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

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.

Finding the Right Therapist for You

by Annabelle Parr

Therapy can be incredibly helpful and healing in the midst of struggle, but it’s not “one size fits all” and sometimes it can be challenging to find the right fit. If you have tried therapy before and been frustrated by a lack of progress, it’s possible you haven’t found the right therapist for you. Having some knowledge about therapy and the different options available can help when you are seeking out help.

What do therapists do?

A therapist’s role is to provide you with empathy, help you learn healthy coping methods and give you tools to manage your emotions constructively. They are there to help you connect with your personal values and get in touch with your own internal strength, while offering you compassionate support and understanding along the way. They are like “training wheels” to help you learn to engage in life in a new way.

What don’t therapists do?

They are not there to pass judgement, minimize your feelings, or offer you advice. No advice means that they are not there to make decisions for you, such as whether or not to stay in a relationship or a job; they can, however, assign you homework to help you make progress and teach you coping mechanisms.

If you ever feel judged or like your therapist is minimizing your feelings, discuss this with them. This will allow you to discern whether you misunderstood their message or whether maybe they are not the best fit for you. It is important to talk with your therapist about the therapeutic process itself, especially if something feels off.

Note: therapy can be helpful and it can be hard.

Therapy is challenging. It requires active work on the part of the client and it requires facing uncomfortable and painful emotions, and likely making difficult changes. As James Hollis (1998) notes, “no one enters the therapist’s office whose adaptive strategies are still working.” So sometimes, clients may feel worse before they feel better because change is inherently uncomfortable. This kind of “feeling worse” is a vital part of the growth process, not a further descent into the same struggle that brought you into the office.

If it feels like you have tried various therapies or therapists, and have not progressed despite your commitment to finding help and engaging in the therapeutic process, you may not have found the right therapist yet. Here are some things to look for when seeking therapy.

1. Connection with the therapist. Therapy requires that you let another person in on your innermost thoughts and feelings. This is not an easy thing to do, so it is important that you feel comfortable with the person you choose. Research shows that the therapeutic relationship itself is the most important aspect of therapy – accounting for about 30% of the variance in treatment outcome, which is more than any other factor including the technique the therapist uses. So make sure that the therapist you choose to see is someone you trust and whom you are willing to talk to. If it doesn’t feel like the right fit, it probably won’t be.
    
2. The therapist’s areas of expertise. While the relationship is the most important piece of therapy, specialization and technique are still very important pieces of the puzzle. When looking for a therapist, make sure to search for someone who has experience working with individuals dealing with your particular concerns. Otherwise, you may end up wasting time and money working with someone who might not conduct a proper assessment, or who does not have experience working with your particular issue. Ask them about their experience working with others who have concerns similar to yours, including the techniques they use and the degree of progress and healing that they typically see in their clients.
    
3. Evidence based treatments. There are lots of different treatment options out there; a good place to start is searching for a therapist with true training in modalities that are supported by solid research (such as Cognitive Behavioral Therapy or Acceptance and Commitment Therapy). Ask questions about their training and choice treatment modalities, what a typical session will look like, how your individual needs will be addressed, whether you will receive homework, what will be required of you in the process, how your progress will be evaluated, and what steps will your therapist take if they find that your progress has prematurely plateaued.

If you are struggling and considering reaching out for help, this knowledge can help you navigate choosing a therapist and can help you recognize sooner rather than later if it’s not the right fit. If you have tried therapy before and have been frustrated by a lack of progress, you are not alone. Remember, effective help is available when you know what to look for.

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

References: 

Hollis, J. (1998). The eden project: In search of the magical other. Toronto, ON: Inner City Books.

Trauma, Panic, and EMDR: Eye Movement Desensitization and Reprocessing

by Annabelle Parr

When you search Google Images for “therapy,” the first thing that comes up is a client laying on a couch talking, while the therapist listens and takes notes. Therapy typically does involve a fair amount of talking and listening, but rarely is it that simple. For example, cognitive behavioral therapy (CBT) is a talk-based form of therapy that involves an active approach where therapist and client work together to change unhelpful thoughts and behaviors that affect the client’s mood.

Though most psychotherapy is talk-based, there are a few exceptions. One form of therapy that is particularly unique and relies on little talking is known as EMDR, or Eye Movement Desensitization and Reprocessing.

What is EMDR?

EMDR is a form of psychotherapy often used to treat trauma, where the therapist asks the client to imagine the distressing event while simultaneously engaging the client in some sort of bilateral stimulation. Typically, this involves therapist directed eye movements from one side to another, but it can also involve taps or tones.

How and why does EMDR work? 

It can be difficult to imagine how therapy might work without relying on much talking. But sometimes we cannot access all of the information that our brain has stored. If we can’t access it, we can’t talk about it. And sometimes, we can rationally understand something, but still feel stuck in painful emotions.

Trauma can be particularly difficult to process because the frontal lobe (the part of the brain involved in higher level processes, like thinking and language) is not always able to fully access the traumatic memory. So we can try to wrestle and reason with it, but find ourselves frustrated by a lack of progress as far as our emotional response goes. EMDR purports to help us approach trauma from a different angle, so that the brain actually reprocesses the way the trauma is stored.

EMDR changes the client’s relationship to the trauma.

Clients tend to find that their thoughts and feelings around the traumatic memory change fairly quickly with EMDR (EMDR Institute, Inc., 2016). There is often a deeper sense of being able to cope with trauma on an emotional level.

EMDR is now offered at CSAM.

