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

Making Space for Anxiety

By Annabelle Mebane, MA, AMFT

Often when we seek out therapy for anxiety, we are hoping that with treatment we can cure our anxiety or get rid of it. Anxiety is deeply uncomfortable, and it makes perfect sense to want to make it go away. Plus, anxiety is evolutionarily designed to show up when we are facing a threat, so of course the impulse is to resolve the perceived danger and presumably get rid of the anxiety too.

But the thing is, anxiety also shows up around the things we care most about.

When we take a risk towards something we care about, our minds and bodies sometimes read that risk as a threat. It’s vulnerable to care and to risk feeling pain, rejection, loss, or failure. And if we “resolve” that threat and make the anxiety go away, that sometimes means we are cutting ourselves off from the richest parts of our lives. We avoid taking the risks that may cause pain and that will very likely cause anxiety, but in doing so, we miss out on the juiciest parts of life.

The primary goal of anxiety therapy isn’t actually to get rid of anxiety.

As someone who has experienced (and still experiences at times) a fair share of anxiety, and someone who is also now a therapist specializing in the treatment of anxiety disorders, I’ve learned that the most effective treatment for anxiety isn’t ultimately about getting rid of anxiety. It’s about learning to make space for it to be there, and still choosing how we want to show up and respond to it.

I know that sounds really hard, and it is. One of the hardest parts of anxiety is the way that it can get us stuck. The way it convinces us we can’t handle the challenge in front of us or the feelings showing up inside of us. The way it convinces us to make ourselves or our lives smaller in order to try to stay safe or comfortable.

So how do we make space for anxiety?

Making space for anxiety looks like slowing down, noticing our heart is racing, our palms are sweating, our head feels light, our body feels tingly and shaky, naming that we are feeling anxious or nervous, and compassionately saying to ourselves “yep, this takes courage for me to be here and do this right now”. It looks like noticing that our mind wants to beat us up – “seriously, you’re still anxious about this?” “other people don’t have this much trouble with this,” “why are you so sensitive?” “you can’t do this,” – noticing these are painful stories, and responding to our mind compassionately, the way we might respond to our younger self or our child.

How do we choose how we want to show up even when we feel anxious?

Choosing how we want to show up means that we decide what matters to us most in this moment, we clarify how we want to behave in this moment, and we do our best to take action toward those values. We don’t get to choose if we feel anxious. We do get to choose if we are going show up and how we are going to respond to ourselves and others when we do.

• Maybe it means going in for your annual check up in service of taking care of your health, and showing up to that appointment as someone who is assertive, compassionate, present, and grateful.

• Maybe it means donating blood in service of giving back to your community and in service of facing a long held fear of needles, and showing up as someone who is open, brave, and willing.

• Maybe it means getting on a plane to fly halfway across the world to attend the funeral of a loved one, and showing up to connect and share love and grief with family.

• Maybe it means joining a dating app, going on a first date, and showing up as someone who is playful, kind, and authentic.

• Maybe it means getting behind the wheel in service of being independent, and showing up as someone who is determined and perseveres.

We choose the action, we choose the qualities of being, and then we do our best and have compassion for ourselves if it doesn’t go exactly as hoped or planned.

Making space for one feeling often makes space for others too.

When we make space for anxiety and stop fighting with it and beating ourselves up for having it, sometimes we also make space for the possibility of a complex experience that includes both anxiety AND joy, connection, love, or pride.

Even as an anxiety therapist, there are some things that I personally just either haven’t yet or won’t ever completely stop feeling anxious about. But whether that anxiety ever goes away completely doesn’t matter to me anymore. If I know I can show up anyway, that’s all I need to know. Sometimes the fact that the anxiety shows up and I still do too is actually part of what makes it meaningful.

I get a choice to be brave and vulnerable, and when I’m not stuck trying to wrangle my way out of the anxiety, I get to make space to also notice and sometimes relish the other feelings I’m having. Most of the best, most meaningful and important moments of my life have come right after feeling an almost overwhelming amount of anxiety and choosing to show up anyway. And from an Acceptance and Commitment Therapy perspective, we hurt where we care. And caring is not something we aim to get rid of, so we make space for the pain and anxiety instead.

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

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