Did you know that by practicing cognitive behavioral

We've known for a while that CBT and mindfulness work for many problems especially stress, anxiety and depression. New research is emerging from Stanford University and elsewhere indicating that CBT and mindfulness are effective for social anxiety. 

If you have social anxiety, you know that some key problems include negative thinking about yourself, doubt about whether others like or respect you and whether you fit in, and excessive worry and anxiety before, during and after social situations. The model of social anxiety below shows how social anxiety is triggered and maintained. We experience a social or interpersonal situation that activates negative beliefs and assumptions about ourselves or others. Once triggered, we feel anxious because of the negative meaning we've given to the situation. 

We may use "safety behaviors," or do things that make us feel less anxiety in the moment, but end up making us feel hopeless and discouraged because we don't learn that we can tolerate anxiety and nothing really bad or scary generally happens. (The exception would be if you are being emotionally, verbally or physically abused or intentionally hurt in some way.) Once social anxiety is triggered, we become self-conscious, worry about what others are thinking, fear being embarrassed, humiliated or looked down on and our self-consciousness causes us to look inward.

An example might be thinking about going to your high school reunion. You tell yourself, "No one will remember me. I was such a nerd in high school. The other kids used to make fun of my thick glasses. I really don't want to go and make a fool of myself again." You perceive the social danger as rejection. You become self-conscious and focus on yourself and your anxiety reactions. You might predict, "I will end up standing in a corner by myself and no one will talk to me. I'll make a fool of myself. I'll feel anxious and won't be able to stand it." So you don't go (safety behavior) and stay home alone with a bottle of wine and ice cream, feeling sad and discouraged.

Imagine, alternatively, if you believed the following: "In high school I was very studious and a few of the jocks made fun of my glasses. I've changed now. I've grown up, have a good job and people tell me I'm attractive. Even though I didn't have a lot of friends in high school, I did have a few close friends who may end up going. I would really like to see them. Yes, I might feel anxious in the first half hour or so but I know it'll pass as I start talking to my friends and having fun." How might the model of social anxiety change if you had these beliefs instead? 

To learn more, see Cognitive Behavioral Therapy and Mindfulness are Effective for Social Anxiety. 

Stay tuned for future newsletters where I'll describe specific CBT strategies, like the Nightmare Technique below, that you can try on your own.

Autumn is almost here. Labor Day marks the "unofficial"

start of the Fall season. Some of us welcome cooler temperatures and enjoy seeing the leaves change colors and fall off the trees (depending on where we live in the Bay Area) while others may miss the more laid-back style of summer, outdoor activities and summer vacations.

I've compiled a few tips to help you peacefully say goodbye to summer and get ready for a busier Fall. 

1) Get plenty of sunshine. In the Fall, the days start getting shorter as Daylight Savings time ends. For some people, this can affect your mood. Make sure you get plenty of sunlight by taking walks during the day and keeping your blinds open. If you work in an office without windows, you can try to eat lunch outside or, if you can't get away, at least get up a few times during the day and look out the window.

2) Plan ahead. If you are a mom or dad, late August marks the beginning of school. Be sure to go shopping early and take advantage of back-to-school sales. Figure out how to balance your work schedule with shuttling your kids back and forth from school, attending teacher conferences and school events, and finding after-school programs. 

Whether you're a parent or not, remember you may need to start getting up a few minutes earlier after Labor Day because traffic tends to increase when everyone is back to school and work.

At work, maintain a calendar, prioritize what's most important (I know this is hard when everything sounds urgent), and learn to say "No" or "I'll get back to you on that" when your boss or co-workers ask if you can help with "just one more project" on top of your already overflowing inbox.

3) One day at a time. It's easy to get overwhelmed with a busy schedule in the Fall, especially as the holidays start: first Halloween, then Thanksgiving. Work may become more demanding too. Learn to tell yourself, "Let me take one day at a time. I can only do so much every day." And if you apply Skill #2, "Plan ahead," it's much easier to establish a daily routine that includes daily relaxation and not get overly stressed about what you need to do tomorrow or next week.

