, be validating, be supportive to yourself. That’s going to create a nice platform to move forward with all these other strategies and tactics.

I guess another thing I want to say is in terms of theoretical approaches or models that we use, I like CBT. For me, it’s straightforward and practical. I know sometimes people say it’s manualized, it’s overly structured, it’s surface level. I hear this stuff all the time, but I think good therapy, different theoretical orientations and styles, we see a lot of overlap across the things that good psychologists do.

I can see how people might have these perspectives if they’ve had certain experiences with CBT, or it’s rigid and structured and not very warm, but I think it’s important to really integrate different perspectives and approaches from different therapeutic modalities. I would say CBT includes these things anyway. The bottom line we want to use the evidence-based practices, but we also want to make sure that we always remember we’re working with people, they’re dealing with very real human struggles. It’s important to be empathic and supportive. This isn’t stimulus-response. Everything’s solved. People are complicated, and emotions are complicated, and we want to be empathic.

Show Your Anxiety Who’s Boss

You’re smiling on my end because I’m thinking that maybe you’ll just go off with your own rebrand of CBT and call it cognitive empathic behavioral therapy or cognitive emotional behavioral therapy. Get that E in there that you were talking about earlier. Your book, Show Your Anxiety, Who’s Boss. Readers, the link will be in the show notes. You’ll be able to find all of the information there. You don’t have to have a pen handy. Let’s move using that book as a platform. Looking at the reader’s question, now we understand, you’re doing this for a reason. You’re uncertain.

You want certainty. No matter who you’re dating, there’s going to be uncertainty. It could be the world’s most genuine human being, the most faithful human being, but there’s uncertainty because that person’s a human being, and we are uncertain creatures. We do odd things sometimes, we have unique personalities. How can our reader move from the uncertainty that is controlling them? The uncertainty is already there. It’s just controlling them. How can they take some steps so that they’re not plagued? It sounds like they’re so plagued by this. How can they move forward?

The first thing I would want to do is just check in with this person and figure out what do you want to do here? They might say, “I don’t know.” For example, if I propose, “Why don’t you have an honest conversation with this person that you’re dating and explain your situation and how you’re feeling, like we considered earlier?” That might be a good step. Maybe she’s thinking, and maybe she’s saying, “I don’t know where this is going to go or how comfortable I feel in this relationship. I’m not ready for that conversation. I don’t want to try to direct someone to hoard something like that if they’re not open to it.”

She might say, “Right now, I just really want to get a handle on these thoughts and feelings and the panic attacks before I do anything.” That’s a mixed bag because that’s going to lead to more attempts to control the feelings and potentially more avoidance. What I would suggest is figure out behaviorally, what are your goals here? What do you want to do? Do you want to continue dating? Do you want to have these conversations with people? Maybe a good starting point is I just want to get better at working through the anxiety.

Go on these dates. I’m feeling anxious. I want to just get more practice acknowledging privately to myself, this is going on. I’m working through it. I’m focused on the date. I’m giving it my best attempt. I’m going to be aware of what’s going on. I’m not going to let this anxiety interfere with the things that I want to do. I’m going to treat it like background noise or a tolerable annoyance. I’m going to figure out a way to proceed in a way that’s really going to help me connect with someone and hopefully find a meaningful relationship.

Got it. Now, I don’t believe her question specifically said this, but I’m doing an overlay on so many clients I’ve heard from with similar themes. If intrusive thoughts of what the ex did, what if those intrusive thoughts are also triggering this anxiety? They’re running behind the scenes.

There we go back to the threat appraisal. If you have the intrusive thought and you think this is serious business, you’re going to get anxious, and you may have the avoidance urge. On the other hand, if you have an intrusive thought and you think that’s just a learned response or a weird thing that happens or background noise or whatever, something that where the understanding is more objective, more neutral, maybe more self-compassionate, maybe even humorous.

