Thought Happens

A handful of my therapist colleagues have this bumper sticker on their cars:

           “Thought Happens”

I Love this. In the spirit of the phrase “S*^@  Happens”, this phrase captures a delightfully cavalier attitude towards the problem that our thoughts can be to us. Stephen Hayes says this: “It’s not the irrational thoughts which harm you. It’s your entanglement with irrational thoughts which harm you.”

Treating Anxiety and OCD has been an education for me in the creativity of the human brain. Our brains will throw all kinds of thoughts at us; both irrational and wise, self-critical and self-affirming, true and untrue. But whatever category of  thought, the problem with having them is not the fact of having them. Rather it is what we do with them once we have them. Not every thought we have should be honored with our time and attention. And yet our brains can be like a demanding adolescent, “oh yeah, if you won’t pay attention to THIS, I’ll give you THAT!”

Most of us can connect to the experience of anxious thoughts or a screaming inner critic distracting us from our experience in the flesh. And when we become more deeply troubled by our thoughts, we can be tempted to believe that the thoughts in and of themselves are our problem. Rather, the problem is when an unhelpful thought captures and holds our attention and keeps us from experiencing our current life and reality to the fullest. We live our lives distracted with the stream of thoughts of the day rather than being fully present and awake to whatever or whoever is right in front of us. Stephen Hayes wrote a book with a wonderful title, Get Out of Your Mind and Into Your Life. How would it change your life if you were less in your mind and more in your life?

–would a work meeting be a time of learning and contributing rather than a time of focusing on whether others in the room value you?

–would a hike be an experience of nature rather than a time to worry about work?

–would a board game be a time of wonder at your children rather than a time to fretting over the family budget?

–would a worship service be a time of opening to God rather than a time of critical review of the skill of the pastor?

–would sex be an experience of intimacy and pleasure rather than an inner evaluation of yours or your partner’s performance?

I believe that all of us can stand to consider how to me more present, aware, connected, and alive. And learning new ways to respond to our thoughts is key in getting there.

Universal OCD Treatment

One of my regular readers observed recently that I don’t write very much about treating Obsessive Compulsive disorder. His comment made me think about how we could all benefit on occasion from an evidence-based treatment that I use for my clients with OCD. ERP, or exposure and response prevention, helps clients face their fears/obsessions while refraining from engaging their compulsions. Whether we have OCD or not, we all have this in common, we try to avoid or neutralize unpleasant feelings in some way.

So how can you benefit from ERP? ERP can help us grow our tolerance for distress in different forms. Start by looking at situations that you have been avoiding and why you have been avoiding them. For my clients with OCD, this might mean they avoid touching people or doorknobs because they are obsessed with the thought of getting contaminated. For someone without OCD, it could mean avoiding certain people, conversation topics, or situations because they are afraid that they cannot contain their feelings without behaving badly or imploding in some way.

With ERP, clients get their hands dirty and face the anxiety they feel without washing. Anxiety doesn’t feel good, but all of our brains (including those of us with no OCD symptoms) need a little training to understand that we can survive the experience of heightened anxiety or negative feeling states. What might exposure and response prevention look like for you?

  • Interacting with that annoying co-worker or family member (exposure) and allowing the feeling of irritation (negative feeling) without lashing out (response prevention).
  • Participating in a group process that you are not leading and is not being led well (exposure), allowing the feeling of frustration (negative feeling), and refraining from correcting the leader of taking over the process (response prevention).
  • Talking with someone you wish to impress (exposure), feeling uncertainty about his or her opinion of you (negative feeling), without exaggerating or casting yourself in an overly favorable light (response prevention).

