NYC Cognitive Therapy | Blog
Noah Clyman's 7 Day Worry Challenge! (part 4)
Worry Challenge; Day 6: Go to yourself for advice

One of the quirks we have is that we seem to be terrible at dealing with our own problems, but we’re usually pretty good at solving other people’s. Why not use this bit of psychological irony as a tool to help you worry less?

Today’s assignment: Imagine that someone is sitting in a chair opposite you. He or she has come to you for advice. For whatever reason, this person values your opinion and guidance. Even more strangely, he or she has the same worry you have. Restrain yourself from your first impulse – throwing your hands up in frustration – and reach deeply into your storehouse of wisdom. You may find that you can come up with some wonderful ideas. You are an incredible solution-finder. Some share these ideas with yourself.

Worry Challenge; Day 7: Talk about it

How are you doing so far? Do you notice that as you apply these tools the intensity and frequency of your worry changes? Are there some worries that fade away and others that hang around? For these worries, I suggest you talk about it with someone.

We feel better and worry less when we’ve had an opportunity to talk to someone about those things that are bothering us. When we can get our worries on the table, say them out loud, it gives us some perspective, and with this perspective can come greater feelings of control and hope. You need, of course, someone to tell your worries to. That person could be a family member, a friend, or a therapist.
Some of my best therapy sessions have resulted not from my brilliant insights, but from just letting my clients talk about their worries.

Today’s assignment: Share your worries with someone. Allow this person to offer support, guidance, and compassion.

Worry Challenge Results; Review what you’ve learned

Congratulations! You’ve reached the finish line of the Noah Clyman 7 Day Worry Challenge. How did it go? What did you learn? What strategies did you like best? Why? Where there any challenges along the way? What benefits did you get from these exercises?

Let’s review what we’ve learned.

Tools for conquering worry:

1. List your worries and write about them
2. Schedule worry time
3. Cut our your catastrophizing
4. Ask yourself some good questions
5. Use coping self-talk
6. Go to yourself for advice
7. Talk about it

Final assignment: Now is the time to create your ongoing plan to manage worry effectively moving forward. Come up with a “worry plan” for each day moving forward. Your plan could be identical to the 7 steps outlined above, or you could make some changes. Find a plan that works for you and write your plan in your notebook or day planner.

I would love to hear about your results! Use the message board to anonymously share your experience.
Noah Clyman's 7 Day Worry Challenge! (part 3)
Worry Challenge; Day 4: Ask yourself some good questions

People who worry too much tend to be somewhat limited in generating options, alternatives, and solutions to potentially stressful problems. This is mainly because their anxiety limits their ability to think outside the box and come up with more creative ideas. They continue to worry in non-productive ways.

Today’s assignment: Look at your daily writing and ask yourself some good Socratic questions about the worries you wrote down. Challenge your thoughts. See if you can poke holes in them. Brainstorm some ideas and solutions that may resolve your worries or at least make your worries less troublesome.

Some questions to ask yourself include the following:

- What am I afraid of?
- Is there another way, a more sensible way, of looking at this?
- Am I looking at worst-case scenarios?
- How would someone else (a good friend or role model, for example) look at this problem?
- How would someone who is more of an optimist look at this?
- What are some alternatives and solutions that I may have missed?

Use your Socratic questions to examine, challenge, and reframe your thoughts. Don’t let yourself get away with any faulty thinking!

Worry Challenge; Day 5: Use your coping self-talk

You probably have a pretty good idea of the importance I place on talking to yourself in a sensible, reasonable manner. This coping self-talk can help you change the way you feel.

Here are some examples of coping self-statements that you can use whenever you find yourself over-worrying. Today, come up with 3 or 4 of your own!

- I can cope with this.
- Don’t make this a bigger deal than it really is.
- Realistically, what is the worst that can happen? If it did, how could I cope?
- What good things might happen?
- Is this worrying helping me in any way?
- I will be able to figure out ways of coping with this.

