Behavioral Change

Behavioral Change

All right. Hi everyone. My name is Nancy Blackwell and welcome to the behavioral change module of the retrain your brain workshop series. This workshop will cover opposite action skills and is part of a four-part series that we're offering through CAPS. The other workshops are emotional awareness, distress tolerance and cognitive appraisal and reappraisal. And we recommend that students view all four workshops in order to get the most out of this series. During this workshop, I will reference a couple of worksheets and those should be linked below. Finally if you feel like you are wanting or in need of further support, please always feel free to call CAPS at 919-966-3658.

Okay, well welcome again to the behavioral change workshop. In today's workshop we're going to be talking about how changing your behavior can help you break free from anxiety and improve your mood. Opposite action is really important and behavioral change is really important because this is where you're actually retraining your brain. Doing things differently is the best and most efficient and effective way to retrain some of those thought patterns that we've gotten stuck in over time.

I want to talk a little bit about action urges. Action urges are the behavioral piece of an emotional reaction. Whenever we have an emotional reaction to a situation part of that reaction is that we have the urge to do or to not to do something. For example when we feel anger, we have the urge to attack. When we feel fear we often have the urge to run away or avoid the thing that is frightening to us. And when we feel sadness we often have the urge to withdraw, isolate, or and disengage from our usual activities. These action urges are really hardwired into our brains and are an essential part of the emotional reaction. Remember that emotions are designed to motivate action that promotes survival, so your brain is trying to help you with these action urges but sometimes it gets a little bit it gets it a little bit wrong. Acting on emotion driven urges always has consequences. Sometimes the consequences are clearly desirable. So for instance say that you were in one of your classes at UNC and a beautiful lion as you see on the screen there walks into your class. You probably immediately feel fearful and have the urge to run away, and to hide. And there are really no sort of negative consequences to acting on that urge, right? It's sort of your only option. In the short term you would get away from the lion, and in the long term you would survive. So all positive consequences there. But sometimes things are a little bit more nuanced and complicated. Sometimes acting on our emotion-driven action urges produces some short-term gain but some long-term pain or negative consequences. For instance instead of a lion walking into one of your classes at UNC, perhaps your professor walks in holding an exam. And immediately you feel you feel fearful and you run away. Now in the short term this might be kind of nice because you get the sort of relief of not having to take this exam. You can probably go do something more fun, be outside. In the short term really positive. But in the long term there's likely some very negative consequences that you don't want to experience such as getting a really negative score on the exam or failing the class. When a behavioral response to a situation works for us, so if it produces some gain, we are motivated to repeat it the next time that we're in that situation. We tend to repeat behaviors that make us feel better. Every time that we repeat a response, we train our brains to do it again by strengthening the association between it and the situation that triggered the emotion. Over time this becomes a really really well-worn pathway in our brain and the brain starts to see the situation and immediately respond with this behavior so it becomes a habit for us. It's easy to understand how this happens when the response produces nothing but gains, as in the lion example.

But what about when the responses produce short-term gain but long-term pain? Why do we tend to repeat behaviors over and over again even when they have long-term consequences? The answer to that is because short-term gain that comes immediately after the behavior is a more powerful shaper of our future behavior than long-term pain or long-term consequences. The further in time that a consequence is removed from the behavior, the harder it is for our brains to connect the two. For instance, we can compare this to maybe training our dogs not to jump up on couches. For the dog to learn that we don't want her to jump up up on the couch, we must immediately tell the dog when she gets up on the couch, "No, get down. You're not allowed up there." That way the dog will sort of connect the two immediately. If we wait till the next day and we say you know, dog, I really didn't like it when you got up on that couch yesterday. No. The dog is going to be totally confused and be totally unable to kind of connect the two because of that big lapse in time that happened. Those consequences that happen right after the behavior are really powerful and that's why we need to work extra hard to evaluate and recognize the longer term consequences of unhelpful behaviors. This is how we really get stuck in a in unhelpful behavioral patterns that we know in the rational part of our brain are unhelpful in the long run. But good news! Once you realize that your habitual behavioral response to a situation is unhelpful, you can start training your brain to do things a little bit differently. And that's what we're going to talk about with opposite action.

