1. What is the way out of this?
Evaluation
Education about anxiety disorders
Understanding how the cycle of anxieties work and what fuels it
Explain how exposure undoes it, create a hierarchy
the importance of accepting and living with uncertainty
Identify irrational beliefs
Identify distorted thinking patterns
Teach how to retrain the mind to think positively

2. Evaluation Inventory – which situations cause anxiety
How severe is the anxiety
How long has he been suffering for
How much is it disrupting the person’s ability to function
How much insight is there in realizing that this is a mind this order as opposed to a real social problem

3. Introduction to evaluation
Me – שלום עליכם good to see you, I give you credit for coming because I know at the beginning it doesn’t feel so comfortable to talk about these things, but don’t worry everyone walks in like that and before long you’ll realize that there is nothing so wrong with having a little nerven, its so normal and common.
But, since each person has it in a little different way then the next so it pays to try understand more clearly how it comes to you, so im going to ask you a couple of simple questions.

4. Me - I assume that if you’re up to talking about this it probably didn’t start yesterday, and chances are that its gotten quite annoying – so what would you say is the issue?
Bochur – well to be honest im not sure where to start, and im not even sure exactly what it is.
Me – could you give me an example of where this becomes bothersome.

5. Bochur – I don’t know why, its going to sound funny but I kind of shter zich from people.
Me – is it even people that you are familiar with
Bochur – yes, in some ways its even worse with people that I know
Me – I would just like to understand a bit better where this comes up

6. Me -Are you able to speak up at the lunch table in yeshiva
Bochur - No, I try just to sit and listen
Me - How about going over to the rosh hayeshiva to ask a question
Bochur - You crazy, I havent spoken to him in months
Me – What about something simple like an עליה

7. Me – I see that these feelings are coming up and that can you tell me what is it that you feel when you come in contact with social situations.
Bochur- I start feeling very tense, sometimes my head starts spinning and I have this feeling of fear that goes through me, it makes me very nervous and puts me in a very bad mood, it takes away my chaishek to be able to learn. It makes me want to just find some corner and live my own life and forget about everybody else.

8. Me – do you ever remember having these feelings and they became extremely intense to the point that decided having strong physical symptoms
Bochur – yes I remember one time I started breathing heavy, my vision became blurry, my legs felt like jelly and I saw something really dangerous was going to happen to me. I almost panicked but somehow I pushed through. So now I am careful to make sure not to go into a situation that could bring that back.

9. Bochur – it’s interesting that you asked me that, but I have avoided that for some time. Its just not worth the pain.
Me – but other areas you find yourself being overly-conscious of what people think?
Bochur – I do not know exactly, is just like everything
Me – do you find yourself worrying in advance about a situation that you may have to be in and face people socially, even if it is not happen for a while.
Bochur – yes all the time, I still remember agonizing for weeks before my brother’s Chasuna

10. Me – so I hear basically that any time you find yourself within range of the public eye you become uncomfortable - And even though you told me a bunch of different places and situations where this happens it seems that the basic idea is – the fear or of being socially judged – do you have any idea why these feelings are coming from?
Bochur – I never kind of connected everything together but not if you say that weight makes sense. But I still do not know why I feel this way.

11. Me – do you realize that the spheres and feelings do not quite make sense, or do you think that there is something really wrong with your social abilities?
Bochur – I know that it does not really make sense and I wish they were not there but it feels so real and I just have no other explanation for it
Me – if you wanted to fix the problem what would you want to fix
Bochur – I do not know that when I came here

12. Education about anxiety disorders
They are very common
This does not show that there is something abnormal with you
It is something that is easily curable if you work for the program
Anxiety is not dangerous, it cannot cause any temporary or permanent damage to yourself

13. Me - you are probably wondering how I knew to ask you all these questions, and even though it is the first time speaking with you I knew how many different areas you were having trouble with, I hate to break it I do not mean to disappoint you, but it is not my brains or special talents that teaches me this, it’s just that it is so common and I have seen it so many times that you get to recognize it so easily it is a standard pattern - it is a no-brainer. And as a matter of fact it is from the easier things to fix. I am not saying it will go away in the second or even in us meeting three or four times but if you stick to the program you will be laughing at these things shortly.
Bochur – I sure wish what you are saying is true, but the way I see it it’s murder and it’s hard to believe that it is so simple but I am ready to give it a shot.
Me – I guess after all you really have no choice anyway, because you have kind of tried it your way this far and look where we are.

