​Battling Anxiety

Dealing with anxiety is exhausting. It robs you from the enjoyment of everyday life – keeping you from being your best self at work and with your friends and family. Over the years, I’ve heard a lot from patients about how anxiety wreaks havoc in everyday life:

• I feel so nervous and caught up in my worry that I can’t even think straight or concentrate at work.

• Why am I so nervous all the time? I should be grateful for everything I have!​
• It takes me so long to fall asleep at night because I’m going over my worries again and again. I’m so exhausted in the morning.

• I’m avoiding _____ because I’m so anxious (e.g., talking to or seeing friends, an important task at work). I miss it but I can’t even enjoy those things anymore because I get so anxious.

If these struggles sound familiar to you, you are not alone.
​There are effective treatments for anxiety, and they can help you get your life back on track.

​Finding Effective Treatment for Anxiety

Finding a therapist in a metropolitan area such as South Florida might feel overwhelming because there are so many options across Broward and Miami-Dade. How do you know which therapist is right for you? Well, it’s crucial to have a connection with your therapist – to feel that your therapist “gets you.” In addition, if you are struggling with anxiety, it is important that you find a therapist who specializes in the treatment of anxiety.
 
Lots of research has been done on anxiety treatment and based on these studies, we have a pretty good idea of what usually works for most people: Cognitive Behavioral Therapy (CBT)

​​What is Cognitive Behavioral Therapy (CBT)?​

Cognitive Behavioral Therapy (CBT) is a type of treatment that helps you change the way you think, and as a result, helps you change the way you behave. In CBT, we will work together to hone in on exactly what kinds of thoughts are spiraling through your mind when you’re caught up in worry and anxiety. Anxious thoughts can take on a variety of flavors, such as: I’m not good enough. This needs to be perfect. Something terrible is about to happen.
 
Once we have a good sense of what your anxiety is saying (Spoiler alert: Anxiety likes to LIE!), we will try out different strategies to help you challenge those nagging, anxious thoughts. In other words, you will learn how to “talk back” to your anxiety and check the accuracy of those thoughts.

The most critical component of treatment involves gradually facing your fears. Psychologists refer to this process of facing your fears as “exposures” because you are gradually exposing yourself to situations that tend to make you feel anxious, and then using the tools learned in therapy to cope with this anxiety. Facing your fears is not easy, but with the right coping tools, a determined mindset, and a solid therapeutic relationship, I’ve seen many patients feel empowered to gradually face their fears, and my hope is that you will feel that way, too.
 
With CBT tools in your back pocket, you should feel confident that if a situation that makes you feel uncomfortable or nervous comes up, you will know exactly how to handle it.

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​CBT for Anxiety with Dr. Penela

Over the last decade, I’ve helped many patients face and overcome their challenges with anxiety using CBT tools. I have received specialized training in using CBT and enjoy using this approach with my patients for one simple reason: it helps most people feel better. I tailor the treatment to meet each person’s specific needs, and as needed will incorporate other approaches, such as mindfulness, family systems, and acceptance-based techniques.
 
Anxiety looks different for each person, and we will work together to identify and practice specific strategies that will help you learn to manage anxiety – in other words, how to kick anxiety in the face, so that you can get back to enjoying life! That said, sometimes therapy feels “mysterious” – what’s going to happen? What will my therapist ask about, and ask me to do?

​What might CBT look like for me?

Let’s take away some of that mystery. I’d like to give you a sneak peek into what Cognitive Behavior Therapy (CBT) for anxiety can look like, depending on the type of anxiety that you are dealing with. These are just a few examples of the kinds of anxiety issues I help therapy patients with and is by no means an exhaustive list. The main themes we’ll cover in therapy are: (1) identifying the worry thought, (2) challenging or talking back to the worry, and (3) gradual exposure (facing your fear).

Social Anxiety

Panic Attacks

Obsessive Compulsive Disorder

Specific Phobias

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Starting treatment

If you're considering starting the challenging but rewarding journey toward beating anxiety, I'm here to help. In a warm and empowering environment, we will work together to help you learn to effectively manage your anxiety and lead a full and meaningful life.

I am Ready to Beat Anxiety

Social Anxiety

Worry Talking Back Exposure

• Identify worry thought:

  II won’t know anyone at this meeting tomorrow, and I am terrible at small talk. I’m sure I’ll stumble over my words and look so awkward, and then others will think something is wrong with me.

• Talk back to the worry with facts and evidence

  Lots of people won’t know each other at this meeting, and even though I’m not great at small talk, I usually warm up to it. Everyone makes mistakes sometimes while speaking. Even if I fumble over my words, it’s likely others won’t think much of it.

• Gradual exposure:

  • Intentionally practice small talk with a trusted friend or family member.
  • At your workplace, plan to engage in small talk with one person each day for at least a few minutes.
  • Go to the upcoming meeting, and plan to engage in small talk with at least two people.

Panic Attacks

Worry Talking Back Exposure

• Identify worry thought:

  I notice that my heart is beating a little faster than usual, so I should probably leave this situation in order to prevent something terrible from happening.

• Talk back to the worry with facts and evidence:

  My heart could be beating faster than usual because I’m walking quickly. I’ve had this sensation before and it usually makes me very uncomfortable, but then it subsides and I am okay.

• Gradual exposure:

  • Intentionally do activities that lead to the experience of a fast heartbeat (e.g., run vigorously or do jumping jacks for a minute)
  • Do these activities in situations where it might be difficult to leave quickly.

Obsessive Compulsive Disorder

OCD and anxiety often go hand-in-hand. You can read more about OCD treatment here.

Worry Talking Back Exposure

• Identify worry thought:

  I’m not sure I did that quite right and that makes me feel very anxious and uncomfortable. I should [insert compulsion] to help myself feel better.

  Compulsions are quite varied and can include: mental rituals (counting or repeating a phrase in your mind), reordering/arranging, hand-washing, etc.

• Talk back to the worry with facts and evidence:

  Even though I feel uncomfortable about messing this up, the compulsion will not actually fix anything, it’ll just help me take the edge off for now.

• Gradual exposure and response prevention (ERP):

  With OCD, the focus of treatment is on learning to gradually ignore obsessions AND reducing the compulsive responses. So, you might start by purposefully doing something not quite right (e.g., mess up on a task) and mindfully experiencing some anxiety/discomfort. Then, you would gradually work on the response prevention component:

  • Engage in the compulsion minimally (e.g., repeat phrase in mind only two times rather than 10 times).
  • Delay the compulsion: wait 1 minute before repeating the phrase
  • Do the compulsion differently: Say the phrase, but only part of it or say it backwards.
  • Do not engage in the compulsion

Specific Phobia: Vomit (also known as emetophobia)

Worry Talking Back Exposure

• Identify worry thought:

  My stomach feels a little queasy, which means I might throw up. If I throw up, I will feel terrible/disgusting/very anxious, and will not be able to recover.

• Talk back to the worry with facts and evidence:

  Since my stomach is feeling queasy, there’s a small chance that I may throw up. I’ve thrown up before and it is uncomfortable, but it is not harmful and I can handle it.

• Gradual exposure:

  • Read stories about vomiting
  • Look at pictures and watch videos of people vomiting
  • Engage in activities that could lead to nausea (e.g., spin in chair to get dizzy, eat foods that previously were avoided due to fear of vomiting)