Just because you are capable of doing something, doesn’t mean you must

By Dr. Shoshana Shea

Simply put, when someone asks us to do something we are capable of doing, we often feel guilty, anxious, and obliged to do it; that doesn’t mean we should though.  Ever notice how being efficient and competent can sometimes feel like a punishment? Or when no one else is taking responsibility for a task, and the task needed to get done two days ago, and that even though you are screaming “No!” inside, you absolutely won’t do it this time, the other side of your brain betrays you, and tells your foot to step forward?

The paradox in all of this is that, in an effort to be helpful and connected, we end up feeling resentful and disconnected.

From an evolutionary biological standpoint, individuals who were able to live in cooperative societies, were able to survive, thrive, and pass on their genes; i.e., our ancestors. So not only is it in our ‘hard wiring’ to say yes without thinking about it, we have many societal and familial reasons to not say no as well. A compliant easy-going child gets praised, and a ‘difficult,’ more independent one often gets punished and shamed.

Don’t get me wrong; I’m not advocating for people to not be helpful and amenable; I’m asking that we pause to consider a few factors before proceeding with an action.

Here are a couple of points to take into account the next time your co-worker, mom, PTA president, the dog groomer, or even the dog asks (or implies that) you should be doing something:

1.     Just because you are able to do something, doesn’t mean you should! Make this your new mantra, “Just because I can, doesn’t mean I should.”

2.     Do you truly have the capacity? Especially in the larger scheme of your life, is the balance tipped all the way towards doing things for others, while there isn’t enough time, energy, and/or space left over for you?

3.     Saying yes is not necessarily always good for the other individual;

4.     Even more important, saying yes is not necessarily good for the RELATIONSHIP.  *See paradox above.  The intention may be that you are saying yes to preserve the relationship, but the outcome may end in you feeling resentful, and ultimately destroy the relationship.

5.     It’s OK to say no. Period. End of story; actually, there is no story; no explanation is needed.

6.     Even extremely kind compassionate leaders say no sometimes.  Saying no clears the path to say yes and build consistency and trust in a relationship.

7.     Check your body; what is it saying? When you get that anxiety drop in your stomach and your thoughts start spinning, your body is trying to get your attention.

8.     Pause next time this comes up; ask yourself if you really want to.

9.     And lastly, and just as important (if not the most important), check to see what emotions are there. Are you feeling anxious, guilty, sad, frustrated?

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

Cognitive Defusion: How Thanking Your Mind for Its Worst Thoughts Can Help You Get Some Distance

By Annabelle Mebane, MA, AMFT

In Acceptance and Commitment Therapy, the overall goal of our work is to help clients increase what we call psychological flexibility, which is basically the ability to do what matters most to you in your life no matter what uncomfortable thoughts and feelings show up.

One of the skills we teach to help people respond more effectively to their thoughts is called “Cognitive Defusion.”

Our default mode is to take our thoughts at face value and to believe that they are true and important. Like a fish doesn’t know it’s in water, we don’t typically notice that we are thinking. We are so accustomed to looking out the lens of our own thoughts that we forget to recognize we’re wearing glasses at all, and that there might be more than one way to see things.

Cognitive defusion is the ability to notice that we are having a thought –

that our mind is “languaging” about our experience. Defusion involves creating a little bit of space that allows us to recognize that just because our mind thought it, doesn’t necessarily make it true or important. Why should we make that space? Because if we can recognize a thought for what it is – words our mind is generating – we can make a choice about how we want to respond to it. Instead of automatically buying into our thoughts or viewing them as directives or imperatives, we can tune in to our values – who and how we most hope to be in a given moment – and decide whether listening to a particular thought and behaving accordingly is going to move us toward or away from our valued direction.

There are a whole bunch of exercises

that we use in ACT to help you learn how to defuse from your thoughts. One of them goes like this. First, you state the thought exactly as your mind has it. For example, “if I go out on this date, I’m going to embarrass myself.” Then you pause, and notice what it’s like to sit with the thought. Next, you preface the thought with “I’m having the thought that…[thought]”, and notice what it’s like to sit with that. Finally, you preface it with “I’m noticing that I’m having the thought that….”, and tune in to what that’s like.

And then you can decide, do you want to listen to that thought, and stay home and avoid the possibility of being embarrassed because it feels more comfortable? Or are you someone who wants to be open, vulnerable, and show up anyways because it’s meaningful to you to try to find a fulfilling connection, even if it’s a risk?

Notice that when we are ‘defusing,’ we aren’t getting caught by the content of the thought, trying to prove or disprove it.

We are simply creating enough distance to allow us to choose how we want to respond.

But here’s the thing, sometimes it feels pretty hard to get that distance and to make a choice based on values.

Why? Because sometimes, or maybe even usually, the stickiest and most painful thoughts our minds have are designed to try to protect us from something painful. And probably, it kind of works. If we continue with the above example, your mind might be trying to protect you from the pain of rejection or disconnection. And yeah, if you stay home, you get the relief of know you can’t embarrass yourself and you can’t get rejected. But the thing is, if you avoid going out on any dates because you might get rejected or feel embarrassed, you are almost certainly also going to miss out on the possibility of a really meaningful connection.

The thing about pain is that it doesn’t show up around stuff that doesn’t matter to us; it shows up around the things that we care most deeply about.

On the flip side of our pain, we can usually find our most cherished values.

Your mind comes up with these painful stories to try to prevent you from feeling pain or loss around the things that matter to you, but a lot of times, when we listen to those stories, that’s what keeps us from accessing the richness of moving toward what really matters.

So for those especially sticky thoughts that seem so powerful and that are really deeply painful, sometimes the best defusion tactic is pretty counterintuitive.