14. statistics
The most up-to-date information suggests that one in eight Americans will, at some point in his or her life, suffer from social anxiety disorder.
This makes social anxiety disorder the third most common psychiatric disorder, after depression and alcoholism. Millions of people - from 10 to 19 million depending on the particular survey cited - are affected by social anxiety.

15. Me – before it begins explaining to you how to get rid of this, I just want to let you know if you facts.
There is nothing dangerous about those feelings and pains and that you have, it is something that we call anxiety - it’s just a fancy word for nervous, and whenever one gets nervous he feels those feelings, but it cannot do anything to you, anxiety may be uncomfortable but it is not dangerous. There is no reason to panic. Obviously I will try to prove this to you through our discussion, but knowing this fact alone should make you feel a lot calmer.

16. Before I tell you what to do I am going to have to explain to you how this works, this is for two reasons firstly in order to fix the problem you must first understand secondly as you said yourself earlier this makes no sense and if you can be really convinced that it is nonsense, most of it will actually disappear.
Let me explain you, what the problem is, and how the problem works. This is a problem in your head, it is like a mind game. Once you will catch on to the system you win the game, it is like playing hide and seek – until you find the person there is a challenge, the second he you see him – even just the peak, the game is over.

17. Understanding how the cycle of anxieties work and what fuels it
The problem:
When the brain
sends warning messages
to the body
When there is really no need to.
Similar to a false alarm
this is usually done by
Exaggerating the likelihood and the severity of the danger
This triggers very uncomfortable physical and emotional symptoms

18. Distress Relief Act to rectify distress subsides temporarily
Scary thought
repetitive, negative thoughts, images, or impulses
Distress
anxiety, fear, disgust, shame
Act to rectify
Avoidance, Analyze, correct
Relief
distress subsides temporarily

19. The relationship between obsessions and compulsions
Understand the cycle
The obsession hits
Obsessions bring along an overload of worry and anxiety
The obsessions drain your body’s energy
You are dying for any kind of relief
There is a force within you pushing you to do something that it perceives as immediate relief.
This relief is only temporary and the cycle begins once again.

20. Bochur – I hear what you are saying it makes sense but at the end of the day I need the relief what you want me to do? It’s just so impossible to be social, and these feelings are real, there are times that I could actually start sweating, and can’t sleep at night. And as a matter of fact it has been getting worse. Me – you are a hundred percent right, but you are missing one important point, they want you to think about the following question. Your words are a contradiction within themselves, on the one hand you tell me there is no reason to be afraid and it is some foolish feeling, and then you tell me that they are so real. The answer is, as much as you understand that it is foolish your behavior, will reinforce it to the point where your body believes it even though your mind understands it – and I want to explain you why?

21. ERP – affects cognition
1) Your negative assumption will not allow you to figure out the truth.
2) The more you avoid something the less you know about it.
3) Facing the fears, will uncover the fallacy of the fear. The fear just melts on its own!

22. Me – to continue what we said, if this is a false alarm, a mistake in reaction, it has just been reinforced by mistake and behaviors. Our job is going to be to retrain our body by using the proper behaviors to realize that the fallacy in this. And ultimately get to the point, to break this cycle that fuels the anxiety. The way to correct it is precisely the opposite of what made it, and that is to expose yourself to these situations and treat the anxiety feelings as nonthreatening mistakes. However, even this must be with a system that we will outline for you.

23. Explain how exposure undoes it
Since this is all a mistake – a false alarm – you have to treat it that way and prove yourself that it is really nonsense.
Secondly, the actual exposure will cause you to get used to it the same way we get used to everything in life.

