Below is a transcript on Anxiety, IBS, Insomnia and Cognitive Behavioral Therapy
Dr. Hedberg: Well, welcome everyone to “Functional Medicine Research.” I’m Dr. Hedberg. And I’m really looking forward to my conversation today with Samantha Osborne. And Samantha is an Asheville based therapist and she serves busy professionals with anxiety and irritable bowel syndrome. She’s certified in cognitive behavioral therapy and integrated mental health techniques. Samantha uses a variety of approaches to help clients move from feeling burned out and overwhelmed by their to do’s to engaged and excited by their work and life.
She earned her master’s degree at the University of North Carolina at Greensboro and has been a featured speaker in several publications including “The Funk’tional Nutrition Podcast” and “Abundant Practice Podcast.” And when she’s not serving clients, you’ll find her taking long walks with her poodle and listening to her favorite podcast. So welcome to the show, Samantha.
Samantha: Thank you so much.
Dr. Hedberg: So I’ve been wanting to have someone on for a long time to talk about cognitive behavioral therapy. So this was really serendipitous. And why don’t we begin by just laying some bedrock information about, you know, what is the cognitive behavioral model and how does it explain where our thoughts, emotions, and our behaviors come from?
Samantha: So CBT is basically a model of therapy that says that circumstances are really neutral. So no matter what happens in the world, that’s not really what’s determining our thoughts, emotions, and behaviors, it’s just information, is an invitation to that. And then we have thoughts about those circumstances that lead to our emotions that lead to behavior that ultimately determine our results. And so CBT says that our thoughts really originate from, you know, different circumstances that we’ve had in our lives, you know, all kinds of home media, cultural expectations. Essentially they’re formed really early, these core beliefs are, and then they’re sort of hardened and solidified over time with different input that we’re getting from the environment.
Dr. Hedberg: And kind of that behavioral therapy is based on the ancient philosophy of stoicism, is that correct?
Samantha: I believe so.
Dr. Hedberg: Some of my patients know I’m a big fan of stoicism, stoic philosophy, which, you know, it’s my understanding that CBT comes from that particular philosophy. And, I know that, you know, from what I know about CBT, it’s very effective for anxiety and other mood disorders and insomnia and also IBS, which we’ll be talking about today. So if our thoughts don’t come from circumstances, where do they really originate from?
Samantha: So our thoughts really come from core beliefs about ourselves and the environment. So you know, when we are kids we have different kinds of experiences that teach us about who we are and what the world is like fundamentally. And then those beliefs about ourselves and the world are then solidified over time with different experiences.
So for instance, you know, if you grow up in an environment that’s really unsafe and abusive then you think that the world is a really unsafe place and then you might have other experiences that reinforce that over time. So then when you’re met with circumstances like, you know, someone approaching you at night, you’re sort of primed to think, oh no, this is a scary, negative experience because of all of the experiences that you’ve had that have been scary and negative. It’s not necessarily that person or that situation that’s creating that fear, but it’s all of the things in your life that have been scary, that are sort of priming you to be afraid of this thing. Does that make sense?
Dr. Hedberg: Yes it does. And I’ve had some guests on previously talking about adverse childhood experiences and things like that. And so do you think that that is really where a lot of these beliefs are shaped or do you think that these things can happen as an adult as well?
Samantha: So I think it’s kind of both end, right? So we know from research that if you have a lot of adverse childhood experiences, you’re more prone to conditions like depression and anxiety and also trauma of course if you’ve experienced trauma. And the more of those that you have, the more solid that that becomes and the more difficult it is for us to change those beliefs, it’s possible, but it’s just more difficult. And that’s very different from someone who had a very positive, healthy upbringing without a lot of adverse childhood experiences. They might have, you know, challenges that come up later on, those are easier to change depending on the event.
But this can also be, you know, thoughts or beliefs about smaller things if we want to say that like, oh it’s difficult to make dinner for myself at home or, you know, it’s very scary to public speak. That might not come from trauma, it might just come from things that you’ve seen in your environment and then your own experiences reinforcing those.
