Unsticking from Anxious Thoughts

By Annabelle Parr, MA, AMFT

Our capacity for language allows us as a species to be excellent problem solvers. It’s the thing that allowed us to invent cars that transport us over large distances quickly, and it’s also what gives us the ability to notice if we have a flat tire, pull over, and replace the tire with a spare (and if you are not the savviest with automotive issues, to understand a YouTube video explaining how).

When we are anxious or afraid, our minds come up with thoughts to try to help us make sense of our fear and problem solve potential threats.

If you get a flat while you are driving, before any languaging kicks in, you might notice yourself feeling a jolt of fear. Fear is an acute feeling that shows up when we are facing a perceived threat. And fear is really adaptive. If we never felt fear or anxiety, we wouldn’t survive long. Usually, right after fear or anxiety (or any other emotion) kicks in, our mind jumps in with some thoughts to try to make some meaning out of that feeling and help us address it. In this case, fear might tell you to “pull over as soon as you can.” Listening to that thought will likely help you resolve the issue and ensure you are once again driving a safe, secure vehicle.

However, sometimes the thoughts that our minds come up with when we are feeling afraid or anxious are not so helpful.

For example, if you feel anxious the next time you get in the car, and your mind says “what if something else goes wrong and I crash? This isn’t safe, I should just stay home”, listening to that thought is probably not so helpful. Sure, listening to that thought would probably give you some relief from the anxiety you are feeling in that moment, but it would also restrict your life in a really significant way.

Anxiety and the thoughts it generates are designed to help protect us, so those thoughts usually feel really true and important.

The problem is sometimes we feel anxious or afraid in the absence of any real, likely, or catastrophic threat, and sometimes the anxious thoughts that visit us are not accurate, helpful, or important. Cognitive defusion – the process of noticing that our thoughts are simply sounds and syllables – can help us create enough distance from those sticky anxious thoughts that we get to choose how to respond.

When we are able to create some space between our selves and our thoughts,

we get to become skilled observers of our experience in a way that allows us to decide whether a particular thought is going to help move us toward our values or if it will move us away from what is meaningful and important to us. We do not have to figure out whether the thought is “true,” we just need to figure out if doing what it says is in line with what matters to us.

So how do we get a little bit of distance from our thoughts?

There are a whole bunch of exercises that can help us get some distance from thoughts that are tripping us up. One of my favorites goes like this. First, you identify the thought and state it as it is (“this isn’t safe, I should just stay home”). Pause, and notice what shows up in your body as you sit with it. Next, restate the thought but preface it with “I’m having the thought that…” (“I’m having the thought that this isn’t safe, I should just stay home”). Again, pause and notice what shows up. And finally, restate the thought but preface it with “I’m noticing that I’m having the thought that…”. Again, pause and notice what shows up.

And the final step is to check in with what matters most to you in this moment

and choose whether that is a thought that will help you engage with your valued direction. Sometimes the answer is yes. But when it’s no (or not entirely), your values can inform what you choose to do instead.

Defusion is a process, and sometimes it can be hard to get unstuck on your own. A therapist trained in Acceptance and Commitment Therapy (ACT), can help you learn the ropes.

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

Getting Comfortable Being Uncomfortable

By Annabelle Parr, MA, AMFT

One of the main goals in Acceptance and Commitment Therapy (ACT) is to help clients get comfortable being uncomfortable. This may sound strange at first, after all isn’t therapy meant to help alleviate suffering? So why would an evidence-based treatment model suggest that we get comfortable being uncomfortable?

Because the struggle to get rid of pain often comes at a cost.

When our energy and attention are wrapped up in trying to move us away from discomfort, several things typically happen:

1. First, the attempt to avoid discomfort or anxiety works. We get an instant sense of relief. This is really rewarding to our brains and our bodies, and because it is so rewarding it can make us more likely to choose that avoidance again in the future.

2. But relief is usually only temporary. In the long run, anxiety finds a way of returning. And when it comes back, it is sometimes even stronger than before. When we avoid the things that make us feel anxious, we reinforce the story our minds tell us that anxiety is unmanageable and that we are in danger.

3. Third, and possibly most importantly, in the fight to try to make anxiety go away it’s easy to lose sight of what is most meaningful and important to us in our lives. Our behavior becomes about trying to get rid of discomfort rather than about being present to and doing the things that matter to us.

There is a Buddhist saying that helps explain the high price of avoidance:

Pain x Resistance = Suffering 

Anxiety and other painful emotions are really uncomfortable, and they are an inescapable part of the human experience. When we try to resist or avoid that pain, instead of allowing it to be as it is and continuing to engage in valued actions, our discomfort escalates into suffering. Maybe that suffering looks like worrying about the fact that we are anxious. Maybe it involves our minds beating us up for the fact that what we are experiencing is not easy, the way it seems to be for others. Maybe that suffering involves feeling unable to connect with something important to us. When we choose a different response and drop the resistance to our pain, we can reduce that suffering.

