Exercising Your Willingness Muscles

by Annabelle Mebane, MA, AMFT

When you’re someone who experiences a lot of anxiety, it’s easy to end up internalizing unhelpful messages like “you’re too sensitive,” or to think that any time you are having any big feelings, it’s “just anxiety” and that you need to push through or get over those feelings. But a crucial component of learning to respond to anxiety more effectively involves learning to respond more flexibly.

The goal of Acceptance and Commitment Therapy (ACT) – an evidence based transdiagnostic treatment model – is to increase what we call psychological flexibility:

the ability to do what matters most to you no matter what uncomfortable thoughts, feelings, memories, or sensations arise in the process. It’s to accept painful feelings, notice painful thoughts as thoughts rather than always buying into them, and choose to move toward your values even when it’s uncomfortable. Without a solid understanding of values, it might be easy to confuse accepting painful feelings and getting distance from painful thoughts with needing to push through all discomfort no matter what.

But acceptance is not about white knuckling your way through pain,

and defusing from your thoughts is not about writing off all uncomfortable thoughts as “just anxiety.” Yes, anxious thoughts can be unhelpful. Yes, they can get you stuck. But rigidly pushing through all anxiety without getting curious about your pain can be just as unhelpful as rigidly buying into every anxious thought and avoiding anything that brings up those anxious feelings.

Here is the thing: your pain is full of really important information.

Sometimes the way your mind tries to deliver that information is not helpful or accurate. But the pain shows up for a reason. And usually that reason is linked to your values. Sometimes, the reason is that you care so much about something that it hurts. When you care deeply, you risk feeling the pain of failure, loss, rejection, grief, etc. Other times, painful feelings show up to alert you that there is something untenable about a situation, relationship, or context, and to compel you to take actions to protect, advocate for, and take care of yourself.

Acceptance allows you to make space for your feelings, to notice your experience with curiosity and compassion, and to choose how to respond in a way that moves you toward your values.

Sometimes that response involves persisting and acknowledging that the discomfort is likely to come along for the ride as the price of growth and vitality. Sometimes the response involves setting a boundary, saying no, speaking up for yourself, or removing yourself from a situation that is unsafe or out of alignment with what you want or need.

Think of acceptance in the context of working out.

If you want your muscles to grow, you will be required to experience and allow for some discomfort. But there is discomfort that feels like pushing yourself in service of growth, and then there is discomfort that feels like you may be injuring yourself and to persist would actually impede your growth. When we are mindful of our feelings and willing to experience and notice them, we are empowered with important information about how to proceed in a way that ultimately moves us toward our values.

IF YOU OR SOMEONE YOU LOVE NEEDS SUPPORT AND MIGHT BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY (CBT) OR ACCEPTANCE AND COMMITMENT THERAPY (ACT) FOR ANXIETY, PANIC, PHOBIAS, STRESS, PTSD, OCD, OR STRESS RELATED TO COVID-19, OR IF YOU WOULD LIKE MORE INFORMATION ABOUT OUR TELEHEALTH SERVICES, PLEASE CONTACT US AT (858) 354-4077 OR AT INFO@CSAMSANDIEGO.COM

Lessons from Traveling in Time

By Annabelle Parr, MA, AMFT

Have you ever wished you could have a do over? Go back in time and alter an embarrassing moment, or seize a missed opportunity, or simply get more time to do the things that matter most to you?

What might we learn if we could travel back in time and do things differently?

Every year around New Year’s, I watch my favorite movie, About Time. It’s a rom com about a man who learns that the men in his family can travel back in time within their own lives, and it is filled with sweetness and some profound messages that are remarkably consistent with the core principles of Acceptance and Commitment Therapy (ACT). If you haven’t seen the film, warning: spoilers ahead. In his travels through time, Tim, the main character, learns a number of lessons about creating and living a full, vital life.

Lesson #1: Traveling in time gives you unlimited chances to behave differently, but the outcome of your behavior is still always beyond your control.

Upon learning that he has the ability to time travel, Tim quickly clarifies that what matters most to him is love (values), and what he most wants to use this unique ability to achieve is finding someone with whom to share his life (goal). One of the first things he learns is that even with the ability to go back in time and try things differently, he ultimately cannot control the outcome of his behavior, just like the rest of us. He can pursue his goal by showing up to each moment bringing the qualities he most wants to embody (values), but the outcome of his actions is outside of his control. He may get to test things out more than the rest of us, and may gather more information on what behaviors may make a particular outcome more likely, but just like the rest of us, in the end, the outcome is still beyond his control.

