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

Unsticking from Anxious Thoughts

By Annabelle Parr, MA, AMFT

Our capacity for language allows us as a species to be excellent problem solvers. It’s the thing that allowed us to invent cars that transport us over large distances quickly, and it’s also what gives us the ability to notice if we have a flat tire, pull over, and replace the tire with a spare (and if you are not the savviest with automotive issues, to understand a YouTube video explaining how).

When we are anxious or afraid, our minds come up with thoughts to try to help us make sense of our fear and problem solve potential threats.

If you get a flat while you are driving, before any languaging kicks in, you might notice yourself feeling a jolt of fear. Fear is an acute feeling that shows up when we are facing a perceived threat. And fear is really adaptive. If we never felt fear or anxiety, we wouldn’t survive long. Usually, right after fear or anxiety (or any other emotion) kicks in, our mind jumps in with some thoughts to try to make some meaning out of that feeling and help us address it. In this case, fear might tell you to “pull over as soon as you can.” Listening to that thought will likely help you resolve the issue and ensure you are once again driving a safe, secure vehicle.

However, sometimes the thoughts that our minds come up with when we are feeling afraid or anxious are not so helpful.

For example, if you feel anxious the next time you get in the car, and your mind says “what if something else goes wrong and I crash? This isn’t safe, I should just stay home”, listening to that thought is probably not so helpful. Sure, listening to that thought would probably give you some relief from the anxiety you are feeling in that moment, but it would also restrict your life in a really significant way.

Anxiety and the thoughts it generates are designed to help protect us, so those thoughts usually feel really true and important.

The problem is sometimes we feel anxious or afraid in the absence of any real, likely, or catastrophic threat, and sometimes the anxious thoughts that visit us are not accurate, helpful, or important. Cognitive defusion – the process of noticing that our thoughts are simply sounds and syllables – can help us create enough distance from those sticky anxious thoughts that we get to choose how to respond.

When we are able to create some space between our selves and our thoughts,

we get to become skilled observers of our experience in a way that allows us to decide whether a particular thought is going to help move us toward our values or if it will move us away from what is meaningful and important to us. We do not have to figure out whether the thought is “true,” we just need to figure out if doing what it says is in line with what matters to us.

So how do we get a little bit of distance from our thoughts?

There are a whole bunch of exercises that can help us get some distance from thoughts that are tripping us up. One of my favorites goes like this. First, you identify the thought and state it as it is (“this isn’t safe, I should just stay home”). Pause, and notice what shows up in your body as you sit with it. Next, restate the thought but preface it with “I’m having the thought that…” (“I’m having the thought that this isn’t safe, I should just stay home”). Again, pause and notice what shows up. And finally, restate the thought but preface it with “I’m noticing that I’m having the thought that…”. Again, pause and notice what shows up.

And the final step is to check in with what matters most to you in this moment

and choose whether that is a thought that will help you engage with your valued direction. Sometimes the answer is yes. But when it’s no (or not entirely), your values can inform what you choose to do instead.

Defusion is a process, and sometimes it can be hard to get unstuck on your own. A therapist trained in Acceptance and Commitment Therapy (ACT), can help you learn the ropes.

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

Lessons from Traveling in Time

By Annabelle Parr, MA, AMFT

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

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

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

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

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

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

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

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

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

The film finishes with Tim sharing,

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

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

CSAM IS HERE TO HELP

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

The Unexpected Benefits of Teletherapy

By Annabelle Parr, MA, AMFT and the CSAM team

It’s been nearly 4 months since we started COVID-19 quarantine, physical distancing, and since we transitioned to offering therapy via telehealth at CSAM. We knew from the outset of this shift that research indicates that, assuming that the therapist and modality are an appropriate fit for the client’s needs, teletherapy is as effective as in person therapy. Even still, we were initially apprehensive about this change, as we were uncertain how it would feel to switch from sitting across from our patients to communicating with them through a screen. Despite our initial worries, we have been pleasantly surprised to discover that not only has our experience been consistent with efficacy research, but that teletherapy has actually had a number of additional benefits we did not anticipate.

And given that the past few months have brought a lot of stress, pain, anxiety, grief, and frustration, we wanted to take a moment to reflect upon some of the beauty and connection that we have noticed amidst this tumultuous time. Below are reflections from our team of therapists on some of the benefits they have noticed about the tele-therapeutic process. 

