Getting Comfortable Being Uncomfortable

By Annabelle Parr, MA, AMFT

One of the main goals in Acceptance and Commitment Therapy (ACT) is to help clients get comfortable being uncomfortable. This may sound strange at first, after all isn’t therapy meant to help alleviate suffering? So why would an evidence-based treatment model suggest that we get comfortable being uncomfortable?

Because the struggle to get rid of pain often comes at a cost.

When our energy and attention are wrapped up in trying to move us away from discomfort, several things typically happen:

1. First, the attempt to avoid discomfort or anxiety works. We get an instant sense of relief. This is really rewarding to our brains and our bodies, and because it is so rewarding it can make us more likely to choose that avoidance again in the future.

2. But relief is usually only temporary. In the long run, anxiety finds a way of returning. And when it comes back, it is sometimes even stronger than before. When we avoid the things that make us feel anxious, we reinforce the story our minds tell us that anxiety is unmanageable and that we are in danger.

3. Third, and possibly most importantly, in the fight to try to make anxiety go away it’s easy to lose sight of what is most meaningful and important to us in our lives. Our behavior becomes about trying to get rid of discomfort rather than about being present to and doing the things that matter to us.

There is a Buddhist saying that helps explain the high price of avoidance:

Pain x Resistance = Suffering 

Anxiety and other painful emotions are really uncomfortable, and they are an inescapable part of the human experience. When we try to resist or avoid that pain, instead of allowing it to be as it is and continuing to engage in valued actions, our discomfort escalates into suffering. Maybe that suffering looks like worrying about the fact that we are anxious. Maybe it involves our minds beating us up for the fact that what we are experiencing is not easy, the way it seems to be for others. Maybe that suffering involves feeling unable to connect with something important to us. When we choose a different response and drop the resistance to our pain, we can reduce that suffering.

The alternative to resistance is willingness.

Willingness is getting comfortable being uncomfortable and allowing our internal experience to be as it is without trying to control or change it. When we are no longer caught trying to wrestle with and get rid of our anxiety, we get to choose what we do instead.

• We can decide to be brave and take a flight to go visit family we haven’t seen in years.

• We can decide to be vulnerable and go out on a first date.

• We can decide to be bold and ask for a raise.

• We can decide to take care of ourselves and schedule that check up, or take care of others and go donate blood.

• We can love more deeply, fully, and wholeheartedly when we are willing to allow the possibility or even the probability that we may one day lose those we love.

When we are comfortable being uncomfortable, our life expands. We can allow ourselves to care deeply about what matters most in our lives. We get to make a choice about who and how we want to be in the world, and about what actions are important enough to us to allow ourselves to feel the pounding heart, sweaty palms, shaky legs, racing mind that comes with anxiety.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, uncertainty or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Lessons from Traveling in Time

By Annabelle Parr, MA, AMFT

Have you ever wished you could have a do over? Go back in time and alter an embarrassing moment, or seize a missed opportunity, or simply get more time to do the things that matter most to you?

What might we learn if we could travel back in time and do things differently?

Every year around New Year’s, I watch my favorite movie, About Time. It’s a rom com about a man who learns that the men in his family can travel back in time within their own lives, and it is filled with sweetness and some profound messages that are remarkably consistent with the core principles of Acceptance and Commitment Therapy (ACT). If you haven’t seen the film, warning: spoilers ahead. In his travels through time, Tim, the main character, learns a number of lessons about creating and living a full, vital life.

Lesson #1: Traveling in time gives you unlimited chances to behave differently, but the outcome of your behavior is still always beyond your control.

Upon learning that he has the ability to time travel, Tim quickly clarifies that what matters most to him is love (values), and what he most wants to use this unique ability to achieve is finding someone with whom to share his life (goal). One of the first things he learns is that even with the ability to go back in time and try things differently, he ultimately cannot control the outcome of his behavior, just like the rest of us. He can pursue his goal by showing up to each moment bringing the qualities he most wants to embody (values), but the outcome of his actions is outside of his control. He may get to test things out more than the rest of us, and may gather more information on what behaviors may make a particular outcome more likely, but just like the rest of us, in the end, the outcome is still beyond his control.