Lesson #2: All the time travel in the world can’t erase pain.

Nevertheless, Tim continues to show up to each moment fully (present centered awareness), holding his goals for the life he hopes to build lightly and being the kind, loving, humorous man he hopes to be (committed actions), and ultimately he does build a beautiful life and family filled with love. As he does so, he learns that even his gift cannot shield him from the pain that comes with being human. Just like the rest of us, if he wants to engage in the joys, he must also be willing to have the pain that is inevitable if we are willing to care, to love, and to be loved (willingness).

Lesson #3: The secret to a rich, meaningful life is being fully present and choosing how you will meet each moment. 

Toward the end of the film, Tim shares my favorite lesson of all. He shares his father’s secret to a good life. His father tells him to live each day twice: “the first time with all the tensions and worries that stop us noticing how sweet the world can be, but the second time noticing.” In the simple act of noticing (present centered awareness), and making a conscious decision about how he responds (committed action), Tim finds how much richer and fuller life can be.

The film finishes with Tim sharing,

“And in the end I think I've learned the final lesson from my travels in time; and I've even gone one step further than my father did. The truth is I now don't travel back at all, not even for the day. I just try to live every day as if I've deliberately come back to this one day, to enjoy it, as if it was the full final day of my extraordinary, ordinary life.”

In this final lesson, Tim sums up the goal of Acceptance and Commitment Therapy: to meet each day fully, with openness to whatever shows up and awareness of our experience, and to choose to actively engage in each moment with the qualities that we most hope to embody. When we are fully present, we begin to notice all of the opportunities we have to engage in our lives as the people we most hope to be. As Tim discovers, we don’t actually need time travel at all; the moments we are given are already full of opportunity to be who we most hope to be right now.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, uncertainty or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Managing Uncertainty and Doing the Next “Right” Thing

By Annabelle Parr, MA, AMFT

There are many different reasons why you might decide to seek therapy. Maybe you are struggling with the stress of the pandemic, including but not limited to stressors like working from home and trying to be a full-time parent, teacher, and employee all at the same time; maybe you are struggling with the emotional repercussions of racism; maybe you’ve started experiencing panic attacks; maybe you have developed a phobia of driving, or needles, or spiders; maybe you are constantly consumed with worried thoughts; maybe it feels like fear is making all your decisions for you. What therapists refer to as the “presenting problem” that brings an individual in to therapy may sound, on the surface, very different from client to client. 

But one common thread that underlies almost all of our suffering (and applies especially to anxiety and related disorders, like PTSD and OCD) is a difficulty with uncertainty.

When the outcome of a situation is uncertain or ambiguous, our minds make themselves busy worrying, as if ruminating on every possible outcome (with heavy emphasis on the worst case scenarios) might prepare us. They grasp for certainty, and sometimes they will even convince us that catastrophe is inevitable because even that feels less uncomfortable than the truth: we don’t know. Usually though, this strategy makes our lives smaller. Our decisions become governed by a desire to avoid either the feared outcome itself or the anxiety that comes with taking the risk.

Here is the thing: rarely, if ever, does life truly give us certainty. 

We control what we do and don’t do, but we don’t get to control the outcome. That’s uncomfortable, I know. But what if that actually frees us up? If we can’t control the outcome, maybe we can stop trying. Maybe, instead, we can give ourselves a little grace and make choices with something else in mind.

Earlier this year, when the pandemic had just started and I felt overwhelmed with anxiety about all the uncertainty about what was going to happen and what to do, my friend reminded me of a quote from Glennon Doyle to “just do the next right thing.”

If you’re like me, and you have a tendency to get stuck on what the “right” thing means, this quote as a standalone mantra could be tricky.

But from an Acceptance and Commitment Therapy standpoint, the “right” thing would be defined as the workable thing. That is, the thing that moves you towards your values, towards who and how you want to be in the world, in service of those relationships and parts of your life that matter most to you. The “right” thing is the thing that, though maybe not the easy or comfortable thing, does not come with the cost of making your life smaller and of moving you away from what CSAM director and author of Be Mighty, Dr. Jill Stoddard refers to as “the me you want to be.”

