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

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

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

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

The Unexpected Benefits of Teletherapy

By Annabelle Parr, MA, AMFT and the CSAM team

It’s been nearly 4 months since we started COVID-19 quarantine, physical distancing, and since we transitioned to offering therapy via telehealth at CSAM. We knew from the outset of this shift that research indicates that, assuming that the therapist and modality are an appropriate fit for the client’s needs, teletherapy is as effective as in person therapy. Even still, we were initially apprehensive about this change, as we were uncertain how it would feel to switch from sitting across from our patients to communicating with them through a screen. Despite our initial worries, we have been pleasantly surprised to discover that not only has our experience been consistent with efficacy research, but that teletherapy has actually had a number of additional benefits we did not anticipate.

And given that the past few months have brought a lot of stress, pain, anxiety, grief, and frustration, we wanted to take a moment to reflect upon some of the beauty and connection that we have noticed amidst this tumultuous time. Below are reflections from our team of therapists on some of the benefits they have noticed about the tele-therapeutic process. 

Common humanity: we’re all in this together.

CSAM Director Dr. Jill Stoddard said, “I was worried that telehealth would make the connection with clients less personal, but what I've found is that my clients are now introducing me to their partners, their kids, and their pets, so in many ways I actually feel MORE connected to them. I was also worried about interruptions from my own kids and dogs, which HAS happened, but my clients have been so patient and understanding. In many ways I think they too feel more connected to me because it's all just so human and we're having a shared, unique experience of having to do things from home with our families around.”

Increased connection: a fuller picture of clients’ lives.

Associate Director Dr. Michelle Lopez agreed. She said, “my experience is similar to what Jill described in that I feel MORE connected to clients. Telehealth has allowed me to have a fuller, more colorful picture of what their lives are like which I am able to envision when I am conceptualizing and tailoring treatment plans. It has also been excellent for exposures. When "we" can walk to the client’s backyard or kitchen (or wherever the exposure task needs to happen) in a matter of seconds, it allows more time for the actual exposure task. A few clients have commented on how much easier it is for them to "arrive" on time because they don't have to account for traffic, being unable to find their keys or shoes, etc.”

Superhero sidekicks: incorporating pets into therapy.

Superhero Therapy creator and lead trauma specialist Dr. Janina Scarlet noted that “an unexpected but interesting side effect of telehealth has been the ability to incorporate pets into therapy. Many people’s pets have become their sidekicks on their mental health journey and my own cat, Hera, has become a kind of mascot of an emotional support pet for many of my clients.”

Increased convenience: involving family and doing exposures at home.

Child and teen specialist Thi Wlodarski, LMFT agreed with Dr. Lopez that exposures have been more easily facilitated: “telehealth has been really beneficial for my clients whose rituals are often done at home. Clients are able to complete exposures in the situations that trigger their anxiety instead of having to simulate it in the office. I've also been able to do more family therapy because all members are home together. I've been able to involve parents who wouldn't normally been able to be present in session. 

Comfort and creativity: therapy from the comfort of home.

Dr. Terra Fuhr said, “I have also found telehealth to be a surprisingly smooth transition. Several clients have commented that it feels easier to open up, be vulnerable and talk about difficult topics from the comfort of their own space. I also wonder if being in the environment where they live life may remind them--or prime them--to talk about the most relevant emotions of their day-to-day lives. We've been able to do more creative exposures. And everyone seems to love not having to factor in commute time!”

As always, we are continually inspired by our amazing clients.

Insomnia specialist Dr. Melissa Jenkins agreed with the rest of the team, and added her feelings of admiration for her clients’ courage and perseverance during this difficult time. “Over the past few months, I have been struck by how bravely and thoughtfully people have welcomed therapy into their homes by way of telehealth. In our current circumstances (in which we are faced with many competing demands on our time and energy as we navigate a new way of living amidst coronavirus), it can be really hard to keep appointments and prioritize mental health. I am truly inspired by my adult clients who are committed to prioritizing their mental health, showing up for appointments and challenging themselves, and by my client’s parents who continue making therapy a normal part of their children’s lives. Sessions, of course, look a little different as we engage in therapy together through screens; however, it has been powerful to connect with clients in their more natural environments (as opposed to a therapy office) and to witness continued growth in the face of substantial adversity right now.”

Teletherapy allows us to keep our clients and our communities safe.

Of course, we are all collectively missing the normalcy of life pre-pandemic. And here at CSAM, we look forward to a time when we can see our clients in person again. However, we are also happy and grateful that we are able to do our part in slowing the spread of COVID-19 by offering our services via telehealth for as long as is needed. Remaining at home and offering teletherapy is consistent with our values of keeping everyone as safe as possible while this pandemic continues. As the number of cases continues to rise both here in San Diego and across the United States, the best thing we can do to keep our clients and our communities safe is to stay home whenever possible. Under these circumstances, telehealth allows us to offer the most competent, compassionate and connected care.

If you need support during this difficult time, CSAM is here to help.

Even as we reflect on some of the upsides of telehealth and the strength, courage and resilience of our clients, we also recognize that this pandemic and the upheaval we are experiencing has increased stress, anxiety, and even trauma for many folks. So know that if you are struggling, you are not alone and evidence based treatment is still available to you.

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