It probably doesn’t feel very funny to the person who’s experiencing this, but maybe for some people it’s helpful to laugh about this a little bit because, as much as you want it to stop or go away, it probably won’t. Maybe you can just see it for what it is and let this stuff unfold in the background without prioritizing it so much.

Can I pause you right there?

Sure.

What you said about the thoughts probably not going away for many people, especially people who have come to me where they’ve been on anti-anxiety meds and now they’re wanting to be off them, or whatever is happening. They’re wanting to address these constant thoughts or panic attacks. They think it will magically go away forever. They’ll conquer the thought, and it will be gone. When they do some work and it’s still sneaking back in, they think they’re broken. They think that they’ll never get rid of it, it’s almost, I think of it as similar to an ant infestation.

The ants come in. You can put out those little traps, and they climb in, and you get them all. A few days later, there’s one walking on through, and whatever you do with it, take it outdoors, squish it, I don’t know. The point is that, is my understanding and how I’ve seen anxiety work that it does tend to trickle back in like ants. We don’t 100% eradicate it because thoughts and unwanted thoughts like ants come in. Is that what you’re saying?

Yes. I love that ant example. I’m going to use that if you don’t mind at some point in the future.

Please, do.

I guess I would explain it because sometimes people think, “I don’t want to go to therapy to just allow these thoughts to be there. I’m already doing that.” Usually, they think they’re just tolerating this, but they’re working so hard to try to get rid of these thoughts. Once we’ve learned this stuff, we learn in two ways that I think are really important or relevant to this conversation. Once we learn this stuff, it’s just going to be there.

We can elicit it to certain stimuli and situations might trigger these thoughts again. Take her example. She’s worrying that somebody will cheat or she’s worrying or she starts to think about her ex, who cheated. If she’s dating, these thoughts are probably going to come up here and there. They may come up a lot, maybe sometimes they don’t come up at all, but it’s variable, it’s unpredictable, it’s uncertain. Maybe acknowledging that sometimes this stuff will be there.

The other side of this is when you try to avoid the thoughts or when you try to control the thoughts, then it’s like your brain learns. If you don’t respond to that noise, then make the noise louder. If I make the noise louder, if I send more thoughts, or the emotional distress that comes with it becomes more intense, eventually, the person might learn. I get to a point where “I cannot take it anymore, and I have to go right back to it and start wrestling with these thoughts and feelings.”

Once again, they learn that this is important when it’s there, when it’s intense, try harder, and get more involved. They learn once again to commit to those responses when, counterintuitively, probably the best course of action is to see it for what it is, leave it alone. Don’t engage in that tug of war with the brain. Just let go, let it be there, and then shift your attention back to life.

A Study On A Polar Bear And A White Rabbit

I’m hearing you say thought pops up. I can see I’m being this reader for a minute. I can see the moment I found out my ex cheated on me. I’m reliving that moment. Instead of running away from it, saying I’m stupid for constantly thinking of that thought, I’m just going to look at the thought and go, “That’s understandable. That was a really scary and hurtful, and life-changing moment. This makes sense that I’m feeling a little scared and anxious here.” Thank you. You’re reminding me of the old study on the polar bear and the white rabbit study. Can you tell our readers just a little bit about that so they understand that we’re not pulling this out of a hat?

I don’t remember the specifics of that study. The general idea is that telling people not to think about something is probably going to increase the likelihood that they do think about it, because there’s not threat appraisal, but the importance of the thought is brought to the table by saying, “Don’t think about this.” We’re assigning some meaning to the thought, “This is a bad thought, it shouldn’t be there, it’s a problem, don’t get involved in it.”

I want to make an important distinction. There’s a big difference between having the thought, we don’t control that, and engaging with the thought. What I try to encourage is to create space for having the thought, because that’s not up to you. Of course, people say, “I wish I didn’t have the thought in the first place.” Since it’s going to happen, let it happen. Part two, don’t fight it. Don’t get more involved. Here’s an example.