Lesson #2: All the time travel in the world can’t erase pain.

Nevertheless, Tim continues to show up to each moment fully (present centered awareness), holding his goals for the life he hopes to build lightly and being the kind, loving, humorous man he hopes to be (committed actions), and ultimately he does build a beautiful life and family filled with love. As he does so, he learns that even his gift cannot shield him from the pain that comes with being human. Just like the rest of us, if he wants to engage in the joys, he must also be willing to have the pain that is inevitable if we are willing to care, to love, and to be loved (willingness).

Lesson #3: The secret to a rich, meaningful life is being fully present and choosing how you will meet each moment. 

Toward the end of the film, Tim shares my favorite lesson of all. He shares his father’s secret to a good life. His father tells him to live each day twice: “the first time with all the tensions and worries that stop us noticing how sweet the world can be, but the second time noticing.” In the simple act of noticing (present centered awareness), and making a conscious decision about how he responds (committed action), Tim finds how much richer and fuller life can be.

The film finishes with Tim sharing,

“And in the end I think I've learned the final lesson from my travels in time; and I've even gone one step further than my father did. The truth is I now don't travel back at all, not even for the day. I just try to live every day as if I've deliberately come back to this one day, to enjoy it, as if it was the full final day of my extraordinary, ordinary life.”

In this final lesson, Tim sums up the goal of Acceptance and Commitment Therapy: to meet each day fully, with openness to whatever shows up and awareness of our experience, and to choose to actively engage in each moment with the qualities that we most hope to embody. When we are fully present, we begin to notice all of the opportunities we have to engage in our lives as the people we most hope to be. As Tim discovers, we don’t actually need time travel at all; the moments we are given are already full of opportunity to be who we most hope to be right now.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, uncertainty or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

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/

Let’s Talk About Anxiety

by Annabelle Parr

Anxiety is a hot topic these days. It’s all over the news, and apparently it is on the rise. In the age of information and technology, we are constantly bombarded with doom and gloom news alerts, including reminders that on top of everything else, we are plagued with increasing anxiety. Eventually, these reminders can get exhausting and may even contribute to the anxiety that is apparently so prevalent in the first place.

Image source: https://www.theodysseyonline.com/poems-read-anxiety

Of course, there are benefits to all this conversation around anxiety: we have a better understanding of what anxiety is and as a result we may be able to understand and empathize with those who are struggling better. But it’s important to be careful that we don’t pathologize all anxiety, and that we don’t lose sight of the strength that exists in those who truly do have anxiety disorders.

Anxiety: Natural Response to Stress or Disorder?

The way we talk about anxiety today, it is easy to believe that all anxiety is inherently bad and forget that it’s our natural response to threat or danger. We actually need anxiety to survive; it prepares our body to respond appropriately in the face of danger. However, our physiological experience of anxiety developed back when the regular dangers humans faced included running from large, sharp toothed predators. So when we are experiencing the fight-or-flight response before a big exam or presentation, it may not feel particularly adaptive. But despite the discomfort that comes with anxiety, it is natural when it is experienced as the result of a particular situation or problem, when it is proportional to the stressor, and when it only lasts until the situation is resolved (ULifeline, 2016). Anxiety, though often painful, is an important and adaptive part of the human experience.

Image source: aconsciouslifenow.com

Though originally an adaptive response, anxiety does have the potential to be harmful when it manifests as “constant, chronic and unsubstantiated worry that causes significant distress, disturbs your social life and interferes with classes and work” (Active Minds, 2016). In other words, anxiety is no longer helpful when it begins to appear when there is no actual threat present. When a person experiences anxiety but has no threat to respond to, what happens? They begin avoiding situations that are actually safe. Their mind and body are telling them that safe situations are threatening, which can have a debilitating effect. When anxiety becomes disordered, it arises unexpectedly, is overwhelming, and, rather than catalyzing adaptive behavior in the face of a threat, often fosters avoidance of everyday situations (Here to Help, 2016).