24. Habituation We get used to everything sooner or later.
A natural and automatic
Part of our sensory systems.
The physiological process designed to return our bodies back to equilibrium after experiencing a novel sensation.
We get used to everything
sooner or later.

25. Facts about the safety and sequence of exposure and habituation
Anxiety is not fatal and can be lived through.
Anxiety is transient and passes away.
Avoidance strengthens fear.
Exposure weakens fear.
Habituation is natural and automatic.
exposure is necessary for habituation.
Anxiety in anticipation of exposure may be a higher than anxiety during actual exposure.

26. Me – let me give you an easy way to put the whole concept into simple terms.
It will also be a way for you to remind yourself how to put this understanding into action when it comes to a hard anxious moment.
It’s a method that’s used even for young children, when helping them get over their anxiety.

27. Face the FEARS don’t Fight the FEARS
Anxiety going up
Anxiety going down

28. Insists that you are in charge Defy – do the opposite
R.I.D.E.
Rename the thought
Insists that you are in charge
Defy – do the opposite
Enjoy – your success

29. Bochur – I hear what you are saying, and I know I am not the one to argue. But I have tried this many times and it just made it worse. According to what you are saying that it’s natural and automatic why didn’t it ever work for me.
Me – that is an excellent question almost everyone tell that to me, that is a sign that she really understood what I told you. But the answer is quite simple too.

30. There is another easy option – it is a coasting down easy ride, but…

31. Me – Before you can start with your exposure is you must design a program properly so let us go back and review what is our personal cycle that fuels our personal anxiety and how do we change the way that we acted until now and what is the best way for us to correct the behavior and ultimately learned to live according to the logical understanding of our brains.

32. Getting the fears clear
What, exactly am I afraid of?
How much am I afraid?
What triggers my fears?
What do I do to ease my fears?

33. Me – you probably wish it was as simple as I am making it.
Bochur – as a matter of fact I do not think it is so simple because if you are going to tell me to go over to theRosh Hayeshiva in the front of the Bais hamedrash tomorrow, there is no way that that is happening. On telling you I will snap, I will go crazy. And let me tell you you cannot imagine the embarrassment that I will have.

34. Creating a hierarchy Rate your fears
On one column, list your fears and avoided a situations due to fears.
In the next column, put a number rating to describe the level of fear evoked by the situation.
Put them in fear order, with the fear with the lowest rating on top

35. 2 – Walk down the aisle to get a sefer when the ביהמ"ד is full 3
My Fear Ladder
Goal - To be able to do whatever necessary in all social situation!
Date
Things I’m afraid to do
My fear temper
1 – Walk over to a simple friend and speak in learning 2
2 – Walk down the aisle to get a sefer when the ביהמ"ד is full 3
3 - Get an עליה in a shtibel 4
4 – talk to a שטאלצי בחור and speak in learning 5
5 Dance in the middle circle at a חתונה 6
6Get an עליה in yeshiva 7
7 - Go to my Rebbe and ask a simple question in ביהמ"ד 10

36. Situation that causes distress Normal compulsion
Goal with specific time constraint
Measure on fearometer
Accomplished or not
Yes – how bad rate
No - why
Ask a stranger a question – change of a dollar / the time
Avoid
Feel negatie thoughts
Ask a stranger a question – change of a dollar / the time – 3x day 2
Go to bobov and look people in the face
Look down
Imagine thyre all watching
Go to bobov and look people in the face For atleast five minutes 3
Go to shull where your friends daven and daven near the door
Come late and leave early
Go to shull whee your friends daven and daven near the door - come early and leave at the end 4
Go to tisch standnear the door
Become scared run
Go to tisch standnear the door – twenty minutes 5
Ask a stranger a that takes explanation - directions
Ask a stranger a that takes explanation – directions 2x day 6
Get an aliya in bobov
Avoid, Feel negatie thoughts 7
Walking to bima in my beis midrash and daven for 10 min
Get nervous run out
Walking to bima in my beis midrash and daven for 10 min – look around smile
Go to tisch stand in the ,middle of the parenchas
Turn red and now everyone sees
Go to tisch stand in the ,middle of the parenchas – fifteen minutes
(work in fives if nec) 8
Go to a chasuna where my chevra are – for five minutes
Im a misfit and everyone knows it 9
Go to a chasuna where my chevra are – dance and talk
Go to a chasuna where my chevra are – dance and talk – twenty minutes
Ask a friend for his opinion
avoid
Do it 2x day 10

