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

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

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

Fostering Resilience during COVID-19 by Connecting with Our Values

By Annabelle Parr

As we enter Mental Health Awareness Month this year, we are collectively experiencing not only a global health crisis, but also a stressor which has potentially significant repercussions for our mental health. At the very least, we are likely to be experiencing a range of painful emotions as a result of this crisis. On any given day, I find myself feeling at least some combination of the following: anxiety, fear, stress, grief, frustration and/or exhaustion. 

As an Acceptance and Commitment Therapy (ACT) therapist, when I am struggling, I ask myself the question: can I be willing to have this pain, and still choose to move in the direction of what matters most to me? The goal of ACT is to help us to live more vital, meaningful lives even as we struggle with the inevitable pain and discomfort inherent in being human. And goodness knows this pandemic has given us all a whopping dose of pain and discomfort.

But what does a meaningful life look like during a global crisis?

Prior to COVID-19, I felt like I had developed a pretty good sense of how to move toward what matters even when I feel anxiety or fear or frustration. But this pandemic has challenged me. At first, I felt overwhelmed as it seemed the world had turned upside down, and I struggled to find ways to live my values when life suddenly felt so restricted by forces beyond my control.

So I began to consider: how can I continue to move toward what matters most to me, even as life has become more restricted by this pandemic?

A few weeks ago, I was scrolling Instagram and came across a post posing the question: “if someone told you that you could save a life, would you?” The post went on to remind us that we are all being given that otherwise very rare opportunity, and that in staying home right now, we are actually saving lives.

https://www.instagram.com/igo_medical/

After reading this Instagram, it clicked for me: I don’t necessarily have to do anything monumental or new or different right now in order to make significant, values based decisions. Instead, I can consider what I am already doing – like staying home except for essential errands, or wearing a mask and maintaining six feet from others when I do need to go out, or calling and connecting with friends and family – and I can connect these actions with my values.

What are values?

Values from an ACT perspective are a collection of verbs, adverbs, and adjectives that describe qualities of being; a.k.a. who and how do I want to be in the world? For me, a few of my values include being compassionate, conscientious, kind, and loving.

Connecting with our values can infuse the choices we are already making with purpose.

When I connect even the simple action of staying home with being compassionate or loving, rather than becoming fused with thoughts about how terrible, frightening, or overwhelming this all is, I can ground myself in a sense of purpose and meaning beyond my discomfort. And I can bring my values to anything I do: when I call family or friends, I can choose to show up lovingly; when I go to the store, I can offer gratitude to the essential workers I interact with; when I watch my favorite TV show, I can connect with my value of being kind and gentle with myself. The key is being intentional about why I do what I do.

You are enough just as you are.

Navigating a pandemic is exhausting; it demands so much of us already, and additional pressure to do more when just getting through the day feels taxing enough can feel less than helpful. Part of the beauty of ACT is that values based actions are not always huge, monumental gestures; in fact, more often, they are the small, intentional choices we make to show up in a particular moment as the type of person that we hope to be in the world. So rather than beating ourselves up for feeling like we are falling short somehow, we might ask ourselves instead, how can I bring the qualities I hope to embody to the actions I am already taking? How can I connect the things I am already doing back with the kind of person that I hope to be? 

“Those who have a why to live can bear almost any how.”

I keep coming back to the wisdom of Viktor Frankl during this time; as a Holocaust survivor and psychiatrist, he is particularly well suited to guide us through crisis. He noted that “those who have a why to live can bear almost any how,” and I might add that those who have a why to act can bear almost any how. The “how’s” of our day-to-day right now pose a whole host of new challenges for us, but when we can connect with a why behind these challenges, we are likely to meet them with much greater resilience.

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, 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

How to Seek Therapy During Social Distancing and COVID-19: Telehealth Services for Anxiety and Stress Management

by Annabelle Parr

Within just the last week, most of us have gone from living our lives as usual to an entirely new pace of life and day to day routine: working from home, homeschooling cooped up kids, adhering to social distancing guidelines to keep ourselves and our communities safe and healthy, etc. As we navigate the COVID-19 pandemic together (yet apart), we are faced with a number of unique stressors in addition to the ones that we might already have been managing, and this may mean that we are experiencing increased anxiety.

