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

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 Tools: An Expert's Advice

reposted from Healthline.com

originally written by Healthline Editorial Team featuring an interview with CSAM Director Dr. Jill Stoddard

Anxiety disorders affect over 18 percent of U.S. adults each year, according to the National Institute of Mental Health. This includes generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and more.

Anxiety can work its way into many aspects of a person’s life, which is why it’s so important to find the resources, support, and advice you need — whether it comes from people’s stories, helpful phone apps, or expert advice.

Dr. Jill Stoddard is the founding director of The Center for Stress & Anxiety Management, an outpatient clinic in San Diego specializing in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety and related issues. She’s also an associate professor of psychology at Alliant International University, and the co-author of “The Big Book of ACT Metaphors.”

We caught up with her to learn about some of the ways she recommends for managing anxiety disorders.

Dr. Jill Stoddard’s advice for anxiety

1. Use your senses

Anxiety narrows your focus onto perceived threats (i.e., whatever you’re feeling afraid of or worried about in the moment) which can impact your focus and memory. Practice mindfully broadening your view by using your senses — what do you see, hear, smell, etc. — to improve attention and experience.

2. Have gratitude

Practice gratitude as another way to broaden your focus. There are the things that you worry about, and there are also the things you’re grateful for.

3. Be accepting

Difficulty with uncertainty and a lack of perceived control amplify anxiety. To “fix” this, we often attempt to get more certainty and more control — for example, by doing internet searches about health symptoms. This actually increases anxiety in the long run.

The antidote is acceptance of uncertainty and control. You can read a book or watch a sporting event without knowing the ending. In fact, it’s the anticipation that makes it exciting! So try bringing this attitude of openness to not knowing, and letting go of control. See what happens.

4. Face your fears

Avoidance is anything you do, or don’t do, to feel less anxious and prevent a feared outcome from occurring. For example, avoiding a social situation, using drugs or alcohol, or procrastination are all examples of avoidance.

When you avoid what you’re afraid of, you get short-term relief. However, this relief never lasts, and before you know it, that anxiety has returned, often with feelings of sadness or shame for having avoided it. And often, the exact avoidance strategies you’re using to feel better and prevent a feared outcome (e.g. reading off your notes during a speech or avoiding eye contact) actually create the outcome you’re trying to avoid (namely, appearing anxious or incompetent).

Consider taking small steps to start facing your fears. What’s one thing you might do that takes you out of your comfort zone? You will build mastery and confidence, and your anxiety might even diminish in the process.

5. Define your values

Do some soul searching about what really matters to you. Who do you want to be? What do you want to stand for? What qualities do you wish to embody as you engage in work or school, or interact with people you care about? If friendship matters, how can you create space in your life for that? When you do so, what qualities do you wish to embody as you spend time with friends? Do you wish to be authentic? Compassionate? Assertive?

These are all values, and making choices in line with values — rather than in the service of avoidance — may or may not impact your anxiety, but will definitely add richness, vitality, and meaning to your life.

Healthline’s tips

To help you keep your anxiety in check, Healthline also recommends trying out the following products in your day to day:

• Add some lavender essential oil to your lotions and soaps, use as an air freshener, or rub small diluted amounts onto your neck or feet.
• Take Kavinace supplements, which can help with anxiety-related sleep issues.
• Try practicing self-guided meditations that emphasize self-compassion.
• Get some relaxing sounds from the Stress Relief Collection.
• Check out biofeedback therapy. Some people find it to be an effective tool in managing anxiety. Use the BCIA directory to find a certified practitioner.

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/

The Case for a Value-Driven Life

By Lauren Helm, M.A.

“Values are what you want your life to be about, deep in your heart. What you want to stand for. What you want to do with your time on this planet. What ultimately matters to you in the big picture. What you would like to be remembered for by the people you love.” – Dr. Russ Harris

What guides you in deciding how to act from moment-to-moment, and day-to-day?  When you come to a fork in the road, how do you decide which direction to go?

