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[@PeterAttiaMD] The Key to Managing Anxiety: Thoughts vs. Thinking | Josh Spitalnick, Ph.D.

· 4 min read
[@PeterAttiaMD] Summarizer
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@PeterAttiaMD - "The Key to Managing Anxiety: Thoughts vs. Thinking | Josh Spitalnick, Ph.D."

Link: https://youtu.be/n8nXCfurzqE

Short Summary​

Here's the breakdown:

  • Most Important Takeaway: Understand the difference between "thoughts" (category 2: internal experiences happening to you) and "thinking/worrying" (category 3: mental rituals or safety behaviors you do in response). Recognizing this distinction is crucial for managing anxiety.

  • Executive Summary: This discussion highlights the crucial distinction between intrusive thoughts (obsessions or fears) and the mental actions (worrying, mental rituals) that anxiety sufferers engage in response to those thoughts. Understanding this difference, particularly the "W" questions (who, what, where, when, why, how, what if) can identify worrying and allows therapists and patients to correctly identify and address anxiety triggers, obsessions/fears and compulsions/safety behaviours.

Key Quotes​

Here are three quotes from the provided transcript that I found particularly insightful:

  1. "For the anxiety sufferer, it is an attempt to resolve uncertainty. Is an attempt to figure out something that you don't have the chance to figure out because that time has not happened yet. It's a fortune-telling mindset of mental action." This clearly defines the core problem of anxiety as a fruitless attempt to control the future.

  2. "Most patients and honestly probably most therapists confuse worries from worrying, thoughts from thinking." This highlights a key challenge in treating anxiety: distinguishing between normal mental activity and compulsive thought patterns.

  3. "That response and all the anxiety disorders is avoidance rituals behavioral or mental. And so it's a therapist's job to figure out those symptoms, the T's, O's, and C's to educate the patient on what they are." Defining the response as avoidance and breaking it down into T's O's and C's (Triggers, Obsessions, and Compulsions) helps the therapist understand what the patient is struggling with.

Detailed Summary​

Here's a detailed summary of the YouTube video transcript, focusing on the key points and arguments:

  • Distinction Between Thoughts/Worry vs. Thinking/Worrying:

    • The core issue is differentiating between passively experiencing thoughts/worries and actively engaging in thinking/worrying.
    • The speaker emphasizes that this distinction is particularly important when dealing with anxiety.

  • The "W's" of Level Two Thinking (Worrying):

    • "W's" represent anxious thinking patterns: who, what, where, when, why, how (ends in W), and what if.
    • Asking questions that start with a "W" often indicates an attempt to resolve uncertainty stemming from anxiety, e.g., Is that snake going to be there? What if they laugh at me?
    • This "W" thinking becomes a problem when the answer doesn't stop the anxiety.

  • Worrying as an Activity (Verb):

    • Worrying is an attempt to resolve uncertainty and a fortune-telling mindset.
    • For most people, worrying is a temporary state that they can move on from.
    • For individuals with anxiety, worrying becomes an endless cycle of solving uncertainties and ritualistic behaviors.

  • The Three Categories of Symptoms (TOCs or TFSBs):

    • The speaker breaks down anxiety symptoms into three categories, represented by two acronyms:
      • TOCs (Triggers, Obsessions, Compulsions): Used primarily for OCD.
      • TFSBs (Triggers, Fears, Safety Behaviors): Used for most other anxiety disorders.
    • Triggers (T): Events, people, places, things that initiate the anxiety response. These are often outside of one's control. Even a thought can be a trigger.
    • Obsessions/Fears (O/F): Internal experiences (thoughts, feelings, urges, physical sensations like increased heart rate) that are out of your control. They are "had," not "done."
    • Compulsions/Safety Behaviors (C/SB): Ritualistic or avoidance behaviors (both physical and mental) performed in response to obsessions/fears. The goal is to reduce anxiety. These are active responses to the triggering stimuli.

  • The Importance of Identifying and Educating on Symptoms:

    • Therapists need to accurately identify these symptoms (TOCs/TFSBs) and educate patients about them.
    • Many patients, and even some therapists, confuse thoughts/worries with thinking/worrying.

  • "Pure O" OCD and Mental Rituals:

    • Addresses the concept of "Pure O" OCD, where individuals believe they only experience obsessions.
    • The speaker argues that these individuals are engaging in mental rituals (constant analyzing and problem-solving) to alleviate the anxiety caused by their obsessions.
    • The speaker actively tries to reach people who think they have "Pure O" because they are often missing the recognition of mental rituals as compulsions.

  • Therapy's Role:

    • Therapy helps individuals make effective decisions between the stimulus (trigger) and response (compulsion/safety behavior).