In her book, Untamed, Glennon talks about this as your “knowing.” The core of you that knows who you are, what you want or need, and what matters most to you. Sometimes that knowing is buried under layers of learning and socialization, stories in your mind about what you “should” do or what others want from you, or strategies designed to shield you from pain, anxiety, and discomfort. But if we get curious about what is underneath all of that, if we start to get curious about our pain and what it has to say, we can find that knowing. In fact, when we get curious about our pain, we get valuable information about what’s most important to us. Because it wouldn’t hurt if we didn’t care. Our values lay on the flip side of our pain; they are two sides of the same coin.

Just do the next right thing means that even in the face of enormous uncertainty, what matters is that we tune in to those values — our knowing — and figure out what it is we can do in this one moment that is in line with what matters most to us. Because this one moment is all we are promised. Nothing else is ever a certainty, even when it feels like it might be. And actually, that may just free us up to live each moment more fully, because really, the only certainty is that we are here now…so what are we going to do about it?

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, uncertainty or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

How Do I Control My Anxious Thoughts?

By Annabelle Parr, MA, AMFT

The human mind is a meaning making machine; it searches for patterns (even where there are none) and does it’s best to make sense of the world around us so that it can help keep as safe and surviving. But if you are reading this, I’m guessing while you are surviving, you might not feel like you are thriving. Because sometimes the thoughts our minds generate feel less than helpful. Sometimes, they get us stuck.

Anxiety tells us all kinds of stories about ourselves and the world around us.

If you’ve ever experienced anxiety, you are probably familiar with all the catastrophic stories your mind can generate in a difficult moment, from “I’m going to fail” to “nobody likes me” to “this is going to be a disaster!” Anxiety disorders, OCD, and PTSD all include sticky thoughts that tend to govern and restrict behavior and continue to drive the anxiety and emotional difficulties. And it makes sense that if your anxious thoughts seem to be controlling your life that you might want to control your anxious thoughts for a change. 

So what do we do when our thoughts seem to be holding us back or getting us stuck? We have a couple of options.

Cognitive Behavioral Therapy works on changing the content of our thoughts.

From a traditional Cognitive Behavioral Therapy (CBT) perspective, we might try what is known as cognitive restructuring. CBT challenges sticky thoughts, examining evidence for and against the thought, and then replacing it with a new, more balanced thought in place of the original. In addition, CBT asks you to act in new ways that might allow you to directly experience evidence that challenges your thought.

For example, say you are stuck on the thought, "I always fail at everything I do." CBT might invite you to consider that although you did fail your last 2 math tests, you aced your last 5 history tests, you are great at taking care of your dog, and you make a mean lasagna. Significantly, this isn't just about "thinking positive." And you aren't replacing the thought with it's complete opposite ("I will never fail at anything I do" or "I am the best at everything"). Those thoughts would not be helpful or true either. You are instead aiming for a more balanced and helpful way of viewing the situation: "I failed this time, but that doesn't mean I have or will always fail at everything.

What if I can’t control my thoughts?

But what if you have tried to challenge those thoughts that tell you how incapable you are or how dangerous the world is, and no matter how many times you try to replace the old thought and control your pesky mind, it doesn’t seem to work? What if trying to change your thoughts only makes you feel like even more of a failure because it’s not helping? Some thoughts are too sticky to challenge. You might be able to come up with a more balanced thought, but you still may have trouble believing it to be true. And guess what? The more we try not to think something, the more present and entrenched it tends to become. (For example, DO NOT THINK ABOUT PUPPIES. SERIOUSLY. DON’T THINK ABOUT A BUNCH OF CUTE, FLUFFY, SNUGGLY PUPPIES…I bet you just thought about puppies.)

Maybe you don’t have to fight with your mind.

Acceptance and Commitment Therapy (ACT) comes at our thoughts from a different angle. ACT says that the problem is not that your mind has thoughts, but rather that you believe that those thoughts reflect the truth about how things are and you behave accordingly. ACT is not concerned with whether a thought is factually correct or incorrect. Instead, ACT asks, is this thought workable? Does it help you to move around in your life effectively? Does it move you closer to what matters most? Or is listening to it preventing you from engaging in your life in important, meaningful ways?

Getting a little distance from your mind is different from controlling it.