Anxiety and fear are specifically designed to help us prepare for and respond to threats.

As Dr. Jill Stoddard put it in her new book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, & Stress Using Mindfulness and Acceptance, “by simple definition, anxiety is a state of future-focused readiness to deal with potential unpleasant events; this is related to but different from fear, which is a more acute reaction to an in-the-moment perceived threat (Barlow, 2002).” It makes sense that many of us would be experiencing both anxiety – as we are grappling with an enormous amount of uncertainty regarding the future health and financial stability of our nation and our families – and fear, as we are facing an immediate threat to our individual and collective wellbeing.

Feeling anxious right now makes sense. Be gentle with yourself.

One important piece of self-care during this time is to recognize and honor our feelings. Anxiety has a purpose: it is specifically designed to motivate us to prepare to manage threats. It makes sense to feel anxious and afraid. A certain amount of anxiety and fear are adaptive in this situation; they are here to remind us that something is amiss. And stress can help us to adjust our behavior in response. As Kelly McGonigal (2013) pointed out, stress releases a combination of adrenaline and oxytocin, which are hormones designed to prepare us for action and to prompt us to connect, increase empathy, and seek and give care to others. All of these feelings are evolutionary responses designed to kick in in moments like this. So as always, responding to our emotions with self-compassion is crucial.

How do I know if my anxiety has gone too far?

If you are finding that the anxiety and stress you are experiencing during this time are impacting your ability to function – that is, if these feelings are negatively impacting your relationships, your sleep patterns (e.g. causing insomnia or impairing your ability to fall or stay asleep), your ability to attend to tasks needed to care for yourself or your family, or you are finding these feelings overwhelming and are unsure how to cope with them – support is available.  

Can I still seek therapy with social distancing requirements?

Despite the fact that we are required to maintain distance from each other and stay in our homes (except for essential work and errands or a walk/run/bike ride outside maintaining 6 feet between ourselves and others) it is important to know that you can still seek and receive therapy amidst COVID-19. Many therapists, including those here at The Center for Stress and Anxiety Management, have shifted to utilizing telehealth in order to both adhere to COVID-19 guidelines and still attend to patients’ mental health needs. Telehealth sessions expand access to care, as they allow therapists to work with anyone living in the state in which they are licensed (CSAM therapists are available to work with anyone in California). Also important to note is that studies have shown therapy via videoconference to be as effective as in person therapy. It is crucial that those who need support during this time are able to access quality care they need, and telehealth allows mental health providers to ensure it is available.

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, 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

5 Life Lessons From Taylor Swift’s Miss Americana and Acceptance and Commitment Therapy

By Annabelle Parr

In her new documentary, Miss Americana, Taylor Swift not only gives her fans a whole new window into her life, she also beautifully exemplifies a way of being that is remarkably consistent with the principles of Acceptance and Commitment Therapy (ACT).

The documentary takes us through Taylor’s life and her rise to fame. She shares how for the first part of her career, she was consumed with a hunger for approval from others. Her entire persona was built on the premise of being a “good” girl: sweet, agreeable, likeable, pretty, thin, reserved, perfect.

A nice girl doesn’t force their opinions on people. A nice girl smiles and waves and says ‘thank you.’ A nice girl doesn’t make people feel uncomfortable with her views. I was so obsessed with not getting in trouble, I’m just not going to do anything that anyone can say anything about.

In ACT, we would say that Taylor was caught in “self-as-content” mode. She viewed herself as equivalent to the content of her thoughts and the content of others’ opinions about her. She was fused to an idea about who and how she was and had to be. And for good reason. She was and is constantly bombarded with both positive and negative messages about herself from millions of people.

1. We are designed to crave acceptance and connection.

For Taylor, just like for every one of us, there are very good reasons for why we come to view ourselves in a particular way: we exist in a context in which we pick up messages about who we are or how we should be, and our minds latch on to those ideas to try to protect us. Back in our hunter-gatherer days, our literal survival was tied directly to social acceptance and cohesion with the group. So we are hard wired to need connection and acceptance.

2. Often we seek that acceptance out by trying to make ourselves into who we think we are supposed to be.

Taylor, like so many of us, tried to fit herself into the mold of what others wanted from her. However, as Taylor found, this strategy often comes at a high price.

