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.

A Lesson on Living Life to Its Fullest

by Shoshana Shea, Ph.D.

“You must defeat your reason before you can start” – Patrick Star

If you want to live life to the fullest, it’s not about forgetting all your troubles and checking out, it’s about slowing down, checking in, and recognizing you have choices. One of the greatest examples of this came from the imagination of Stephen Hillenburg, “SpongeBob Squarepants” show creator, and his writers. The character is Larry the Lobster; the name of the episode, “A Life in a Day.” As I watched that episode for the 100th time, I was thinking more about Larry’s secret to living life to the fullest; he pronounces, “You got to take risks. Live on the edge…by living each day like it was your last.” Larry goes on to say, “By livin’ like, me, Larry!” 

Living life to the fullest does NOT mean that we should try to ignore all our fears and worries.

Patrick The Starfish, states, “This is the moment where we redeem our miserable lives,” and decides that he must live moment to moment and find the most dangerous of feats; then he will truly be living! To Patrick, ‘Living life to the fullest’ seems to mean that we should try to forget reality and just live without regard for the long-term consequences. I think many of us can relate to that idea, that we wish to live completely free of fear and shut off our worries like a faucet. If only it were that easy! Patrick pronounces, “You must defeat your reason before you can start.” This is my absolute favorite line! It can sound so appealing to ignore that voice in our head that urges us to be cautious and go the opposite direction. But as appealing as it might sound to have no fear, as Patrick discovers, this can have pretty big consequences.

Cautious isn’t necessarily the same as stagnant or boring…

While Patrick is out thrill-seeking within inches of his life, Spongebob interprets living a full life to mean not taking any risks at all. He embodies that voice in our head that tells us to stay firmly planted inside our comfort zone. That familiar voice which can paralyze us, and which can make life stagnant, boring, and small.

Moving towards our values is not easy; otherwise we’d all be doing it!

When we are heading in a direction that is deeply meaningful to us (TOWARDS our values), we have to remember that the short-term is usually not easy at all. When we are moving AWAY from our valued direction, the short-term is usually a relief and can be enthralling at first. What we later find out is, ultimately, an AWAY move reveals that the hard stuff is still there and there are usually negative consequences to whatever method of avoidance we chose in the first place: Drinking excessively, overeating, acting impulsively, reckless thrill seeking (like Patrick), or staying well within our comfort zone (like Spongebob), etc. 

Mindfulness is a useful tool to help us move towards are values.

Mindfulness is often misunderstood to mean that we are only “allowed” to be in the present moment, and not think too much, or to not think at all, about the future. Being mindful is about non-judgmentally NOTICING and having awareness of what we are thinking, feeling, and experiencing, while we are in the present moment. For example, if we are aware that we are feeling sad about our work situation, we can notice the physiological sensations that arise, any other emotions that might be present, and any thoughts that emerge. We can make deliberate decisions about the direction of our life based on these observations. Mindfulness helps us stay the course. It can help bring us back if we have strayed or feel stuck. Contrary to Patrick’s version of “living in the moment,” it’s not about making quick, impulsive, reckless decisions and remaining cut off from our thoughts and emotions. After all, our thoughts and feelings can have really important information for us. Opposite of Patrick: Slow down.

Once we recognize thoughts that help us to move towards what’s meaningful, we have choices about our actions.

A mindfulness tool we use in Acceptance and Commitment Therapy (ACT), is to look at whether our thoughts and actions are serving the function of moving us TOWARDS our values or are they moving us AWAY from what’s most meaningful. Often life throws up some curve balls. We can decide how we are going to relate to those barriers and take action. For example, using the example from above, if we notice we are unhappy at work, we might start researching other job opportunities, setting up informational interviews, and continuing to show up to work every day (all examples of TOWARDS moves), rather than quitting the next day (an example of an AWAY move), and putting ourselves in a bad position.

What will you decide?

