When You Stress About Stress You’re Stressed

By: Jill A. Stoddard, PhD

Image source: https://www.amazon.com/Stressed-Desserts-Spelled-Backwards-Poster/dp/B017C9AZUQ

What is your go-to when you feel stressed out?  Do you like a few glasses of wine, an hours long vent session, or a creative excuse to get out of a social engagement?  These are all examples of experiential avoidance—an unwillingness to experience uncomfortable internal emotions or sensations and active efforts to change, reduce, or eliminate them (Forsyth and Eifert 1996).  Does experiential avoidance work to alleviate feelings of stress?  Yep.  It works or we wouldn’t do it.  But how long does that last?  Look at your personal experience and take inventory:

1.     what do you do or not do when you feel stressed?

2.     what does it get you (i.e., what discomfort does it relieve)?

3.     what is its cost?    

When our reactions to stress result in only temporary relief but come at a cost to our health, our relationships, or other areas of importance, it’s time to reevaluate our relationship to stress. 

Think of it this way (Stoddard, 2019):  Imagine I have you in a little booth suspended above a barracuda tank.  I tell you, “Whatever you do, don’t get stressed and you will be fine.  Unfortunately, if you do feel stressed, the floor of the booth will open, dropping you into the barracuda tank.  But just don’t get stressed and you will be totally fine!” 

What do you think is going to happen?  Right—you’re stressed…and fish food.  Is it because you just didn’t try hard enough to control your stress?  Was the incentive not quite high enough?  Of course not—our most primitive instinct is to survive.  So why did you get stressed and end up swimming with the fishes?  Because when you are unwilling to experience stress, you are stressed about stress so you are stressed (Hayes, Strosahl, and Wilson 1999).  See the trap?  Your relationship to stress becomes one in which you evaluate it as bad, dangerous, and deadly. 

So, of course, you are stressed about having stress. 

So what should you do the next time you hear on Good Morning America or in the Huffington Post “Stress is bad for you!  Stress will kill you!  You shouldn’t get stressed!”  It turns out, stress has been wrongfully getting a bad rap (McGonigal 2013).  While stress does release adrenaline (the hormone thought to be harmful to the body), it also releases oxytocin, the bonding hormone that enhances empathy and motivates us to seek and give care.  Oxytocin is a natural anti-inflammatory—it’s good for our bodies and actually strengthens our hearts.  And, fascinatingly, all we have to do to mitigate the negative effects of adrenaline is simply appraise stress as helpful.

Come again?  Stress, helpful?  YES--stress can motivating!  Stress is what prompts you to prepare for the important job interview, watch over your small children in a crowded place, and get ready for the big game.  If you were totally chill, you’d likely bomb the interview, lose your kid at the mall, and blow the game.  As it turns out, there is an optimal arousal zone when it comes to doing well (Yerkes and Dodson 1908):  when stress is very high or very low, it has the potential to negatively impact performance.  But a moderate level of arousal is helpful. 

The best way to manage stress is simply to change your relationship to it.  So stop struggling to avoid and reduce your stress (how’s that working for you, anyway?), and instead work on accepting that to be human is to know stress, and stress need not be our enemy.  You can do that by remembering:

1.     stress is motivating and can improve performance at moderate levels

2.     stress prompts us to seek connection with others and this is good for our health

3.     stress is only damaging when we evaluate it as damaging

4.     when we are stressed about stress we are stressed

Now, don’t get me wrong—I’m not suggesting you give up your meditation practice because it makes you feel less stressed.  There is nothing wrong with getting your bliss on—as long as your strategies don’t come at the cost of other meaningful and important pursuits.  So go ahead and yoga-it-up—just don’t neglect your friends and family while you’re at it.

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, depression, 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

References

Forsyth, J. P., and G. H. Eifert. 1996. “The Language of Feeling and the Feeling of Anxiety: Contributions of the Behaviorisms Toward Understanding the Function-Altering Effects of Language.” The Psychological Record 46: 607–649.

Hayes, S., K. Strosahl, and K. Wilson. 1999. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: The Guilford Press.

McGonigal, K. 2013. “How to Make Stress Your Friend.” Filmed June 2013 in Edinburgh, Scotland, video, 13:21, https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend/transcript

Stoddard, J. 2019. Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, and Stress Using Mindfulness and Acceptance. Oakland: New Harbinger Publications.

Yerkes, R. M., and J. D. Dodson. 1908. “The Relation of Strength of Stimulus to Rapidity of Habit-Formation.” Journal of Comparative Neurology and Psychology 18: 459­–482.