Opposite action is simply doing the opposite of what your emotion is telling you to do or not to do. For example, when you're feeling angry instead of attacking act with kindness. When you're feeling fearful or anxious instead of avoiding, approach the situation that you're fearful of. And when you're feeling sadness instead of withdrawing or isolating, get active, get connected again. This works because it gives your brain new learning experiences that teach it more helpful ways of responding to a situation. For fear and anxiety, approaching a situation that you fear gives your new your brain new information that can contradict past learning. For example, if you're afraid of dogs and you approach situations with dogs in a safe manner, you might learn a lot of new things. Maybe you learn that the situation or the dog is really friendly and sweet, and that it's not as scary as you think it will be. You might learn that, okay the dog wasn't super nice, but I was able to handle the situation better than I thought I would. It's more positive than I thought it was going to be. There's a lot of possibilities and a lot of new learning that happens when we act differently. With sadness and depression, getting active again after experiencing a loss or after processing a loss gives your brain the chance to experience positive emotions again and to discover that you can still function and to start really rebuilding your life. Every time that you do opposite action in a situation, you create new associations in your brain, which contradicts the earlier associations. This can be a slow process but the more that you repeat opposite action the stronger those new connections are that you're building.

All right so underneath here there should be links to two things - there's an opposite action worksheet and that's something that you can fill out on your own but there's also a step-by-step guide - I think it's called the opposite action handout - that lays out the various steps of engaging in opposite action. I'll just go through those steps quickly and then you can work on the worksheet yourself on your own time but the steps I think are helpful to kind of go through and talk about a little bit.

The first step of opposite action is to identify and name the emotion and the situation that's triggering it. Let's stick with a fear of dogs as our example. Let's say that you really want to get a dog at some point but you've had this really kind of persistent fear of dogs and you're wanting to work on that. Say that you're walking down the street and approaching you see a dog and you start to feel that anxiety and fear building up in you. Just identify a name okay? "I'm feeling fearful and feeling anxious right now, and the reason that I’m feeling anxious is because there's this dog that's approaching."

Step number two is to identify your automatic thoughts or initial appraisals of the situation. You might have the automatic thought that, "Oh my gosh, this dog is going to bite me." You're going to want to identify that and then evaluate the truthfulness of that claim. So maybe you've got some evidence that says, "Okay. He's going to bite me. He's off his leash and he's running at you and gnashing his teeth." Okay in that case run away. But if you evaluate the thought and you say, "You know what? He looks really friendly. He's with his owner. He's on a leash. He's a cute little, adorable sweet dog." Then you can go ahead and move on to step three.

Step three is to identify the action urges that the emotion is producing and then evaluate the helpfulness of acting on them. So you're feeling that fearfulness and anxiety as you're looking at this dog. The action urges would be to run away. Now as you evaluate the helpfulness of acting on these urges, you want to think about both short-term and long-term consequences. In the short term that might feel really good because you get to avoid this thing that you fear and you can just go hang out in your PJs somewhere else and not have to deal with interacting with a dog. But as you're thinking about long-term consequences you remind yourself, "Oh, it's really important to me that I get a dog at some point. Maybe my partner wants a dog or my roommate has a dog or something like that." You think of the long-term consequences and you say, "You know if I give into this action urge of continuing to avoid this dog, I’m never going to get used to dogs. I'm never going to be able to have a dog in the future like I want to do.

