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

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

Empowering Yourself with Mindfulness: Attending Intentionally to What Matters in This Moment

By Annabelle Parr

We wake up each day to a new series of updates about coronavirus and its wide reaching effects: perpetually breaking news stories with new research, new statistics, new predictions, new guidelines, new stressors. Our attention is yanked like a yo-yo by the instant and constant stream of news in the palms of our hands. Additionally, attending to what used to be a basic task – grocery shopping – now feels like a massive feat involving lots of planning and caution. For those with kids at home, we are trying to attend to their needs, their schoolwork, and their emotions, even as we do our best to navigate working simultaneously.

Where we used to have separate spaces for separate parts of our lives, at least to some degree, we are now navigating the jumble of integrating every facet of our lives into one space: our home. With so many demands and pressing issues competing for our attention constantly, it’s easy to feel overwhelmed. It’s easy to feel like our minds have been hijacked in the same way that it feels our lives and routines have been.

This is hard, AND…

Yes, this is a scary and difficult time. Yes, there is a seemingly endless list of stressors to occupy our anxious minds. Yes, there is a lot of uncertainty and only so many variables within our control. AND. We are not helpless or powerless. As our hearts are flooded with emotions, our minds retain their ability to make choices about how to proceed when faced with the facts and the resulting feelings. We can choose to empower ourselves within situations in which our control over external variables is limited.

What does it mean to empower ourselves during COVID-19?

When I say that we can empower ourselves, I don’t mean that we can empower our way out of our pain. Our pain – our fear, our anxiety, our grief, our anger – is a natural human response when faced with loss and uncertainty, of which we are all getting an enormous dose. Our pain simply is. It is here for good reason, and it often points directly toward what matters most to us. It deserves to be felt and heard.

Empowering ourselves involves increasing our psychological flexibility in service of greater meaning.

When I say that we can empower ourselves, I am drawing on the wisdom of Acceptance and Commitment Therapy (ACT), which says that suffering is a result of psychological inflexibility. When we increase our ability to think and respond flexibly in the face of pain and stress, we empower ourselves to make choices based on our values. We reduce the struggle that comes from fighting with our pain – as if that were the battle to be won – and we free ourselves up to pursue that which brings meaning to our lives.

In his beautiful work Man’s Search for Meaning, Holocaust survivor, psychiatrist and creator of logotherapy (another form of therapy grounded in meaning), Viktor E. Frankl (1959) stated “that everything can be taken from a [person] but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way” (p. 66).

What if I feel guilty for focusing on meaning when basic needs demand my attention?

It may feel incredibly difficult or even indulgent to consider what brings us meaning when we are facing such a collective threat to our health and our financial stability. It may also feel trivializing to invoke the words of a Holocaust survivor here, as even though what we are facing is difficult, it is nowhere near the level of the atrocities which Frankl witnessed and endured.

Yet he suffered such unfathomable horror, pain, and loss, that the wisdom he emerged with certainly seems worth attending to during our own trying times. Additionally, suffering is not something that is meant to be compared. Frankl (1959) himself noted, “suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore, the ‘size’ of human suffering is absolutely relative” (p. 44).

In other words, we do not have to experience the rock bottom of human atrocity in order to allow ourselves space and self-compassion for our emotional experience in the midst of suffering. This is hard. Your pain makes sense. 

An important piece of the psychological flexibility puzzle is mindfulness.

So, how exactly do we empower ourselves to become more psychologically flexible? A good place to start is with mindfulness, or present centered awareness. Jon Kabat-Zinn (1994), founder of mindfulness-based stress reduction, succinctly defines mindfulness as the ongoing practice of “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (p. 4).

In her book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, & Stress Using Mindfulness & Acceptance, CSAM director Dr. Jill Stoddard (2019) invites us to imagine that when we are not engaging mindfully, we are like airplanes on autopilot. Not fully present to what is happening inside and outside of our skin, we are running on muscle memory. We are still making choices for which we are responsible, but we are not totally conscious of the fact that we are doing so.

It is easy to get lost in this space. When we are running on autopilot, we are more likely to react rather than respond: “if your autopilot has commandeered the cockpit, the space between intense emotion and response is utterly nonexistent, leading to an instant, impulsive reaction. It’s as if the intense emotion is a detonator and the reaction is a bomb” (Stoddard, 2019, p. 45). 

Sheltering in place during a pandemic is likely to create some intense emotions and difficult circumstances to which we may react. If we are on autopilot, we are much more likely to react in unhelpful ways, like lashing out at our loved ones and communicating ineffectively. Additionally, when we are on autopilot we may be unaware of what we are actually feeling and experiencing. We may be more likely to numb out in unhealthy ways, and less likely to attend to the things that help care for our minds and bodies. Also significant, we are likely to miss the little nuggets of joy that fly by us as we zone out into the distance.

So let’s flip it around. What does mindfulness empower us to do? When we show up to each moment mindfully, that is, we focus our attention on purpose, in the present moment, non-judgmentally, we are able to….

• Notice and identify our emotions. Our emotions can span the full range of experience, from afraid to anxious to stressed to exhausted to angry to sad to grateful to joyful. Remember, the purpose of mindfulness is not to judge our experience, but simply to notice it.

• Choose how we internally respond to our own emotional experience. Responding gently, with the same kindness and compassion we might have for ourselves as children, for our child, for our friend, or for another loved one is generally a good place to start.

• Choose action in line with the kind of person, partner, parent, friend, employee, citizen, etc. that we want to be. It can be helpful to consider the qualities of being you aspire to embody, such as being compassionate, loving, loyal, diligent, reliable, kind, etc. Then you can purposefully choose to behave in a way that aligns with your personal values.

• Choose what we point our attention towards. This is especially important right now, given that our smartphones are perpetually present and can alert us to every single news update all day long. It’s important to stay informed enough to stay safe and responsible, but that doesn’t mean we are required to be glued to the news all day. When we are more present, we can make a choice about when we decide to update ourselves, how often, and for what purpose. It’s also easy to mindlessly let the day slip away watching Netflix or going down some other rabbit hole of distraction. It’s okay to watch Netflix or to let ourselves be unproductive, but it’s important that we connect with our intention and our reason for our behavior. When we watch our favorite show mindfully, we get to actually engage with it from a place of enjoyment so that we can return to our other tasks more rejuvenated.

• Be present to the things for which we are grateful. When we are more fully present to the moment, we give ourselves the opportunity to appreciate the sweetness in small moments we might otherwise miss. As much as this period of time is full of tragedy, there is goodness to be found if we know where to turn our attention. John Krasinski is working on helping us out here, with Some Good News. But we don’t need a celebrity news channel to tune in to gratitude and goodness. There is goodness to be found in the gift of time with our loved ones, watching our children play together, waving to neighbors from a solid 6 ft. + physical distance, or reconnecting virtually with friends we rarely find time to talk to under normal circumstances. Mindfulness allows us to be present to the joys when they show up and to actively cultivate engagement with the things that bring us meaning; we might just have to be a bit more creative in how we engage those things 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, 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

References

Frankl, V. E. (1959). Man’s search for meaning. Boston, MA: Beacon Press.

Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

Stoddard, J. A. (2019). Be mighty: A woman’s guide to liberation from anxiety, worry & stress using mindfulness & acceptance. Oakland, CA: New Harbinger.

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