Anxiety Tools: An Expert's Advice

reposted from Healthline.com

originally written by Healthline Editorial Team featuring an interview with CSAM Director Dr. Jill Stoddard

Anxiety disorders affect over 18 percent of U.S. adults each year, according to the National Institute of Mental Health. This includes generalized anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder, and more.

Anxiety can work its way into many aspects of a person’s life, which is why it’s so important to find the resources, support, and advice you need — whether it comes from people’s stories, helpful phone apps, or expert advice.

Dr. Jill Stoddard is the founding director of The Center for Stress & Anxiety Management, an outpatient clinic in San Diego specializing in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety and related issues. She’s also an associate professor of psychology at Alliant International University, and the co-author of “The Big Book of ACT Metaphors.”

We caught up with her to learn about some of the ways she recommends for managing anxiety disorders.

Dr. Jill Stoddard’s advice for anxiety

1. Use your senses

Anxiety narrows your focus onto perceived threats (i.e., whatever you’re feeling afraid of or worried about in the moment) which can impact your focus and memory. Practice mindfully broadening your view by using your senses — what do you see, hear, smell, etc. — to improve attention and experience.

2. Have gratitude

Practice gratitude as another way to broaden your focus. There are the things that you worry about, and there are also the things you’re grateful for.

3. Be accepting

Difficulty with uncertainty and a lack of perceived control amplify anxiety. To “fix” this, we often attempt to get more certainty and more control — for example, by doing internet searches about health symptoms. This actually increases anxiety in the long run.

The antidote is acceptance of uncertainty and control. You can read a book or watch a sporting event without knowing the ending. In fact, it’s the anticipation that makes it exciting! So try bringing this attitude of openness to not knowing, and letting go of control. See what happens.

4. Face your fears

Avoidance is anything you do, or don’t do, to feel less anxious and prevent a feared outcome from occurring. For example, avoiding a social situation, using drugs or alcohol, or procrastination are all examples of avoidance.

When you avoid what you’re afraid of, you get short-term relief. However, this relief never lasts, and before you know it, that anxiety has returned, often with feelings of sadness or shame for having avoided it. And often, the exact avoidance strategies you’re using to feel better and prevent a feared outcome (e.g. reading off your notes during a speech or avoiding eye contact) actually create the outcome you’re trying to avoid (namely, appearing anxious or incompetent).

Consider taking small steps to start facing your fears. What’s one thing you might do that takes you out of your comfort zone? You will build mastery and confidence, and your anxiety might even diminish in the process.

5. Define your values

Do some soul searching about what really matters to you. Who do you want to be? What do you want to stand for? What qualities do you wish to embody as you engage in work or school, or interact with people you care about? If friendship matters, how can you create space in your life for that? When you do so, what qualities do you wish to embody as you spend time with friends? Do you wish to be authentic? Compassionate? Assertive?

These are all values, and making choices in line with values — rather than in the service of avoidance — may or may not impact your anxiety, but will definitely add richness, vitality, and meaning to your life.

Healthline’s tips

To help you keep your anxiety in check, Healthline also recommends trying out the following products in your day to day:

• Add some lavender essential oil to your lotions and soaps, use as an air freshener, or rub small diluted amounts onto your neck or feet.
• Take Kavinace supplements, which can help with anxiety-related sleep issues.
• Try practicing self-guided meditations that emphasize self-compassion.
• Get some relaxing sounds from the Stress Relief Collection.
• Check out biofeedback therapy. Some people find it to be an effective tool in managing anxiety. Use the BCIA directory to find a certified practitioner.

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/

Hey Siri, I’m Feeling Anxious: Apps for Anxiety

by Annabelle Parr

There seems to be an app for everything these days. Smartphones have become like little pocket genies – your wish is its command. Whether you want a date, a ride, or help with a physical or mental health concern, your smartphone claims to have you covered. 

Recently, there has been a surge in apps claiming to help calm anxiety. Some offer mood tracking, others offer guided breathing and meditation, still others allow you to track your thoughts, claiming to utilize CBT methods to help you reframe unhelpful ideas. While technology can be a powerful tool, it’s important to think critically about how we use it and the effect it can have before we rely on it too heavily.

What does the data say about anxiety apps?

Depression and Anxiety: The official journal of the ADAA recently published a study conducted to assess commercially available anxiety apps. Researchers analyzed 52 anxiety/worry relief apps that purportedly use psychological techniques. They discovered that 67.3% of the apps were developed without any input from a healthcare professional, and only 3.8% of them had been rigorously tested.

So the people developing anxiety apps may not actually know much about anxiety, and they almost certainly don’t know if their app will really help you.

Authors of the study concluded that while apps have the potential to broaden access to mental health resources, there is currently a major lack of data regarding the efficacy and effectiveness of the available options. As such, the application space has yet to reach its full potential in helping people with anxiety.

What if an anxiety app is helping me?

Of course, the issue here is a lack of data. You may have found an anxiety app that does help you to manage your worry throughout the day. Guided meditations, breathing exercises, and journaling our thoughts and feelings can certainly be useful.

Should I ask Siri or a professional?

However, an app does not replace professional treatment. If you are dealing with anxiety that is impairing your ability to function in your day to day life, it’s important to seek professional guidance.

Human connection is important for our mental health.

Furthermore, while apps may one day prove to be a useful anxiety management tool, they will never replace the human connection that takes place in the context of therapy. In fact, it is actually the therapeutic relationship itself that is the most important aspect of therapy – it accounts for around 30% of the variance in treatment outcome, which is significantly more than any other factor, including the specific techniques used by the therapist (like CBT or mindfulness). This means that who your therapist is, how you relate to them, and the relationship you share is the most helpful part of therapy. An app will never be able to offer this relationship.

Technology may help us manage anxiety, but it may also be a source of anxiety.

Finally, when considering anxiety apps, it is important to note that according to the APA, smartphone use has been linked to higher stress levels, particularly in those who check their phones constantly.

Given the rapid development of technology and its ever broadening influence in our lives, it is important that we stay curious and aware of the potential it has to both help and hinder us, particularly when it comes to something as important as our mental health.

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:

American Psychological Association (2017). Stress in America: Coping with Change. Stress in America™ Survey.

Sucala, M., Cuijpers, P., Muench, F., Cardos, R., Soflau, R., Dobrean, A., Achimas-Cadariu, P., & David, D. (2017). Anxiety: There is an app for that. A systematic review of anxiety apps. Depression and Anxiety: The official journal of ADAA, 34(6). 518-525. 

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

Mental Health Awareness Month

by Annabelle Parr

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

Risky Business

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

Our State of Mind Impacts Our Emotions and Our Behavior

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

Evidence Based Therapy

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

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

Cognitive Behavioral Therapy

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

Acceptance and Commitment Therapy

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

The Human Condition

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

CSAM IS HERE TO HELP

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