Schedule a Call

MOVING MOUNTAINS

Resources

FILTER

Surgeons General Connect on Mental Health at Dartmouth

Posted on by Mountain Valley Treatment Center

One of the many benefits of Mountain Valley’s beautiful location in the Upper Valley region of New Hampshire is our proximity to Dartmouth College and its world class medical school and teaching hospital. Mountain Valley’s relationship with Dartmouth provides us with many benefits, such as Dartmouth psychology interns and psychiatry fellows doing clinical rotations in Mountain Valley’s therapeutic milieu, our residents undergoing exposure work on the Dartmouth campus, and ample cultural and recreational activities for our residents to enjoy on the weekends. Occasionally, it also allows us the fortune of being first-hand witnesses to historic events such as Dartmouth hosting U.S. Surgeon General Vivek Murthy and his seven living predecessors for a panel discussion titled, “Future of Mental Health and Wellness.”

During the discussion, Murthy and his predecessors discussed their concerns about the national mental health crisis and how to combat it. This comes on the heels of Murthy releasing a new Surgeon General Advisory calling attention to the public health crisis of loneliness, isolation, and lack of connection in our country.

Murthy said that in the face of unprecedented loneliness and mental health issues, community is one of the keys to repairing the crisis. Murthy brought the conversation to the challenge of community and interpersonal connection. “For a lot of us this issue is very personal,” he said, asking the audience to raise their hands if they or someone in their lives had struggled with mental health or loneliness; almost everyone in attendance in the basketball arena raised their hand.

This discussion prompted me to reflect on how loneliness in particular can have profound and far-reaching effects on mental health, impacting various aspects of well-being. We humans are social creatures, and a lack of meaningful social connections can contribute to a range of emotional and psychological challenges, including debilitating anxiety. It is no coincidence that coming off the devastating effects of the COVID 19 pandemic and the explosion of social media and other immersive online experiences that our country is facing epidemics of both loneliness and anxiety.

Loneliness and anxiety are interconnected, and the relationship between the two can be complex. Loneliness, characterized by a perceived lack of social connection or meaningful relationships, can have various effects on anxiety.

Here are some ways in which loneliness can impact anxiety:

  • Increased Stress Levels: Loneliness often leads to heightened stress levels. The absence of social support can make it challenging for individuals to cope with life’s stressors, contributing to increased feelings of anxiety.
  • Negative Thought Patterns: Social isolation can give rise to negative thought patterns and self-perceptions. Individuals who feel lonely may be more prone to self-doubt, negative self-talk, and a heightened sense of vulnerability, all of which can contribute to anxiety.
  • Rumination and Overthinking: When individuals are lonely, they may spend more time ruminating on negative thoughts and experiences. Overthinking and dwelling on perceived social inadequacies can exacerbate anxiety symptoms.
  • Impaired Coping Mechanisms: Social connections often serve as a crucial support system for coping with life’s challenges. Loneliness can limit the availability of these coping mechanisms, making it harder for individuals to manage stress and anxiety effectively.
  • Physical Health Impact: Loneliness has been linked to various physical health issues, including increased inflammation, cardiovascular problems, and compromised immune function. The stress associated with loneliness can contribute to these health issues, potentially worsening overall well-being and increasing anxiety.
  • Social Anxiety Development: Long-term loneliness may contribute to the development or exacerbation of social anxiety. The fear of judgment, rejection, or negative evaluation can intensify in the absence of positive social interactions, further isolating individuals and perpetuating a cycle of anxiety.
  • Sleep Disturbances: Loneliness can disrupt sleep patterns. Difficulty falling asleep, staying asleep, or experiencing restful sleep can contribute to fatigue and irritability, which are common symptoms of anxiety.
  • Reduced Emotional Regulation: Social connections play a role in emotional regulation. Loneliness may impair an individual’s ability to regulate emotions effectively, leading to heightened emotional reactivity and an increased susceptibility to anxiety.

Addressing loneliness involves not only building social connections but also addressing the underlying thoughts and beliefs that contribute to feelings of isolation. Seeking support from friends, family, or mental health professionals can be crucial in breaking the cycle of loneliness and alleviating associated anxiety symptoms.

This is why the importance of group therapy, exposure and response prevention (ERP) therapy, and the therapeutic milieu approach to treatment are so invaluable in confronting the epidemic of anxiety and loneliness that is currently confronting young people across the country. ERP has many benefits, but one of the greatest in this context is breaking the cycle of avoidance. It’s important to note that the relationship between loneliness and anxiety is bidirectional. While loneliness can contribute to anxiety, individuals with anxiety may often struggle with forming and maintaining social connections, creating a vicious circle of reinforcement of maladaptive behaviors and responses.

Regina Benjamin, surgeon general from 2009 to 2013, emphasized the complex challenge of mental health issues. “Health does not occur in the doctor’s office or in a hospital alone,” Benjamin said. “It occurs where we live, where we learn, where we work, where we play, where we pray — everything that we do.” Treatment that takes place within a therapeutic residential milieu allows those struggling with anxiety to heal and learn not simply in the siloed isolation of an office, but alongside peers in a collaborative environment that enhances feelings of autonomy and self-efficacy.