Anxiety in the Courtroom

Witness Preparation Services

by Annabelle Parr

Have you ever felt especially nervous before a big presentation? Do you find your heart racing and palms sweating when you have to speak in front of a large group of people? You’re not alone. On average, people rate their fear of public speaking higher than their fear of death. Potentially one of the highest pressure, highest stakes public speaking situations is on the witness stand in a courtroom or during a deposition. Even the most experienced witnesses can feel anxiety, which left unaddressed can hinder their testimony. Anxiety is the number one communication obstacle in legal proceedings (Pitera, 2013).

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Witnesses typically have very specific fears related to testifying. Some common witness fears include, but are not limited to, a fear of letting people down, losing their job, making a mistake, looking incompetent, being embarrassed, judged or blamed, or having to reveal private, personal information. Witnesses also tend to take on more responsibility for the outcome of the case than is necessary or realistic (Pitera, 2013).

Though the source of a witness’s anxiety may be completely unrelated to their credibility or honesty, jurors tend to judge witnesses more on the basis of behavior than testimonial content (Afremow, 2011). Therefore, a testimony could be flawless and completely true, but if it is delivered poorly the concrete verbal content may not matter.

Typical anxious behaviors that jurors tend to interpret as signs of unreliability include non-verbal cues such as poor eye contact, fidgeting, appearing tense, and inconsistency of demeanor or tone (Afremow, 2011). Helping witnesses to become conscious of these subtle reactions as well as the sources of their anxiety before testifying can help them to manage the visible cues thus increasing their perceived credibility.

Meeting with a licensed psychologist who specializes in anxiety management is a great way to help prepare witnesses and allow them to address their anxiety before taking the stand. Using cutting edge, evidence-based, cognitive-behavioral techniques, the therapist can help witnesses modify their anxiety, bringing it into an optimal range for peak performance.

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Therapeutic techniques that can help prepare witnesses include:

• cognitive reappraisal, which involves changing catastrophic cognitions that fuel anxiety and lead to poor performance
• grounding, mindfulness, and relaxation
• reduction of safety seeking, avoidance, or anxiety driven behaviors such as lack of eye contact, speaking too softly, fidgeting, talking too much or too little, or looking to the attorney for reassurance
• video-taped feedback, which can help reduce anxiety by showing the witness that they don’t look as anxious as they feel, as well as helping them to notice and address visible safety behaviors

A therapeutic setting offers a safe space to practice testifying and receive non-judgmental, constructive feedback and tools that the witness can apply in court and during depositions. If you or your client are preparing to stand as a witness, know that feeling anxiety is normal, but that it doesn’t have to determine the tone of the testimony.

CSAM IS HERE TO HELP

If you or someone you know might benefit from witness preparation services for anxiety or stress, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Afremow, J. (2011). Witness this: Behavioral science in the courtroom. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/trust-the-talent/201110/witness

Pitera, M. J. (2013). Witness tip: Anxiety is the #1 barrier affecting communication. Litigation Insights. Retrieved from http://www.litigationinsights.com/witness-preparation-2/witness-tip-anxiety-is-the-1-barrier-affecting-communication/

Part 2: Thriving through the Embrace of Life: Learning to Open through the Pain

Part 2

Thriving through the Embrace of Life:

Learning to Open through the Pain

By Lauren Helm, M.A.

In the first segment of our blog on learning how to thrive, we explored the role that suffering may have in preventing or blocking our ability to live a valued, full life. Part two continues our discussion of thriving versus suffering, and introduces an alternative approach to responding to emotional or physical pain or discomfort.

“Human beings, we have dark sides; we have dark issues in our lives. To progress anywhere in life, you have to face your demons.” – John Noble 

It can be said, in a sense, that in running away from our pain, we are metaphorically running away from our demons. These demons appear large, menacing, and powerful. They wave their limbs in frightening gestures, and offer deafening roars or shrieks when we move close to them. Our instinct is to flee – to run and escape these frightening beings – for fear that irreparable harm will come our way.  However, our constant attempts to hide away from painful events leads to the cycle of suffering that prevents a thriving, full life. Thriving is not happiness without pain. To thrive is to experience the full range of what it means to be human, and to consciously move forward on a path that is in alignment with who you want to be, and with what is important to you. Life is made up of the “good” and the “bad,” or the “pleasurable” and the “painful,” but focusing on removing the bad or the painful is likely to also prevent you from experiencing the beautiful , the awe-inspiring, and the heart-warming types of life experiences.