At the end of the episode, Patrick has convinced Spongebob that really living is about engaging in a series of dangerous acts. As they are heading towards their demise, Larry saves them, but only after they are all severely injured. Larry chides them as they are heading towards the sharp rocks, “Look guys, my advice wasn’t meant to be taken literally, I meant to live life to the fullest; not to maim yourselves!” So what will you decide? To live like Patrick and “defeat your reason before you can start;” to live like Spongebob, and not take any chances or go outside your comfort zone; or to live like Larry…where risk is absolutely encouraged but in a calculated deliberate manner?

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.

Navigating Romantic Relationships During COVID-19

by Annabelle Parr

One of the many challenges presented by COVID-19 is the way it has altered how we are permitted to relate to one another. Required to maintain distance between ourselves and others, we are allowed out of our homes only for essential business and errands, or to take walks or runs as long as we keep at least six feet between ourselves and those we pass. Initially this six feet rule was termed “social distancing,” but experts have proposed that we shift our terminology to “physical distancing.” While this may seem like a trivial shift, it speaks to the importance of relational connection and reminds us that we must keep a physical distance from one another, not an emotional one.

Humans are inherently social creatures; we evolved in a context that dictated that connection and cooperation with the group was vital to our survival. So what a strange situation we find ourselves in where, for our collective wellbeing, we must put physical distance between ourselves and others. Paradoxically, you may find that this new paradigm is helping you to reconnect with friends and loved ones you rarely spoke with prior, taking advantage of the technologies that allow us to see one another even when you are not in the same room, city, or even country. You may also be finding that this shift has thrown new, challenging, unprecedented and unexpected variables into your romantic relationship. Whether you are dating, in a committed relationship, or married, COVID-19 has altered our daily lives in such a way that it is bound to impact our relational lives.

Dating during coronavirus

If you were dating prior to the COVID-19 outbreak, it may feel difficult to know how to proceed. With so many options for online dating and dating apps, the dating landscape has changed dramatically over the last decade, even prior to coronavirus. However, while these apps may help you find and connect with people you wouldn’t otherwise meet, typically, the dating itself has still involved actually meeting in person. For the time being, meeting in person is not an option.

But what if you are still interested in dating, meeting new people, and pursuing connection? If it is important to you to continue dating during this time, there are options available to you if you are willing to be flexible and creative. Rather than going out on dates, you can opt for talking on the phone, setting up a video call happy hour, or even a Netflix Party to share in a favorite TV show or movie together.

It’s also important to know that there is no pressure. If meeting for the first time through your computer screen does not sound like something that is in line with your values at this moment in time, that’s okay. Give yourself permission to take a break and know that this is temporary. Tune in to what matters to you and what you need to do to take care of yourself during this time.

Relationships during coronavirus

Maybe you are already in a committed relationship. If you do not live with your partner, you may have found that suddenly it feels like you are in a long distance relationship. Depending on any number of variables (from whether you or your partner lives with others, whether their roommates are still working outside the home, etc.), you may not be able to see each other or connect using any form of physical touch right now.

If, on the other hand, you are living together or have chosen to quarantine together, you are likely now spending near 24/7 in the same space together. This can present its own set of challenges. As much as we love our partners, as relationship expert Esther Perel noted, “our need for togetherness exists alongside our need for separateness.” And it can be hard to find that separateness during shelter in place.

Marriage and/or children during coronavirus

If you are married and/or raising children with your partner, not only are you and your partner now together 24/7, but the kids are home as well. Trying to navigate working from home and homeschooling children on top of everything else presents a lot of new variables to manage as a couple and family.

Tips for tending to your relationship during coronavirus

Whether coronavirus has meant that you and your partner cannot see each other in person, or whether it means that you are now almost constantly together, connection and communication are crucial for navigating this time together. Here are some tips for maintaining a loving, balanced relationship during COVID-19:

1. Acknowledge and have self-compassion for your emotions. Allow yourself to have your feelings. Be gentle with yourself and know that however you are feeling is okay. When we are willing to have our feelings and to be compassionate to ourselves in the midst of pain and struggle, we are able to make deliberate choices about how we communicate and behave that are in line with the type of person and partner we want to be. When we are unwilling to have our feelings, or we are unkind to ourselves, our emotions may find unhelpful ways of leaking out and may come to covertly control our reactions.

