This document summarizes Reid Wilson's presentation on a self-help paradigm for anxiety disorders. The paradigm involves four steps: 1) Step back - change your frame of reference to see anxious thoughts as mental games rather than serious threats. 2) Want it - purposefully choose to want uncertainty and anxiety. 3) Step forward - take action toward feared situations while generating motivations. 4) Be cunning - outsmart anxiety by seeking out uncertainty and distress to reduce their power over time. The goal is to detach from anxious content and take ownership of fear through exposure.

1. Step Back, Want It, Step Forward, Be
Cunning: A Self-Help Paradigm
Reid Wilson, PhD
Chapel Hill, NC
IOCD Conference
11 AM
July 30, 2016

2. Reid Wilson, Ph.D.
Anxiety Disorders Treatment Center
421 Bennett Orchard Trail
Chapel Hill, NC 27516
[919] 942-0700
rrw@med.unc.edu
www.anxieties.com
www.PlayingWithAnxiety.com
www. NoiseInYourHead.com

3. 3
Video clips of Robyn & Bob
courtesy of Psychotherapy.net
Strategic Treatment of Anxiety Disorders
(6 video set)

4. Step back
4

5. “This is
serious!”
“This is a mental
game”
Change your frame of reference

6. If a fearful thought pops
up, take it seriously
I must get rid of my doubt
I must get rid of my
distress
“This is a mental game”
The content of my
obsession is irrelevant
I’m going to handle
generic doubt
I’m going to handle the
distress caused by doubt
“This is serious!”

7. OCD’s Rules
1. Be careful or you might cause a horrible problem OR
Be worried that you’ve already caused one
2. If a fearful thought pops up, take it seriously
3. Feel absolutely certain
4. Use your anxiety as a gauge: if you feel uncomfortable,
then there is still Danger
5. Always act defensively
7
Back away/avoid
Give up territory Do rituals/compulsions
Worry/dread future

8. 8

9.  Step away from the content –
Make the content irrelevant
 Step back from the moment &
label it
9

10. “I can’t handle that!”
“I don’t like it, but
I can handle it”
• Contaminating my family
with salmonella
• Accidentally burning down
house
• Realizing that I’m a bad
person
• Running someone over
• Touching a child sexually
• Causing something
A generic sense of
uncertainty &
distress
10

11. 11

12. 12

13. 13

14. Want it
14

15. 15

16. The Power of Paradox
Purposely, voluntarily, choose…
 “I want this”
 “If it lasts, I want it to last”
 “If it’s strong, I want it to be
strong”
16

17. 17

18. The amygdala
“I want this”
18

19. Notice threatening thought, image or
impulse
Want that!
Notice that you feel scared
Want that!
Hang out while feeling uncertain &
19
Giving Your Amygdala a Chance to
Learn

20. “Only do what you want to do”
20
“And if you want to get
stronger,
you have to want to do the hard
stuff”

21. 21

22. Step forward
22

24. 24

25. 25

“Run hills hard”

26. • “Look 5-6 feet ahead”
• “Shorten stride”
• “Pick up tempo”
• “Raise the arms”
• “Swing the arms”
Once commands relegated to unconscious…
1) get body forward by dropping head & raising arms
2) apply energy to task 3) push forward & up
4) get faster turnover of legs
Step 1: Create Your Strategy
“Run hills hard”
Step 2: Generate Commands
Step 3: Frame the Action
26

27. 1. Act as though the content is irrelevant
2. Accept the obsession when it pops up
3. Seek out uncertainty
4. Seek out anxiety
5. Create rules if you need them
Step 1: Create Your Strategy
Step 2: Generate Motivations or Commands
• “I want this”
• “Stop washing”
• “Don’t figure it out”
• “Let go”
• “Give me your best shot”
• “I gotta risk something here”
27Stepping Forward

28. DETACHMENT & OWNERSHIP
• Challenging the difference between
what Disorder tells her to be afraid of
& what she’s actually afraid of. She
is just plain scared. Perfect.
• Therefore, we can [but don’t have to]
go to the highest item on Disorder’s
list. And why not? It’s a meaningless
hierarchy.
• She picks the dirtiest spot on the
floor to touch. Ownership in the28
Segment 11 3.5 min

29. Ownership by linking with outcome
picture
• She can’t get behind “I want this”
• But totally gets behind “I want the
outcome”
[Again] The work is always moment-by-
moment
[Again] “It is totally understandable that29
Segment 12 4 min

30. Be cunning
30

31. Your
Job
Disorder’
s Job
Frequency
Intensity
Duration Duration
Intensity
31

32. 32

33. Making the messages his own
33
 “What’s next?”
 “Let ‘em come – Give me your
threats”
 “I don’t care… I’m not playing this
game”
 “You wanna go? Give it to me – Let’s
go”
 He’s mindful

34. 34
1. Move toward any task that you predict
will generate at least some uncertainty or
distress regarding your theme.
2. When you notice that you feel bothered
by doubt or distress (whether before,
during or after that task):
A.Step back and acknowledge that it’s
happening (“Ugh. This is hard.”)
B.Welcome exactly what’s happening
(“Yes, and this is what I’m looking for.”)
How to Score a Point

35. 35
C. Sub-vocalize a message that helps you
stay engaged in your chosen activity:
1) Encourage yourself (“I can do this.”)
2) Instruct yourself (“Keep moving!”), or
3) Talk in a cunning way to Anxiety (“Give me
more, please.”)
3. Then turn your attention back to your
chosen task, even while you still feel
uncertain and uncomfortable.
SCORE!

36. 36