Dr. Hedberg: Right, right. So let’s talk a little bit about anxiety because I know CBT is very effective for that. So what are some of the underlying causes of anxiety? It’s my understanding that underlying anxiety can be…like fear is the real cornerstone of anxiety, and then anxiety is worrying about the future, and depression is having negative thoughts about the past. So can you talk a little bit about what’s really causing anxiety in most people?
Samantha: So I would say in general, my really simplified explanation of anxiety is when we overestimate challenges or problems and then we underestimate our ability to meet those challenges or problems. And that can show up in a lot of different ways. Often people with anxiety are prone to pretty common thinking errors, and that just means that their mind is giving them information that seems rational or reasonable, but really just keeps them stuck in that anxiety loop. So that could be things like catastrophizing, kind of jumping to the worst-case scenario, jumping to really negative conclusions about the future, filtering out positive or easy things that are happening and over-focusing on negative or hard things that are going on, scary stuff that’s happening. So it’s really just when we’re kind of overblowing this, you know, oh no, the world is hard right now and it’s gonna be hard into the future, I can’t cope now and I’m not going to be able to cope later on.
Dr. Hedberg: Right. So Homo sapiens are about 300,000 years old, so part of this has to be an advantage through our evolutionary process because if we weren’t thinking about the worst-case scenario, we didn’t have much chance of survival. So in one sense it was a good thing but now it sounds like it’s just, it can become too overwhelming and it’s not so much a beneficial trait in Homo sapiens as much as it used to when we were just worried about daily survival. What do you think about that?
Samantha: I think that’s a really excellent point and very true. So I think with most mental health conditions like anxiety or depression, even some other things, there are kernels of this that are helpful and they just get kind of twisted to where they become unhelpful or maladaptive, right? So to your point of, oh, if I go out hunting today, I might be attacked by a tiger, so I should prepare for that and take these certain routes because the last time I didn’t see a tiger this way, and I’m gonna carry the stick because I know that will help me, right? That’s like appropriate planning and preparation for something that could be really negative.
On the other hand, you know, in modern life we’re not really faced with that level of risk typically and so, you know, we just end up putting that skill to use in overdrive. So we fear a lot of, well, what’s gonna happen if I get stuck in traffic today? Then I’m gonna be late, then my boss is gonna be mad at me, then I’m gonna have to do more work, then I could potentially get fired, right? So it just kind of spirals out of control a lot of times and people with anxiety typically have a hard time walking that back and saying, okay, what’s the most realistic thing here that I can appropriately plan for?
Dr. Hedberg: And how do you see social media as a player in anxiety in our modern society? Because I’ve read a lot of studies on the effects of social media really driving mental disorders like anxiety and depression. So how do you think social media would cause anxiety or make it worse?
Samantha: Well, and I think in some ways there are tools and resources that if people are using them, they can be a real help. So a lot of great accounts on Instagram from therapists, The Holistic Psychologist is somebody that I follow. And they’re really doing a lot to kind of put good information out there about how to take care of your mental health. But as far as it being a detriment, I think a lot of this just has everyone kind of being able to see too much into other people’s lives in a way that’s very filtered and curated.
So feeling behind a lot is what I hear from a lot of my clients. Like, oh, I’m missing out on a lot, I’m not doing as much as other people, I’m not able to keep up as much. And really we’re not taking into consideration that that’s a very filtered, curated…you know, they’re just showing you what they want you to see, not a total picture of what’s actually happening. So we’re seeing a lot of other people doing really well and then we’re seeing our own internal landscape of like stress and fear and anxiety and it just feels like, wait, other people are doing well and I’m not doing well internally, what’s going on here? What’s wrong with me? I think that’s what a lot of people experience now with social media.
Dr. Hedberg: So in addition to anxiety, which is of course on the rise, insomnia is on the rise as well, that’s a major problem in our society. So can you talk a little bit about CBT and insomnia?
Samantha: So CBT has been used to treat insomnia for several years now. There is a particular program called CBT-I that’s kind of the model that’s used when we’re treating anxiety for people…I mean insomnia for people. And really it kind of works against insomnia or kind of tries to treat the problem in two very specific ways, so changing behaviors related to sleep, and then also changing thoughts and beliefs associated with sleep.