Instead of beating yourself up for having such self-critical thoughts, you can actually thank your mind. You can thank it for trying to help you and for trying to protect you, and then you can let it know that you are going to take it from here.

It sounds nuts to thank your mind for telling you that you are weird or a failure or incompetent or unworthy or too sensitive, but when we meet our pain with compassion, understanding that our minds are just trying their best to do their job and keep us safe, we sometimes can start to take away the power of that really painful story and get just enough space from it to decide to respond based on something other than the avoidance of pain.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

Anxiety Is Like A Metal Detector

By Annabelle Parr

I spend a lot of time reading articles related to enhancing mental health, to highlight and repost relevant pieces, as I value spreading awareness in this area. It’s wonderful that the conversation around mental health and anxiety is more open than it used to be, reminding us that our struggles are deeply human and we are not alone. But one thing I notice is that sometimes the way anxiety is discussed – even with the utmost compassion, can still imply that anxiety is bad. 

Don’t get me wrong; anxiety can lead to problems in our lives. Anxiety can turn into a full blown anxiety disorder, and by definition, anxiety disorders cause significant distress and impairment in a person’s life. And even if we are not in the realm of a full blown anxiety disorder, it can be very uncomfortable. So uncomfortable that sometimes we make choices designed to avoid or get rid of anxiety at the expense of what matters to us.

It’s true that anxiety, and the way that we respond to it, can be a problem.

However, I think when we focus exclusively on the negative parts of anxiety, we are missing a big piece of the picture that can empower us to change how we relate and respond to it. Anxiety – like any feeling – is information. And most of the time, at least part of that information has to do with what is most important to us in our lives.

For example, if someone experiences a lot of social anxiety and fear of judgement, what might that say about what matters to them? It might mean that they deeply value connection and relationships. Maybe it is really important to them to show up in their relationships as kind, compassionate, engaged and authentic, and maybe the anxiety has to do with worrying that something they could say or do will be incongruent with those values.

The problem with anxiety occurs when we take our anxious thoughts at face value,

and when our behavior is driven not by our values, but by trying to avoid the feared outcomes our minds generate. For example, social anxiety might involve thoughts like “I can’t go to that party. What if I make a fool of myself or say something stupid or am too anxious to even talk, and my friends don’t want to hang out with me anymore?” Such thoughts can feel very real and powerful, and our instinct is not usually to get curious about what they might indicate about what is important to us.

Instead, our instinct is often to think that outcome is likely, and to decide to stay home from the party to avoid anxiety and try to prevent rejection. But if instead, we can notice that thought, get curious about why it is visiting us and what it says about what is matters to us, we might recognize that in fact we deeply value connection. So much so that it feels excruciating to risk the possibility of rejection. And yet, in not going to the party, we are certainly missing an opportunity for the connection we so deeply crave.

When we can identify the values underneath the anxiety, we then get a choice about what to do next.

Getting curious about our values and what is really meaningful to us in our lives then allows us to identify actions that would move us in our valued direction. For example, you could choose to go to the party even though you are feeling anxious in service of your value of connection, or you could choose to stay home in order to experience relief from the anxiety.

From an Acceptance and Commitment Therapy perspective, our pain and our values are like two sides of the same coin: if we flip the pain coin over, we find what means the most to us in our lives. Or, as one of my clients said, anxiety is like a metal detector: when it starts beeping and getting loud, it means there is treasure under the surface, and that treasure is your values.

Sometimes it can take some curiosity and creativity to get to the core of what the value is, because anxiety can be sneaky and tricky and it’s not always immediately apparent. But if we can look at anxiety as important information, it can help us change how we relate to it. We don’t need to make it go away, we just need to figure out what really matters to us and make choices toward our values.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

What If Everything You Know About Anxiety Is Wrong?

By Annabelle Parr, MA, AMFT

When we experience anxiety, our minds are really good at coming up with all kinds of “what if” thoughts. And those worried thoughts often deal in extremes and absolutes, like the title of this post.  

Good news: it’s unlikely that everything you know about anxiety is wrong.

If you’ve ever experienced anxiety, at the very least you know what it feels like in your mind and your body. But it is possible that some of what you’ve learned about anxiety is not workable (that is, it doesn’t move you toward the kind of life you want to live).

Anxiety in the information age:

These days, the internet is filled with articles and podcasts discussing stress, anxiety, and self-care. It is so important to make information accessible and to talk openly about the difficult and painful parts of being a human. When we are suffering, knowing that we are not alone in our experience can make all the difference.

As much as it is wonderful that these topics are getting so much air time, the way we talk about them matters.

As anxiety is a rather hot topic these days, we decided to bust some of the common myths that, though well intentioned, can actually keep us stuck.

Myth #1: You can self-care your way out of anxiety.

There is a fair amount of content out there that sends the message that if you just take enough bubble baths, do enough yoga, or drink enough herbal tea, your anxiety will finally go away. Or that if you’re ever going to get a handle on your anxiety, you have to eat healthy, get good sleep, and exercise regularly. None of those activities are bad or wrong, and they can help us feel good.

But when we engage in a behavior (ANY behavior – even “healthy” behaviors) where the purpose is to control or avoid our internal experience, we may paradoxically find ourselves even more stuck. Our anxiety might go away momentarily, but we may find that in the long term (or even in the middle of downward dog) our anxiety actually gets more powerful. And then when anxiety doesn’t go away, we think that we are doing self-care wrong, or worse, that there is something wrong with us since it’s not working. Cue cycle of chugging herbal tea and feeling anxious about the fact that we are still feeling anxious. 

Myth #2: If you just got the hang of positive thinking, you’d be anxiety-free.