Today’s assignment: Create and rehearse coping self-talk. Write these statements on 3x5 index cards and review them in the morning, afternoon, and evening. Cultivate your inner-coach.
Noah Clyman's 7 Day Worry Challenge! (part 2)
Worry Challenge; Day 2: Schedule your worries

After you begin to worry, you quickly discover that the worry can be very forceful and insistent. One way of combating this is, oddly enough, to do your worrying at designated times. Build worrying into your day. Call this your “worry time.” Whenever you sense that your worries are creeping into your mind, remind yourself that it is not yet your time to worry and that the worrying will have to wait. Jot down this worry in a worry diary, a notebook or a day planner that you use for other appointments. Assign a time for you to worry. Treat your worries like an appointment and schedule it for 15 minutes. It could be first thing after your morning coffee, or just after lunch, or on your trip home from work. (Just avoid bedtime). Combine this step with step 1 and write about your worries, intensely and non-stop, for 15 minutes.

The value of this approach is that it provides you with a sense of having addressed the worry. You will be able to worry about whatever is bothering you – but only at a specified time. This approach allows you to feel more comfortable not worrying (or at least worrying less) the rest of your day.

To practice this scheduled and concentrated form of worry control, start with a smaller worry and work up to your more distressing concerns.

Today’s assignment: Set aside a 15-minute block of time to worry. When this time arrives, take out your notebook and write intensely and non-stop about your worries for the entire 15 minutes.

Worry Challenge; Day 3: Cut out your catastrophizing

Worriers are consummate catastrophizers. They are constantly vigilant, on the lookout for horrendous problems and imminent disasters. This vigilance in and of itself can be stressful, not to mention emotionally and physically draining.

And even if a feared event did happen, would it always result in the catastrophic results like the following?

- If I lose my job, I’ll wind up in a box on the street!
- If I fail the test, my life will be totally ruined!
- If I have sex, I could contract HIV and that means I will be alone forever!
- If I don’t meet my deadline, I’ll be fired!
- If I’m late, they’ll never talk to me again!

Probably not. Whenever you emotionally exaggerate the importance of a situation (by saying, for example, “This is the worst thing that could ever happen!”), you can be sure that your stress level will rise accordingly. You can quickly turn something small that warrants some concern into a major catastrophe that elicits major stress.

Today’s assignment: Catch yourself catastrophizing. When you catch yourself imagining the worst, put it in perspective.
Noah Clyman's 7 Day Worry Challenge! (part 1)
It’s springtime! The sun is shining and nature is in bloom. This is the time of year when you can, literally, “stop and smell the roses”… unless you’re hijacked by worry.

Worrying is appropriate and healthy when it motivates you and leads you to attempt to resolve a problem in a productive, adaptive manner. Most of the time, however, the sole function of worry is that it robs you of life’s joy and interferes in your day-to-day functioning. I have counseled many clients who have described how their lives were ruined by worrying – the constant state of tension; feeling in a fog, preoccupied; and unable to relax and let go.

Not sure if you’re a worrier? Simply indicate to what extent each of the statements below describes you (“not at all like me,” “a little like me,” or “a lot like me”).
1. After I start worrying, I find it very difficult to stop.
2. People who know me well tell me that I worry too much.
3. I often think of worst-case scenarios when I worry about a problem.
4. I frequently become anxious and worry about things that could happen but usually don’t.
5. When I worry, I usually just upset myself more, rather than try to resolve my worries.
Answering more than one or two of these statements with “a lot like me” suggests that worrying is a problem in your life.

Never fear! I have created the Noah Clyman 7 Day Worry Challenge. Each day – for the next 7 days - I am going to provide you with a worry-busting “strategy of the day” to help overcome your worry habit. Each strategy is an established CBT technique that has been shown in clinical trials to reduce worry. These 7 techniques are hand selected by yours truly based on what I have observed to be the most effective interventions with my clients.

My instructions to you, the reader, before we begin: Read each exercise carefully and completely. Then carry it out. Stick with it for the week. These strategies will help you (a) worry less, (b) become more mindful, and (c) enjoy the here-and-now. With practice, these cognitive therapy techniques can produce remarkable changes.