So a lot of times people just have a lot of misinformation about what will actually be helpful to them in terms of sleeping and then a lot of fear associated with, well, if I don’t get a good enough night’s sleep, then I’m not gonna be able to sleep tomorrow. And then that creates the emotion of anxiety, unrest, uneasiness, which doesn’t really lead to sleep. So CBT-I really tries to correct that from, you know, a thought and a behavior standpoint.
Dr. Hedberg: One of the techniques I’ve used myself is just accepting the insomnia. And so sometimes I’ll wake up at 3:00 or 4:00 in the morning and, you know, years ago I might get a little upset, you know, I’ve got a big day ahead of me, I start to worry a little bit that I’m gonna be tired and things like that. But using CBT, I just get up and I’ll, you know, smell some peppermint oil or some lavender, and then I have a foot massager, so I’ll lay down and use the foot massager for about 15, 20 minutes. I might listen to a podcast that I like or some music that I like and I’ll just get back into bed and just read a little bit of fiction. And usually going through that process, you know, 30, 45 minutes, I usually just fall right back asleep. So is that a good technique? Do you have any other techniques that you would recommend in that regard?
Samantha: I think those are great practices. I mean, I think one of the major thoughts that we try to combat with CBT-I and insomnia is I won’t be able to fall back asleep and so if that’s what you’re constantly thinking, oh no, I’ve woken up, I’m not gonna be able to fall back to sleep, then you probably…that anxiety isn’t gonna help bring on rest. So we really recommend that if people aren’t asleep and they can’t fall asleep within 15 to 20 minutes that they do get up and do something else that’s low light and pretty relaxing. So I think all the techniques you just described would be really excellent ways to kind of change your environment and then when you’re ready, get back in bed and you should be able to fall asleep pretty quickly.
Dr. Hedberg: And I forgot to mention sometimes I’ll journal as well and then the game “Tetris” actually I’ve read can be very helpful in the way that it causes changes in the brain. I mean, I don’t recommend, you know, using a computer or cell phone in the middle of the night because of the blue light but I have a red, blue light blocking glasses that do block 100% of the blue light. And I found that to be very effective for myself and for some people just playing “Tetris” for 5 or 10 minutes and that can get you back to sleep pretty quickly as well.
So we’ve talked about anxiety and insomnia, and then irritable bowel syndrome, so this is a pretty big issue in our society. I believe it’s up to now, about 40% of Americans have IBS, 60% of them have SIBO, small intestinal bacterial overgrowth. And I look at this as number one in the patients that I’ve seen, there’s usually a heavy antibiotic history going back to childhood, sometimes it’s because they weren’t breastfed, which sets the stage for the microbiome, or if they were a cesarean birth rather than a vaginal birth, they’re also gonna have more microbiota issues, and also if they’ve taken antibiotics within the first three years of life which is when the microbiota really sets in, that’s another big factor. But then going into childhood and adolescence, I see combinations of trauma and too many antibiotics as really the big issues there that set people up. Is there anything else that you can think of as some underlying causes of IBS?
Samantha: I think those are the two big ones. I would say sometimes people have really physical manifestations of their anxiety. So if we think about, you know, rest and digest versus sort of the fight or flight systems being turned on, a lot of times people with anxiety will experience a lot of gut issues just as a result of having that fight or flight system really in overdrive all of the time. And then another thing can be that people will have a really serious GI issue like they’ll get an infection or maybe they’ll have food poisoning or something, and then that experience is so like traumatic for them or difficult for them to deal with that then they have residual fear about that happening again or maybe I’m allergic to this particular food.
Like there comes a lot of hyperfocus on how can I prevent this from happening in the future? That then creates a lot of gut issues because they’re so anxious when they eat and anxious around certain foods and then they hyper-focus on every sort of pain or some sensation and that just kind of creates more anxiety which then leads to more and more gut health issues. So it can be really hard to kind of pinpoint down exactly what the problem is. Obviously there are, you know, physical and medical causes but then we can also have psychological things that just perpetuate the severity of symptoms.
Dr. Hedberg: That’s a really good point about the anticipation of a problem with a particular food. I see that quite a bit as an issue. And I would imagine the CBT approach would be to confront that and do it over and over again, is that correct?