Then move on to step four if you realize that you're that acting on your urges would not be helpful. Step number four is to identify actions that are opposite to your action urges. In this case this would be to do some small behavior that would be in approaching the dog rather than running away or avoiding the dog. Maybe you don't have to immediately run up to the dog and give it a hug. Maybe your approach action is to continue walking and say hello to the dog as you walk by. Or maybe you can ask the owner, "Is your dog friendly? Can I pet its nose?" or some small step like that. The next time that you're in a similar situation continue to try one of those opposite actions and see what happens.

Hopefully the idea here is that you'll get your brain will get new learning and you'll have positive experiences with doing something a little bit different. And then step six goes on and on. You continue doing the opposite action when you're in this situation until your emotional reaction to it including your action urge changes. For instance if every time that you pass a dog you continue to in some way sort of engage with it and approach the anxiety of the situation, eventually you'll start to not feel anxious in that situation anymore and you won't have the action urge to run away. Ok, so the best way to use the worksheet is to retrospectively think of situations. So think of various situations when you were feeling strong emotions, whether those whether those were fear and anxiety or sadness and depression. You kind of work through the different aspects of that and that way you can identify different opposite actions for the future.

So some tips for implementing an opposite action plan - it's important to note that at first, the opposite action will not make the emotion go away. You will likely still feel the difficult emotion and this is unpleasant but it's necessary. You must feel the difficult emotion in order to rewire your brain's response to that situation. You can use breathing strategies like square breathing to calm yourself down before starting the opposite action, but it's important to refrain from using other techniques like distraction or self-soothing or engaging in any sort of substance use as this really interferes with the learning process. Again your brain needs to feel that distressing emotion in order to rewire the response to it.

Number three is start really small - so push yourself a little more each time that you're engaging in opposite action. As we talked about with the dog example maybe just walking by the dog at first is a big step for you. Maybe asking if you can pet it is the next step. Maybe asking if you can walk your friend's dog is the next step. Start as small as feels comfortable to you and push yourself a little bit more every time.

Remember that the experience sometimes won't be as positive as you would hope it would be, but that it's still helpful. There's always the risk that something negative will happen. Maybe even though you know a dog is super gentle and friendly maybe the dog will bark at you or see a squirrel run by and start barking. There could be some further anxiety-provoking things that happen when you're engaging in opposite action, however those experiences give your brain some important new learning. Maybe you'll learn that being around a barking dog isn't quite as scary as you thought it would be, or that you coped with it better and that you don't have to run away. Or maybe you weren't really scared at all when that happens. Whatever happens - even if it's not super positive - your brain still has some important new learning that's happening.

Number five: be kind to yourself. Opposite action is really really hard work and sometimes it sounds simple but we know it's not simple. It requires courage. It requires perseverance, and it's often very uncomfortable. When you notice the unpleasant sensations of an emotion - an unpleasant emotion in your body - tell yourself this is okay. I’m rewiring my brain. This isn't a comfortable process but it's going to help me in the long run, so be kind to yourself. And be patient to achieve lasting change in your brain this takes time and you need to repeat the new behavior many times over an extended period. This is like imagining that you're trying to cut a new path through the woods because you've decided that the one you've been using in the past isn't working super well. The first handful of times that you walk a new path you're going to find it pretty rough. There's going to be a lot of brambles and a lot of sticks and brush and it's going to be really hard to see where you're going but if you keep walking that new path over and over again your steps will eventually beat down that underbrush smooth out the trail and make the going a lot easier. At the same time you'll use that old unhelpful path less and less. Weeds and underbrush will start to grow in until it's just the much easier option to follow that new path that you created through opposite action.

Finally if working your plan feels too hard to start, that's okay. Reach out for help. If you're already working with the therapist or in the process of finding one, ask your therapist for some help with your plan and if you don't have a therapist, please call CAPS at 919-966-3658 and talk about getting connected with services that can provide additional support as needed.

 Well thank you so much for tuning in to the behavioral change portion of the Retrain your Brain workshop series. Hope this was helpful and best of luck to you bye.  