If positive thinking works for you, helps you cope, and allows you to be the person you most want to be, carry on. But if it doesn’t, you are not alone. When I am at my most anxious or upset, trying to convince myself to believe a more positive thought often makes me feel worse. I might be able to come up with a more positive thought, but then I just feel frustrated that I can’t make myself believe it. Research supports that trying to suppress our thoughts can actually increase the frequency and intensity of the very thought we are trying to avoid.  

While traditional Cognitive Behavioral Therapy works on helping people to engage in more balanced thinking (NOT unrealistically optimistic positive thinking), Acceptance and Commitment Therapy can help us change our relationship to our thoughts. Our thoughts, after all, are just words. Sometimes they have helpful information to share, but they aren’t always great at communicating it to us. 

Myth #3: You need your anxiety to go away before you can do the things that matter to you.

Anxiety is good at convincing us that we can’t or shouldn’t do things that matter to us until we feel less anxious. But the best antidote to anxiety is doing what matters to you even when anxiety is at its loudest. Because here’s the thing: anxiety typically shows up around the things that you care most about. So if you wait for anxiety to go away before you go after the life you want or before you show up as the kind of person you want to be, you may end up waiting forever.

So is your anxiety coping skills toolkit workable?

Workable simply means: does this behavior help you move in the direction of your values (who and how you want to be in the world) and does it have a cost to you? So if you have a stellar self-care routine that helps you feel more present, engaged and able to show up in your life as the person you want to be, keep doing your thing. And if positive thinking has helped you live a more meaningful, fulfilling life, keep it up.

But if you find that you are trying to control your anxiety and make it go away, and instead it just keeps getting more powerful, more intense, and more uncomfortable as your life gets smaller and more restricted, Acceptance and Commitment Therapy (ACT) may help. ACT is designed to help you change your relationship to anxiety and help you develop psychological flexibility: the ability to do what matters to you no matter what.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

Feeling Guilty for Having Feelings?

By Annabelle Parr, MA, AMFT 

The past five months have been painful, and as our world has turned upside down, it makes sense that we may have felt some combination of anxiety, fear, sadness, depression, grief, frustration, and/or anger during this time. Despite the fact that we are in the midst of a global pandemic, our minds are really good at dismissing our very legitimate pain by coming up with all kinds of stories about how things “could be worse,” or how we “should be grateful” for what we have when others are struggling or have struggled more than us.

Perhaps the only thing that can make pain hurt more is feeling guilty for having it.

It goes without saying that pain hurts. And our minds, designed to protect us and keep us safe, want to problem solve our way out of emotions that hurt. So our minds begin to tell us these stories about our pain and how we shouldn’t have it, in hopes that it can be avoided or controlled. But do these stories truly help us move through our pain more effectively? Do they help us show up to this moment as the kind of person we want to be in the world?

Let’s start with the “it could be worse” story.

It is probably true that things could be worse.

But pain isn’t meant to be compared. Someone always has a more painful or uncomfortable situation, and if we want to compare our pain to that of others, we will find no shortage of suffering. Just because someone else has it worse, that doesn’t mean our pain is insignificant. 

And here’s the thing: we are in the middle of a PANDEMIC.

That’s really hard. It means we are all dealing with some sort of loss. And yes, some losses are bigger or more painful or permanent, but loss is loss and it hurts no matter how big or seemingly small. So yes, perhaps it could be worse. But that doesn’t mean this isn’t painful. 

What about the “we should be grateful” story? Isn’t it good to be grateful and think positive?

Gratitude is a beautiful thing, but it cannot exist without pain.

Contrary to what our minds may tell us, gratitude and pain are not mutually exclusive. In fact, they are inextricably intertwined. Because in order to experience gratitude, we have to value and care about the person or thing for which we are grateful. And we only feel pain around the things that we care about and value. So when we squelch our pain, we squelch our capacity to care, and we also deny ourselves access to gratitude.

Plus, gratitude loses its goodness when it’s used as a punishment for pain.

Using gratitude as a way to try to chastise ourselves out of our pain (“You should be grateful! Don’t you know it could be worse?”) is unlikely to be effective. The more we try to control our emotions, the more entrenched they become. Not only does this strategy tend to be ineffective, it also warps gratitude from something beautiful and meaningful to a punishment for having legitimate emotions.

It’s not pain OR gratitude. It’s pain AND gratitude.

Rather than using “it could be worse, you should be grateful” stories to try to guilt ourselves out of having any anxiety, anger, pain, or grief, we can let our pain exist, acknowledging that emotions are not problems to solve. They simply are. AND we can also intentionally choose to pay attention to what is good in our lives.  We can even use our pain to help guide our focus toward what is important to us. For example, if I am grieving the loss of hugging loved ones, I can also connect with gratitude for having family that live near me. It’s both/and, not either/or.

Gratitude is an action, as much as it is a feeling.

When we are in the middle of a wave of sadness or anxiety over this whole situation, we might not feel particularly grateful. However, we can still choose to act in a manner that expresses gratitude to those we love or appreciate. We can write thank you notes to our doctors or healthcare workers, or we can call our parents or grandparents, or we can choose to say thank you to the grocery workers in the checkout line.

None of this erases our pain, nor is it meant to do so.

Instead, it simply connects us with what matters, and helps us to show up in our lives and relationships in a manner consistent with the kind of person we want to be. It helps us be present for the goodness so that the important things don’t pass us by. And it is a reminder that our current emotional state does not control or define who we are, and we do not have to control our emotions in order to choose our actions.

So if you are not feeling grateful (or whatever you think you “should” be feeling), that’s okay.

If you value expressing gratitude, you can choose to take actions consistent with this value whether you feel grateful or not. You get to decide what you do. But you cannot force yourself to feel or not feel something. So give yourself grace, and remind yourself that even if it could be worse, that doesn’t mean this shouldn’t hurt.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

Therapy in the Time of COVID-19 and Shelter in Place: What is Teletherapy?