First, it cuts us off from parts of ourselves that are absolutely integral to who we are.

Our wholeness suffers when we are required to squeeze into a box of who we think we “should” be. We lose touch with who we truly are as we seek approval and try endlessly to please others. Taylor notes, “I became the person who everyone wanted me to be.” She literally stopped feeding herself in an effort to make herself small enough to fit into the mold of what was expected of her. 

Second, no matter how desperately we try, we will never please everyone.

Approval from others is a fragile foundation on which to lay our self-worth, because inevitably we will disappoint some people sometimes. Even as Taylor was starving herself, she saw that “there’s always some standard of beauty that you’re not meeting.” There are a number of double binds that are particularly present for women, and they include more than just paradoxical beauty requirements (e.g. be skinny, but also have a big butt). As Dr. Jill Stoddard noted in Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry & Stress Using Mindfulness and Acceptance Strategies, “we are evaluated as less competent when we are seen as likeable; when we are considered competent, we are more likely to be labeled unlikeable (Heilman et al., 2004; Rudman and Glick, 1999)”. This likability bind is another that Taylor is intimately familiar with. As Taylor states so poignantly,

When you’re living for the approval of strangers, and that is where you derive all of your joy and fulfillment, one bad thing can cause everything to crumble…When people decided I was wicked and evil and conniving and not a good person, that was the one I couldn’t bounce back from because my whole life was centered around it.

Most of us are not mega-famous like Taylor, but her words are incredibly relatable for anyone who has ever relied on approval from others to feel okay.

3. The thing is, we cannot avoid discomfort.

It might seem like if we just make ourselves perfect enough, we could avoid rejection or criticism or failure. But even if we could be perfect and avoid all of those things, we then would have to wrestle with the pain of making ourselves smaller to be more acceptable. ACT teaches us that pain is inevitable, and that the problem is not the pain itself but the rigid and inflexible ways we respond to it and the ways we restrict our lives to try to avoid it. 

4. It’s not your fault, and it is your responsibility to do something different if you want to see change.

Taylor describes feeling muzzled for most of her career. She says that it was her own doing, which is true to an extent in that she discovered that she could choose to speak up and be true to who she really is. However, it’s also important to note that she was muzzled by a culture and a context that told her in order to be liked, accepted, successful, and safe, she was not allowed to have an authentic voice. It was not her fault that she was muzzled, but it was up to her to break free. And in doing so, she is setting a powerful example for other women, pop star and otherwise, that authenticity and success are not mutually exclusive. She is helping to shift a culture that has muzzled women for centuries.

I want to wear pink and tell you how I feel about politics. And I don’t think that those things have to cancel each other out.

5. Our values can help set us free.

As viewers watch Taylor descend into isolation and depression resulting from others’ negative opinions of her, we also see her begin to change and grow in really powerful ways. She transforms from the stereotypical picture of a “good girl” into a bold, strong, mighty, authentic woman. She is no longer driven by the opinions of others, but grounded in what is important to her: being present with her family and her partner, and using her voice to stand up for what she believes in. She displays a willingness to risk rejection and discomfort in the service of speaking up for women, the LGBTQ+ community, sexual assault survivors, and minorities. She is often advised to stay small and quiet, but chooses instead to be true to who she is.

ACT in ACTion.

In cultivating a willingness to risk pain and rejection, getting present to who and what matters most, and recognizing she is far more than the stories told about her, Taylor is able to make choices in line with her own authentic, personally held values. The documentary finishes with Taylor saying,            

I want to still have a sharp pen and a thin skin and an open heart.

This last piece of wisdom is important: the key is not to stop caring, but rather to get grounded in who you are and what you care about. Our pain points us toward our values. It hurts precisely because we care. Vulnerability is a strength, and it is only when we are willing to risk discomfort that we are truly able to connect with what matters.

Rather than let her experiences and her pain harden her, Taylor allowed herself to feel her feelings and to use them as fuel to get clear on who she wants to be in the world. Her thin skin and open heart are not only the things that give her songwriting such power, but also the things that empower her to stand strong in herself even when it isn’t easy or comfortable.