When loneliness and anxiety have reached a crisis point, the therapeutic milieu fosters a sense of community and belonging. Individuals often share common experiences and goals, and the supportive environment encourages social interaction, reducing feelings of isolation and loneliness, and promoting a sense of connection. A therapeutic milieu plays a pivotal role in the holistic approach to mental health treatment. By emphasizing safety, community, and collaboration, it creates an environment where individuals can feel secure, connected, and supported on their journey toward recovery. The sense of belonging, mutual support, and normalization of daily activities within the therapeutic milieu contribute to the overall well-being of individuals receiving mental health care.

MOVING MOUNTAINS

Resources

FILTER

Interoception – Making Sense of Our Inner World

Posted on by Mountain Valley Treatment Center

As the external sensations of our world continue to become more abundant and all consuming, we often overlook the sensations of our inner world. One of the most important and foundational sensory systems we have is our interoceptive system. Interoception is our body’s internal radar of the condition of our body, conveying information about the state of what is happening within the bounds of our skin.

Our internal organs like our heart, lungs, intestines, bladder and even skin have receptors that send signals to our brain about the condition of those major organs. Interoception is our body’s ability to recognize and respond to those signals. For example, interoception includes awareness of changes in heart rate, blood pressure, body temperature, or sensations of pain, hunger, thirst, and other autonomic functions. Interoception also plays a significant role in emotional regulation, as emotions are a cascade of autonomic internal physiological responses that need our interpretation.

As with all things, when it comes to interoception, balance is key. People with limited interoception experience a disconnect between their mind and internal states, therefore they are often unaware of their emotional experiences and have challenges appropriately responding to the cues and signals their body is sending.  A common situation most of us have probably had at some point is the phenomenon of being “hangry.” When this happens, we are disconnected from our bodies and missing the cues for hunger, resulting in irritability or dysregulation. On the other hand, some people are hyperaware of their internal sensations. To provide a similar example, this is when we have a hard time focusing on a meeting or class before lunch because all we can think about how our stomach is growling and feeling empty.

Whether you have limited or heightened interoceptive awareness, building a better relationship with your body’s internal cues is valuable for emotional wellness.

Limited Interoceptive Awareness 

If you experience limited connection to your internal sensations and are often unaware of what is happening in your body, here a few ways to foster a stronger mind-body connection:

  • A guided body scan meditation that cues you to focus on the sensations happening in specific parts of your body.
  • Yoga, Tai Chi, or other movement practices that require you to be attuned to sensations such as breathing, heart rate, etc.
  • Biofeedback is the process of conducting vitals or using a heart monitor to practice recognizing what different states of arousal feel like inside your body.
  • Expand your vocabulary and practice using a variety of different language to describe your internal experiences.  Communicating a visceral experience to yourself or others can be really challenging! Practice naming and describing sensations like their location, intensity, texture, size, color, etc.

 Heightened Interoceptive Awareness 

If you experience hyperawareness, and maybe even a little anxiety about your internal sensations, engage in interoceptive exposures to develop resilience to rebuild your relationship with those internal experiences. Examples of interoceptive exposures include:

Breathing: hold your breath for 30 seconds or breathe through a straw for 60 seconds.

Heart Rate: engage in intense exercise (burpees, running up and down stairs, jumping jacks) for 30 or 60 seconds.

Dizziness: shake your head side to side for 30 seconds or spin in a chair for 30 seconds.

Derealization: Stare at yourself in a mirror for 2 minutes or stair at a wall without blinking.

Temperature: Turn the cold water in the shower for 30 or 60 seconds or sit in a sauna/steam room for several minutes.

*These can be graded up or down according to your comfort level and can be increased as you build interoceptive tolerance.*

With each exposure, try to turn towards the internal sensations that you are having or practice diffusing the from the sensation (i.e. removing judgement and objectively observing and describing what is happening). As with all exposures, the most important part is to REFLECT on your experience. What happened? What did you learn? How does experience change how you might engage with your internal sensations moving forward?

MOVING MOUNTAINS

Resources

FILTER

Motion through Emotions

Posted on by Mountain Valley Treatment Center

Ever wonder why we rock babies to sleep, get dizzy when we spin, or find swinging in a hammock so relaxing?

All these activities engage our vestibular system. Although it is not commonly discussed, our vestibular system is one of our seven sensory systems (touch, smell, sight, hearing, taste, proprioception, and vestibular) and plays a vital role in our functionality from a physical, psychological, and social perspective. On the level of the body, our vestibular system helps us find a center of gravity, stay balanced, and feel grounded. From a psychological perspective, a well-functioning vestibular system helps support self-awareness, organized thinking, and stable sense of self. Due to its role in stabilizing the body and mind, it influences how we respond to our environment, including our social surroundings.

Engaging in activities that challenge the vestibular system and improve vestibular processing lead to higher levels of cognitive, emotional, and physical functioning. It is recommended that people of all ages get out to move their bodies and challenge their vestibular processing to achieve a general a sense of general well-being.