By Annabelle Parr

During this incredibly stressful time of COVID-19, we are having to make major life adjustments.  With the new shelter in place restrictions, you might wonder whether psychotherapy is still an option available to you. The short answer is yes!

Telehealth, also known as video conferencing or online therapy, has been available long before COVID-19, and is an important alternative to in person care.

Traditionally, therapy is done in person. However, with the emergence of new technologies, there have been an increasing number of telehealth / video conferencing options and platforms emerging and available in the mental health field over the last decade. This means that not only do we have the infrastructure available to offer confidential, HIPAA compliant virtual therapy, but also that there is already plenty of research on telehealth and its efficacy in mental health treatment.

Prior to coronavirus, teletherapy expanded access to care to individuals who were not able to get to a therapist’s office, whether that was due to scheduling difficulties or a lack of mental health care options in their community. Now, shelter in place poses a barrier to accessing in person care for all of us. Thus, telehealth via video conferencing offers convenient access to care for everyone as we are required to stay at home as much as possible.

How effective is telemental health care?

According to the Anxiety and Depression Association of America, “from a large body of research we know that telemental health leads to high patient and provider satisfaction ratings and achieves health outcomes equivalent to in-person care across all diagnostic groups” (Yellowlees, 2020). So as long as the client is willing to engage in therapy virtually and is not an extreme risk to themselves or others, research shows that telemental health is as effective as in person treatment.

How does virtual therapy work?

Typically, telehealth involves video conferencing with your therapist using a secure, HIPAA compliant platform. No extra equipment or complicated applications are required.  Clients can use their smartphones or a laptop computer with a built-in camera. Therapists are able to offer telehealth services to patients located in the state in which they are licensed. So a therapist licensed in and practicing in California is able to offer teletherapy services to patients located in the state of California. Though not all therapists were offering telehealth options prior to COVID-19, given the current situation, many have adjusted their practices to offer video counseling options to patients in need.

What should you look for in a telehealth provider?

The same things you would look for in a therapist you would see in person: you want to ensure that the therapist you choose has expertise in the areas in which you are seeking treatment for, and you want to make sure the therapist feels like a good fit for you personally. One thing we know for sure is that the quality of the therapist-client relationship is the most important factor in producing successful treatment outcomes across settings, in-person or online. This means that in order for therapy to be effective, you have to have a solid trusting rapport with your therapist. Assuming those two conditions are present, telehealth is likely to be just as effective as working with the same therapist in person.

If you find yourself struggling, feeling stuck, and/or could use some help navigating your feelings, you could benefit from Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness, and Telemental Health Services. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.

I Get Nervous in Social Situations…Do I Have Social Anxiety Disorder?

By Annabelle Parr

Most of us probably know what it’s like to feel nervous about public speaking or before going on a first date. We might feel anxious before a job interview, or find our palms get sweaty right before we shake hands with someone we’ve just met. But for the 7 percent of US adults that experience social anxiety disorder in a given year, the fear of humiliation and embarrassment can be debilitating (National Institute of Mental Health, 2017).

What is social anxiety disorder?

Getting anxious in a social situation does not mean that you have social anxiety disorder. In order to receive this diagnosis (American Psychiatric Association, 2013), you must experience persistent fear or anxiety about one or more social situations, causing you to either avoid or suffer through the feared situation. In addition, you must also fear that your behavior will reflect your anxiety and that this will lead to negative social repercussions, like humiliation or rejection. Finally, the anxiety must be out of proportion to what might be expected in that context. This fear, anxiety, or avoidance around social situations must last for at least 6 months and it must make it difficult to function in important areas of life, such as work, school, or relationships. 

What are some examples of situations that trigger social anxiety?

Individuals experiencing social anxiety might find themselves feeling anxious about any number of situations, including making small talk with coworkers, interacting with the cashier at the grocery store, ordering a latte, going on dates, attending parties, eating in public, giving a speech or presentation, or performing in front of an audience. The main fear underlying social anxiety is experiencing rejection or humiliation.

Social anxiety isn’t all bad.

Like all anxiety disorders, social anxiety disorder is an adaptive response gone awry. The reason we all know that heart pounding, cheeks flushing, palms sweating reaction to a nerve-wracking social situation is that we have evolved physiologically to avoid any trace of rejection. Humans are inherently social animals, and our survival has depended upon our ability to function in the context of relationships. Beyond basic survival, relationships also add joy and meaning to our lives. As a result, we are literally neurologically wired to connect with one another. We achieve that social connection by concerning ourselves with what those around us think, need, and feel. Imagine a world where everyone only cared about themselves and paid no attention to the impact they had on others…yikes! So a little anxiety around situations that might result in rejection can be a really healthy, adaptive response. However, if you find yourself so afraid of rejection that you can’t be vulnerable enough to engage in necessary or meaningful social interactions, that’s when social anxiety can become problematic.

Risking rejection is part of the process of having deeper connections.

The paradox here is that in order to seek connection, you are also automatically risking rejection. You cannot get the joy and reward of interacting and bonding with others if you are not also willing to accept that this will sometimes result in pain, embarrassment, or rejection. Social anxiety disorder – unlike manageable anxiety that shows up in any number of vulnerable situations – hinders connection because the desire to avoid rejection overwhelms the impulse to seek connection. In other words, you miss out on both the risks and the rewards.

What are the consequences of social anxiety disorder?