Sometimes it just takes a little willingness to open up to all that life has to offer, even when there is pain involved. This may take a certain degree of faith or bravery, because actively taking steps forward into valued territories often entails some degree of risk. There is risk in opening up to vulnerable but deep love, there is risk in pursuing an education or career path that inspires you but has no guarantees, and there is risk in boldly moving forward when there will likely be a certain level of pain (and growth) in doing so. Openness to the fullness of life on some level requires an acceptance of all that comes with it – the ups and the downs. In fact, an embracing of the twists and turns of life may very well be what leads to the transformation and growth that fosters thriving and well-being. Remember, pain in and of itself is not the problem. Suffering-caused by efforts to avoid pain- leads to the seemingly inescapable vortex of pain, and is a beast that feeds itself through escalating distress and avoidance. It requires extensive time and energy to maintain, and yet convinces us of its necessity. However, paradoxically, the way out of suffering is in “embracing the demons.” The alternative to suffering is thriving, an embracing of life.

Metaphorically, this cycle is like feeding a hungry tiger. Dr. Russell Harris, an ACT practitioner, explains how this works: “You discover a baby tiger in your house, and it’s cute and cuddly, so you play with it. Then it gets hungry, and restless, and irritable, so you feed it – and it settles down. But over time, the more you feed that tiger, the bigger it grows - and the more food it needs, and the more aggressive it gets when it’s hungry. Now it’s not cute anymore; it’s scary.  And you spend more and more time feeding it, because you’re terrified that if you don’t, it’ll eat you! But the more you feed it, the bigger it gets” (Harris, 2007).

Acceptance and Commitment Therapy (ACT) is an empirically supported treatment that teaches clients to reduce suffering and truly thrive.  ACT is an experiential therapy and so relies on the use of metaphors and experiential exercises to facilitate learning in an experienced way. Metaphors can help us to really connect with concepts and ideas so that we can begin to apply these concepts; so that we can begin to more openly experience difficult life events, instead of automatically avoiding them. So that we can thrive.  Another commonly used metaphor in ACT that illustrates this point is the Chinese Finger Trap Metaphor. The more that you struggle with, and try to escape the finger trap by trying to pull your fingers out of the trap, the tighter the trap becomes. The struggle to control the situation and escape makes it worse. Instead, the way out of the trap is to yield, and bring both fingers closer together within the finger trap. And then it loosens, and you are set free.  Similarly, in the ACT Quicksand Metaphor, the cycle of suffering is represented by the experience of being in quicksand. If you struggle and try to fight your way out of quicksand, you sink more quickly. The way out of quicksand is to make as much contact with the sand as possible, lying on your back, and in doing so, you rise to the surface.

It is through the willingness to make full contact with life, the embracing of the many possible experiences that make us human, that we thrive. There is richness and fullness of life to be found when we creatively choose to embody meaningful living. We can start this process by letting go of trying to control the pain, and committing to act in ways that allow us to thrive.

Clinicians who wish to incorporate metaphors and experiential exercises into their therapy practice can check out Dr. Jill Stoddard’s The Big Book of ACT Metaphors here.

If you'd like to speak with Dr. Stoddard or another professional at the Center for Stress and Anxiety Management for help learning about how to “embrace your demons,” please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego).

References

Harris, R. (2006). Embracing your demons: an overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70.

Harris, R. (2007). Acceptance and Commitment Therapy (ACT) ADVANCED Workshop Handout. Retrieved from: http://www.actmindfully.com.au/upimages/2007_-_advanced_act_workshop_handout.pdf

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.

Tags: anxiety, anxiety therapy, acceptance and commitment therapy, ACT, stress and anxiety in san diego, Center for Stress and Anxiety Management, mental health, emotion regulation,anxiety disorders, fulfillment, suffering, thriving, pain, personal values

What is Acceptance and Commitment Therapy?

By Lucas Myers and Jill Stoddard, Ph.D.

Perhaps you've come across Acceptance and Commitment Therapy (ACT) online or even on our website. Maybe you have encountered it through the popularity of Mindfulness, a “hot topic” in psychology and self-help with strong ties to Buddhist traditions. You may have read, or heard an anecdote about how ACT is helping normal people everywhere to cope with anxiety, depression, and stress. So what is ACT?

ACT is a type of psychotherapy that helps people to accept difficult inner experiences, like negative thoughts and uncomfortable feelings, instead of trying to suppress or avoid them. Why, you might ask, would I want to accept feeling badly? Because pain is universal. There is not a human on the planet that has not or does not experience difficult thoughts and feelings. ACT (informed by Buddhism and other traditions) suggests that pain is not the problem. Rather, it is our attempts to avoid or eliminate pain that cause true suffering. We call this pursuit of pain relief “experiential avoidance.” Take the person who uses alcohol or drugs to cope with upsetting experiences by numbing himself to avoid the unpleasant feelings that follow. While this might work in the short term, the substances ultimately don’t “fix” the pain and, in fact, lead to more suffering when relationships, work, and other areas of functioning are negatively impacted. In a less extreme example, consider a person who feels self-conscious about her appearance or intelligence and avoids dating for fear of rejection. Again, this may bring some protection from feelings of vulnerability, but it doesn’t solve the self-consciousness. Worse, it prevents the possibility of having a loving relationship even if this is something that's personally important.