However, for the purpose of this hack, we want to equip you with ways to engage the vestibular system to quiet the mind and body during intense anxiety. Here a few simple ways to use vestibular input to soothe the nervous system:

  • Rocking– use a rocking chair, office chair, or simply sway back and forth if it is socially appropriate to do so. Focus on slow, rhythmic, movement forward and backward.
  • Swinging– set up a hammock, go to a playground, or swing on a porch swing. Focus on slow, linear movement, either front-to-back or side-to-side.
  • Yoga– engage in slow, rhythmic movement that incorporate changes body and position, challenging one’s balance.
  • Sit on an exercise ball or unstable surface– slowly bounce on an exercise ball or try to practice being still and balanced on an unstable surface such as a trampoline, balance board, or balance beam.
  • Paced walking– walk in a slow rhythmic pattern of either back and forth, a circle, or a “figure 8” pattern.
  • Ride a bike–focus on pedaling a slow, controlled, and consistent pace or bike in a circle or figure-8 pattern.

MOVING MOUNTAINS

Resources

FILTER

Pre-Gaming and Reframing: Helping Families Return To College After a “Failure”

Posted on by Mountain Valley Treatment Center

Mountain Valley interviews Lisa Rosen, PsyD, about how she helps prepare families for a return to college after an anxiety-based withdrawal.

MV: So, Dr. Rosen, in our last newsletter we discussed how Mountain Valley helps prepare residents and parents for the transition from high school to college. But today we want to hear about the experience of families who have tried college, and it just didn’t work the first time. What’s that like for a family to have to try again after a false start?

Dr. Rosen: Well, there’s no denying that this experience is painful and disorienting for the resident and the parents. The level of anxiety over trying again can be very high, which is why we really focus on “pre-gaming” the return to college very early in the family’s treatment experience. The more pre-gaming we can do, the better. Pre gaming means really digging into the initial experience of college and gleaning insights from that experience for this next attempt, an attempt that includes a whole new set of skills and insights that the young person, and her parents, did not have the first time around. Pre-gaming is our way of getting really practical and concrete about what steps to take to be successful in college. We do this with the resident as a part of their treatment, and we do this with parents to empower them to better support their child’s return to college. This includes teaching them how to navigate their own anxiety!

MV: What are some examples of this support?

Dr. Rosen: We provide two categories of support for the child. First, we explore the setting itself, asking questions together like what supports are available in that setting? Is there enough support at this college? Is this the right setting to optimize this particular young person’s learning? Is this the right school? This kind of analysis is part of the resident’s therapeutic journey at MV. We use the resident’s past experience to look at their future experience from all sides—the social emotional setting and supports, the academic rigor, the learning support. In other words, we have to help the young person become reflective and analytical about the setting they may return to. The other category of support involves, of course, reflection regarding the state of the resident when they had that initial college experience. How much of their struggle was simply driven by what was going on emotionally for them at the time, separate from the external environment. What new skills and insights do they have to bring to this or another college environment?

MV: So, it sounds like you kind of flip the initial “failure” on its head, looking at it as an important source of information and as the beginning of a process of understanding that can form the basis of a successful college experience. To carry your “pre-gaming” analogy forward, is this a little like debriefing an early season loss in sport so that you can improve and succeed going forward, viewing this “loss” as a useful and instructive beginning rather than as an unsuccessful ending?

Dr. Rosen: Yes, and that brings me to the parents. We talk a lot about cognitive distortions as a part of our work with our residents. But this is also very useful in our work with parents. Reframing is an important part of correcting cognitive distortions around what can feel, understandably, like a crisis. Parents may think “our child has been working toward this very specific goal of this very specific college for twelve years and we have had this very linear view of how life is supposed to unfold and suddenly the plan is upended, it’s a disaster.” We help parents reframe this “crisis” as a “challenge” and one that has yielded important data. In terms of empathy for these parents, we know that reframing does not mean denying their feelings—it’s really hard, we know, and it can still feel terrible to the parent and the child. But ultimately, it’s really an opportunity to revisit some initial assumptions, to learn about our patterns and our child’s needs, and craft a more effective strategy for reengaging college.

It’s a balance of empowering the young adult to own their experience and apply new insights to their college experience and it’s also a chance to help parents balance their own role as supports. They are still parents after all, and their college-aged child is part adult and part child and still needs engaged parenting. But we also need to allow space for the child to learn from their own bumps and setbacks.

The pregaming we do helps the parents not only reframe the initial setback of a college withdrawal, it also helps them reframe future setbacks with a more flexible attitude, viewing each success and each setback as an opportunity for growth and learning—as a new and useful data point and an opportunity to practice new skills. It’s a win-win. We win if our kid succeeds. We also win if our kid experiences a setback and is equipped to reflect and say, “you know, mom and dad, here’s what I really need to be successful, here’s what I really care about, here’s what’s not working for me on this campus.”

The years from 18 to 22 may be what we define as “adult,” but what do we really want as parents? We want our kids to succeed from 25 to 80! We have to learn to play the long game here. That’s what we want college to prepare our kids for—a long and positive adult future. With that perspective, what a great opportunity college provides as a relatively safe laboratory to prepare our children for the challenges and opportunities of adulthood. That’s at the core of our pre-gaming and reframing approach to returning to college.

 

MOVING MOUNTAINS

Resources

FILTER

Anxiety Goes to College!

