I was very excited to interview therapist Samantha Osborne in a discussion about anxiety, irritable bowel syndrome (IBS), insomnia and cognitive behavioral therapy (CBT). I had been wanting to interview someone for a long time on CBT because it is so effective for conditions like anxiety, insomnia, and IBS. We discussed why we develop the thoughts that we do as well as beliefs and emotions and the many triggers of these conditions. We also covered some excellent CBT strategies to overcoming these conditions that you can do on your own.
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,