When social anxiety reaches disordered levels, it can make it impossible to focus on anything but anxiety, so you are unable to be truly present in the situation and you white-knuckle your way through. Or it is so overwhelming that you avoid the situation entirely, and life becomes restricted by fear. It can result in isolation, loneliness, and underperformance in areas which you might otherwise excel. The catch is that the anxiety is so strong that it prevents you from learning that a positive outcome is possible. In Acceptance and Commitment Therapy (ACT), this is called experiential avoidance.

Does social anxiety have to rule my life?

No! The good news is that social anxiety is highly treatable. With Cognitive Behavioral Therapy (CBT), clients can learn to reframe their anxious thoughts to be more realistic, as opposed to catastrophic. They can learn that anxiety is not all bad, but how we view it drastically affects how it impacts us. And with the help of a therapist, they can learn to slowly face the things that have come to feel impossible. ACT, the third wave of CBT, can also help clients to get in touch with their values and act in ways that bring meaning to their lives, even when they are experiencing something difficult, like anxiety or fear.

Getting anxious in social situations is a pretty universal experience. It’s hard to find someone who has never been nervous about some kind of vulnerable, human-to-human experience. But when it becomes something that is making it difficult to engage in life in the ways that bring you purpose and joy, it might be worth reaching out for some help.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, AND MINDFULNESS. DR. SHOSHANA SHEA CAN HELP. SHE CAN BE CONTACTED AT 619-269-2377.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

National Institute of Mental Health. (2017). Social anxiety disorder: Statistics [Webpage]. Retrieved from https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder.shtml 

What We Resist Persists

by Shoshana Shea

Have you ever had these thoughts: “Everything REALLY IS fine, so why do I feel so sad?”  Or “I’m unhappy, yet I have nothing to be unhappy about.”  Or “I have a lot of NOISE in my head; I can’t get this nagging feeling to go away, even though I have a ‘good life,’ overall.”  Normally, our first instinct is to rationalize or push away uncomfortable feelings.  We try to think our way out of these painful periods in our lives. And for the most part, that has worked out fine.  On the other hand, we have never fully gotten rid of the thought, “Maybe I could be happier?”  Or perhaps we know we’re not happy, but we feel stuck and don’t know what to do.  Despite trying to push the thoughts away, they can become more intrusive, more frequent, and more oppressive.  In Acceptance and Commitment Therapy (ACT) there is a common saying, originally opined by famous analyst, Carl Jung: “what you resist persists.”  In other words, even our life long strategies of thinking ‘harder,’ or further rationalizing, and/or attempting to ignore our feelings, can become ineffective in pushing pain away.

This is not necessarily a bad place to be in your life.  According to Buddhist nun, author, and world renown teacher, Pema Chodron (1997), “...feelings like disappointment, embarrassment, irritation, resentment, anger, jealousy, and fear, instead of being bad news, are actually very clear moments that teach us where it is that we’re holding back. They teach us to perk up and lean in when we feel we’d rather collapse and back away. They’re like messengers that show us with terrifying clarity, exactly where we’re stuck. This very moment is the perfect teacher, and lucky for us, it’s with us wherever we are.”

I’m fine, but not really.

This “I’m fine, but not really” experience can happen in any situation in our life – in our romantic relationships, friendships, work, family, and inside ourselves.  Consider this scenario: Sally has a decent paying job, but she is overworked. She comes home feeling drained and anxious, sometimes numb. The boss just gave her a cost of living raise, but not a merit one.  She has the thought, “I should just be happy I have a job at all when so many people don’t.”

Why do the thoughts persist?

The thoughts persist because our body is trying to alert us that ‘an important something’ is needing our attention, and we can no longer continue the way we have been doing so.  Our job is to do a deeper investigation in order to generate more effective coping strategies in our lives and ultimately, to move in a more meaningful life direction.  The thoughts will continue as long as we don’t address the underlying causes.

Our brain runs on templates

Another reason these thoughts persist is that our brains will engage in familiar behavioral and thinking patterns that maintain the status quo.  We want a quick fix where relief is readily available.  Having to sit and do a deeper investigation of our feelings and possibly take actions that initially heighten our pain for the purpose of getting the long-term pay-off is not to our brain’s liking.  We will, therefore, look for coping strategies that are readily accessible and that we have utilized in the past. Given that our neural pathways like this familiarity and run on these (often outdated) templates to help us cope and navigate any situation, we will avoid trying something new or unfamiliar; even if that familiarity does not involve a happy outcome, it’s a predictable one. 

Forging a new neural pathway is akin to having to cut down a path through a cornfield

Furthermore, creating a new neural pathway has been compared to walking through an overgrown cornfield, as opposed to a path that is already cut down and well-tread. Forging a new path is akin to taking out a pocket knife and cutting down one stalk at a time.  That can be fairly disheartening and who knows what lies on the other side of the field, so why expend the effort?  An even more unsatisfying work situation or relationship may be at the end of the path.  So we fall back on old “safe” behaviors and continue to feel unsatisfied in our lives.

The paradox in all this is that this built-in mechanism that is meant to protect us is actually keeping us from being more content in our lives.  The Rochester Meditation Center’s Daily Tejaniya for May 2, 2018 captures that idea perfectly: A meditation student said her meditations were deeply unpleasant because she had to face a torrent of random thoughts, distracting fantasies, and harsh self-judgments.  “Do you want it to stop?” Sayadaw asked her.  “Yes!” she said. “That’s the problem,” he said.

So What Can We Do?

1. Stop struggling, as the example with the meditation teacher and student above implies, we have to stop pushing back on the thoughts and telling ourselves we can’t think that way. Remember, what we resist persists!
    
2. Thoughts are not the problem – Acknowledge that the thoughts are there, and know that our brains, albeit exhausting, are trying to find a quick fix to the situation by thinking ‘harder.’ 
    
