Is Your Anxiety The problem? Why Getting Rid Of Your Anxiety Isn’t The Answer:

When people start to have anxiety problems they usually believe that anxiety itself is a problem. When anxiety becomes the focus of attention people overlook the actual fear or fears that create anxiety in the first place. The problem with this is that it often fails to activate problem solving, because the anxiety creates distractions from addressing the actual situation that is being avoided. People can successfully avoid treatment for panic by focusing on being anxious about being anxious, which ironically tends to generate more panic and amplify the belief that anxiety is indeed the problem. In some circumstances, because people have tried to get rid of their anxiety unsuccessfully, they believe that nothing can be done for their anxiety. Sometimes people get angry when anxiety treatments are presented as options, because they don’t want to be invalidated for their efforts to get rid of anxiety.

People have anxiety about all sorts of things: Losing people they love, sickness or illness, death; threats of losing power, status, money; being in situations that threaten physical integrity or safety, being humiliated or shamed in public, being verbally attacked, being fired, or loss. In a given situation coping well with these situations means incorporating some degree of acceptance, acknowledgement, and sadness. It also might activate problem solving, fixing, or making changes to prevent these things from happening in the future. This is what normal people do in normal situations, and creates understandable, realistic, and adaptive ways of coping. Community supports, problem solving, religious institutions, family, and other means of coming together helps people to naturally solve painful life circumstances and problems.

People that have a lot of problems with anxiety generally tend to have problems identifying and responding to the actual thing that makes them anxious. If you are afraid of having conflict, and then you tend to avoid people when conflict is present, and then you have anxiety because you have conflict, and then you blame your anxiety, and then you try to get treatment for your anxiety, you can create ways to avoid addressing the actual problem. For example, treating anxiety with relaxation techniques without actually looking at what it is about the conflict, exactly, that is making you so anxious evades problem solving. When “the problem” becomes “the anxiety” most people’s solutions are to get rid of how they feel, not to figure out how to deal with conflict. If you could figure out how to respond to conflict adaptively, chances are your anxiety will naturally go down.

You can’t address emotional problems by failing to identify the thing that evokes the emotion in the first place. Here are some brief questions to help you figure out your anxiety:

What is it about this situation that you are actually afraid of? What is the actual threat?

What is the realistic likelihood of this actually happening?

If you had to approach what you are afraid of, what uncomfortable sensations, emotions, or experiences would you have to be willing to tolerate?

If what you are afraid of is actually happening, how would you approach this situation effectively?

What is one adaptive, problem solving step that you could take?

What can you do to validate the pain or difficulty of this situation to yourself?

Tolerating Uncertainty in Uncertain Times: Values, Anxiety, And Willingness In The Era Of The Coronavirus

In this pandemic, many people’s lives have been disrupted in ways they never imagined. People are struggling with losses, lack of structure, difficulty with motivation, changes in schedule, computer fatigue, lack of ability to control things, feeling restricted and limited in what they can do, and being told what to do by governmental authorities. Anxiety prevails when times are uncertain, time frames are not set, and no one knows what it will mean for “things to go back to normal.” People usually cope better when they have a clear answer as to when the stress and restrictions will end; as they can predict and control how long they will have to tolerate what may not feel tolerable. The not knowing is the challenge.

Sitting with uncertainty is often a major part of adaptive coping. Often when people feel out of control they behave in ways that produce an illusion of having more control, including trying to be more controlling themselves. Anxiety behavior tends to be restricting, rigid, and inflexible. Some pick fights with people they love. Some try to micro-manage the people around them. Some yell, lash out, or escalate. Some people withdraw, sleep, or restrict their interactions with others. Some stop reaching out to friends or people they love. Some avoid getting things done or move forward. Some drink alcohol or use marijuana in excess. Others cope by antagonism or rebellion, externalizing blame to authority figures who can’t make this end, either.

In an era of a pandemic, there is no immediate quick fix. No one knows what will happen, who will contract the virus, and who will be taken by the virus. No one can cheat death. Here are some things to keep in mind in the era of uncertainty:

-Anxiety behaviors are not a way to obtain certainty. People often have their own “personal fix” of what they do when they are stressed. Some of this has some sense of normalcy and is not harmful, such as sleeping a bit more or eating more chocolate. However, some anxiety behaviors have hurtful outcomes. What is your anxiety behavior when stressed, and does it actually control the outcome of when the pandemic will “end”?

-Be willing to accept the discomfort of uncertainty. In the face of uncertainty, people have found ways to cope well. Find the ways in which people are coping well and see what you can do to manage stress and anxiety without making it worse. Reach out and ask what other people are doing with boredom, fatigue, work-life changes, and other related stressors. Find the news, heroes, and people who have survived great life challenges well. Once you accept what you can not control, your anxiety may not disappear but it will go down. Trying to control what you can not control makes it worse.

-Keep in mind your values. What is important to and who is important to you and why? What does this tell you about your spiritual values, who/ what to trust, and who you rely on when you are having a hard time? A willingness to yield control often means finding more trust in community. People are rediscovering lost values as limits are being placed on them, and finding new ways and means of connecting to family and loved ones. Keep asking and looking people for the silver lining, the unseen benefit, or the ways that people are enhancing their sense of connection.