In this video, we’ll be talking about how changing your behavior can help you break free from your anxiety and improve your mood.  First, we’ll teach you how to evaluate your current behavioral responses to situations that provoke fear and sadness, so you can decide if they are helpful or unhelpful.  Next, we’ll show you how to develop and implement a personal action plan to “unhook” your brain from unhelpful behaviors that are keeping you stuck in fear/anxiety and sadness/depression.

The Behavioral Piece of an Emotional Reaction 

Action urgesWhenever we have an emotional reaction to a situation, we have the urge to do (or not do) something.  For example:

  • when we feel anger, we have the urge to attack
  • when we feel fear, we have the urge to run away/avoid 
  • when we feel sadness, we have the urge to withdraw, isolate, and disengage from our usual activities 

These action urges are “hard-wired” into our brains—they’re an essential part of the emotional reaction (remember: emotions are designed to motivate action that promotes survival)  

Acting on Urges Acting on these emotion-driven urges always has consequences. Sometimes these consequences are clearly desirable (“All gain, no pain”).  Examples:   

  • Fear (running from mountain lion):  If a mountain lion strolls into your Econ class, triggering some fear in you, you’ll have the urge to run away (or perhaps freeze up and play dead, if it’s too late to run).  If you were doing an after-the-fact cost-benefit analysis here, would you recommend acting on the urge to run?  YES—necessary to escape serious and imminent threat to life and limb 
  • Sadness (withdrawing after loss):  When you’ve suffered a significant loss that triggers some sadness in you (loss of important relationship, role, opportunity or dream), you’ll have the urge to withdraw to a safe space, isolate, and disengage from your usual activities.  If you were doing an after-the-fact cost-benefit analysis here, would you recommend acting on the urge to withdrawYES—gives you time/space to focus on processing the loss, without having to worry about mtn lions and other distractions. 

But sometimes things are more complicated: acting on the urge gives you some short term gain (typically, relief from the unpleasant sensations of the emotion)but also some long term pain (which is often much more unpleasant than those sensations)Examples:

  • Fear (running from professor with exam):  Suppose it’s not a mtn lion that strolls into your Econ class, but a professor with an exam.  If you feel a flash of fear, you’ll have the urge to run away–even though the professor is not a real threat to your safety (false alarm)Is acting on this urge (bolting from exam room) going to be helpful?  
    • ST consequences? Immediate relief from those unpleasant sensations  
    • LT consequences? Pretty negative (get zero on test, prevents you from learning that you can cope with taking tests, increases your anxiety about your academic performance, interferes with your ability to enjoy college, etc).  
    • If you were doing an after-the-fact cost-benefit analysis here, would you recommend acting on the urge to run or not? NO (explain) 
  • Sadness (staying in cave after have processed loss).  After you’ve processed stay in your cave ruminating about it, rather than going back out, resuming your normal activities and re-engaging with others.  Is acting on this urge to continue hiding going to be helpful now? 
    • ST consequences? Immediate relief from anticipated discomfort of trying to re-engage with your life while you’re feeling a little down 
    • LT consequences?  Again, pretty negative—keeps you from having experiences that could help you feel better (like getting some good food, sunshine and exercise, hanging out with friends, discovering that you can still function even in the face of loss); interferes with your ability to move on from the loss; makes you feel even more alone; etc).  
    • If you were doing an after-the-fact cost-benefit analysis here, would you recommend acting on the urge to run or not?  NO  

Opposite Action: Doing the OPPOSITE of what the emotion is telling you to do/not do.  For example,    

  • When you’re feeling fearful or anxious and having the urge to run away, act opposite to that urge by APPROACHING the thing you’re afraid of (“feel the fear and do it anyway”) 
  • When you’re feel sad or depressed and having the urge to withdraw, act opposite to that urge by GETTING ACTIVE again  

Why this worksGives your brain new learning experiences that “teach” it more helpful ways of responding to the situation. To illustrate 