Posted on by Mountain Valley Treatment Center

Have you ever felt anxiety during a big vacation or dread at news of a new job or promotion?  Maybe a little (or a big) panic before a happy event like your graduation or wedding?  If so, that’s actually pretty normal!  Big life events generally involve transition and transitions are characterized by a disruption of routine and homeostasis—the predictable, familiar habits and circumstances that anchor us and help us feel calm and rooted. Big events bring big change, which is why even happy events can trigger an anxiety response—especially if you are already prone to anxious emotions.

One of the biggest transitions in young adulthood is leaving home to go to college. This transition, as traditionally navigated in the U.S., involves an instantaneous and wholesale change of virtually every aspect of a young person’s life and is, as a result, fraught with emotional obstacles. In fact, longstanding statistics indicate that about a quarter of all college students respond to these stressors by dropping out during their freshman year and up to 40 percent of all college students drop out over the course of their college experience and fail to earn a degree (based on six-year tracking). For young people with a history of anxiety, this wholesale transition can seem particularly overwhelming and can trigger staggering fear for both the would-be freshman and their parents!

So, we asked Mountain Valley therapist Sharon McCallie-Steller a question common among parents of college-aged young people: “How do you deal with anxiety when your child goes to college—both your child’s and your own?”

MV: Sharon, talk a little about what it’s like for young people who are getting ready for college. College should be a great thing, an exciting adventure. Why is it so scary and overwhelming for some?

Sharon: Anxiety is always focused on the anticipation, the uncertainty, about what might happen—fear around all the “what-ifs?” Since college represents a whole new life experience for a student—leaving home, leaving a familiar school situation, leaving friends, changing your whole environment and support network—there is a lot to process. It should be exciting, of course, but high levels of excitement often feel a lot like anxiety! So, for a student who is prone to anxiety, this very exciting time of anticipation can trigger an anxiety response.

MV: How can parents be helpful to their child during this time?

Sharon: Sometimes a parent’s well-intentioned and understandable impulse is to try to fix their child’s anxiety. They often make two mistakes. The first is to minimize their child’s emotional experience. Again, this is always well-intentioned, and it takes the form of trying to calm the child with statements like, “it will be fine,” “you’ll do great,” “just relax,” “everything’s going to be fine,” et cetera. This communicates to the child that they should not feel anxious, which can actually increase the anxiety and create separation between the parent and the young person. The reality is that it makes sense to be anxious in the face of so much change—it’s normal!

So a better place to start is to validate your child’s anxiety by simply acknowledging it: “Wow, yes, this is a big change. It sounds like you are really feeling anxious.” This immediately connects you with your child’s experience and creates room for helpful conversation. “Okay, mom gets it.” It makes you a safer ally. At this point, you might be in a better position to ease into the work that I call “planning to cope.” You can work with your child to dig a little deeper into the specific worries to  visualize real situations and discuss possible solutions: what if you struggle to find your classes, where can you can go for help and guidance, what do you want to make sure you’re involved in and how do you access that. But, again,  the first step for parents is to validate the childs experience.

MV: So the main points I’m hearing are: 1) validate the feelings—they are normal and acceptable, 2) visualize the specific points of anxiety, 3) discuss a practical plan for coping with those points.

Sharon: That’s right.

MV: So that covers how to help you deal with your child’s anxiety when they go to or go back to college. But what about your own anxiety as a parent?

Sharon: Yes, well parental anxiety around this time of year is often very high as well. I won’t see my child every day, I won’t be able to monitor their safety and wellbeing. Home like will change. I won’t have the same access to their friends. There are very real threats living on your own away from home and the familiar. You know as a parent that this transition is not all sunshine and rainbows. So just know that it’s normal and appropriate to have some anxiety. But as a parent you can reflect on what is, maybe, an outsized fear: what am I catastrophizing, what is my own anxiety and fear that I might be projecting onto my child, what is my own stuff that might be getting in the way of me being excited.

If significant fear comes up for you during this transition, it’s a great opportunity to do your own work, to seek support and growth. This can take the form of joining a parent group—which many colleges provide, or processing with your spouse, or joining a PTA group for parents of seniors. If the fear begins to interfere with your relationship with your child or ability to enjoy this adventure, you might consider therapy or parent coaching.

As part of your own work, this can be a great opportunity to reflect on what you know about your child’s capabilities and to anchor yourself in that. “She’s spent so much time preparing. She got into college based on her abilities. She has these attributes and abilities.” And like you’ve now done with your child, you can create your own practical coping plan for addressing concerns that cause anxiety.

MV: So, the plan for dealing with anxiety when your child goes back to college is much the same for the parent as for the child?

Sharon: That’s right. Validate and normalize the feelings, right-size the threats—gauging anxiety against reality, make a coping plan, and use this as an opportunity to work on yourself and build a support network.

MV: So if, after doing all this preliminary work, your child’s anxiety remains very high, how do you know if it might be smart to pause and get some help before?

Sharon: The question to ask is if the anxiety is interfering with daily functioning. Is my child making it to work, engaging socially, doing the things necessary to prepare for college like packing and planning? Or are they avoiding, staying in their room, not getting basic tasks done. If the latter, they might not be ready and you might consider speaking with your child, and a professional, to assess whether to hit pause and get some help addressing the anxiety itself. One thing to consider is whether deferring is, itself, an avoidance strategy or just a wise decision to prioritize growth and increase the odds of success. Conversation with a parent coach, educational consultant, or therapist can help you assess this question. Many parents and students choose to defer for these reasons and most colleges are set up to accommodate such a decision.