So, no time like the present – let’s get started right now!

Worry Challenge; Day 1: List your worries & Write about them

One way that you can cope with your worries is by listing them in order of the amount of stress they trigger.

For example:
1. Job security
2. Mother’s health
3. Kids’ safety in the city
4. Possible IRS audit
5. Losing hair
6. Upcoming meeting at work
7. Forgot spouse’s birthday
8. Getting back to a friend about an invitation

Next, write about your worries. Research has shown that writing about stressful and worrisome experiences can reduce stress-related symptoms. By writing down your worries, you begin to feel you are more in control of them. Much of your worrying goes on in a somewhat vague, ill-defined manner. Sometimes you aren’t even quite sure what you’re worrying about. Bu committing them to paper, you are dealing with them in a more direct way. Instead of floating around out there somewhere, they are now in a concrete form.

Today’s assignment: sit down and write about your worries intensely and non-stop (no distractions or breaks!) for 20 minutes.
Power of Positive Thinking versus Cognitive Therapy
I met someone recently at a party who asked what I do for work. When I responded that I'm a cognitive behavioral therapist, she questioned, "Oh, isn't that the power of positive thinking? Like if you're sad, tell yourself, 'don't feel that way, just think positive!'" This is a common misconception and I'd like to offer some insight on the matter.

CBT is about learning to think realistically, which is not to be confused with 'positive thinking.'

CBT involves recognizing the irrational and dysfunctional nature of many negative thoughts that occur when people are experiencing a mood disorder, like clinical anxiety or depression.
For example, let's say you are feeling depressed. The 1st step is to identify why you feel this way, in other words, what causes this emotion? The secret is in your thoughts, what you say to yourself. Just as you start to notice your mood sink, ask yourself, "What is going thru my mind right now?"
So let's say you identified the thought, "I'm unlovable." If you believe this thought to be 100% true it makes sense you would feel depressed! Anyone would feel depressed if they believed this thought. The problem is NOT your emotions (because they are quite logical here) but the problem lies in your faulty thinking. (Important: this does not mean you're 'bad' for having these thoughts. Faulty thinking is a symptom of psychological problems, just like a cough is a symptom of the flu. These thoughts are not intentional - they occur rapidly and are often outside our immediate awareness. The good news is that you can learn to change these thoughts and therefore feel better!)
A cognitive therapist does NOT tell you, "Oh come off it! You're the best thing since sliced bread!" Instead, a good cognitive therapist helps you examine your thoughts and consider how accurate and useful they are. The therapist will help guide you to recognize distorted thoughts, see yourself in a more balanced way, and build self-compassion. So we might pursue the following lines of inquiry: How do you define 'unlovable'? Does everyone define the term 'unlovable' in this way? If no, why not? What is the evidence that you're unlovable? What is the evidence this label is not true about you, or not completely true all the time? If you conclude there are things about yourself you don't like, what can you do to improve?
'Positive thinking' on the other hand would be telling yourself, "I'm not unlovable, I'm perfect in every way at every moment!!" This is an exercise in futility because you know it is not true. No one is perfect all the time! This kind of positive thinking is ineffective and illogical.

The point of CBT is to help people examine negative thoughts, identify cognitive distortions or errors, and replace distorted thoughts with more accurate thoughts, so they can feel better.

Just wanted to offer some clarification here!
Insomnia Tips
Sleep disturbances of various types are an increasingly common problem. It is estimated that approximately 30-40% of the general population experience occasional sleep disturbance and 65% of patients who suffer from depression or anxiety disorders suffer from insomnia. Most people seem to function at their best when they get an average of 7 to 8 hours of sleep per night. While it is normal for our sleep patterns to be intermittently disturbed, disturbed sleep which lasts for weeks is not.