37. Bochur – How can I know fore sure that if I do this nothing will really happen to me
Me – excelent question, and that brings us to one of he main principles that you have to understand, when I say understand I mean in two ways
1 – understand how this creates the anxiety
2 – understand how it will undo any type of recovery that you try

38. A prerequisite for recovery
Accepting to be willing to live in a world with uncertainty.
This means realizing:
Bad things do happen
They may happen
I cannot control it
And it may even be my fault!

39. Bochur – how do you expect me to live with the constant worry that something terrible may happen, and why can’t I control it?
Me – this is something that we can discuss at length, but let me explain just a few pointers and I hope you will trust what I am telling you, and if not we will just have to invest some more time to go through it more covinncingly – but at the end of the day this is what has to happen. And once you understand it it wont bother you and it wont be so scary – as a matter of fact it will save you loads and loads of worrying and give you velt of menuchah in your life

40. Anxiety disorders are fueled by:
The need for 100 percent security and the certainty
2) Putting in a tremendous amount of effort to attain this
3) The realization, after all my sacrifice I am still vulnerable

41. Understanding the frustration
Feeling you need something for survival.
Paying a high price to get it.
Realizing that it’s not attainable
Worst of all, my efforts are futile.
I am not in control.
I am doomed and hopeless.

42. We all learned to live with it
The source of the error you are defying your own understanding and acceptance of the world as it is.
Everyone is resigned to the fact that they are not in control.
We all learned to live with it
Even people with anxiety disorders live by these rules,
except for the specifics of where the disorder haunts them.

43. I agree that it would be a nice thing to have, but you understand quite clearly that it is just impossible to attain. And you yourself live your life this way in regard to everything else – so just apply your common sense principles here too.
The bottom line – when you feel yourself getting anxious. Stop! Ask yourself am I looking for security in some area – if yes remind yourself that this is inviting anxiety. And if you continue – you know where you are heading

44. Bochur – I hear what you are saying – but I am having a hard time letting go. I just feel lost And then I start getting all anxious
Me – it is true that it doesn’t go easy, and you can’t change you’re natural way of living that you have been using for the past ____ amount of years, in a second. But the understanding and the reinding yourself will make a tremendous difference.
If this is not enough we will have to get a slightly deeper understanding of how the “ocd brain” thinks and then to understand the effect that this has had on bringing you to this way of living.
Ultimately we will have to find a way to correct these distorted thinking patterns.

45. Identify irrational beliefs
Overimportance of thought
Overestimation of danger
Desire for certainty
Perfectionism
Consequences of anxiety

46. Identify irrational beliefs
Overimportance of thought - If I am scared there must be some truth to the fear
Overestimation of danger – I will surely pass out or get humiliated
Desire for certainty – I cant put myself in a situation that
Perfectionism
Consequences of anxiety

47. The way his mind perceives the world is wrong and irrational.
Remember: not every reason will apply to every case.
1) Why do you see things differently than others? 2) Do you wish that your children be as careful as you? 3) Why is it that there are only certain things that trigger me, and for everything else I can let it slide? 4) I notice that there are times when it is better and times that it is worse, if it were real why would it fluctuate? 5) Very often we see that it jumps from one thing to another, what happened to my old way of thinking? 6) The same person is usually able to see other people with OCD symptoms and a laugh. 7) You have come to me for help, you know deep down that this is wrong. 8) Why is it, that when I ask you specific questions, you smile and smirk with embarrassment of your own assessment?