Common humanity: we’re all in this together.

CSAM Director Dr. Jill Stoddard said, “I was worried that telehealth would make the connection with clients less personal, but what I've found is that my clients are now introducing me to their partners, their kids, and their pets, so in many ways I actually feel MORE connected to them. I was also worried about interruptions from my own kids and dogs, which HAS happened, but my clients have been so patient and understanding. In many ways I think they too feel more connected to me because it's all just so human and we're having a shared, unique experience of having to do things from home with our families around.”

Increased connection: a fuller picture of clients’ lives.

Associate Director Dr. Michelle Lopez agreed. She said, “my experience is similar to what Jill described in that I feel MORE connected to clients. Telehealth has allowed me to have a fuller, more colorful picture of what their lives are like which I am able to envision when I am conceptualizing and tailoring treatment plans. It has also been excellent for exposures. When "we" can walk to the client’s backyard or kitchen (or wherever the exposure task needs to happen) in a matter of seconds, it allows more time for the actual exposure task. A few clients have commented on how much easier it is for them to "arrive" on time because they don't have to account for traffic, being unable to find their keys or shoes, etc.”

Superhero sidekicks: incorporating pets into therapy.

Superhero Therapy creator and lead trauma specialist Dr. Janina Scarlet noted that “an unexpected but interesting side effect of telehealth has been the ability to incorporate pets into therapy. Many people’s pets have become their sidekicks on their mental health journey and my own cat, Hera, has become a kind of mascot of an emotional support pet for many of my clients.”

Increased convenience: involving family and doing exposures at home.

Child and teen specialist Thi Wlodarski, LMFT agreed with Dr. Lopez that exposures have been more easily facilitated: “telehealth has been really beneficial for my clients whose rituals are often done at home. Clients are able to complete exposures in the situations that trigger their anxiety instead of having to simulate it in the office. I've also been able to do more family therapy because all members are home together. I've been able to involve parents who wouldn't normally been able to be present in session. 

Comfort and creativity: therapy from the comfort of home.

Dr. Terra Fuhr said, “I have also found telehealth to be a surprisingly smooth transition. Several clients have commented that it feels easier to open up, be vulnerable and talk about difficult topics from the comfort of their own space. I also wonder if being in the environment where they live life may remind them--or prime them--to talk about the most relevant emotions of their day-to-day lives. We've been able to do more creative exposures. And everyone seems to love not having to factor in commute time!”

As always, we are continually inspired by our amazing clients.

Insomnia specialist Dr. Melissa Jenkins agreed with the rest of the team, and added her feelings of admiration for her clients’ courage and perseverance during this difficult time. “Over the past few months, I have been struck by how bravely and thoughtfully people have welcomed therapy into their homes by way of telehealth. In our current circumstances (in which we are faced with many competing demands on our time and energy as we navigate a new way of living amidst coronavirus), it can be really hard to keep appointments and prioritize mental health. I am truly inspired by my adult clients who are committed to prioritizing their mental health, showing up for appointments and challenging themselves, and by my client’s parents who continue making therapy a normal part of their children’s lives. Sessions, of course, look a little different as we engage in therapy together through screens; however, it has been powerful to connect with clients in their more natural environments (as opposed to a therapy office) and to witness continued growth in the face of substantial adversity right now.”

Teletherapy allows us to keep our clients and our communities safe.

Of course, we are all collectively missing the normalcy of life pre-pandemic. And here at CSAM, we look forward to a time when we can see our clients in person again. However, we are also happy and grateful that we are able to do our part in slowing the spread of COVID-19 by offering our services via telehealth for as long as is needed. Remaining at home and offering teletherapy is consistent with our values of keeping everyone as safe as possible while this pandemic continues. As the number of cases continues to rise both here in San Diego and across the United States, the best thing we can do to keep our clients and our communities safe is to stay home whenever possible. Under these circumstances, telehealth allows us to offer the most competent, compassionate and connected care.

If you need support during this difficult time, CSAM is here to help.

Even as we reflect on some of the upsides of telehealth and the strength, courage and resilience of our clients, we also recognize that this pandemic and the upheaval we are experiencing has increased stress, anxiety, and even trauma for many folks. So know that if you are struggling, you are not alone and evidence based treatment is still available to you.

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

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.