Many of us may be unaware of the processes that underlie our daily actions and the forces that shape how and why we make the decisions that we do. Often we may just go through the motions, paying little attention to what we are doing and what is happening around us. We go through the routines:  get up in the morning, have breakfast, brush teeth,  go to work, come home, make dinner, go to sleep…and repeat. Sometimes we may reflect on the day and wonder where our time went, feeling almost as though we were not really there. Have you ever driven somewhere, only to realize once you’ve arrived that you barely remember driving at all? It can be as though we were merely on automatic-pilot, with little attention devoted to “steering” ourselves throughout our lives.

And yet, there are times when life really DEMANDS our attention; when it quite literally forces us to focus on the issue at hand. Life is full of flux and change; there are sorrows and pain, joys and celebration. What then? How do you decide how to respond?

When we have little conscious awareness of who we are and who we want to be, we can act quite haphazardly. Automatic-pilot does not necessarily turn off.  If something stressful or threatening happens, we may react reflexively. Perhaps a loved-one makes a comment that rubs us the wrong way, and we lash out. Maybe we have been assigned an important project, and the deadline looms in the near-future, but we automatically procrastinate and avoid thinking or doing anything about it until the last minute because it is anxiety-provoking.

In a sense, automatic or reflexive behaviors can be thought of as “mindless.” There is little conscious or intentional thought behind them. They are like habitual ways of responding to life. However, not only does a “mindless” approach not create the fullness of life that many people desire, it also can get us into trouble when challenging situations arise. For example, most of the time we automatically avoid uncomfortable or painful situations. It makes sense that human beings would avoid pain. Avoidance of pain or threat has allowed us to survive as a species –  avoidance of tigers and bears kept us alive. However, in our modern age, we rarely, if ever, encounter predators that threaten our survival. Threat and discomfort tends to show up for us in our jobs, relationships, traffic, social activities, etc. What if “mindless” avoidance of discomfort costs you a sense of meaning in life? What if it interferes with or prevents you from engaging in activities or life experiences that are deeply rewarding to you, albeit challenging or difficult at times?

If this has been your experience, it may be time to pause and clarify your values. Your values help define who you want to be in each moment. What you value is what gives your life meaning. When we are disconnected from our values, we can go through life somewhat aimlessly and “mindlessly.” But when we take the time to learn about what is really important to us, we can give ourselves a great gift. By knowing your values, you can begin to craft your day-to-day experience in a much more conscious, intentional way. In a way, it can be a creative process. You get to decide during each metaphorical fork in the road, who you want to be and what you want your life to be about.

“What if what was at stake is a kind of self-liberation -- the liberation to be about what you most deeply would choose to be about--- not to avoid guilt, or get applause, or otherwise objectify yourself but just to be in the world how you choose to be in the world.” - Dr. Steven Hayes, co-developer of Acceptance and Commitment Therapy

Dr. Jill Stoddard likes to ask, “What is this in the service of?” This is an exceptionally helpful question to ask yourself during the mundane activities of life, and during the momentous ones. Is what you are doing serving to avoid discomfort? Or is what you are choosing to do serving you in living a valued-life? The practical nature of identifying your values is that you can begin to create action-plans and goals that line up with your values, instead of goals that purely focus on fending off the pain that inevitably is a part of life. The fact is, pain IS a part of life, and so is joy. Life is a myriad of experiences. We can live meaningful lives when things go smoothly, and even when life feels like a bumpy ride. It is up to us, however, to decide if we want to consciously respond to life and take back the steering wheel. We can begin with our values. Who do you want to be today?

If you'd like to speak with a professional at the Center for Stress and Anxiety Management about clarifying your values and living a more meaningful life, please click here.

Check out these free resources on values and related topics: 

http://media.psychologytools.org/Worksheets/English/Values.pdf

http://www.thehappinesstrap.com/upimages/the_complete_happiness_trap_worksheets.pdf.pdf

http://www.thehappinesstrap.com/free_resources

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References

Harris, R. (2007). The happiness trap: Stop struggling, start living. Exisle Publishing.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.

Tags: acceptance and commitment therapy, ACT, Center for Stress and Anxiety Management, values, steven hayes, CSAM, meaning, fulfillment, mindful, pain, life, Russ Harris, personal values, mindless, avoidance, automatic pilot