MOVING MOUNTAINS

Resources

FILTER

Proprioception and Anxiety Grounding

Posted on by Mountain Valley Treatment Center

Ever feel “out of your body” when severely anxious? Ever experienced the grounding effects of big a hug? What happens to our sense of body awareness when we are anxious? And how can we engage our sensory system to manage acute feelings of fear? 

Most people are familiar with the classic five: smell, touch, taste, sight, and sound.  However, many people are not aware of the other sensory systems that are essential to our human experience. One of which is proprioception.

Proprioception is your sense of body awareness. Within our skin, muscles, and joints, live tiny little receptors called proprioceptors, who are responsible for perceiving our body position and our movement. These receptors send signals to our brain, telling it where our body is in relation to itself or the external environment. This is the sense that allows you tell how far away something is when you go to grab it or whether your arm is in the right position to catch a ball. 

Like all other sensory systems, our proprioceptive system is directly related to autonomic nervous system, and therefore plays a role in sympathetic arousal (“fight, flight, and freeze”) and parasympathetic arousal (“rest and digest”). Research has shown that when our sympathetic system is engaged, our sense of proprioception is impaired. This would explain that “vertigo” and “out of body” experience people often describe during high states of anxiety. However, the inverse relationship is also true, and when proprioceptive system is engaged, it stimulates our parasympathetic nervous system, helping us to move to calmer state of being. 

So how do we engage our proprioceptive system? Here a few quick tips:

Do “Heavy Work” – to engage the proprioceptive system, we need to engage the muscles, tendons, and joints of our body. One of the easiest ways to do this is through “heavy work”, such as: 

  • Lifting weights 
  • Using resistance bands  
  • Push/Pull activities 
  • Yardwork/gardening tasks (shoveling, moving a wheel barrel, lifting heavy objects, etc.) 

Apply Deep Pressure – Another way to get input to the muscles, tendons, and joints of your body is to apply pressure to them. So yes, your deep tissue massage can help with your anxiety! Here is a list of few examples:

  • Massage 
  • Weighted items (weighed blankets, vests, etc.) 
  • Stress balls or thera-puddy (pressure to the hands) 
  • Chewing gum (pressure to the jaw) 
  • Hugs

Foster Body Awareness & Coordination  – finally, activities that require one to coordinate their body in space also inherently engage the proprioceptive system. These activities may include: 

  • Yoga
  • Tai Chi
  • Body scans 
  • Climbing 
  • Hiking (especially on uneven terrain!)

MOVING MOUNTAINS

Resources

FILTER

Thinking Intentionally – 5 Steps to Work Through Cognitive Distortions

Posted on by scottc

At Mountain Valley, we have sometimes questioned how much thoughts really matter and introduced the Acceptance and Commitment Therapy (ACT) strategy known as cognitive defusion. Today, we are going to be discussing a skill that involves actually engaging with distorted thinking that often accompanies anxiety or fear. This strategy is called cognitive restructuring and it is a classic skill from Cognitive Behavioral Therapy, which poses that if we change the way we think, we can change the way we feel and behave.

To understand cognitive restructuring, it’s important to understand cognitive distortions. Cognitive distortions are dysfunctional, often automatic thoughts patterns, that contain fallacies and bias in reasoning, leading to a “distorted” perception of one’s experience. For example, have you ever said, “no one ever wants to talk to me,” found yourself only noticing the bad things that happen in our day, or feel as though everyone is thinking about you? All of these are examples of different distorted thinking patterns that often function automatically in our everyday lives.

These thoughts often come from more deeply rooted “core beliefs,” or core “schema” that serve as a “lens” and “frame of reference” from we view and interpret the world. However, for the purposes of this article, we are going to stay more practical with how to deal with the surface level distorted thought, and we will save deeper core belief work for another day.

Here are 5 steps to working through the distorted thinking in a moment:

  1. Notice your thoughts – To change your thoughts as a way to change your mood and behavior, you have to be aware of what you are thinking. When you are feeling anxious, notice what you are thinking. Example: You walk into a room and the room is silent. You think “no one ever says hi to me. They must not like me very much.”
  2.  Write the thought down – Write the thought down on a piece of paper. This will help you begin to view the thought more objectively and become less emotional attached to the thought so you can see it for what it is.
  3.  Check for evidence that supports or does not support the thought – What evidence do you have that this thought is true? What evidence do you have that this thought is false? What evidence may be lacking or missing in order of us to draw any concrete conclusion? Example: Evidence for the thought could be that you walked in the room and its true, no one actually said hello to you. Counter evidence could be that when other people walked in the room, no one said hi to them either. People seem to be reading their books or on their phones not really paying attention. Also, there is no evidence that anyone has ever said that they didn’t like you.
  4.  Check for distortions – Check your thoughts against the pre-identified common cognitive distortions identified in CBT (see the list below). What distortions are present in this thought? Example: This thought includes the cognitive distortions such as personalizing, overgeneralizing, and fortune telling.
  5.  Re-write the thought – Now that you have looked at the evidence for and against the thought, and identified distorted thinking patterns within the thought, it’s time to rephrase the thought in a more balanced manner. Example: “No one said ‘hi’ to me today because people seem to be focused on themselves,” or, “people in the room are so focused on what they are doing that they aren’t saying hi to anybody.”

