Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General...

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www.drbrianott.net Anxiety: Body, Behavior, Anxiety: Body, Behavior, and Beliefs and Beliefs Brian D. Ott, Ph.D. Brian D. Ott, Ph.D. Massachusetts General Hospital Massachusetts General Hospital Harvard Medical School Harvard Medical School Massachusetts School of Professional Massachusetts School of Professional Psychology Psychology

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Page 1: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

Brian D. Ott, Ph.D.Brian D. Ott, Ph.D.

Massachusetts General HospitalMassachusetts General HospitalHarvard Medical SchoolHarvard Medical School

Massachusetts School of Professional PsychologyMassachusetts School of Professional Psychology

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Audience ParticipationAudience Participation

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What just happened?What just happened?

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

• Body ResponseBody Response

• Behavioral ResponseBehavioral Response

• Beliefs Beliefs

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

• Body ResponseBody Response

• Behavioral ResponseBehavioral Response

• Beliefs Beliefs

Page 6: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

• Body ResponseBody Response

• Behavioral ResponseBehavioral Response

• BeliefsBeliefs

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

Were you feeling anxiety or fear?Were you feeling anxiety or fear?

Page 8: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Anxiety or Fear?Anxiety or Fear?

FearFear helps you stay alive in an helps you stay alive in an immediately dangerous situation.immediately dangerous situation.

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Anxiety or Fear?Anxiety or Fear?

Anxiety Anxiety gets you ready for an gets you ready for an immediately dangerous situation…immediately dangerous situation…

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Anxiety or Fear?Anxiety or Fear?

that may not be as likely to happen or that may not be as likely to happen or dangerous as you think.dangerous as you think.

And…And…

Page 11: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Anxiety or Fear?Anxiety or Fear?

……interferes interferes with living with living your life.your life.

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

same kind of response same kind of response

butbut

fear helps us move through lifefear helps us move through life

anxiety gets in our wayanxiety gets in our way

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

““Lots-O-Labels”Lots-O-Labels”

PhobiaPhobia

Panic DisorderPanic Disorder

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Post Traumatic Stress DisorderPost Traumatic Stress Disorder

Obsessive Compulsive DisorderObsessive Compulsive Disorder

Page 14: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Anxiety: Body, Behavior, and BeliefsAnxiety: Body, Behavior, and Beliefs

““Lots-O-Labels”Lots-O-Labels”

PhobiaPhobia

Panic DisorderPanic Disorder

Generalized Anxiety DisorderGeneralized Anxiety Disorder

Post Traumatic Stress DisorderPost Traumatic Stress Disorder

Obsessive Compulsive DisorderObsessive Compulsive Disorder

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Johnny and MaxJohnny and Max

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Johnny and MaxJohnny and Max

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Johnny and MaxJohnny and Max

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““It doesn’t make sense.”It doesn’t make sense.”

““It’s just a fence, a bell, a building.”It’s just a fence, a bell, a building.”

““Nothing bad about them, Nothing bad about them,

but I can’t stop the feeling.”but I can’t stop the feeling.”

““Why can’t I talk myself out of this?”Why can’t I talk myself out of this?”

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PhobiasPhobias

Answer:Answer:

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PhobiasPhobias

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Johnny and MaxJohnny and Max

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Johnny and MaxJohnny and Max

TriggerTrigger

Body’s Body’s EmergencyEmergencyResponse Response

SystemSystem

Page 24: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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““It doesn’t make sense.”It doesn’t make sense.”

““It’s just a fence, a bell, a building.”It’s just a fence, a bell, a building.”

““Nothing bad about them, Nothing bad about them,

but I can’t stop the feeling.”but I can’t stop the feeling.”

““Why can’t I talk myself out of this?”Why can’t I talk myself out of this?”

Page 25: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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PhobiasPhobias

So how do we help Johnny?So how do we help Johnny?

Page 26: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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PhobiasPhobias

So how do we help Johnny?So how do we help Johnny?

How do we stop pooch drooling?How do we stop pooch drooling?

Page 27: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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PhobiasPhobias

So how do we help Johnny?So how do we help Johnny?

How do we stop pooch drooling?How do we stop pooch drooling?

How do we stop Brian Ott drooling?How do we stop Brian Ott drooling?

Page 28: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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PhobiasPhobias

Talk some sense into me!Talk some sense into me!

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PhobiasPhobias

Solution:Solution:

Hide the meat andHide the meat andring that bell.ring that bell.

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Johnny and MaxJohnny and Max

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PhobiasPhobias

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PhobiasPhobias

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Problem:Problem:

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PhobiasPhobias

More you avoid, the more you will avoid.More you avoid, the more you will avoid.

The more you avoid, the less chance of The more you avoid, the less chance of conditioned response extinction. conditioned response extinction.

Page 40: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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PhobiasPhobias

Solution:Solution:

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PhobiasPhobias

What have we learned so far?What have we learned so far?