  • Fear/anxiety: Approaching the situation you fear gives your brain new information that can contradict past learning (e.g., that the situation is not as dangerous as you think it will be; it’s generally not as bad as you thought it would be and you can usually handle it better than you thought you could).   
  • Sadness/depression: Getting active again after loss gives your brain the chance to experience positive emotions again, to discover that you can still function, and to start rebuilding your life  

Each time you do opposite action in a situation, you create new associations in your brain, which contradict the earlier associations. As you continue doing opposite action again and again in that situationyou’ll be creating a new pathway in your brain—an alternative to that old one that isn’t working so well. The more you repeat the opposite action, the stronger this new pathway will get.  And the less you use the old pathway, the weaker it will get. Over time, your brain will get so good at following the new pathway that it hardly thinks about the old one—and the new behavioral response will become a habit.  

How to do Opposite Action, Step by Step:  Use OA handout 

Tips for Implementing an Opposite Action Plan 

1.  At first, opposite action will not make the emotion go away (although it can help it pass more quickly). You will likely still feel the emotion as you are doing the opposite action. This will be unpleasant, but … 

2.  To create lasting change in your brain, you need to let yourself FEEL that emotion  

a. To “rewire” your brain’s response, you need to activate the existing circuitry  

b. Analogy to craftsman reshaping metal (has to heat it up in order to make it pliable enough to reshape) 

3.  Can use square breathing to help yourself calm down before you start the OA 

a. But don’t use other DT strategies (like distraction, self-soothe, etc)will interfere with the learning process. 

b. Same goes for alcohol or other drugs – using them to “numb” your emotions when you’re doing OA interferes with the learning process. 

4.  Start small, with OAs that move you just a little past your comfort zone (looking at photos of dogs).  When you’ve repeated those actions enough to “teach” your brain you can handle the situation, move on to OAs that are a little more difficult for you (looking at video of dog playing, watching dog out the window, being in the same room as a friendly dog, touching a friendly dog)   

5.  Don’t go too fast too soon, but do push yourself a little: Each time you do an OA, try to make yourself do it for a little longer than you think you can handle.  (If you think you can handle looking at photo of a dog for 5 minutes, push yourself to do 7 minutes instead).  This will enhance the learning process.    

6.  When you do OAs, there’s always a risk that the outcome will sometimes be less positive than you hoped it would be (even a gentle and friendly dog will sometimes do things that activate your fear circuits, like bark when the doorbell rings or the dog next door starts barking) 

-But the experience still gives your brain some important new learning (that being around a barking dog isn’t as bad as you expected; or that it is as bad as you expected, but you can cope with it—don’t have to run away 

7. Be kind to yourself:  OA work is hard—it requires courage and perseverance and it’s often uncomfortable. When you notice the unpleasant sensations of the emotion in your body, tell yourself: “I’m rewiring my brain — need to heat up its circuitry to reshape it.”   

8.  Be patient: To achieve lasting change in your brain, you need to repeat the new behavior many times over an extended period.   

-Old path/new path metaphor: Imagine that you’re trying to cut a new path through the woods, because you’ve decided the one you’ve been using isn’t working very well.  The first handful of times you walk the new path, you’ll find the going pretty rough (hard to see where you’re going, weeds and underbrush will “grab” you and slow you down, etc).  

-But if you keep walking that new path over and over again, your steps will eventually beat down the underbrush, smooth out the trail, and make the going easier.   

-At the same time, as you use the old path less and less, weeds and underbrush will grow up in it, until it’s harder to follow than the new path … and you’ll develop the habit of using the new one instead  

9.  If working your plan starts to feel too hard, reach out for help.  If you’re already working with a therapist or in the process of finding one, ask your therapist for help with your plan.  If you don’t have a therapist, come in during our walk-in hours to get connected with one.  Good luck!   

Homework:  Practice Opposite Action with worksheet