4) Practice being mindful. You don't have to meditate for 30 minutes a day to be mindful. Mindfulness means be present in the current moment and giving all your attention to what you are doing in the here and now. You can wash dishes mindfully, drive mindfully, listen to music mindfully, talk with a friend or loved one mindfully, work mindfully - you can probably do just about anything mindfully.

You may say, "I don't have time to be mindful." Research shows multi-tasking is less efficient than doing one task at a time. Even if you shift your attention back and forth between activities, be present with each task as you do it. For example, you can mindlessly talk on the phone and type on the computer at the same time, perhaps making a few typos that you'll correct later. Or, you can take a mindful approach. When you hear the phone ring, you shift your attention to the caller and what he/she is saying so you are present with the conversation. Then you return to typing after you hang up.

5) Plan some "me-time" every day. Be sure to make time every day for a pleasurable or relaxing activity. Start your morning with a walk or stretch for 10 minutes as you get out of bed. Eat lunch with friends or take a yoga class at lunchtime. Get home at a reasonable time and sit down for a healthy dinner. Spend enjoyable time with your kids or partner. If you have a favorite hobby, try to fit it into your schedule. Spend some time reading. Write a list of all the things that bring you peace and joy. Now find time every day to pursue at least one thing on your list.

6) Wind down for better sleep. Be sure to start winding down several hours before bedtime. Many of my clients complain about sleep problems. When I ask about their bedtime routine, they often say they were working right up until bedtime, they were online emailing friends and co-workers or surfing the Internet, or had a glass of wine to relax. You may not know this but electronics and bright light stimulate the brain and alcohol interferes with your natural sleep patterns. To learn about CBT treatment for insomnia, see Insomnia and Sleep Problems.

7) Be mindful of your thoughts, words and actions. One of my favorite quotes, by an unknown author, says:

Watch your thoughts, they become words.
Watch your words, they become actions.
Watch your actions, they become habits.
Watch your habits, they become your character.
Watch your character, it becomes your destiny.

For most of us, we never question our thinking. We see something happen and we develop an interpretation based on our own experiences or insecurities. We forget to take off the dark glasses that prevent us from seeing clearly. Some of us have "thought-action" fusion, where we assume a thought is equal to reality i.e. If I think it, it means it's true or that it will happen. A thought is just a thought. Learn to watch your thoughts objectively and react to them productively.

You may feel your dreams and nightmares are out of your

control. If so, try this technique and see if you can create happier ending for your scary or unpleasant dreams.

1) Start practicing relaxation techniques every night before bedtime (see Tip 6 above).

2) Choose a nightmare that you often experience and would like to work on.

3) Create a new ending for the dream. Your change should occur before anything bad or traumatic happens to you or anyone else.

The more unusual and out-of-the-ordinary the change is, the more effective this tool may be. For example, you could imagine yourself as having superhuman powers who can escape danger.

4) Write down the new dream with the new ending.

5) At bedtime, practice your relaxation techniques and then rehearse your dream by visualizing the new dream with the new ending. If possible, try this step during the day too so you get extra rehearsal of the new dream.

Source: This nightmare protocol was adapted from the Behavioral Research and Therapy Clinics at the University of Washington.

greater peace and joy in spite of anxiety and stress. But I am just one person, with my own opinions - informed by my personal and clinical experience and research data - about what's helpful and what's not. I see my role as a Cognitive Behavior Therapist to be your guide and coach. The client's role - your role - is to be an expert on yourself, take action in your life, and provide me with feedback on what actually is and isn't helpful to you.

I'd like to compile a list of the most helpful tips and tools that you've used to manage anxiety and stress. You can send me an email at [email protected] with the following:

1) What is your favorite tool or strategy for coping with anxiety?

2) How have you used this tool or strategy in your life? What problems or situations has it helped you with?

3) How has your life changed for the better since you started using this tool or strategy?

I'll compile the responses anonymously (no names) and post a summary in my next newsletter.