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

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

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.

How Do I Know If I Need Therapy?

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

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, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Mental Health Awareness Month

by Annabelle Parr

Since 1949, May has been designated as Mental Health Awareness Month. Given that 20% of U.S. adults will experience a mental health condition in their lifetime, having conversations about mental health and the resources available for those who are struggling is incredibly important.

Risky Business

This year’s mental health theme focuses on “Risky Business.” Mental Health America is working to start a conversation around risky behaviors that may increase the chance of developing mental illness or that may accompany an existing mental health issue. The specific behaviors they are focusing on are: marijuana use, risky sex, prescription drug misuse, internet addiction, compulsive buying, and exercise extremes.

Our State of Mind Impacts Our Emotions and Our Behavior

It’s important to understand that mental illness consists not only of difficult emotions, but also includes behavior changes or an impairment of functioning in day to day life. Such behavior changes can manifest as either avoidance of certain situations and/or engaging in new behaviors to attempt to numb or escape the pain that accompanies the mental health problem. Neither avoidance nor risky/numbing behaviors will resolve the mental health concern; they provide short term relief, but actually serve to maintain and worsen the situation in the long run.

Evidence Based Therapy

If you are concerned that you are struggling with a mental health problem or if you are overwhelmed with feelings of stress, anxiety, or depression and aren’t sure how to cope, seeking professional help can be a good place to start. A therapist can offer support and help you to work through those things that you are struggling with. He or she can also help you address any behaviors that may be impairing your ability to function in life, work, or your relationships.

Evidence based therapies including Cognitive Behavioral Therapy and Acceptance and Commitment Therapy have been scientifically demonstrated to effectively treat anxiety, depression, and many other emotional and physical difficulties.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) involves helping clients learn to identify and modify unhealthy, unhelpful, or inaccurate thoughts and unhealthy or unhelpful behaviors that serve to maintain emotional difficulties. Gradual, repeated exposures to feared situations also help clients learn to face that which they may have avoided previously. CBT challenges clients to face difficulty in the context of a warm, safe, therapeutic environment.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) also involves reducing experiential avoidance behaviors, but differs from CBT in that it focuses on accepting difficult thoughts and feelings in order to live a meaningful, values-based life. ACT challenges clients to embrace difficulty in the context of a warm, safe, therapeutic environment.

The Human Condition

Whether or not you find yourself in the 1 of 5 adults struggling with mental health, all of us will face pain, difficulty, and struggle at some point or another. Asking for help in the midst of struggle is a sign of strength, not weakness. One of the beautiful things about suffering is that it can lead to connection when we let those we trust in on our pain. While it can be tempting to turn to those risky behaviors listed above, we only exacerbate our problems by doing so. In turning to a trusted loved one or a professional, we can begin to find meaning and healing in the midst of pain and suffering.

CSAM IS HERE TO HELP

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