Samantha: Exactly. So there’s a couple of ways that, you know, you can go about treating that. And one of the main tools in CBT is just experimentation. So I have this thought or belief that I hold to be absolutely true but it’s causing me all of these problems. Like the results that I’m getting from holding this thought or belief are problematic for me. And so I’m just gonna test, oh, if I, you know, have dairy, I’m definitely gonna have GI issues. If I have a little bit of dairy, if I have a lot of dairy, if I have dairy at certain times, right, that can create extra problems for me. If I have tomatoes, if I have garlic, whatever it might be.
And so you’re just doing a lot of experimentation around small amounts, large amounts, in different contexts and just really paying attention to, okay, if I’m calmly eating and chewing all my food to liquid and in a relaxed environment, do I end up having symptoms and are they as severe as I’m anticipating that they’re gonna be?
Dr. Hedberg: And you brought up the rest and digest so the vagus nerve, which is key and the parasympathetic nervous system. And I’ve read quite a few papers over the years about what vagal tone and people lose the proper tone of the vagus nerve. And the vagus nerve is a big player in the parasympathetic nervous system and the rest and digest. I just see too many people stressed out while they’re eating, which is going to dampen the vagus nerve and they’re gonna lose vagal tone over time and then that can lead to, you know, all kinds of gut issues. Do you have any specific recommendations for improving the tone of the vagus nerve?
Samantha: Not specifically around that. I mean, I would say that whenever people are eating, one of the things I really recommend is only focusing on that. So even if it’s just 10 minutes that you can eat, you know, don’t be eating and working or eating and walking around or eating and doing these other things. It’s really about like focusing on sitting down, being calm, eating, really chewing your food and that can kind of help kick off digestion in a really positive way. And people also just have a more calm…they’re more calm, so they’re more likely to be in that rest and digest space anyway rather than doing 10 other things and then trying to force digestion basically.
Dr. Hedberg: I mean, just having the news on is stressful while you’re eating, checking social media, being on a computer, you know, all those kinds of things. And people used to just sit down for dinner with the family in a very relaxed state and now there’s not so much of that. There’s a lot of other things going on, there’s cell phones at the dinner table, there’s TV, there’s people eating on the run in their car, you know, during their lunch hour and things like that.
So now there is some good research on cortisol and norepinephrine, which is of course adrenaline and how it affects the gut microbiota. And so that’s an important thing to know for everyone that any kind of stressful situation is gonna drive cortisol and adrenaline and it’s gonna change the behavior of your gut microbiota which is going to affect everything including your digestion. And so what you’re talking about is doing things to dampen or balance those stress hormone levels while people are eating.
Dr. Hedberg: So let’s talk a little bit more about some specific strategies and your process for anxiety, IBS, and insomnia. So what are some of your recommendations for things people can do on their own? Tools, apps, anything they have access to support change?
Samantha: I mean, I think in general, the things that I really try to recommend for people in terms of exercises would be to number one, start to pay attention to your thinking. And you can do that just by noticing your thoughts but you can also do that more specifically by keeping a thought record. So that’s just a piece of paper that at the top says circumstances, thoughts, emotions, behaviors, results, and then alternative thoughts that you have options for.
And anytime you’re sort of repeating behaviors that you don’t want to be repeating or you’re experiencing really strong emotions that feel hard for you, you can start there and then work backwards or work forward to try to figure out what’s going on. So that can be really helpful. And then the second thing would be learning to identify common thinking errors, so that would be like I’m jumping to conclusions, worst-case scenario thinking, you know, I’m filtering out certain things and I’m only focusing on other things. And I have a resource that clients can use to just identify the 10 most common thinking errors and how to challenge those and I can send that to you as a link if you’d like, Dr. Hedberg.
Dr. Hedberg: Yes, I’ll definitely include that in the show notes so they can download it.
Samantha: Okay. And then the third thing I would say is just a general thought challenging tool. So that could be, you know, something as simple as, you know, performing a cost-benefit analysis on the thought. So what am I getting from thinking this way and what is it costing me? And that can be really helpful or just some specific questions that you can ask like, am I basing this thought on evidence? Is that more emotion-focused, that kind of a thing? In terms of apps, I really love the CBT I coach that’s specifically designed to help people with insomnia. It’s a very old looking app, but it’s actually really effective and helpful.