Part of anxiety has to do with a learned physical Part of anxiety has to do with a learned physical “reflex” - the “reflex” - the BODYBODY on Automatic on Automatic

Conditioned body reactions have to be reduced by Conditioned body reactions have to be reduced by a change in a change in BEHAVIORBEHAVIOR – “All action, no talk.” – “All action, no talk.”

Need to move in small steps towards the situation Need to move in small steps towards the situation starting at a middle level of anxiety.starting at a middle level of anxiety.

Page 42: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Johnny and MaxJohnny and Max

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Panic DisorderPanic Disorder

What is a Panic Attack?What is a Panic Attack?

What’s the difference between a What’s the difference between a

Phobia and a Panic Attack?Phobia and a Panic Attack?

Page 44: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Panic DisorderPanic Disorder

Page 45: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Panic DisorderPanic Disorder

Involves one of three concernsInvolves one of three concerns

Losing control (usually in public)Losing control (usually in public)

Going crazyGoing crazy

DyingDying

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Panic DisorderPanic Disorder

Seems perfectly reasonable.Seems perfectly reasonable.

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Panic DisorderPanic Disorder

I can’t I can’t control this.control this.

Emergency Emergency ReactionReaction

SensationSensation

Fail!Fail! Try to Try to StopStop

TriggerTrigger

Page 48: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Panic DisorderPanic Disorder

I can’t I can’t control this.control this.

Emergency Emergency ReactionReaction

SensationSensation

Fail!Fail! Try to Try to StopStop

TriggerTrigger

Panic AttackPanic Attack

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Panic DisorderPanic Disorder

What to do with a Panic Attack?What to do with a Panic Attack?

Can’t Overcome a Strong Rush of AdrenalineCan’t Overcome a Strong Rush of Adrenaline

Distraction and Relaxation often make things worse.Distraction and Relaxation often make things worse.

(note: do relaxation techniques when feeling good)(note: do relaxation techniques when feeling good)

““Can’t beat them, join them.”Can’t beat them, join them.”

Page 50: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Panic DisorderPanic Disorder

I can’t I can’t control this.control this.

Emergency Emergency ReactionReaction

SensationSensation

Fail!Fail! Try to Try to StopStop

TriggerTrigger

Panic AttackPanic Attack

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Social PhobiaSocial Phobia

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Social PhobiaSocial Phobia

Can have Can have

BOTHBOTH

Conditioned ResponsesConditioned Responses

ANDAND

Anxiety Triggering ThoughtsAnxiety Triggering Thoughts

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Social PhobiaSocial Phobia

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Social PhobiaSocial Phobia

BELIEFS can trigger a false alarm of BELIEFS can trigger a false alarm of

the bodies emergency systemthe bodies emergency system

when when expectationsexpectations don’t match don’t match experienceexperience

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Social PhobiaSocial Phobia

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Social PhobiaSocial Phobia

When predicting a catastrophe, ask yourself:When predicting a catastrophe, ask yourself:

Am I being a good bookie and a good actuaryAm I being a good bookie and a good actuary

In my experience is the likelihood of the In my experience is the likelihood of the emergency emergency

Is the damage estimate correctIs the damage estimate correct

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Social PhobiaSocial Phobia

If I look at MY personal experience, If I look at MY personal experience,

what are the odds a catastrophe will occur?what are the odds a catastrophe will occur?

If the catastrophe does occur, If the catastrophe does occur,

how bad will it be for me?how bad will it be for me?

Page 58: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Social PhobiaSocial Phobia

If the belief is accurate – find a way to cope with a If the belief is accurate – find a way to cope with a bad situation.bad situation.

ButBut

If the belief is inaccurate – time to create a new If the belief is inaccurate – time to create a new belief about the situation that better matches belief about the situation that better matches your experience.your experience.

Page 59: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Take Home MessagesTake Home Messages

When anxious:When anxious:

First ask: First ask: how much how much BodyBody conditioning conditioning

and how much and how much BeliefsBeliefs? ?

Page 60: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Social PhobiaSocial Phobia

For Body conditioning:For Body conditioning:

• Build a staircase Build a staircase • Ring the bell Ring the bell • Keep ringing the bell until calm downKeep ringing the bell until calm down• Then go a bit farther up the staircaseThen go a bit farther up the staircase

Page 61: Www.drbrianott.net Anxiety: Body, Behavior, and Beliefs Brian D. Ott, Ph.D. Massachusetts General Hospital Harvard Medical School Massachusetts School.

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Social PhobiaSocial Phobia

For beliefs, the thinking part:For beliefs, the thinking part:

• Think about the horse race and hurricanesThink about the horse race and hurricanes• Ask self is what expecting match what I know Ask self is what expecting match what I know

has happened in the past?has happened in the past?• If yes, use your coping skillsIf yes, use your coping skills• If no, build a new If no, build a new BeliefBelief based on experience based on experience

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