Cognitive restructuring doesn’t always get the best wrap in the therapeutic world. You often hear people say “just change the way I think? If only it were that easy.” And the truth is, it’s not that easy at all. Thinking is very much an automated process and our ability to have agency over our thinking and the core beliefs that drive those thoughts, is by no means a small challenge. It takes practice, consistency, and patience. Over time, as you continue to notice, question, and be intentional with your thoughts, you’re thinking patterns will change, your behavior will follow, and the anxious thoughts that once limited your life will no longer stand in the way.

Cognitive Distortions: 

  • Black-and-white (or all-or-nothing) thinking: I never have anything interesting to say.
  • Jumping to conclusions (or mind-reading): The doctor is going to tell me I have cancer.
  • Personalization: Our team lost because of me.
  • Should-ing and must-ing (using language that is self-critical that puts a lot of pressure on you): I should be losing weight.
  • Mental filter (focusing on the negative, such as the one aspect of a health change which you didn’t do well): I am terrible at getting enough sleep.
  • Overgeneralization: I’ll never find a partner.
  • Magnification and minimization (magnifying the negative, minimizing the positive): It was just one healthy meal.
  • Fortune-telling: My cholesterol is going to be sky-high.
  • Comparison (comparing just one part of your performance or situation to another’s, which you don’t really know, so that it makes you appear in a negative light): All my coworkers are happier than me.
  • Catastrophizing (combination of fortune-telling and all-or-nothing thinking; blowing things out of proportion): This spot on my skin is probably skin cancer; I’ll be dead soon.
  • Labeling: I’m just not a healthy person.
  • Disqualifying the positive: I answered that well, but it was a lucky guess.

MOVING MOUNTAINS

Resources

FILTER

Be Well with Dr. Thibault’s Five Activity Types

Posted on by scottc

Since this month’s feature is about a balanced approach to anxiety treatment, today I am going to share  five categories of activities that have been shown to foster resiliency, hope, and well-being in the face of challenging situations. 

These five different types of activities were first identified in Occupational Therapy literature, by Dr. Rachel Thibault, who specialized in working community-based rehabilitation settings in post conflict and disaster relief initiatives. During her work in these settings, Dr. Thibeault conducted research on what activities supported individuals in finding hope, resiliency, and meaning despite their dire circumstances. She was able identify five different types of activities essential to fostering well-being in the face of challenging situations. It has since been suggested that all people should strive to incorporate these activities within their daily routine as a way to buffer against the stressors of everyday life. 

Below is a chart that describes the different activity subtypes, along with examples of activities for that category. It is recommended that someone try to engage in at least two of the five activity categories a day as a means to promote their hope, resiliency, and wellbeing. 

[table id=7 /]

MOVING MOUNTAINS

Resources

FILTER

The Work/Rest Cycle in Anxiety Treatment

Posted on by scottc

Mountain Valley interviewed its executive program director, Zack Schafer, MS, OTR/L, about how our clinical and residential team balance orthodox ERP with complementary modalities to accelerate and sustain treatment results.  Zack’s expertise as a mental health occupational therapist helps him wed the efforts or our clinicians and our residential team in ways that make treatment more approachable, practical, and sustainable. 

Mountain Valley: Zack, can you briefly describe what ERP is and what makes for an effective exposure?

Zack: ERP, or exposure and response prevention therapy, is a therapeutic intervention that aims to help someone more adaptively respond to their fear (or other emotion) so they can live with greater freedom and agency. In ERP, the premise is not that fear, anxiety, or other emotions are the “problem” per se, but rather that the challenges arise in our response to those emotions. 

For example, let’s take someone who experiences social anxiety and responds to this anxiety by staying in bed and avoiding school, or only agreeing to go out in public if they can listen to music on their headphones. For this person, these attempts to reduce or avoid their anxiety—known as “safety behaviors”—are preventing them from fully engaging in their lives.  Over reliance on safety behaviors will also lead to worsening anxiety over time—a kind of vicious cycle. The problem is not that they feel anxious, but rather that they react to that fear ineffectively, leading to increased anxiety and problematic avoidance. 

ERP works by exposing someone to the things or situations that trigger their fear (Exposure) and coaching them avoid engaging in their maladaptive “safety” responses (Response Prevention).

To provide an example of ERP intervention, let’s go back to the example of above. For this person, an ERP session may look like having them go into a store without any headphones on or going into a store with the headphones and no music. The degree of challenge of the exposure depends on many factors, but the goal is always the same: we want this person to feel their anxiety fully while refraining from using their headphones or engaging in any other strategies that distract, avoid, or otherwise reduce the feeling of their experience. 

There are many different schools of thought and theories about what the “goal” of ERP is regarding habituation, inhibitory learning, etc. At Mountain Valley, we use ERP to help residents experience their emotions and regain a sense agency in how they respond, so they can be free to meaningfully participate in their daily lives.  

Mountain Valley: What other modalities, activities, and experiences do we employ here that you would consider either supportive of or complementary to ERP?

