Author: Katie Leoni, Psy.D.
Exposure therapy is an evidence-based treatment used by the clinicians at SF Bay CBT to help our clients struggling with anxiety. Avoidance is a strong component of anxiety and it is common for people to avoid something that makes them anxious or fearful. In exposure therapy, clients are asked to directly confront the anxiety and avoidance. The idea is that the more you expose yourself to whatever it is that is making you anxious (i.e., social situations, taking BART, public speaking) the more opportunities you have to modify your automatic thoughts and beliefs and create a more balanced and rational mindset. If this sounds nerve-wrecking to you, you’re not alone! It is natural to feel nervous and worried about confronting your anxiety triggers. A saying often used in exposure therapy is “short term pain for long term gain” which acknowledges the willingness to tolerate discomfort in the moment in order to overcome and effectively manage your anxiety in the long term.
Rationale for Exposure Therapy
Physiological changes happen in the body in response to danger. The fight or flight response is our body’s way of reacting to life-threatening situations and taking immediate action to keep us safe. Your amygdala is activated and you either stay and fight the threat or flee. This response sends signals to our bodies in order to help shut down unuseful systems and activate survival systems. However, our brain doesn’t always do the best job of distinguishing between actual and perceived danger. Because of this, fear (actual danger) and anxiety (perceived danger) produce extremely similar responses in the body.
For example, if a tiger were to come into the room that you were in (actual danger), your fight or flight response would be activated. You’d notice an increase in your heart-rate, your blood pressure would go up, your mind would go blank, and you’d become hyper-alert. This would be an adaptive response because you have to act quickly to the life-threatening danger in the room. The signals that your body is giving you physically would cue you to move out of the way, or avoid, in order to keep yourself safe. It’s based on survival. Now, imagine you are extremely anxious about public speaking. Public speaking is uncomfortable for many but is not a life-threatening situation. However, people’s bodies can react in ways that make it seem this way and thus, become anxiety provoking for that person. When you stand up in front of a room full of people, your body will react as if a tiger just came into the room and in order to prevent this response from happening, you do everything in your power to avoid public speaking. When you avoid or escape the trigger, the physical symptoms decrease, and you feel relieved. But you also teach your mind and body that those physical symptoms really were a sign of danger, and you strengthen the association between public speaking and that uncomfortable physical response. Avoiding only reinforces the idea that public speaking is dangerous and your ability to cope with it is low.
In exposure therapy, we work on educating clients about this response and help to retrain the mind and body when faced with perceived dangerous situations. Chances are you’ve been anxious about this thing/situation for some time and thus, it takes time to retrain your brain and central nervous system to differentiate between fear and anxiety and to respond accordingly to the threat that is present. In order to do this, a person must activate the fight or flight response, which is done by exposing oneself to the perceived danger/anxiety provoking situation.
What Does Exposure Therapy Look Like?
There are several different types of exposures that exist and ways in which they can be practiced in therapy. Usually it is a gradual build-up (called a hierarchy) to the situation that makes you anxious. For instance, if you have a phobia of spiders, being asked to hold a spider would not be the first step. To start, you may be asked to think of spiders or look at pictures of spiders. This still activates the fight or flight response but in a way that allows learning to take place so that you are prepared to work through your hierarchy. The key in exposure therapy is to confront the avoidance and test out beliefs about perceived dangerous situations that may be distorted.
Types of exposures often used:
You might have to do things in session or exposures outside of sessions on your own. It depends on what your specific anxieties are. You and your therapist will collaboratively identify useful exposures for you based on your needs. Another important component of exposure therapy is learning relaxation techniques and other coping skills to help you before, during, and after exposures. Again, your therapist will work with you to teach you these helpful tools. If you’d like to learn more about exposure therapy and how it can help you, please contact us for a free phone consultation.
Author: Diana Corwin Gordon, Psy.D.