You see, there is a genius to this treatment because, at the core, we humans function very similarly. While folks with OCD have overly sensitized sections of their brain that need retraining, all of us tend to pull away from experiencing negative feelings from time to time, and sometimes that winds up hurting us or others around us. We are actually created to contain an unbelievable variety and vastness of emotions. Most of us make a mistake when we think we cannot handle it! Perhaps that feeling that feelings cannot be contained is a good indicator that you might benefit from psychotherapy. The process of therapy should broaden and expand your ability to contain more emotions, whether you are getting treatment for OCD, anger management, or broken relationships.

So, do you need a little ERP?

The Snowless Snowstorm; How To Anticipate

While this week’s big east coast storm dumped snow in many places, here in Baltimore, we were prepared for upwards of 8 inches of snow and ended up with nothing. People flooded the grocery stores for milk and TP, clients rescheduled, school was cancelled, and as it turned out, it was all for rain. All the anticipation was for something much smaller and less consequential than expected.

In anxiety treatment, we talk a lot about anticipatory anxiety because it tortures people so….and often for an event that winds up being something like our snowless snowstorm. People spend so much time anticipating the way any certain event may go wrong that there is almost no way reality can live up to the imagined tragedy! Anticipatory Anxiety does a number of unhelpful things to its sufferers:

  • It makes living fully in the present moment nearly impossible.
  • It can make sufferers extremely sensitive and reactive to any physical experience of anxiety.
  • It can make connecting with God very difficult.
  • It can cause loss of sleep.
  • It builds a dysfunctional myth that anxiety does something useful for its sufferer.

In treatment, it becomes very important to talk about the experience of anticipating stressful events. And it is not helpful to convince clients that the snowstorm won’t have snow! The ability to convince ourselves something will go well is not the cure for anticipatory anxiety. Well-meaning friends all too often fall into this trap! Some more helpful skills to develop are:

  • Learning to allow anxious thoughts, but not drill into them.
  • Developing mindfulness and the ability to observe one’s own inner experiences.
  • Learning how to be prayerful without over-focusing on anxious thoughts.
  • Getting clear on what is and is not in your control, and learning what acceptance really means.

What of this connects with you? How does anticipatory anxiety negatively impact your quality of life? I hope you’ll share your thoughts.

Courageous Anxiety

Anxiety can play a bit of a game with us. One of anxiety’s main tactics is to take us out of our present moment experience and into an endless series of possible negative outcomes. One of the best combatants to this strategy is to welcome and even enhance our experience of distress in the present moment. What, you say? Welcome distress? Not way! I’ve spent a lifetime trying to avoid the distress of anxiety symptoms!

Reid Wilson wrote a great article on this topic recently and he makes this interesting statement: “I’m learning that each time I’m tempted to resist a moment of distress, anxiety, or painful reflection about the past, I invite greater suffering….At that point, I’m stuck in avoidance and can’t move forward to actually solve the problem. But if I can open myself to the painful reality of the moment, I actually suffer less.”
This profoundly counterintuitive wisdom can serve us all in anxious moments. A client very recently reflected to me that one thing the therapy process had taught her was how to experience negative emotions rather than avoid them. She and other clients with whom I work have learned to turn their attention towards their anxiety symptoms and even try to get them to increase. This paradoxical approach gives the client the upper hand by playing a game with new rules. For some, the #1 rule is that God created in such a way that we can allow a vast expression of human emotion and be OK. Anxiety would like you to believe otherwise. Anxiety would have you believe that if you feel it, YOU WILL NOT BE OK.

Wilson also says, “this shift from “symptoms=bad” to “symptoms=interesting” can utterly transform the way (we) view (our)selves and the world. By accepting what the present moment offers, by not resisting, (we) widen (our) present possibilities.” Changing one’s relationship with anxiety from that of ‘terrified victim’ to ‘courageous experiencer’ turns the rules upside down and opens us up to learning so much more about what drives the anxiety.

For Reid Wilson’s full article, entitled, “Finding the Courage to Stay in the Moment”, CLICK HERE.