Zack: As a program we try to address anxiety from a holistic perspective, so we compliment ERP with psychoeducation, skill building, and an experiential milieu focused on decreasing anxiety, managing stress, and promoting adolescent health and well-being. This includes teaching in the moment anxiety management strategies such as breathing techniques, sensory strategies, and tactics to decrease distress. We educate around lifestyle factors and support healthy participation in self-care, diet, exercise, and sleep. We engage kids in restorative exercises, such as walking in nature, yoga, breath work practices, and journaling. We also seek to engage residents in activities that allow for them to center, contemplate, connect, create, and contribute – experiential principles recognized by occupational therapy as essential for hope, resiliency, and well-being. 

Mountain Valley: So I know that strict ERP advocates leaning into a normally anxiety producing situation, fully engaging the feelings of distress it elicits, and doing so without engaging in any safety behaviors, i.e. any coping, self-soothing, or accommodation tactic designed to reduce distress. The idea is largely to develop distress tolerance and, in so doing, to indirectly reduce that distress over time, but as a byproduct of ERP, not as the main goal. When and why do we encourage what might be considered safety behaviors at Mountain Valley such as meditation, therapeutic breathing, ice baths, PRN anxiety medications, etc.? We are both athletes and you once described this relationship between ERP and other strategies using an athletic “work, recover, compete” analogy. Can you describe that again here?

Zack: Yes – that is an excellent point. In the traditional delivery of ERP, the goal is to have the person experience their anxiety fully and not engage in strategies to decrease their distress. However, although we are an ERP program, we also promote coping skills, stress reduction, and positive daily experiences. So, it can sound a little confusing and contradictory. But this is where that “athlete” metaphor comes into play. 

In this analogy it’s helpful to think of ERP like “training.” The purpose of training in sports is to condition the body and mind to the demands of the task, build the skills needed to complete the task, and to “stress test” one’s limits. The goal of training in sports is to prepare the athlete for the game or event, just like the goal of ERP is prepare a resident for the “game” of life, where exposures and anxiety can happen anywhere.  But in both activities, you have to alternative training with rest for the training to be maximally effective.  Any elite athlete will tell you that the quality of your rest is just as important as the quality of your training. 

That’s why we want make sure there is a balance between doing hard work and engaging in restorative practices. Making everything a challenge and trying to always increase distress as an “exposure” is not sustainable or realistic. However, always engaging in restorative or pleasurable activities, or always waiting for anxiety to go away before we engage in our life, is also not realistic. 

Like many things, it’s about balance. Ultimately, we want to help our residents become more dynamic and adaptable so they can be free from the grip of their anxiety. We want them to feel empowered to embrace their anxiety when it is intense and we want to feel empowered to reduce their anxiety in adaptive ways should they need to – but at the end of the day, the goal is always to promote their ability participate and meaningfully engage in their lives.  

MOVING MOUNTAINS

Resources

FILTER

Bring It On

Posted on by scottc

He who has overcome his fears will truly be free. -Aristotle

I woke up to a bright light and a loud roaring in my ears. I was hunched over, bouncing slightly in my seat. My face was pressed against something cold and hard. Where was I? How did I get here? I started to panic.

While I sat up and groped for my mind, for some clue to my situation, my chest began to heave like a sprinter and my normally sub-40 pulse banged out an urgent 200 BPM alarm in my head. I couldn’t form a thought and my body was clenched, holding on, trying not to fall any deeper into panic.

Even once I realized that I was on a 737 flying from San Francisco to Denver, I continued to grip my tray table as if it was the only thing keeping me from falling 30,000 feet to earth, or, worse, running down the center aisle screaming like a madman. For the rest of the flight I was absolutely gripped with fear, fear that I might spiral again into panic.

It wasn’t until much later that I was able to deconstruct the event, to connect the previous all-nighter in San Francisco and the two compensatory venti coffees slammed just before boarding to this very panic-worthy episode of falling asleep and waking up hyper caffeinated and completely disoriented. Now it all makes sense to me. At the time, though, and for many months later, the episode seemed random, out of the blue, and completely outside of my control. When, I wondered, might my mind and body betray me again.

***

Panic attacks are scary. They can also be self-perpetuating and invasive, insinuating themselves into new situations seemingly at random. Like the sumac we have here in New Hampshire, panic doesn’t always stay put once it takes root; it can send out secret subterranean tendrils which shoot up through the ground to claim random new territories.

Like sumac, the panic that started on that airplane began to generalize to other areas of my life: public speaking, overly formal business conversations, and even phone calls—anywhere I felt that a panic attack might have significant, if mostly social, consequences.

Panic entered my life, ironically, as I was approaching the pinnacle of my career as an elite adventure athlete. While I was calmly risking my life running hundreds of miles at a time in very dangerous places—the Sahara Desert, Taliban controlled parts of Tajikistan, -65°F arctic tundra—I was also developing a profound fear of airplanes, telephones, and everyday conversations. It did not make sense. My hard-won identity as a tough athlete—cool in the face of danger, a master of my own body and mind—was suddenly threatened by this outsized fear of everyday activities. So, who was I now? How might this unpredictable, episodic madness unravel my life and my career? I kept my struggles to myself, afraid that I might be losing my grip.