In ACT, rather than trying to “correct” a thought or control the content of your mind, the focus is on helping you to step back, get some space from those sticky thoughts, and observe them for what they are: words. This process is known as cognitive defusion. 

A simple trick to get some space from your mind is to refer to it as a separate entity. So when you have a sticky thought, you might think, “my mind is telling me that I can’t handle this.” Or you might give your mind a name: “Neville is telling me that I can’t handle this.” Then, rather than trying to convince yourself that you can in fact handle it, you would focus on connecting with what matters to you, and choose to act in service of your values regardless. Because the thing is, you can have a thought and choose to behave in direct opposition to it. And this can be really powerful. Let’s try it right now. Say to yourself, “Self, I cannot raise my hand.” And raise your hand. See? No matter how sticky the thought is in your mind, it doesn’t have to keep you stuck with it.

If you can change your mind, great! If you can’t, no problem.

Whether you choose to replace a sticky thought with a new, more balanced thought or whether you choose to remind yourself that a thought is just your brain trying to make sense of the world, you do not need to fight with your mind. You just need to give it a little wiggle room. Minds can change. But what matters is that you know that your thoughts are not in control, even when it feels like they are. No matter what your mind is saying at any given moment, it is the YOU that has those thoughts that gets to decide what you do.

CSAM Is Here to Help

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Fostering Resilience during COVID-19 by Connecting with Our Values

By Annabelle Parr

As we enter Mental Health Awareness Month this year, we are collectively experiencing not only a global health crisis, but also a stressor which has potentially significant repercussions for our mental health. At the very least, we are likely to be experiencing a range of painful emotions as a result of this crisis. On any given day, I find myself feeling at least some combination of the following: anxiety, fear, stress, grief, frustration and/or exhaustion. 

As an Acceptance and Commitment Therapy (ACT) therapist, when I am struggling, I ask myself the question: can I be willing to have this pain, and still choose to move in the direction of what matters most to me? The goal of ACT is to help us to live more vital, meaningful lives even as we struggle with the inevitable pain and discomfort inherent in being human. And goodness knows this pandemic has given us all a whopping dose of pain and discomfort.

But what does a meaningful life look like during a global crisis?

Prior to COVID-19, I felt like I had developed a pretty good sense of how to move toward what matters even when I feel anxiety or fear or frustration. But this pandemic has challenged me. At first, I felt overwhelmed as it seemed the world had turned upside down, and I struggled to find ways to live my values when life suddenly felt so restricted by forces beyond my control.

So I began to consider: how can I continue to move toward what matters most to me, even as life has become more restricted by this pandemic?

A few weeks ago, I was scrolling Instagram and came across a post posing the question: “if someone told you that you could save a life, would you?” The post went on to remind us that we are all being given that otherwise very rare opportunity, and that in staying home right now, we are actually saving lives.

https://www.instagram.com/igo_medical/

After reading this Instagram, it clicked for me: I don’t necessarily have to do anything monumental or new or different right now in order to make significant, values based decisions. Instead, I can consider what I am already doing – like staying home except for essential errands, or wearing a mask and maintaining six feet from others when I do need to go out, or calling and connecting with friends and family – and I can connect these actions with my values.

What are values?

Values from an ACT perspective are a collection of verbs, adverbs, and adjectives that describe qualities of being; a.k.a. who and how do I want to be in the world? For me, a few of my values include being compassionate, conscientious, kind, and loving.

Connecting with our values can infuse the choices we are already making with purpose.

When I connect even the simple action of staying home with being compassionate or loving, rather than becoming fused with thoughts about how terrible, frightening, or overwhelming this all is, I can ground myself in a sense of purpose and meaning beyond my discomfort. And I can bring my values to anything I do: when I call family or friends, I can choose to show up lovingly; when I go to the store, I can offer gratitude to the essential workers I interact with; when I watch my favorite TV show, I can connect with my value of being kind and gentle with myself. The key is being intentional about why I do what I do.

You are enough just as you are.

Navigating a pandemic is exhausting; it demands so much of us already, and additional pressure to do more when just getting through the day feels taxing enough can feel less than helpful. Part of the beauty of ACT is that values based actions are not always huge, monumental gestures; in fact, more often, they are the small, intentional choices we make to show up in a particular moment as the type of person that we hope to be in the world. So rather than beating ourselves up for feeling like we are falling short somehow, we might ask ourselves instead, how can I bring the qualities I hope to embody to the actions I am already taking? How can I connect the things I am already doing back with the kind of person that I hope to be? 