An Anxiety Christmas Miracle

No joke. This really happened. On a flight over the holidays, I sat next to a woman with panic disorder and a flight phobia who just realized she had forgotten her anxiety medication. Worse still, she had her six-year-old daughter with her. Her first panic attack sent her crawling over me to squat in the aisle, crying and heaving, sweating profusely and looking like she may vomit. She was trying to escape, only to realize there was nowhere to go, especially since she couldn’t very well run away from her young child or off the plane, for that matter. Imagine her surprise when I identified myself as an exposure therapist with specialized training to treat panic! It was a day-after-Christmas-anxiety-miracle!

Our ride on the plane that day turned into a bit of a family conversation, as the woman’s daughter needed as much explanation about what was going on as the mother needed psycho-education about panic! –Mom’s body feels very, very uncomfortable right now, that’s why she’s crying. But she isn’t in danger, she just feels uncomfortable.— The mom had never had treatment for anxiety other than being prescribed a benzodiazepine and had no understanding of the panic cycle or the mechanics of panic. She’d never learned the role of her thoughts in an anxiety attack. The one thing she was doing during her panic was saying repeatedly, “I’ve got to relax, I’ve got to relax.” Felt a little like a child crying in pain while saying, “I’ve got to laugh, I’ve got to laugh”. We talked about all of those things though, and she ate it up!

It struck me that so many people out there have such serious, life-impacting problems with anxiety and yet they have never tried getting therapy and never even learned that much about their problem. Some, like this woman, have no idea that there is anything to be done other than take a pill.

In another blast of irony, I ran into a colleague on my layover after this very flight (we were heading to the same convention). He offered me a free drink voucher that he couldn’t use due to taking anti-anxiety medication. This is a man who travels 100 days per year to destinations that require air travel takes anxiety medication for every flight. I started to wonder just how many people were medicated for anxiety in that airport!

You would misunderstand me if you heard from this that I am anti-medication for anxiety. I’m not. Many of my clients have determined that even with treatment, they need it. But it’s a shame that there are folks with anxiety disorders out there who don’t even have basic tools to care for themselves in the midst of elevated anxiety symptoms.

I may never know how the story unfolds for that mom and her little girl, but I did feel the grace of the chance to offer an act of kindness to this woman and her little girl. And, at the end of our flight, the woman gave me a giant hug. Perhaps her response to the anxiety Christmas miracle will be to learn a little more about her debilitating anxiety and maybe, just maybe, get treatment.

5 Sure Ways to Feel More Anxious

I have seen a lot of anxiety in my office lately. It seems that the holiday season really revs up anxiety for many. All of the social gatherings, visits with difficult relatives, shopping, and expenses come together into a perfect storm of anxiety and stress. Sometimes the best way to understand an unhelpful pattern is to identify it clearly. In that spirit, I’ll give you these sure ingredients that together make a swarming, swirling, anxiety brew:

  • Take every “what if” that pops into your head very seriously. Think it through until you consider EVERY way something could go wrong.
  • Never decide a plan of action for anything. In fact, avoid ALL problem solving.
  • Believe that every physical sensation of anxiety is actually a health crisis.
  • Avoid, at all costs, focusing on the present moment.
  • Don’t get an assessment or professional help for unremitting anxiety.

How many of these are daily practices for you? Many of us in the field of treating anxiety are thinking about attention training. These “ingredients” for anxiety are about where we focus our attention! And the good news is that attentional focus is changeable! Start noticing when your attention drifts to the future, and then gently invite yourself back to the present and see what happens.

Are you willing to take a fresh look at the role of anxiety in your life? What are your best practices for focusing your attention on the present?

Adrian Wells, PhD, is doing writing and research in the area of attention training and the treatment of anxiety disorders.

Is Worry a Sin?

I spoke at a church group this weekend on the topic of anxiety and tried to wrestle with this verse in Philippians: “do not worry about anything….”. Guilt isn’t unusual with my clients who come from a Christian background. “If I just trusted God enough, I wouldn’t worry like this. After all, the Bible says DO NOT WORRY!!”