In order to remain employed and to continue my career as an athlete, I had to fly, I had to talk on the phone, I had to speak publicly. So I continued to muscle my way through these activities as best I could while trying, unsuccessfully, to manage the anxiety and stave off panic. My initial strategies included prescribed medication for public speaking or flying, breathing exercises, and—when possible—avoidance. None of these strategies worked. Some made things worse. Least helpful of all were my attempts to ignore or resist panicky feelings when they emerged. The more I fought those feelings, it seemed, the more they fought back and the stronger they became.

***

It wasn’t until months later that I bumbled into a concept that turned my white-knuckle experiences of flying and public speaking into something vaguely resembling actual exposure and response prevention therapy (ERP)—the clinical modality so successfully utilized by my colleagues at Mountain Valley Treatment Center. I was sitting on the floor of the Las Vegas International Airport failing to be hypnotized by a “fear of flying” hypnosis app I’d recently downloaded to my phone. Instead of dropping, as instructed, into a state of “deeeep relaxation” where the monotone hypnotist’s droll suggestions would insinuate themselves deep into my subconscious mind, I was wide awake, listening with my quite conscious mind, hoping this sleepy sounding guy would get to the freaking point before I had to board that damn airplane. Fortunately, he did.

As feelings of fear and panic approach, he suggested, invite them to come all the way to you. Lean into the feelings, experience them fully, consciously, and completely. Locate these sensations in your body, name them, feel them. Explore them with your mind the same way your tongue might explore the contours of a sore tooth. This guy was a nut, I thought. Invite panic? His approach makes no sense. So I decided to give it a try.

I boarded the plane, took my seat, and buckled my seatbelt. Right on cue, when the flight attendant started droning on about oxygen masks and exit lights and life preservers, the usual feelings of panic started to rise in me. But this time, instead of trying to push them back down, I invited them to join me, albeit a bit angrily. “Come on M#@$!* F#@!!!,” I mouthed silently, “bring it on! Let’s see what you’ve got. Okay, there you are, a tickle in my solar plexus, moving up my spine now. My head is filling with cotton and I’m getting dizzy. I’m handling this. Come on heart, you can beat faster than that. Is that all you’ve got? Bring it on!”

I wasn’t very nice to those feelings, but once I invited and engaged them, they proved less formidable than I’d thought. I did not fall from the sky. I did not run down the center aisle screaming like a madman. As I practiced this approach on subsequent flights and other high stress events, the feelings continued to show up, generally, when expected, but now they more or less moved along, they passed through me; I wasn’t there to block their path anymore. I stopped cursing my feelings and started engaging the feelings with calm, curious detachment.

As my sense of confidence and mastery over these feelings developed, it occurred to me that I had already been applying a similar mindset to other areas of my life for years. As an athlete, external challenges—a mountain, a race, a contest—elicited a sense of competition, of complete engagement, of “bring it on” defiance. But it had not occurred to me to apply that same mindset to “fear itself,” as Roosevelt put it, i.e. to an adversary that was fundamentally internal rather than external.

In the authoritative ERP training manual we use at Mountain Valley Treatment center, Exposure Therapy for Anxiety: Principles and Practice, by Brett J. Deacon and Jonathan S. Abramovitz, and Stephen P. H. Whiteside, this mindset is referred to literally as the “bring it on attitude.” During intentional exposures to highly distressing or triggering situations, the authors suggest that “instead of trying to resist or control unwanted or fearful emotions and experiences, patients should focus on better tolerating, accepting, and even welcoming these experiences…” This combination of exposure and full emotional engagement is at the core of exposure therapy. The “bring it on attitude” toward anxious feelings is the catalyst that activates exposures, making them therapeutic rather than simply unpleasant.

Once I recognized the connection between the challenges of adventure and the challenges of panic, my experience of anxiety actually began to shift from a threat to be avoided to an adventure to be engaged. A contest. Once I reframed them as adventures, my internal “anxiety expeditions” (what I now understand as “exposures”) became even more gratifying than my other expeditions, which were more dangerous but less scary. This, frankly, felt more badassed to me. When you successfully climb a mountain, it doesn’t make the mountain smaller. Instead, it makes you a mountaineer—freer to go where you want and to do what you want to do. That is the point of exposure therapy.

***

Several months ago, a very talented occupational therapist was considering a position at Mountain Valley. I knew that taking the position would move her from her high-level research and organizational work, back into the trenches of clinical care for highly anxious adolescents. It would be a huge change and a significant challenge, but her gift for clinical work was obvious and I hoped she would take the job. A few weeks after her initial interviews, I checked in with her.

“So, what are you thinking?” I asked.

“Well,” she answered, “honestly, I’ve been thinking a lot about it, Will. I’m just really nervous about the job.”

My heart sank. I understood her concerns but I was so disappointed. She would have been an incredible hire for Mountain Valley. While I tried to mask my disappointment and formulate a positive response, Kevi finished her thought.

“So I think I need to take the job.” In other words, bring it on!

For me, that interaction sums up the core of our philosophy at Mountain Valley: the evidence-based notion that engaging fear is the best way to flip it on its head, transforming anxiety from disability to ability, from enemy to ally. When our residents bravely engage in this work, as they routinely do, their personal Mount Everest of fear doesn’t necessarily get any smaller. Instead, they become mountaineers—confident and free to live the adventure they want.

Bring it on.

© 2025 MVTC EDC. All rights reserved.

Privacy policy