The alternative to resistance is willingness.

Willingness is getting comfortable being uncomfortable and allowing our internal experience to be as it is without trying to control or change it. When we are no longer caught trying to wrestle with and get rid of our anxiety, we get to choose what we do instead.

• We can decide to be brave and take a flight to go visit family we haven’t seen in years.

• We can decide to be vulnerable and go out on a first date.

• We can decide to be bold and ask for a raise.

• We can decide to take care of ourselves and schedule that check up, or take care of others and go donate blood.

• We can love more deeply, fully, and wholeheartedly when we are willing to allow the possibility or even the probability that we may one day lose those we love.

When we are comfortable being uncomfortable, our life expands. We can allow ourselves to care deeply about what matters most in our lives. We get to make a choice about who and how we want to be in the world, and about what actions are important enough to us to allow ourselves to feel the pounding heart, sweaty palms, shaky legs, racing mind that comes with anxiety.

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

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

Mental Health Awareness Month: Fitness #4Mind4Body

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

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

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

An Acceptance and Commitment Therapy Approach to New Year's Resolutions

by Annabelle Parr

As we enter another new year, many of us have set our 2017 resolutions. Maybe you make resolutions, maybe not, but either way this is generally a time of reflection. In what ways do we hope this year will be different from last? What are we hoping to change in our lives? What goals do we have going forward?

 The new year always seems to be a good time to think about making some changes because it gives us the chance to start fresh in some ways. But in other ways it is simply just another day. Nothing changed automatically on January first. What can change is our perspective, and it is our job to ensure that our actions follow. This is the tough part. Do you find yourself already struggling to maintain your resolution? Do you wonder why we have such a hard time keeping our resolutions for more than a few weeks? How do we make our resolutions stick?

The truth is, change is often slow. Occasionally we are able to make huge changes immediately, but more often than not change takes time. New year's resolutions often fail to take into account that it may actually take you all year to create the change you were hoping to see on January second. When we fail to recognize all the small steps on the road toward change, we set ourselves up for disappointment and failure. A new year's resolution sounds like an easy solution: set a major goal for the new year ahead. But our resolutions are empty unless they are backed by action, and creating a resolution doesn't necessarily help us to make an action plan.

Acceptance and Commitment Therapy (ACT) offers some ideas and tools that can be very helpful in guiding us along the process of change. Whether you come in to see a therapist for Acceptance and Commitment Therapy, or whether you apply the wisdom it can offer to your life on your own, this model can help us to keep our resolutions all year long.

ACT aims to increase psychological flexibility, which means that you are able to connect to the present moment consciously and choose to behave in a manner as consistent with your values as the situation allows. Part of the purpose behind ACT is to get in touch with your personal values (not those determined for you by society, family, friends, or any other external source), and then use these values to guide your actions and formulate specific goals. This is usually what we are aiming for with our new year's resolutions.

For example, if my resolution is that I want to eat healthier, a good place to start is to examine my values. Do I feel like I "should" eat healthier because I feel pressured by our health conscious culture or by my friends, family or partner? Or do I want to eat healthier because I value my physical health, deep in my heart? Or perhaps I value my role as a model to my children, and want to eat healthier for this reason. Once I determine my values and make sure that my resolution is driven by my own intrinsic motivation, then I can create a concrete plan of action to move forward.

The Choice Point Model, another helpful ACT tool, offers us a framework to use when we face a decision. A choice point is a moment in time where we can choose to act in a manner that is either consistent or inconsistent with our values. The Choice Point is about identifying the hundreds of moments in a day where we can be on autopilot and be driven by thoughts and feelings, or we can make a conscious, deliberate choice that is in the service of our values. When in this moment, we can use the acronym STOP:

S: Slow down. Take 3 mindful breaths.

T: Take notice. What are you thinking and feeling?

O: Open up. Make room for those thoughts and feelings instead of trying to avoid the discomfort.

P: Pursue values. Do what matters to you.

Sometimes, in a Choice Point, we will choose to avoid or procrastinate acting in a values consistent manner, and that is okay. Give yourself grace when this happens. But remember that though avoidance may provide relief for the moment, in the long run it will make us feel worse. So if we can STOP and choose to act in accordance with our values as frequently as possible, it will serve us.

As you approach this new year and begin thinking about your potential resolutions, remember that big change happens slowly, choice point by choice point. Remember to consider your values, and to STOP when you hit a choice point. If you feel you need some extra support along the road to change or healing...

CSAM IS HERE TO HELP

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