Clients often ask me how they can improve their sleep, aside from taking medication. Here are some general sleep hygiene guidelines for improving the quality of your sleep. The more you unlearn your bad sleep habits and practice good sleep hygiene, the better your sleep will slowly become, but don't expect immediate results. If insomnia is part of an emotional disorder such as, depression, anxiety or a medical disorder, make certain you are getting treatment for that problem.

REGULAR SLEEP TIMES: Make a habit of going to bed and waking up at the same times everyday, regardless of how tired you are or are not. If not a regular bedtime, then at least try to wake up the same time everyday.

THE BED IS FOR SLEEPING: Use your bed only for sleeping and sex. Don't read, watch TV, talk on the phone, etc. in bed. As much as possible, getting in bed should be associated with going to sleep. Make a habit of doing everything else in a nice comfortable chair.

AVOID NAPS: While a very short nap during the day (no more than 15 minutes to half an hour) is probably OK, try to avoid sleeping during the day.

NUTRITION: Avoid all caffeine products after 3 PM (coffee, tea, cola, chocolate), use herbal teas instead. Avoid alcoholic drinks, they may help you to fall asleep, but will disturb your sleep later in the sleep cycle. If you are often awakened by the need to urinate, get into the habit of drinking earlier in the evening, but avoid liquids for at least an hour before bedtime. If you must drink then, drink less or just wet your mouth.

PROGRESSIVE MUSCLE RELAXATION (PMR): Learn how to focus your mind on deeply relaxing your muscles, one muscle group at a time. Ask a therapist to teach you PMR and use PMR audio tapes while falling asleep.

GIVE UP ON TRYING TO FALL ASLEEP: Relaxation exercises also help because they give you something else to focus on besides worrying about not sleeping. Sometimes trying too hard to get to sleep backfires and you start to worry about not getting to sleep, which then keeps you awake. Instead make your goal getting as relaxed as possible. Give up on trying to sleep, the goal is getting relaxed, it's almost as good as being asleep and won't backfire. Other distractions such as sound machines, soft music, etc., may also help.

DON'T LAY AWAKE IN BED: If you are laying awake in bed for more than approximately 45 minutes, get out of bed, into your most comfortable chair or couch and do something drowsy (read something boring, watch some boring TV, etc.). When you start to get drowsy again, get back into bed.

PHYSICAL EXERCISE: Do get some exercise on a regular basis (walking, running, biking, etc.). Don't exercise too soon before going to bed though (leave approximately 3 hours).

**If the above suggestions seem overwhelming, I suggest starting with the easiest ones first. Also, if after reading these suggestions you notice that your problems seem to lie in one area and not others (e.g., you sleep a lot during the day or drink several cups of coffee) focus your energy on those problem areas.
Tips for Managing Nightmares
You may feel your dreams and nightmares are out of your control. If so, try this technique and see if you can create a happier ending for your scary or unpleasant dreams.

1) Start practicing relaxation techniques every night before bedtime (I suggest picking up a sleep CD with a focus on 'body scans' or 'progressive muscle relaxation.')
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.

Try it and let me know how it went.

Source: This nightmare protocol was adapted from the Behavioral Research and Therapy Clinics at the University of Washington.
Am I a Hoarder?
Hoarding has gained a lot of attention lately thru reality television shows like A&E's "Hoarders." Sufferers of this condition, aka 'hoarders,' are identified as people who live in cluttered environments and have difficulty discarding their possessions. This definition creates confusion for city dwellers who often have to fit a lifetime of belongings into a 1-bedroom or even studio apartment! The majority of people living in small spaces will answer "yes" to these typical assessment questions for hoarding: "Are your rooms cluttered?" "Do you have a need for additional storage space?" "Do you ever buy items you don't have room for?" Therefore, how do we know if we have a problem?

It is important to consider the severity of the problem. Truthfully, almost every one of us has some characteristics of hoarding. The degree to which your symptoms interfere with your overall functioning is the important variable here. For instance, if you have some difficulty throwing away a week's worth of newspapers and they form a little pile on the floor, you are probably not a hoarder. But if you have six months' worth of newspapers scattered across the living room floor, making it difficult to get from one end to the other, you may be a hoarder. Use your friends, family, and neighbors as a point of reference. Is my saving behavior similar to other people I know or does it seem extreme? Also, since many hoarders minimize or deny the problem, ask yourself: Do other people in my life consider my saving behaviors a problem?