So why would you want to accept difficult feelings? Because experiential avoidance often doesn’t work, frequently makes things worse, and typically comes at the cost of pulling you away from the things that matter most. , The alternativeis acceptance. ACT focuses on teaching acceptance of internal experiences in the service of moving toward a life that is guided by values—a life that is characterized by meaning, fulfillment, and vitality.

While there are many different strategies employed to create meaningful change, ACT focuses on building three main skills:

1. Defusion - distancing and letting go of unhelpful beliefs, thoughts and memories

2. Acceptance - acknowledging painful feelings, sensations, and urges and allowing them to pass without struggling to avoid or eliminate them

3. Contact with the present moment - being present in the here-and-now and engaging each moment with openness and curiosity

These skills enable a person to fundamentally change his or her relationship with painful thoughts and feelings, freeing him up to make valued choices. Examples might include spending time with friends and family, pursuing a hobby or career, expanding one's skills, or contributing to one's community, just to name a few.

Defusion involves recognition that thoughts and feelings that are sometimes overwhelming are often passing images or irrational statements we tell ourselves. Learning to step back and observe thoughts as entities separate from ourselves reduces the degree to which we allow ourselves to get “hooked” by their content, or mistake thoughts as facts. Defusion allows us experience thoughts as just words, and words as sounds and syllables instead of meaningful truths we must pay attention and react to. Defusion practices allow thoughts to come and go, passing like leaves floating down a stream. The leaves have no power over the stream.

Acceptance, also called Willingness, begins with recognition that our reactions to distressing thoughts and feelings can be changed. Five strategies for acceptance include:

1. Giving oneself permission not to be perfect

2. Acknowledging weaknesses 

3. Acknowledging an unpleasant thought or feeling instead of running from it 

4. Letting feelings and thoughts pass without giving in to the compulsion to act on them

5. Letting go

Contact with the present moment, sometimes referred to as “mindfulness” involves non-judgmental, present focused awareness of both internal and external events. ACT encourages people to check in with themselves and question their responses to life's challenges in each moment. Mindful attention is given to awareness of thoughts, emotions, and physical sensations. Increasing awareness of experience can lead to better mastery of one's reactions to the problems and difficulties that life brings. Energy that would otherwise be invested in avoiding unpleasantness can then be invested in actions that change life for the better. An individual can learn to get in touch with his deepest values and allow this knowledge to act as a guide to a rich and meaningful life.

A unique and even fun aspect of ACT is its reliance on the use of therapeutic exercises and metaphors to help clients experientially derive meaning from the treatment concepts that are presented. . For example: your therapist might play a little game of “Simon Says” with you. But in this version of the game, Simon represents your mind commanding you to act in a certain way. You hear those commands but then DO whatever you want! If Simon says, “raise your hand,” you can hop on one foot instead. The idea is to experientially “get” that you don’t have to obey Simon any more than you have to listen to what your mind is telling you. You might also hear an ACT therapist say, “don’t believe this is true because I’m saying it is so; what does your experience tell you?” Your ACT therapist wants you to learn by experience.

ACT is often summarized using two simple acronyms. The core causes of many problems are represented by FEAR:

Fusion with your thoughts

Evaluation of experience

Avoidance of your experience

Reason-giving for your behavior

As an alternative to these behaviors, ACT!

Accept your reactions and be present

Choose a valued direction

Take action

Acceptance and Commitment Therapy is generally a short-term treatment. With the help of a good therapist, anyone can learn to accept the pain and stress of life, as it comes and goes, to make room for a new commitment to values and living a life with purpose and meaning.

In addition to its widespread use for anxiety and depression, ACT has been adapted to effectively treat substance abuse, body image issues, PTSD, chronic pain, tinnitus, smoking, borderline personality disorder, and others.

If you would like to learn more about ACT contact us.

References:

Acceptance and Commitment Therapy. Retrieved from: http://www.actmindfully.com.au/acceptance_&_commitment_therapy

Hayes, Steven. ACT. Rectribed Sept 23from: http://contextualscience.org/act

Serani, Deborah. Two Takes on Depression: Acceptance and Commitment Therapy. Retrieved  from: http://www.psychologytoday.com/blog/two-takes-depression/201102/acceptance- and-commitment-therapy

Stoddard, Jill. Introduction to Acceptance and Commitment Therapy [Powerpoint Slides]. Retrieved from personal correspondance September 28, 2013.