People with social anxiety often to be socially effective, so we want to think about our interaction with people or the other person. We want to show interest. We want to be engaging. We want to have that reciprocity. People with social anxiety become excessively self-focused. What should I say next? How am I doing? Do I look awkward? Am I nervous? That takes them away from what they really want to be doing. They’re not going to be effective socially if they’re so focused on themselves.

Same thing here. We want to help people understand that these private experiences, like intrusive thoughts, are going to happen. There may be an emotional component. That happens at the same time. The trick is, here I am trying to go on a date or do other things, and I got to make a choice. Do I get more involved with my thoughts and feelings because I don’t like them? Do I take that step back, hands off, redirect back to what’s more important, more meaningful in the moment, and just let that noise be there in the background?

Now, one thing I do try to point out to clients because they’re thinking, “I just got to put up with this awful noise.” Generally, when we practice things like this, this is called response prevention for people who are familiar with anxiety treatments and talk about that more. Generally, when people don’t engage with intrusive thoughts and difficult emotions in the way that I described, they learn three new things. One is that anxiety declines on its own. We don’t have to do anything about it. When your body’s ready to calm down, it’ll calm down.

If we just wait it out, the anxiety will decline. We don’t have to rely on special tactics to control it. As I keep saying, “If we do that, it may backfire and the anxiety might spike.” That’s one important opportunity for new learning. It generally declines. Number two, it’s important to learn, and very empowering to learn that anxiety is tolerable. If I get anxious while I’m doing something important, maybe I can deal with that. Maybe with more experience, more practice, I can get to a point where I can feel anxious and still be effective at the same time.

I think when we have those experiences, it feels so good, it’s so rewarding. I try to promote that. Let yourself feel how you feel, but live your life, do the important thing at the same time. Finally, when we don’t engage with these unhelpful or irrelevant thoughts and feelings, “We might learn for ourselves that I can deal with the uncertainty. I don’t know for sure that I’m on the right track with what I’m doing with the feelings or the dating. There are a lot of unknowns. Maybe I can allow for that. Maybe it’s okay to have a certain amount of uncertainty in my life, and I don’t have to do more work to try to establish complete certainty. I’ll never get there. Maybe I can let a certain amount of uncertainty be there in my life and get on with things.”

Such a beautiful summary. I am so appreciative of your wisdom, your expertise, your kindness, your compassion, your adorableness. Thank you.

Thank you, Carla.

How To Manage Panic Attacks

This has just been amazing. Are there any other highlights you’d like to share with our readers?

Yes, I want to touch on the panic element.

Thank you.

Here’s somebody, not only are they getting anxious, and it makes complete sense to those of us who are thinking about a scenario like this, but the panic attacks are so scary. Those readers who are unfamiliar with panic, psychologists often describe it as an intense surge of fear. We might even see panic as qualitatively different from anxiety. I think anxiety is anxiety. Just varies in intensity, but with a panic attack, it’s like a fear response.

It can be really intense. Sometimes people hyperventilate and their heart’s beating really fast, and they’re sweating. It’s scary. I guess the final point I want to bring up here is if somebody’s having a panic attack, usually what’s going on is they’re getting anxious about something. What if this person I’m dating cheats on me, and then they get anxious, and then they start to get anxious about the anxiety. “Why do I feel this way, and what’s going to happen because of this anxiety?”

Often, the thinking moves toward, “I’m going to lose my mind, or I’m going to have a heart attack, or I’m going to die.” That’s terrifying. Of course, anxiety is going to spike even more because there’s that threat appraisal. I think with panic, I still have the same opinion. When you get down to it, it really is just a feeling. It’s just an emotional experience, and we don’t have to fear panic itself. That might be hard to believe for people who experience panic attacks, because it is so scary. I do think it’s important conceptually to understand that panic is just anxiety.