Also, there are important emotional and psychological characteristics to consider. Hoarding is not the same as collecting. Generally speaking, collectors are proud of their possessions and enjoy showing them off. If you are a hoarder, however, you feel embarrassed by your possessions. You purchase items with the intention of finding some function for them but end up feeling embarrassed by them. Unlike collectors, hoarders feel uncomfortable with others seeing their possessions and often outright refuse to let others view their possessions. Whereas collectors feel satisfaction when making additions to their collection, hoarders feel ashamed, sad, or depressed after acquiring additional items. So it is necessary to ask yourself how you feel about your possessions.

If you believe that your clutter is distressing and impairs your functioning, Cognitive Behavior Therapy can help. In addition to helping you create an action plan to clean up the clutter, I can help you with the emotional parts of the problem. Together, we will explore why you save and the special meaning you attach to possessions. We will work to build your motivation and identify barriers that get in your way. I will teach you to recognize faulty thinking and replace negative thoughts with more balanced and realistic appraisals.
Solutions for Anxiety and Stress at Work
In my previous blog, I presented a survey to help you identify if anxiety/stress at work are a problem for you. After reading that blog you might have been saying to yourself, "Okay, Noah, so we've identified that I have a lot of stress and anxiety at work - Now what? What can I do about it?"

Here are some tips to reduce your anxiety and stress at work.

What can you change?

Pinpoint your stress triggers at work and then ask yourself to what extent you can remove or at least reduce the impact of that stress. In some cases, you don't have the ability to eliminate some of the sources of stress at work: Getting the boss fired may not be likely; and asking for a raise the day after the company announces downsizing plans may not be in your best interest. What you can change, however, is you. It's important to begin by recognizing what's in your control and what's not.

The fine art of delegating

One problem I frequently observe in my practice is that people create their own stress by taking on more than they can handle. This often happens because they fear that the job won't get done as well as if they would have done it themselves. In fact, it may be the case that having a coworker or assistant to do the job results in a less than perfect outcome in terms of performance quality and effectiveness. However, that may not be such a disaster - the outcome may be quite satisfactory without being quite perfect. Sometimes lowering your standards, and settling for a less than perfect job, can result in less stress. Also, many times these assumptions aren't accurate at all. The reality is that other people can be taught. You may be pleasantly surprised by the level of work that others can bring to a task or responsibility. Even if you're right, and others don't do the job as well as you do, you're probably still better off delegating than taking on everything yourself and feeling incredibly stressed.
Here are some further tips for this:
Package your request for help in positive terms: Tell the person why you selected him or her. Offer a genuine compliment reflecting that you recognize some ability or competence that makes that person right for the job.
Don't micromanage. After you assign a task and carefully explain what needs to be done, let the person do it. Don't interfere unless you clearly see that things are taking a wrong turn.
Reward the effort. If the person did a good job, say so. And if he or she didn't do it quite the way you would have but put a lot of effort into the task, let him or her know that you appreciate the effort.

Make your lunch break a stress break

Lunchtime isn't only about eating; it's a great time to work on lowering your stress. Try to get out of your work environment at lunch. Even if your outing is as simple as going for a walk around the block, go. Better yet, find a park, library - anything relaxing - that can put you (however temporarily) into a different frame of mind. Find your lunch-time oasis.

Coming home more relaxed (and staying that way)

When you get home, it's important to have something relaxing planned to look forward to. Leave your work at work and take time to unwind and provide loving kindness for yourself. Here are some of my personal favorite relaxation activities:
- Take a relaxing bubble bath or shower.
- Have a drink (one will do).
- Sit in your favorite chair and simply veg.
- Listen to some relaxing music.
- Read a chapter from a good book.
- Take a relaxing walk.

Keep these tips in mind and you are now better prepared to cope with the chaos!