3. “You can’t control your first thought, but you can [certainly] control the second” (Hendrix & Hunt, 2013.) The first thought is our primal brain (i.e., the part of the brain that we share with many other species) reacting to pain and perceived danger. The second thought has the potential to engage our higher ordered thinking human brains, in a more fully embodied way, to include more information than our initial thoughts. This is our opportunity to look at the larger picture!
    
4. Understand that the thoughts and emotions are there for good reason.  Something does need our attention; however, we need to engage our thoughts in a different way, not by pushing back on them or getting pulled down into their content.
    
5. Sometimes we do have to make some hard choices – Initially, in the short run, we may have to make some difficult decisions and put in some hard work, for the long-term payoff. As in the case of Sally, she may need to find a new job and/or take a pay cut at first, so she can ultimately have more upward mobility.  That will likely involve more pain at first; our brains don’t like that, and will tell us all kinds of stories about why we can’t handle making a change in our lives.
    
6. The body never lies – If we are in pain, our body is only alerting us to that and wants us to move towards a better quality of life.  The body knows making a mindful change will lead us to a better place.  Instead of loneliness and disconnection, if we tune into our “gut,” ultimately, we will come to a more connected fulfilling place.
    
7. Therapy can be helpful to make some changes – A therapist can identify where we are getting stuck and help us relate to our thoughts in a more helpful way. By taking us through a deeper investigation, our wisdom can emerge to help facilitate meaningful changes and action in our life.

If you find yourself struggling, feeling stuck, and/or could use some help navigating your feelings, you could benefit from Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, and Mindfulness. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.

References:

Chodron, P. (1997). When things fall apart. Heart advice for difficult times. Boston, MA: Shambala Publications, Inc.

Hendrix, H.  & Hunt, H.L. (2013). Making marriage simple. 10 relationship-saving truths. New York, NY: Harmony Books.

The Rochester Meditation Center. (May 2, 2018). The Daily Tejaniya.

Why It’s Okay to Be Mad

by Annabelle Parr

Humans are wired for connection. Relationships bring us immense joy, but they can also be challenging at times. There will inevitably be moments when we miscommunicate and misunderstand each other, and this can lead to frustration and conflict where both partners feel angry and hurt.

Here’s an example.

Julie and Rob both have busy lives, children they love, and full-time jobs. Julie wants Rob to spend more time with the family. Rob wishes Julie understood the overwhelming pressure his boss puts on him. Julie never “signed up” to be a single parent; and Rob doesn’t seem to understand that she has pressures and responsibilities of her own at work. Julie, unlike Rob, makes time for the family. It is the third night in a row that Rob has called to say he won’t be home before the boys go to bed. Julie is tired and frustrated. She snaps, “You don’t have to come home at all, for all I care.” Rob feels demoralized. It seems like he can’t please anyone no matter what he does. Julie is fuming and can’t seem to make Rob understand how she feels so alone.

Both Rob and Julie’s feelings are valid, but neither one of them is feeling heard. Both of them are now feeling angry. Anger is not a bad thing; there are no “bad” emotions. However, when people get angry, conflict does have the potential to escalate.

We tend to equate anger with aggression, but anger is an emotion while aggression is a behavior.

The problem isn’t anger itself. As Tina Gilbertson notes on her blog, “anger has never hurt anyone.” Emotions, no matter how strong, cannot cause harm. Rather, it is our behavior and our emotional expression has the potential to inflict injury. So, our negative connotation towards anger is due to our lack of understanding surrounding how to express ourselves when we feel mad.

Allowing ourselves to get angry is actually healthy.

While getting aggressive is destructive, allowing ourselves to feel angry is vital. Here’s why.

1. Anger, like any emotion, is information. Ignoring anger is like ignoring your smoke alarm. Approaching the screeching alarm may be uncomfortable, but it’s a sign that something is amiss. When we ignore such a vital piece of information, we invite the underlying problem to turn into a full blown fire.

“…feelings like… anger… instead of being bad news, are actually very clear moments that teach us where it is that we’re holding back…They’re like messengers that show us, with terrifying clarity, exactly where we’re stuck.”
- Pema Chödrön

“Anger is the feeling that says No to opposition, injury, or injustice. It is a signal that something I value is in jeopardy.”
- David Richo

2. Anger is energy that we can use to create change. We can either take this energy out on ourselves and/or others, or we can channel it into positive, constructive change. For example, rather than getting into a yelling match with a family member, you can use your angry energy as courage to set a firm, clear boundary. Or rather than ruminating on all the bad things that happen in the world, you can use your anger as motivation to get involved in volunteering for a cause close to your heart.

“We begin to use our anger as a vehicle for change when we are able to share our reactions without holding the other person responsible for causing our feelings, and without blaming ourselves for the reactions that other people have in response to our choices and actions. We are responsible for our own behavior. But we are not responsible for other peoples’ reactions, nor are they responsible for ours.”
- Harriet Lerner

3. Anger can help protect us, at least for a time. Anger helps us to draw a line between what we will accept in our lives and what we will not. It can also help us ease into pain that we may not be ready to fully experience without a protective layer - anger. Holding on to anger across our lifetime is toxic. But allowing ourselves to be angry for a time may give us the space we need to set boundaries and create room to heal.

“My dictionary defines forgiveness as a ‘letting go of resentment.’ But how do we let go if we believe our anger protects us from further injury or, in some strange way, holds a perpetrator accountable? Resentment and righteous indignation distance us from our own pain, and we need distance to survive. At least initially.”
- Daniel Gottlieb

4. No matter how hard we try to repress our anger, it will eventually find its way out at our expense. We cannot will our emotions away. They’ll simply find other outlets or ways to catch up with us. The only way to get rid of an emotion is to feel it and allow it to move through us.