2. Clearly state your feelings and your needs. Our partners are not mind readers, nor should they be. We are all individuals with unique feelings and needs, and we can best support each other when we are each clear about what helps us to feel safe and loved. I-statements provide a useful template for communicating your feelings and needs clearly (I feel [x] when [y], and I need [z]).

3. Give your partner space and compassion to process and experience their emotions. Know that it’s totally normal for each of us to feel and think differently about this situation. You and your partner may have different needs, feelings, and opinions, and just as it is important that you allow yourself to have your experience, it’s important that your partner has the space to have their experience as well. In any given moment, one of you may feel anxious about all the uncertainty, while the other may feel grateful for time to slow down; one of you may want to be productive, while the other may be exhausted. One of you may want to be as informed as possible and process the information aloud, while the other may want to watch Netflix and only update as necessary.  

4. Work together to creatively support each other. You may have different needs during all of this, and that can be hard to manage. Carve out time to meet each other’s needs and find ways to compromise. For example, those in long distance scenarios may find one partner is craving a FaceTime date, while the other wants to ditch their screens for a while having been glued to them all day while telecommuting. Plan a time for a screen date to maintain connection, and also plan out some time for a screen detox.  

5. Stay connected with friends and family. Romantic relationships are not meant to function like islands; yet when we are stuck in the same space for weeks on end, it can start to feel like we are literally stuck on an island together. Make sure to reach out for support and connection with friends and family during this time. Having a wider net for support in times of stress is crucial.

6. Strike a balance between connection and separation. If you are in a long distance scenario, you may be craving more connection. If you are quarantining together, you may be craving more separateness. (Though of course the reverse can be true in either scenario as well). It is important to find time to connect, share our emotions, needs, and experiences, and be together, and it is equally important to have some space to ourselves, to read or engage in personally enjoyed activities, or catch up with other loved ones. Being intentional with our time and space, and honoring our own and our partner’s need for both connection and separateness can help us to strike a balance.

7. Laugh together. Humor can be so healing during times of stress. Finding things to laugh about together can help us bond and help defuse some of the tension we may be feeling. Whether this involves watching funny videos or shows together, playing silly games, or just finding the humor in little moments, laughter really is good medicine. It might sound hard to laugh during such a stressful time, but it’s important to seek out something that brings us a little joy and levity.

8. Connect with gratitude. This does not mean you are not allowed to feel anxious or sad or angry or exhausted about this massive upheaval. However, pausing to mindfully appreciate small joys or victories can help shift our perspective, even if just for a moment, and can help us to weather the storm with more resilience. See if you can notice the things that you are grateful for in your partner, the little moments with them that you cherish. Try to connect with something you are grateful for each day, whether it has to do with your relationship or not.

9. Utilize the tools available to you. We are still able to go outside, breathe in fresh air, take walks or go on a run. And thankfully we live in a time in which we have a whole host of technology available to us that allows us to stay connected in ways never before possible. None of this is an ideal situation, but don’t forget to utilize what is available to you to help create balance in your life and relationship where possible.

10. Seek professional support. If you are experiencing stress, anxiety, trauma, or depression that is impacting your ability to function effectively in your relationship (or any other important area of your life), professional support is available. Many therapists, including Dr. Shea, are offering telehealth services to clients during shelter in place. Telehealth or teletherapy typically involves conducting sessions via a videoconferencing platform or over the phone, and studies have shown telehealth to be as effective as in person therapy. It is okay to ask for help, and help is still available to you.

Relationships can be challenging even in the best of times, and as we face this totally unprecedented global stressor, expect that it will present some new challenges to your relationship. As much as it is a time filled with stress, anxiety, and fear, this is also an opportunity to develop resilience and skills to navigate situations full of uncertainty. Rest in the knowledge that this is a period of trial and adjustment for us all, and be gentle with yourself, your partner, and all of your loved ones.

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.