-Do your part. If you have something to offer at this time, consider the benefit or value of what you can do for others. Often contributing is a way to distract from our own anxiety and involves universal benefit. Donate to a food drive, reach out to neighbors, do errands for someone who is quarantined, pick up trash in a nearby park or bike path, give blood, make masks, cook or bake for family members, repair something that is broken, join a neighborhood volunteer task force, or start online Zoom socials.

Why Your Psych Meds Aren’t Working- A Bitter Pill To Swallow?

Psychiatric meds actually do work, and they very well may be working. Psychiatric medications have helped numerous people with many different things, including nightmares, anxiety, symptoms of bulimia, public speaking, mood regulation, paranoid thoughts, and depression.

However, there is one thing that medications will never do, and that is get rid of emotions. Emotions are hard wired, biologically adaptive responses to situations that help people survive. They give people important information about threatening situations and painful circumstances. The allow people to know what matters, what to hold close, what to pursue, what risks to take, and what to avoid. Without emotions we would not have important information about ourselves, our circumstances, our environment, and other people.

People have tried numerous and unsuccessful things to get rid of emotions. This might include drinking, drug use, numbing out, hurting oneself, picking fights, avoiding, sleeping, dominating a conversation, being coercive, smoking marijuana, or being violent. The simple truth is, emotions can’t be eliminated. If they are temporarily eliminated, they come back.

Some people don’t like their emotions because their emotions show up when other people tell them what to do, how to think, how to feel, or how to react. Thus they minimize or inhibit their emotions in these situations because they are trying super hard to fit in, avoid conflict, live up to someone’s standards, please a parent, or survive in their environment. However, this can lead to a very unhappy life and can be very painful.

Sometimes people are very sensitive to emotions, thus they tend to have strong reactions to things that may, to others, not seem like that big of a deal. While this can lead to bigger, out-of-control emotional problems, it is also important to learn how to discern when a threat is actually a threat, vs. when a person develops a fear or phobia about something that is not a threat.

Emotions are often related to eccentric, atypical, or problematic behavior. If you have a behavior that you are trying to stop doing, just consider if not doing that behavior brings up any discomfort, anxiety, or restlessness for you. Asking people to stop doing behaviors such as self-harm, drinking, escalating an argument, threatening suicide, doing a behavior excessively or repetitively, or picking a fight is quite hard. The benefits if these behaviors can sometimes include getting a point across, expressing an emotion, getting taken seriously, reducing anxiety, or getting another to be validating or affirming. Sometimes significant others don’t react at all until another person escalates or flips out, which makes the problem behavior even harder to stop. (After all, it worked!).

If you think your psych meds aren’t working it may be worth asking yourself: What feelings do you have that are intolerable? What do you think your feelings might be telling you? What feelings do you try to ignore? What feelings are trying to get your attention? How willing are you to bear with some of the discomfort of what is going on for you? If you honored your feelings and what they were telling you, what sort of action would you take?

Understanding, naming, managing, and controlling moods are a lot of work. Thankfully, there is are services available that are focused on doing just that- and aren’t focused on dosages or prescriptions. While meds do wonders for people- they are not, thank goodness, the only way of helping a person solve emotional problems. In fact, the entire basis of the group services that I provide help people with all of this- managing mood, understanding emotions, listening to one’s wisdom, and taking necessary steps to tolerate feelings better. Getting rid of what you feel is just not an effective long term strategy for solving emotional problems.

What if your depression and anxiety was not something you actually “have”?

Depression and anxiety are often considered something that a person “has”. Once they “have” depression and anxiety, there seems to be a mentality both in the general public and among mental health professionals that it is very hard to not have. Or that the obvious solution is to get rid of it- and in most mainstream ways of thinking, that solution is often medication.

Part of being a successful professional means that I need to help people think about the treatment of their think depression and anxiety differently- and figure out what to do about it. If depression and anxiety were a thing a person had, it would be a permanent condition: not subject to change. There would be no point in getting help. When people think of depression as a thing a person has, it becomes a noun. It is a reified, concretized, objectified, thing. People might think of it as actually existing or residing within them, somewhere in their brain or their heart. It feels bad and they will do anything to avoid or get rid of it if possible.

Depression is not only seen as a “thing” a person “has”, but it is also often cited as a cause. In other words, the reason you may be depressed is because don’t get out of bed. Yet the reason you don’t get out of bed is because you are depressed. The reasoning is not only rhetorical; it doesn’t solve any problems. Telling people that the reason they have problems is because they have anxiety or depression isn’t usually helpful- and doesn’t provide any solutions. If only people were interested in what actually causes depression or anxiety!