Image source: http://www.huffingtonpost.com/2015/05/18/anxiety-photos-katie-crawford_n_7292548.html

So what is the takeaway? Anxiety is uncomfortable, but it helps us respond to threat, uncertainty, trouble, or feelings of unpreparedness (Active Minds, 2016). Anxiety becomes a problem (and possibly a disorder) when it comes seemingly out of nowhere and in the absence of a stressor proportional to the response, and it interferes with functioning in some way.

Recognizing Strengths as well as Struggles

There is no denying that feeling anxious is not pleasant. It can range from uncomfortable to unbearable. For those with anxiety disorders, anxiety is unpleasant on a whole new level; it can be completely overwhelming and paralyzing. It is hard to describe how out of control one can feel in the middle of a panic attack, or how draining it is to go through the day (week, month, or year) flooded with anxiety.

But in the midst of this struggle, it’s important to remember that anxiety doesn’t own you. It may be a part of you, and it may influence your life in various and profound ways. But anxiety does not determine who you are. A diagnosis does not define you. You are not a disorder. You are not weak, powerless, or alone.

Image source: http://quotesgram.com/from-brene-brown-quotes/

Acknowledging the pain anxiety can bring is so important, but it can also be helpful to recognize that struggling with anxiety may also foster certain strengths. According to Dr. Tracy Foose (2013), trait anxiety is associated with being “highly conscientious, honest, detail oriented, performance driven, socially responsible, [and] self-controlled.” Furthermore, learning to cope with anxiety can push us towards an increased self-awareness and knowledge of ourselves. Because it is so uncomfortable, it can motivate us to grow and change parts of ourselves or our lives that may not be serving us. And once we learn that we can move through the discomfort of anxiety, we often feel stronger and more confident in ourselves knowing that we have the fortitude to move through something so profoundly difficult (Sutherland, 2011).

Finally, if you do feel like anxiety is controlling your life, you don’t have to stay stuck in this space. Not only can anxiety teach you to embrace vulnerability and reach out for support from loved ones, but therapy offers very effective treatment. Cognitive Behavioral Therapy and Acceptance and Commitment Therapy can teach valuable coping skills, and can help to change your relationship to anxiety. Nothing will ever take anxiety away completely, but we wouldn’t want that because without anxiety, we wouldn’t survive. But therapy can help us learn that even in the worst throws of anxiety, we will survive, and even thrive.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), 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.

References:

Active Minds. (2016). NSOD: Difference between normal anxiety and an anxiety disorder.  Retrieved from: http://www.activeminds.org/component/content/article/512-nsod-difference-between-normal-anxiety-and-an-anxiety-disorder

Foose, T. (2013, Feb. 19). Positive traits seen in anxiety disorders. SF Gate. Retrieved from: http://www.sfgate.com/health/article/Positive-traits-seen-in-anxiety-disorders-4291474.php

Here to Help. (2016). What’s the difference between anxiety and an anxiety disorder?  Retrieved from: http://www.heretohelp.bc.ca/ask-us/whats-the-difference-between-anxiety-and-an-anxiety-disorder

Sutherland, M. (2011). The Benefits of Anxiety. Retrieved from: https://willowtreecounselling.ca/articles/the-benefits-of-anxiety/

ULifeline. (2016). Anxiety vs. anxiety disorders. Retrieved from: http://www.ulifeline.org/articles/439-anxiety-vs-anxiety-disorders

The Importance of Clinical Research

By: Sarah Bond

Clinical research is fundamental to the advancement and understanding of the field of psychology.  It is important not to underestimate the significance that clinical research has had upon the development and implementation of psychological interventions.  This is accomplished by randomly selecting a subset of the population to serve as a sample in which the potential effect(s) of a given variable are observed.  Clinical research provides practitioners and researchers with insight into the effectiveness of the associated variable(s) under study.  It helps us examine isolated factors that may not be clearly evident outside of a controlled setting.  For example, we may examine the clinical treatment outcome of a specific intervention to determine whether or not it is an effective treatment for a given disorder.