Wonder if the writer of this verse was looking for ways to heap impossible commands on folks so they would feel like turds? That is a possibility. But it is also possible that the writer was addressing an emotional state that he knew was a present reality for his audience. The folks reading this letter were undoubtedly worried and anxious about the writer’s welfare—he was in prison and facing possible execution!—along with all the stress of being in a fledgling religious start-up; worry was most certainly among them!

Following the “do not worry” phrase there are three interesting suggestions:

  • Present your requests to God—the practical reality of doing this would encourage the worried to isolate their spinning thoughts to specific requests. This mirrors anxiety treatment in it asks whether worry is productive or nonproductive. In productive worry, there is an answer to the question, “can I do anything about this?” Taking this suggestion seriously might mean that the answer is “yes, I can ask God about specific concerns”.
  • Practice thanksgiving—The practice of gratitude can be good for ANYONE who is tempted to over-focus on negatives and what ifs.
  • Figure out which thoughts to lock onto (and defuse the others)—Perhaps most fascinating to me is the long list of things that are listed as things to “think about”. “Whatever is true, honorable, just, pure, pleasing, commendable, excellent, worthy of praise…”. This mirrors anxiety treatment in that we teach clients which thoughts to fuse with and with thoughts to defuse. If a thought is helpful towards living one’s values, then, by all means, lock on (fuse) to it! If it is unhelpful, defuse it! This is the work I often do with worriers.

Speaking to this group this weekend helped me ponder the ways this Biblical writer tried to work out what to do with worry, and I appreciate that thoughts are taken seriously in the suggestions. As I find both personally and in doing treatment with many worriers, OUR BRAINS ARE NOT OUR FRIEND……sometimes!

So, is worry a sin? Worry is so varied and textured that I think it is difficult to say. The question I prefer to ask is, “what is the spiritual invitation in the midst of this text?”  If we don’t perceive suggestions like these as invitations to something good, I believe we are missing the point.

 

Biblical quotations are taken from the NRSV. The Worry Cure by Leahy has taught me about productive and nonproductive worry and The Confidence Gap by Harris has taught me about thought defusion.

Rumination and Other Mood-Destroying Activities

I’ve been talking a lot with clients lately about rumination. There are many definitions, but I’ll throw out this provocative one to start the discussion, “a train of thought, unproductive and prolonged, on a particular topic or theme.” (Osborn, p.44) Rumination can be about anything, but essentially it is a brooding, churning mental activity. And with the folks who come into my office, it is clearly mood-impacting. Rumination research (yes, there is such a thing) shows that those who ruminate have likely suffered from depression (Kumar, p. 14).

There is a difference between rumination and productive processing.

RUMINATION: “It was so stupid of me to say that to my coworker, he probably resents me and I always screw up interactions with him. Why would I be so stupid? I always do stuff like this and mess things up. You know, he has a lot of pull and can influence our boss. I wonder if he told her? You know, I don’t think she likes me very much and this is the last thing I need. I could lose my job. Oh God, then what am I going to do? I can’t ask my parents for help, etc.……(ends with person living in van down by the river).”

PRODUCTIVE PROCESSING: “It was so stupid of me to say that to my coworker he probably resents me. Maybe I should follow up with him because I really think I made a mistake and want to make things right with him.”

Two things I hope you’ll consider:

  • Both the rumination and the productive processing begin with the same negative thought. It is very difficult, if not impossible, to change that reality. We all have negative evaluations of ourselves that pop into our minds. The important life-skill to develop is what to do with those thoughts. Martin Luther said this about sin, but it holds true for the “sin” of negative self-evaluation too, “You can’t help it if a bird flies over your head, but you don’t need to let him make a nest in your hair.”
  • One trick of rumination is the false belief that it helps. When I really press this with clients, they can see that their ruminations don’t help them, but they go into them with some idea that they either deserve the self-critique (and that it somehow helps) or that there is a productive end to it. As if getting used to the idea of living in a van by the river is what will make them feel better. But remember, mood follows thoughts. If you’re living in a van in your mind, no matter how wonderful your life is, you will be depressed.