“Passive anger [passive aggression] is inappropriate and not an adult way of behaving. Strongly expressed anger is called rage. Strongly held anger is called hate. Unexpressed anger is resentment. Anger can be unconsciously repressed and internalized. It then becomes depression, i.e. anger turned inward.”
- David Richo

“Let go of the battle. Breathe quietly and let it be. Let your body relax and your heart soften. Open to whatever you experience without fighting.” 
- Jack Kornfield

So next time you find yourself feeling angry, give yourself grace and permission to feel it. Because, as David Richo (1991) wisely states, “the anger has pointed to where it still hurts.”

How to Handle Anger Constructively:

1. Pause. Take a deep breath and center yourself before trying to communicate.
2. Acknowledge and accept what you are feeling. Give yourself the benefit of the doubt; your feelings exist for good reason. Ask yourself what exactly you are feeling – frustration, pain, fear, rejection. Get curious about what caused that feeling to arise.
    
3. Have compassion for yourself.
    
4. Have compassion for the other person. Give them the benefit of the doubt as well, and recognize that their feelings exist for good reason too. Get curious about their emotions and what has triggered that emotion in them.
    
5. Respond rather than react. Reacting is reflexive; it’s a knee jerk reaction that occurs when someone hits one of our sore spots. Reacting is natural and happens to everyone from time to time. But how you move forward after you react is important. Notice your own reaction and then respond to it. Responding is pausing, communicating without blame, and listening from a place of compassion rather than defensiveness.

If you find yourself struggling with anger and could use some help navigating these feelings, you could benefit from Cognitive Behavior Therapy, Acceptance and Commitment Therapy, and mindfulness. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.

References:

Chodron, P. (1997). When things fall apart: Heart advice for hard times. Boulder, CO: Shambhala Publications, Inc.

Gottlieb, D. (2010). The wisdom of Sam: Observations on life from an uncommon child. Hay House, Inc.

Kornfield, J. (1993). A path with heart: A guide through the perils and promises of spiritual life. New York, NY: Bantam Books.

Lerner, H. (1985). The dance of anger: A woman's guide to changing the patterns of intimate relationships. New York, NY: Harper & Row Publishers. 

Richo, D. (1991). How to be an adult: A handbook on psychological and spiritual integration. Mahwah, NJ: Paulist Press.

When Panic Sneaks Up and Attacks

by Annabelle Parr 

It’s a regular Thursday morning and John is driving to work along the same stretch of freeway that he drives every day. He is having a stressful week, but his mind isn’t dwelling on anything in particular. His thoughts bounce from what to make for dinner to an errand he has to run during lunch to a meeting he has this afternoon. He doesn’t feel particularly anxious.

Suddenly, his heart starts racing and his palms begin sweating. He can’t explain what is happening; it doesn’t make sense to him. First he feels confused, then he begins to worry that something is wrong. He starts to feel short of breath and then he begins to feel as if he is going to faint. Because he is driving, he is afraid that if he passes out, he will crash and die.

John doesn’t know what happened to him. He worries it may have been a heart attack, but when he goes to the doctor, he learns that it was actually a panic attack. He is confused because he didn’t feel afraid or anxious prior to the attack. His doctor explains that you don’t have to feel panic to experience a panic attack.

Our body is built to respond adaptively to danger.

At some point or another, we have all experienced the feeling that our safety is being threatened. We know what it’s like to feel consciously afraid and to feel our body physiologically preparing for danger. Our heart starts racing, our palms start sweating, our breathing gets shallow, and our muscles tense up. Our body goes into fight-flight-or-freeze mode to help us respond adaptively to whatever threat we are facing.

Panic attacks are the body’s way of trying to prepare us for an unconscious perceived threat.

Sometimes, our body responds to a threat that our conscious mind is not aware of. This is what happened in the above example. When we do not feel afraid, the physiological response itself can feel threatening and overwhelming. This exaggerated and unexplained response can result in a panic attack. Panic attacks create the feeling that your body is turning against you rather than working to help you. What may once have been an adaptive response to an external threat has morphed into what feels like a threat coming from within.

What is a panic attack?

A panic attack is defined as the abrupt onset of intense fear or discomfort that peaks within several minutes. Panic attacks can emerge from a calm state or an anxious one, making them difficult to predict. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), a panic attack includes at least four of the following symptoms:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed or faint
9. Chills or heat sensations
10. Paresthesia (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying

What’s the difference between a panic attack and panic disorder?

Panic disorder can develop when a person experiences recurrent and unexpected panic attacks, and develops a persistent concern or worry about additional panic attacks or their consequences and/or significant maladaptive behavior changes related to the attacks. It is possible to experience panic attacks without having panic disorder.

Are panic attacks dangerous?

People experiencing panic attacks often end up in the Emergency Room worried they are having a heart attack. While uncomfortable and overwhelming, a panic attack itself is not dangerous. But because they can arise unexpectedly, it can feel as if they are. If we have just been on a long run or are about to give a big presentation, we know why our heart is pounding or our palms are sweating. But when our heart begins pounding and we start trembling and we can’t figure out why, these symptoms are frightening. They seem to originate within our body rather than as a response to something external.

Is it all in my head?

Absolutely not. While panic attacks are psychologically rooted, they result in a very real physiological response. And though a panic attack may seem to arise out of the blue, there is always an external trigger. Our minds detect a threat, whether consciously or not, and our body responds accordingly. A feedback loop then ensues as our mind interprets our physiological response as threatening, and our body continues to attempt to prepare us to address a threat.

If you experience a panic attack, there is nothing to be ashamed of. It’s not a sign of weakness or that you are going crazy. It’s not your fault. Though it doesn’t feel this way, a panic attack is your body trying to help protect you.

Are panic attacks permanent?