Many clients come to us with concerns about overeating, binge eating, and feeling out of control around food. Clients often recognize that their concerns about eating are complex, and that they overeat or binge for a variety of reasons. Sometimes these reasons are psychological in nature, and other times they are situational, but many clients feel frustrated by how difficult it is to change their eating habits.
We work with our clients to identify all of the factors that are contributing to their problem, and we use evidence based interventions to target them. Using intuitive and mindful eating approaches, we teach clients to identify their triggers, tune into their natural hunger/fullness cues, and feel more in control of their food choices. In this blog post, we will explain how we use a two pronged approach for treating these concerns: 1) identifying and treating common reasons for overeating/bingeing and 2) introducing intuitive and mindful eating principles. Taken together, these two areas of focus often help our clients reduce episodes of overeating and binge eating, and help them feel more in control and confident around food.
Common Reasons for Overeating/Bingeing
We work with our clients to understand the thoughts, feelings, and situations that trigger overeating or bingeing. We encourage clients to notice what's going on for them emotionally when they feel out of control around food. We meet urges to overeat or binge with curiosity and compassion, rather than judgement, and try to help our clients see these experiences as opportunities to learn more about their own needs. Depending on the specific triggers, we use a variety of evidence based techniques to alleviate the underlying causes of bingeing and overeating, including:
-Treatment for underlying psychological conditions
-Collaborative CBT problem-solving (helping clients determine all of their options for solving a problem, and the pros and cons of each)
-Thought modification (helping clients think more rationally)
-Emotion regulation skills (helping clients develop a toolkit of strategies for dealing with complicated emotions)
-Body acceptance and body image improvement
Our goal is to help our clients understand themselves better, and to help them address the underlying causes of overeating and binge eating. When these underlying causes are addressed, the urge to overeat or binge naturally diminishes.
Introduction to Intuitive and Mindful Eating
Intuitive Eating, initially developed by dieticians Elyse Resch and Evelyn Tribole, is an approach to eating that helps people tune into their internal cues of hunger and fullness. Many psychologists, physicians, and dieticians have put their own twist on this approach, but all share an emphasis on mindfulness, body awareness, and internal cues. We draw from many different theorists to offer a personalized and comprehensive approach to intuitive/mindful eating for each client.
Intuitive and mindful eating approaches teach clients to trust themselves about how, when, and what to eat to feel physically and emotionally satisfied. We work with clients to develop health affirming behaviors, such as eating foods that make them feel good and exercising in ways that feel energizing, rather than focusing on weight loss. Some goals of intuitive and mindful eating include:
-Tuning in to natural hunger and fullness cues
-Learning to stop eating when you feel satisfied
-Eliminating forbidden foods
-Developing confidence and trust in one’s own body and instincts
-Developing a healthy set of beliefs about food
-Finding true satisfaction and enjoyment in food
-Discovering ways to be healthy and happy, regardless of body size, weight, or other numerical indicators
-Read more about the principles of Intuitive Eating here
Using intuitive and mindful eating strategies, we strive to help our clients develop a happy, healthy, and satisfying relationship with food. As psychologists, we are uniquely qualified to treat overeating and binge eating, because we can offer a multifaceted approach to treating these concerns. We treat the underlying psychological conditions that make binging and overeating more likely, as well as providing practical strategies for getting in touch with your own internal cues. When appropriate, we coordinate care with dieticians, physicians, and other members of your medical team to ensure that you get the best care possible.
If you are interested in learning more about our approach to reducing binge eating and overeating, please contact us for a free phone consultation. We’d be happy to tell you more about our approach and to determine whether our services are a good fit. Stay tuned for part 2 of this blog post (coming soon), which will outline some practical strategies for incorporating intuitive and mindful eating principles into your daily life.
Diana Gordon, Psy.D., Kari Kagan Psy.D., and Katie Leoni, Psy.D.
Drs. Gordon, Kagan, and Leoni practice psychotherapy in downtown San Francisco and Oakland. Their areas of expertise include anxiety, sleep, stress, depression, and addiction. They blog about these topics to provide research-based information about common problems and strategies to help manage them.