48. OCD defies the basic accepted principles of logic
Logic tells me that if I breathe heavily or turn red its almost not noticeable and no one really cares.
OCD tells me, if that was true then I wouldn’t be feeling these panicky feelings…

49. Me – your feelings are all a result of this mistake, you’re beliefs are irrational, and you should know that most people that suffer with these kinds of feelings have one or more of these irrational beliefs upon which the anxiety is based and fueled. Try to go through this list and see which of these false beliefs apply to you

50. Bochur – At the end of the day it still feels real and its being repeated in my head again and again and its so annoying Me – firstly, don’t make the most common mistake and that is to try to deal with it with logic. Secondly, the fact that you know that it is not logical should take away half of the intensity.

51. How do we speak and deal with someone who is not logical and will not agree to my set of basic principles.
How do you respond to the drunken can collector, rummaging through the garbage to find a five cent can, he turns to you and calls you an idiot?
Do you begin explaining to him that you have some great accomplishments in life, and why you feel that his assessment was incorrect?!
Why not????

52. The OCD within you is like that drunkard
Do not answer him
Do not prove him wrong
Do not try to understand him
Do not fight with him
Do not analyze him
Do not be afraid or intimidated by him
Do not avoid him
Treat him like what his true value is:
a worthless drunkard,
not worthy of the slightest bit of attention

53. Bochur – why is it that even after I hear all of this, I still feel that I cannot control.
Me – there are two parts of this answer. Firstly, remember the goal is not to control the if you are trying to control it you lost before you begin.
Secondly, it’s probably those annoying feelings that are getting to you, and you have to realize that those feelings are being produced by you yourself. Let me explain you how that works

54. The downward arrow
Most fears are built on a series of thoughts that build one on top of another and each one increases the intensity of the fear
It is important to recognize the different parts so that you can actually see how irrational the beliefs really are

55. I have a feeling that I may appear clumsy or odd in public
Most fears begin with a slight fear of discomfort and end with the fear of severe catastrophe
I have a feeling that I may appear clumsy or odd in public
1 - I am afraid when I walk past that group, I will turn red and start breathing heavily
2- as soon as my friends know this they will think something is wrong with me
3 – that will make me even more nervous, and will make me look even more foolish and they will realize that I am about to snap.

56. Bochur - Why would I come to such false conclusions – I hold myself to be a normal person as a matter. Me – there are certain ways of thinking, that are more thinking from emotion than from logic, when a person has a habit of thinking this way it will fuel this downward spiral. As a matter of fact, people in the field have put together a list of 10 common cognitive distortions that fuel this type of anxiety. There is nothing to be afraid of because once you see what it is you will be able to work on changing it rather easily.

57. Identify distorted thinking patterns
Overgeneralization
Mental filter
Jumping to conclusions
Magnification and minimization
Emotional reasoning
Should statements
Blame

58. If it was simply the pain then all people would react similarly
We feel the way think
It’s not the situation that causes the anxiety it’s the thoughts!
*********
If it was simply the pain then all people would react similarly

59. Connections between anxiety and negative thoughts
Is the base on which the anxiety is built.
Is the fuel that keeps it going
Is undermining and undoing any exposure or cognitive treatment
Drains the persons emotional strength that he desperately needs for survival
Negative thinking

60. How to prepare positive self talk responses
All analyzing and preparing responses must be done when you are calm and rational, and the knots when you are suffering from sliding down the negative spiral.
Get to know yourself, make a list of negative thoughts that plague you.
Try to see which of the distorted thinking patterns are pushing you to think this way.

61. Behave and act according to your positive interpretation
After all the thinking is completed the most important correction is in your behavior. Force yourself to act Positively and happily and you will feel happy and positive.

62. Practice makes perfect
Once you have gone through the steps and you know:
1) which negative will come to you
2) which distortion fueled them
3) how to see them in a positive light.
You no longer have to go through the steps
Just the label them as one of those thoughts on the list that I know are dangerous, false, irrational, and not worth entertaining.
laugh at them and enjoy your conquering of them.