And then Bloom: CBT is really great for people just to start getting in the practice of, you know, paying attention to those thoughts and getting some support around that. And then as far as books would go, I really love “When Panic Attacks,” that is an excellent resource on drug-free solutions for anxiety, and then “Reclaiming Your Life from IBS” and Quiet Your Mind to Get to Sleep. Those are all CBT based solutions for anxiety, IBS, and insomnia. And they all are drug-free solutions. So it’s not about like here, take this pill, solve the surface level issue, it really helps you get to sort of root cause healing around some of those things that, you know, can really make a big difference.
Dr. Hedberg: Excellent resources. So the app was a CBT-i Coach?
Samantha: Yes, it’s CBT-i Coach. I think it’s the only one in the app stores so it would be pretty easy to find. It has a little moon on it. That’s sort of what you’re looking for.
Dr. Hedberg: And you said Bloom: CBT, is that a book or…?
Samantha: That is an app as well. And it doesn’t have a website, it’s just in the app store, I think it’s on Android and iTunes. But it really is education and resources and then they do have a little bit of coaching in there too so you can ask questions about some of your thinking. Because I think that’s the hard part for people, in the beginning, is okay, I can identify these thoughts but they seem true to me, how do I figure out how to fix this or overcome these things?
Dr. Hedberg: Excellent resources. I also want to recommend a book to everyone, it’s called “A Guide to the Good Life: The Ancient Art of Stoic Joy.” And that’s by William Irvine. That’s one of the most highly recommended books on stoicism which of course ties in with CBT but it helps to avoid the feelings of dissatisfaction that so many people have, especially in the U.S. And it’s got some great techniques in there just to improve your mood and how to be more content with what’s going on around you because as, you know…I mean we all know that stress is always going to be there. It’s just not something that we can avoid. And so the more tools we can have to deal with it when it does come because it will come, the better. So that’s a great, great book that I recommend to a lot of people. Why don’t we close with just talking a little bit about your process so that patients can get a better understanding of how you work with people? So can you just lay a little bit of a framework overall on kind of where you start and how you work people through your process and CBT?
Samantha: Sure. So really I will bring people in for a consultation session just to kind of see what their main challenges are and what their goals for therapy are and if I’m a good fit for them. And then if they are dealing with some of those major issues like anxiety and then IBS are the two main things that I treat and typically people have sleep issues as well. And so I just kind of go over a real history of that, where did those problems start? What makes them worse? What makes them better? What things have people already tried that may or may not have been effective? And what are their ultimate goals for feeling better? You know, are they wanting a reduction of symptoms for a certain reason? Are they hoping to give a presentation? Are they hoping to travel more with reduction of symptoms? Kind of what is their ultimate goal there?
And then we really just work week by week on identifying thoughts in different situations and then systematically replacing those thoughts, also coupled with behavioral exercises to kind of support feeling better sooner. So that can look different with IBS, anxiety and insomnia but typically that’s the same process is just kind of figuring out what thoughts are getting you stuck, what behaviors can we help to move things along? And then what healthier thoughts can we replace those things with and kind of have a pattern.
And people typically get better. You know, obviously that varies on complication of case, but typically CBT is really resolved with, you know, 8 to 10 sessions, people start feeling markedly better. And then if they want to continue working on other issues, they can but really for people who are coming in for very specific reasons, they can feel a ton of relief really quickly.
Dr. Hedberg: Excellent. So how would you like people to find you online? What is your website and any other resources you want people to know about you?
Samantha: So you can find me at samanthaosbornetherapy.com. And I have a newsletter there where you go get, you know, weekly tips and suggestions from me. And then I’m also on Instagram @samanthaosbornetherapy. And I post a lot of inspirational and educational content there so just to kind of encourage people in that space.
Dr. Hedberg: Excellent. Well, thanks for coming on and talking about CBT. I really appreciate it.
Samantha: Thank you so much for having me.
Dr. Hedberg: All right, well thanks for listening everyone. If you go to drhedberg.com and do a search for cognitive behavioral therapy, you’ll find a full transcript of this discussion as well as all of the resources and links that Samantha and I had mentioned during the show. All right, well take care everyone. And I will talk to you next time.
Samantha wants to offer you her free guide to relieving your anxiety.