Might you be able to shift some of your ruminations to productive processing? As a rule, ACTION is an antidote for rumination.

References: The Mindful Path through Worry and Rumination by Sameet Kumar and Tormenting Thoughts and Secret Rituals, Ian Osborn

What To Do With Worry

Most of us think of worry as something we are incapable of changing. It can be tempting to think of worry as something that can only be impacted by fixing external circumstances. If we remove or resolve the source of our worry, we won’t worry any more, right?

Not necessarily. You see, worry is a cognitive function, a mental spinning that keeps our minds so busy that we often cannot access the feeling underneath it. As soon as we resolve one source of worry in our lives, another will pop up. Those of us who have a habit of worrying will find something to worry about! I had a meeting recently the outcome of which was going to be potentially life changing. I was most definitely worrying about that meeting in the weeks and days leading up to it. When I drilled down beneath the worry and to the level of my emotions, I found fear. There were layers to the fear, and it was complicated to sort through, but it shed a new light on the tension for me. I had some spiritual fears and some more practical ones.  Allowing myself to feel those fears, to make room for them inside, allowed me to work with the invitation within that emotion for processing the fears. Is God good and looking out for my family no matter what the outcome? Am I connecting this experience to past experiences? Do I need to reframe this somehow?

The long and short of it is that your worry problem might actually be an avoidance problem. It’s hard to face fears and other negative emotions. Worry, as annoying as it can be, can mask those unwelcome emotions. The solution? Allow worry to serve as an invitation to you to drill down into the fears and emotions that are unconsciously or consciously driving the worry. In admitting, allowing, and making room for those emotions, you may find some relief.

What’s underneath your worry?

Anxiety and “As Is” Spirituality

Specializing in treating anxiety and anxiety disorders has been spiritually enlightening to me.  I did not expect that. Jon Kabat-Zinn in his book, Full Catastrophe Living, says that pain + resistance = suffering. In other words, we all have pain that causes us suffering, but add all of our resistance to that pain and we greatly increase our suffering.  For anxiety sufferers, their thoughts about anxiety greatly increase their experience of suffering with anxiety. Those thoughts are the resistance to it. “I shouldn’t feel so anxious!”, “No one else is uncomfortable here”, “I’m having a heart attack!”, “Everyone is watching me sweat”….. For the anxious soul, the racing heart and shallow breath are a small problem made much worse when accompanied by the committee of critical and alarming voices inside.

In using Acceptance and Commitment Therapy (ACT) for anxiety treatment, the “A” is acceptance of the full range of one’s thoughts, feelings, and experiences. In other words, to relinquish the inner battle and get more OK with how you may tend to react to things. There was a ready connection for me to an important spiritual task, which is being able to come to the table spiritually without so much internal criticism. I call this “As Is” spirituality. I have found with many believers, and certainly those from my tradition, that people are so hard on themselves internally that they won’t come to God in any real way. It is as if they are waiting to clean up their act first, then approach once they are squeaky clean. The beginning point and the end goal are confused in this thinking. In Christianity, isn’t dependence on Jesus for transformation the whole point anyway?

The remedy is similar. “As Is” Spirituality and “As Is” Anxiety living are all about people just being where they are in the messed up state they are in and learning a little self-compassion. Coming to the table with all of it and believing that there is reception on the other end is key. Treatment for anxiety, then, can be framed as a spiritual task that involves self-compassion and learning to tolerate oneself! “As Is” spirituality! How are you doing in the process of learning to tolerate yourself? If we can’t get our heads around that, then how do we learn a new relationship with our anxiety? And how do we ever begin an authentic relationship with God?

Stay tuned next week for more on self-compassion.

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