No, panic attacks do not have to be a permanent fixture in your life. Though you do not cause yourself to have a panic attack, you can learn how to prevent and manage them. Panic disorder is one of the most treatable disorders, and Cognitive Behavioral Therapy has been proven to be a highly effective form of treatment.

Cognitive Behavioral Therapy

Psychoeducation and understanding what is happening in the mind and body during a panic attack is a big part of healing. Treatment also involves examining triggers, teaching clients skills to address the acute symptoms of the attack as well as the overall stress level, and using repeated exposures. Exposure therapy incorporates an experiential piece into treatment, where the client is incrementally exposed to the feared situation and learns that they will survive.

Cognitive Behavioral Therapy can help clients to overcome the fear of panic attacks themselves, and empower them to face the situations that they may have previously avoided in order to try to prevent an attack. Clients can learn that not only will they survive a panic attack, but that they can actually move on and begin to thrive.

If you are experiencing panic attacks, avoiding situations you fear could trigger an attack (driving, crowded spaces, public speaking, etc), or find that your day to day functioning is impacted by anxiety, you could benefit from Cognitive Behavioral Therapy. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.

When Pain Demands To Be Felt

by Annabelle Parr

We all struggle at some point in our lives. To hurt is to be human, no matter how much we want to avoid it. For most of us, our natural, reflexive reaction is to try to move away from pain. But avoidance will not serve us; it only brings us more anguish in the long run. The response that will serve us best is to feel. As author John Green (2012) wisely put it, pain demands to be felt.

Instead of viewing emotional pain – grief, loss, sadness, anxiety, stress, fear, or even depression – as a threat or as something inherently bad, we can get curious about these feelings, the wisdom they offer, and the purpose they serve. As Rumi reminds us in the poem The Guest House, every emotion is simply a guest. No emotion is ever permanent, but each one serves a purpose. “Each has been sent as a guide from beyond,” so we should learn to sit with each emotion and ask why it is present.  

It can be scary to make contact with the pain that life brings, especially if that is exactly what you have been trying to avoid doing your whole life. It can feel overwhelming and unknown. A therapist can model for you how to approach your pain with mindfulness and compassion, showing you how healing that experience feels, and teaching you to approach yourself and your emotions in the same way. They can help you learn that leaning into the feeling does not mean that the emotion controls you, but rather that you are simply giving it the space it needs to move through you. They can help you to come alongside whatever is causing you pain, and look at it more deeply with you so that you can begin to heal, instead of staying stuck. In fact, the connection that comes from leaning in with someone who profoundly sees and hears you can be incredibly healing.

The more we are able to embrace the pain in our lives, the more deeply we will feel those things that we all desire: love, joy, connection, and peace. Because emotions are not actually opposites, but two sides of the same coin. To know love is to know loss, to know joy is to know sadness, to know connection is to know isolation, and to know peace is to know conflict. And as Brené Brown (2010) reminds us, “you cannot selectively numb emotion. When we numb [hard feelings], we numb joy, we numb gratitude, we numb happiness.”

Here are some tips based on mindfulness and cognitive behavioral therapy for you to begin this process of being with pain, thereby allowing the wisdom inside you to emerge:

• Practice RAIN (Brach, 2013). This mindfulness acronym can help us to connect to the moment and to our feelings in a meaningful way.
  1. Recognize what is happening. Name your thoughts or emotions, or any feelings or sensations you are experiencing.
  2. Allow life to be as it is. Do not try to suppress or push away the discomfort that may accompany your thoughts or feelings. Simply allow yourself to be as you are.
  3. Investigate with kindness. Connect more deeply with what you are experiencing, using a gentle curiosity to delve into your experience. You might think about how you are experiencing your feelings in your body, or perhaps ask what it is your feelings want from you.
  4. Nonattachment. Rest in the natural awareness that your thoughts and feelings do not define you or your identity.
• Pick up a good book that offers some helpful wisdom regarding being with our emotions. Here are some suggestions: Constructive Wallowing by Tina Gilbertson, Radical Acceptance by Tara Brach, Daring Greatly by Brene Brown.

• Remind yourself that pain is a universal.  No person is impervious, although its content varies by person. Therefore, try not to compare your pain to others.  "Pain, no matter, how large or small, is still painful," and needs our attention.
• Consider the Acceptance and Commitment Therapy (ACT) concept, "pain can be our ally." When we are hurting, often that pain can remind us of what is most meaningful, and help you to turn your attention to how you can get your values better fulfilled.
• Practice using compassionate self-talk and self-love. For example, say to yourself “no wonder I feel this way.” Put a hand on your heart, cradle your face, or even give yourself a hug. Small gestures and touch have been shown to be very healing. Try this self-compassion exercise from Kristin Neff if you need a little guidance:

http://self-compassion.org/exercise-2-self-compassion-break/

• Reach out to a friend or family member for support.
• Contact a professional if you feel you could benefit from some deeper exploration. 

If you or a loved one might be interested in mindfulness, acceptance and commitment therapy (ACT) or cognitive behavioral therapy (CBT) for stress, anxiety, depression, trauma, grief, weight, eating, body image, substance use, or challenges related to relationships, work, or other life transitions, Dr. Shoshana Shea can help. If you would like more information or if you are interested in setting up an appointment, please contact her at 619-269-2377 or shoshanashea@gmail.com.

References: 

Brach, T. (2013). Working with difficulties: The blessings of RAIN. Retieved from https://www.tarabrach.com/articles-interviews/rain-workingwithdifficulties/

Brown, B. (2010). Brené Brown: The power of vulnerability. [Video file]. Retrieved from http://www.ted.com/talks/brene_brown_on_vulnerability

Green, J. (2012). The fault in our stars. New York, NY: The Penguin Group.