“Those who have a why to live can bear almost any how.”

I keep coming back to the wisdom of Viktor Frankl during this time; as a Holocaust survivor and psychiatrist, he is particularly well suited to guide us through crisis. He noted that “those who have a why to live can bear almost any how,” and I might add that those who have a why to act can bear almost any how. The “how’s” of our day-to-day right now pose a whole host of new challenges for us, but when we can connect with a why behind these challenges, we are likely to meet them with much greater resilience.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

My Horcrux Diary

guest blog post by Dr. Nic Hooper

Have you read the quote below by T.E. Lawrence?

"All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.”  

I’m a dreamer. Always have been. Ever since I could remember, I wanted to do remarkable things that would make the world a better place. Over the years, I’ve had lots of ideas for how to do this but often I would ‘wake up in the day to find it was vanity’. In other words, the ideas remained just that; ideas. On a recent project, I became a ‘dreamer of the day’.

I research an approach to human suffering named Acceptance and Commitment Therapy (ACT). The pitch of ACT goes something like this: if we can be willing to experience all of our thoughts and feelings, both positive and negative, whilst continuing to move in valued directions, then we will do a decent job at this game of life. One night, after delivering an ACT intervention to teachers, I had this thought: “It is really easy to forget our values; I need to create something that will remind people of what is important to them.” In the following weeks I came up with the idea of an annual diary. For the most part, this diary would be like any other diary i.e. it would have days and dates and spaces to record meetings. However, it would also provide an opportunity for the user to record what is important to them at the beginning of each week.

Ok, so there was the idea. Now I had to do something with it. The first step was easy; I loaded Microsoft Word and spent hours and hours and hours (with my co-author Dr. Freddy Jackson Brown) shaping the words and lines that would make up the inside of the diary. The second step was more difficult. I had to figure out how to take that file and turn it into a product. First question: a publisher or a printing house? No publisher was interested so we went with a printing house. Then, more questions. What sort of spine to go for? How thick should the paper be? How many copies should we buy? How should we sell it? What are the best postage and packaging options? How should we advertise it? How should we accept payment for it? How do we pay tax? Who is going to post them? How should we grow the product over time?

During the first and second steps I faced a fair bit of discomfort (i.e. seemingly powerful negative thoughts often crossed my mind: “this is a waste of time”, “nobody will like it” or “you should be spending this time with Max”). However, the third step of making my idea a reality brought the most discomfort: once I had the completed product, I sent it out there into the scary world. And given that success or failure has implications for how I feel about myself, my diary is a bit like a Horcrux in the Harry Potter story. In that story, the bad guy (Voldemort) poured his soul into a number of items and placed them out there in the world. Those items were called ‘Horcruxes’. His thinking was that this strategy would make him more difficult to kill.

Like Voldemort, I poured my soul into this Horcrux. And like Voldemort, any attack on the Horcrux feels like it kills a part of my soul (‘attack’ is an extreme word that is possibly misplaced here. By ‘attack’, what I mean is any evidence I see that the diary is not worthy, whether it be a lack of sales, little interest on social media or negative feedback). My Horcrux diary is now out there in the world fending not just for itself but, in some ways, for me also. A bit of my soul is unprotected; it can be scrutinized, criticized or ignored. It can fail. And if it fails then it will hurt like hell.

The feeling of vulnerability that comes with trying to do something remarkable is tiring, and it often makes me question whether it would have been better to stay a ‘dreamer of the night’. If my Horcrux is inside my mind then nobody can see it; nobody can hurt me. However, every time I think about this I come to the same conclusion. Although being a ‘dreamer of the night’ comes with built-in safety, if I didn’t do something with my dreams then I’d be living a life out of step with my value of making the world a better place, and consequently, I’d feel empty.

Why am I telling you all this? For two reasons. Firstly, I want you to see how ACT is in my blood. Just in this blog you will spot how I used important ACT processes (willingness, defusion, self-as-context, values). Secondly, and more importantly, I want you to see that having ACT in my blood helped me to chase my dreams, and that it can help you to do the same. Chasing dreams will bring vulnerability but if you know what to do with vulnerability then you will be free.

Interested in checking out Dr. Hooper’s Annual Diary for Valued Action? Check it out here.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com