It’s just a feeling. When I say just, I’m not trying to minimize the struggle of that, but understanding that I think is really valuable in those moments where things get so overwhelming and it feels like I’m going to lose control. Anxiety about anxiety, sometimes that helps people to think about panic in that way, or what I would say in cognitive therapy, we would talk about catastrophizing or having catastrophic thoughts about anxiety itself.

That’s when the anxiety spikes and they become panic. What I would suggest for somebody who’s having a panic attack. Of course, there are relaxation things that you can do, like slowing your breathing down, and that’s valuable. I think the most important thing is, once again, to acknowledge that, and probably moving toward a catastrophic place in my thinking about anxiety itself, causing the anxiety to spike, and having a panic attack.

It’s really scary, but same concept. I don’t have to do anything about it. I can wait it out. I can let it unfold. The sooner I can get back to doing ordinary things, “This is happening the better, because then I’ll learn for myself that it really is just a feeling. I’m maybe I’m more effective and functional than I thought.” That sense of empowerment that comes with that can be really rewarding.

Your empathy and compassion, and genuineness just shine through. Carl Rogers would love you, remember, if you were in therapy. Genuineness, empathy, and unconditional positive regard. You’ve got it.

Thank you, Carla. I want to say Carl Rogers is one of my heroes. I thought about him earlier as we were talking because I think about anxiety. All these scary things that we have to deal with in life. I always remember, I love this, Roger said, “It’s an awfully risky thing to live your life.” You have to take risks all the time. That’s scary. Acknowledging that to be validating about that is so important.

Get In Touch With Dr. Joel

I don’t know if you have kiddos or not, but he has that same father-like, gentle, best friend-ish quality, which made him such a superstar in the realm of psychotherapy. Readers were talking about Carl Rogers, just he was amazing. You have that energy that takes it away from any judgment, any airy-fairiness, and down to wait a second, if we can just have this, what I describe as a gentle parent attitude toward the self, just that gentle, loving, empathic parent attitude toward the self is so healing. You have been amazing. Thank you for joining us. Where can our readers find you and your book, which again, will be in the show notes, but what would you like to say?

They can find me through my website. It’s CBTChico.com. CBT is like cognitive behavioral therapy. I have a private practice in Chico, California. Of course, my book, Show Your Anxiety, Who’s Boss, you can buy that wherever you like to buy books. I also have a blog on psychology. It hasn’t been updated in a while, but I’ve got some materials there. Those are the main places people can find me.

Perfect. You’re on Instagram, too.

I’m on Instagram. Don’t use it a lot.

You’re there. Thank you again for sharing your time and energy, and wisdom with us. To our readers, thank you for joining us, for sharing your time and your commitment to evolving in this very risky journey that we call or often risky journey of life. Thanks again. Bye-bye.

Thanks so much, Carla.

Important Links

• Dr. Joel Minden on LinkedIn
• Dr. Joel Minden on Instagram
• Chico Center for Cognitive Behavioral Therapy
• Show Your Anxiety Who’s Boss: A Three-Step CBT Program to Help You Reduce Anxious Thoughts and Worry
• Joy from Fear
• The 5 Most Useful Responses to Anxiety
• CBT and Me – Psychology Today
• NAMI HelpLine
• Dr. Carla Manly Website
• Dr. Carla Manly on Instagram
• Dr. Carla Manly on Twitter
• Dr. Carla Manly on Facebook
• Dr. Carla Manly on LinkedIn
• Dr. Carla Manly on YouTube
• Dr. Carla Manly on TikTok

About Dr. Joel Minden

Joel Minden, Ph.D., is a clinical psychologist and author of the empowering book “Show Your Anxiety Who’s Boss.” Dr. Minden is the director of the Chico Center for Cognitive Behavior Therapy and a lecturer in the Department of Psychology at California State University, Chico. Dr. Minden’s work focuses on the management and treatment of anxiety using Cognitive Behavioral Therapy (CBT).