In order to further advance standards of care, we must compare current treatment options to novel interventions.  This challenges us to continuously advance our understanding of the most relevant and beneficial treatments available for our clients.  We have an ethical obligation to ensure that we understand how a given intervention will likely influence the treatment outcome prior to determining the best approach to utilize when helping a client.

Clinical studies provide findings that allow practitioners to analyze data and generalize interpretations to help their clients.  For instance, both cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have been indicated by clinical research to be efficacious treatments for anxiety disorders as well as many other conditions (e.g., depression, chronic pain, eating disorders).  Clinical research provides a means for psychologists to determine the best type of treatment for their clients.

Most clinical studies utilize human participants.  There are strict ethical guidelines set forth by the American Psychological Association (APA) that must be ensured prior to and throughout administration.  For this reason, all academic research studies must submit a research proposal to be reviewed by the respective university’s Institutional Review Board (IRB).  In doing so, the IRB is obligated to determine whether or not a given study is ethical prior to implementation.  During the study, participants are asked to sign an informed consent, which is similar to a contract.  It thoroughly explains the intention and potential risks associated with the study.  If any deception is used, it is mandatory to debrief participants following administration.

In essence, clinical research is important to providing optimal client care.  It not only deepens our understanding of current practices, but it also helps us advance and learn about new treatment options that can potentially improve treatment outcomes.  We depend upon clinical studies to help us understand how different variables influence our daily lives.

If you are interested in being a participant in clinical research, you can visit https://www.facebook.com/Paidresearchsandiego.

Tags: San Diego, psychology, psychologist, research, clinical research

Warning Signs of Mental Illness

by Sarah Bond

Living in a Western society, it is considered part of our yearly routine to visit our primary care physician, dentist, and optometrist for yearly check-ups. While the aforementioned doctors are important and play an active role in managing our health, it is crucial that we do not minimize the significance of other medical professionals, such as those in the field of mental healthcare. Unfortunately, there are many people who are living with distressing symptoms without an awareness that they are afflicted with a mental disorder.

A mental illness can be defined as a “health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning” (NIH, 2005, p. 1).  According to the NIH (2005), approximately one in four Americans are known to be impacted by mental illness. Thus, it is likely that either you or someone close to you has suffered from the symptoms of a mental illness in some way. Data indicate that mental disorders account for four of the 10 most predominant causes of disability in America (National Institutes of Health, 2005).

While the symptoms vary in intensity from one person to another, ranging from mild to severe, they cause unnecessary problems for people that can be managed or treated with appropriate care. Thus, it is critical to raise awareness about mental healthcare, so that more individuals will take action and seek the care from mental health professionals that can alleviate unnecessary distress from their daily lives. Although mental disorders each have their own set of specific symptoms, the NIH (2005) has created a list of “general warning signs” that can be used as a guide to help you determine whether someone should seek professional help (p. 1).

“Warning Signs” from the NIH (2005):

• Marked personality change
• Inability to cope with problems and daily activities
• Strange or grandiose ideas
• Excessive anxieties
• Prolonged depression and apathy
• Marked changes in eating or sleeping patterns
• Thinking or talking about suicide or harming oneself
• Extreme mood swings—high or low
• Abuse of alcohol or drugs
• Excessive anger, hostility, or violent behavior

If you or a loved one has experienced any of the previously mentioned “warning signs,” or if you are interested in learning more about your current state of mental health, then contact a local mental healthcare professional. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in stress and anxiety problems, please contact us.

Reference

National Institutes of Health. (2005). The science of mental illness. Retrieved from http://science.education.nih.gov/supplements/nih5/mental/other/copyright.htm

Tags: anxiety, CBT, psychologist in san diego, mental health tips, therapy in san diego, PTSD san diego, warning signs