CSAM is excited to announce that Dr. Terra Fuhr is now certified in EMDR. Dr. Fuhr explained that she decided to pursue certification because she saw several colleagues find great success using EMDR. Then she began to occasionally refer clients for simultaneous EMDR treatment, and saw firsthand the remarkable healing that it facilitated. She found that EMDR helped clients break through in places where they got stuck using only CBT. This effect was so powerful that she felt inclined to add EMDR to her mental health tool belt as a modality to help her clients, so that now she can offer EMDR in conjunction with CBT and ACT.

What can EMDR be used to treat? 

EMDR was originally used to treat trauma and PTSD, but today is applied to numerous other issues. Dr. Fuhr describes how helpful it can be in treating panic disorder. One reason for this is that clients’ most severe panic attack is stored as a trauma. Using EMDR to heal the trauma of panic can be enormously helpful in helping the client break out of the panic cycle. It can also be applied to “small traumas,” like an embarrassing moment, negative thinking patterns or feelings such as low self-esteem (EMDR Institute, Inc., 2016).

While there is some debate in the scientific community regarding the how and why EMDR helps, studies have offered support for its efficacy, and over the 25 years that it has been in existence, millions of people have been successfully treated using EMDR (EMDR Institute, Inc., 2016). EMDR can be offered on its own, or in conjunction with CBT or ACT. For some clients, it can be a helpful adjunct to their healing process.

CSAM IS HERE TO HELP

If you or someone you love might benefit from eye movement desensitization and reprocessing (EMDR), 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.

For more information about Eye Movement Desensitization and Reprocessing, visit The EMDR Institute.

References:

EMDR Institute, Inc. (2016). What is EMDR? Retrieved from: http://www.emdr.com/what-is-emdr/

A ‘Yes’ Community

a guest blog repost by Dr. Nic Hooper

Two days ago, Thursday June 1st 2017, an article in The New Scientist magazine was published that I co-wrote. It is a great achievement because it will be one of the largest impact writings about Relational Frame Theory (RFT) i.e. it is possible that more people will lay their eyes on this article than for any other RFT article that currently exists.

At a personal level it feels like a big deal; it feels like an ‘I made it’ moment. And, of course, ‘I made it’ moments matter only because of the history of moments where me making it wasn’t, by any means, a sure thing. I think of my A-Levels where I studied like hell for Psychology and scraped a B. I think of the first two years of my degree where my average mark was 57 (see picture below) and I think of starting my self-funded PhD where some members of staff in the Psychology Department weren’t happy about me being accepted onto the program because I wasn’t ‘PhD material’. How the hell did I, an average boy from a working class family, make it to a point in my life where I publish in a magazine that has a readership of over 100,000 people?

The answer is quite simple. When I was 20, I started reading a book about a new approach to human suffering named Acceptance and Commitment Therapy (ACT). This is when everything changed for me. Prior to this point, unhelpful thoughts and feelings heavily influenced my decisions. Sure, they kept me in a comfort zone where I was safe but in that comfort zone I could make no progress towards the things that were important to me.

Have you seen the film ‘Yes Man’ with Jim Carrey? The film documents how a man’s life changed when he started saying ‘yes’ to everything. It’s a cool idea and following what I learned about ACT it is pretty close to the way I began interacting with the world. Of course, I differ from ‘Yes Man’ in that if someone asks me to steal a pig from a farm and paint it green then I wont say ‘yes’ (most of the time). However, if someone asks me to do something that is in line with my values, and provided this something wont infringe too much on my ability to self-care, then I say ‘yes’.

Over the years I have especially said ‘yes’ when the offer made me feel uncomfortable or when my mind fed me thoughts like: ‘You’re going to get found out – you’re not smart enough to do this’. My values guided my decision-making. Yes to a PhD, Yes to presenting my work at international conferences, Yes to travelling to the US to meet people like Steve Hayes and Kelly Wilson, Yes to lecturing in Cyprus, Yes to writing a book, Yes to going to the ACT Dublin Conference, Yesto meeting up in Bristol with some people I met at that conference, Yes to setting up an ACT centre with those people, and Yes to trying to write this New Scientist article with those people. Sure, it wasn’t plain sailing and it brought me plenty of failure and discomfort along the way but there is no doubt that I am where I am because of how readily I said ‘yes’. And I was able to say ‘yes’ because ACT taught me that saying ‘yes’ to things that are important to you, even when they bring discomfort, is a way of living that brings liberty and fulfillment (see any recent work by Aisling Curtin and Trish Leonard to learn more about ACT inspired comfort zones).

I guess you might be wondering why I am telling you these things. Well, for two reasons. Firstly, I wanted to advocate for ‘yes’ living because of the positive effect it has had on me. However, secondly, and more importantly, I wanted to make a prediction for the future. Here I am, one average person, who became introduced to ACT, started moving outside of his comfort zone when his mind told him that he wasn’t worthy or capable, and started to achieve remarkable things (relative to what I thought was possible). But I am not the only person in the ACT community with that story. You see the thing about ACT is that it isn’t an approach you ‘do’ to other people; it is an approach that starts with oneself. So here is my prediction: ACT will get bigger and will stay the course. I don’t think this will happen because ACT will win therapy wars with 1000’s of studies (those wars don’t have winners). I think it will happen because over time more and more ‘average’ people will start to achieve remarkable things by saying ‘yes’ when their mind tells them that they aren’t good enough. If this does happen then although none of us will be remembered as individuals, as a ‘yes’ community we might just change the world.

Originally posted on NicHooper.com