I think of depression and anxiety as verbs: aspects of experience and subject to change. Emotions, depression, and anxiety is caused; it is not a cause. It is something that can increase or decrease based on a wide range of factors. Those factors are worthy of exploration and can help a person feel more in control. If a person believed that depression and anxiety was caused, and those causes could be better understood and addressed; a person might have better options for not being depressed. Knowing when and how depression might show up also might make a person more able to predict and control its occurrence; and have less experience of depression and anxiety as an unknown “thing” that creeps up “out of the blue” and remains a static “thing” a person “has.” It’s mysterious, stigmatized entity prevents us from understanding or treating it.

Part of working with people is helping them gain an awareness on causes, reasons, triggers, and stimuli that evoke high anxiety and severe moods. Much of the time people don’t always realize the extent to which they are bothered by losses or threats; and the lack of paying attention can sometimes cost them in very painful ways.

Why Isn’t My Teenager Honest With Me?

One of the problems teens struggle with is honesty. And it’s not only honesty with one’s parents or authority, but honesty with oneself.

Part of psychological distress comes from hiding the more difficult and disturbing aspects of experience from oneself. While this can sometimes be adaptive, it can become problematic when it comes to drinking, sexting, drug use, teen pregnancy, domestic violence, and other situations teens can sometimes get themselves into.

Being honest about a situation means admitting it is actually happening, admitting it is real, admitting the distress is real, and addressing potential consequences. Not admitting it is real, not asking for help, and not coping with the situation can lead to even more problematic consequences. Addressing something openly- while often difficult- can lead to prevention of further problems.

Admitting to the reality of a situation also may involve admitting to one’s role or part in the situation. Teens can sometimes not be honest because they have a fear of getting into trouble or a fear that it will escalate an intense reaction in the person they tell. They would rather avoid the short-term pain of intense reactions than the long-term problems of the situation. And teenagers are often not thinking about long- term consequences! The double bind is to deal with it all alone. A teenager who is all about gaining independence and relying less on one’s parents may believe that secret keeping is the only way to gain privacy and independence.

If you are a parent and want to increase you teen’s ability to confide in you, consider the following:

What are you doing to invite conversations about difficult topics, and what are you doing to punish conversations about difficult topics?

Are there topics or themes in your own life that are “off topic”? Are there conversations that would be too emotional for you to handle if someone were to ask?

Is the short-term anxiety of “not knowing” something worth avoiding based on the long-term consequences of not having a conversation at all?

What types of things do you “hide” from yourself because if you admitted they were true, you’d have to face the consequences?

If you were being completely honest with yourself, what situations would you have to confront?

What types of things did you keep from your parent/s when you were a teen, and what do you wish could have been different?

Being open about emotionally “forbidden” topics will help create an environment where openness is encouraged. Being more and more comfortable with intense emotions, painful life situations, and one’s own ghosts will help you develop deeper relationships. Avoiding painful life situations can sometimes create more psychological distress than seeing what is in front of you, admitting it exists, and taking steps to address it.

Should I Get Back On The Horse? Two Ways To Approach Your Fear That Won’t Work.

If you get thrown off a horse, should you get back on? Some people will suggest that you need to get back on the horse immediately so that you will gain mastery over your fears. If you don’t get back on the horse, then your fear will haunt you the rest of your life.

Is this really true? Here are some ways of approaching fear that isn’t very effective. The first is to fight your fears or treat the situation like a battle zone. It means taking the reins, having control of the situation, bucking up, grinning and bearing it, tightening your muscles, and powering through. It can be coercive and forceful. In some cases it means blinding yourself, dissociating or disconnecting from the fear, or minimizing or reducing the value of what your fear might be trying to tell you. Generally it is doing the thing that you are afraid of as a way to prove yourself or prove your point.

The reason this doesn’t work is because it often means engaging in life as if it is a battle. Staying in the battle field often means getting hurt, risking relationships with others, being coercive, or putting the other on the defensive. Getting back on a high strung or agitated horse to gain mastery over fears is not an effective way to manage fear.

The other ineffective way of handling fear is to completely avoid anything associated with the fear. This means that any mention of the feared object or situation is avoided. Conversations stop, people stop making eye contact, the air becomes stilted and stale, people avoid people, and people avoid a wide range of stimuli that becomes associated with the feared situation. The person may be humiliated that they gone thrown off a horse, so they go out of their way to hide it. While people lead perfectly fulfilled lives without riding horses, the person who can’t drive past a barn, watch a television show with a horse on it, have a conversation about what happened when they were thrown off a horse, or set foot on a farm may find themselves restricted in ways that have nothing to do with riding the horse itself.

Handling fear effectively means being able to approach the situation with a flexible style that involves both challenging oneself, listening to the validity of the fear, being kind to oneself, backing off when things are too overwhelming, identifying smaller steps to approach the fear, and figuring out why the situation/ issue/ activity is important to you.

Fear is a useful emotion in that it provides information about oneself and one’s situation. Fear protects us from danger, gets us out of threatening situations, and helps us cope adaptively. Fear can also be so extreme that it takes over our lives, restricts our ability to do the things that are important to us, or prevents us from having a life- the life we want.

Here are a few questions to help you figure out your fear:

  • What about the situation, event, activity, or relationship is important to you? You may decide not to ride horses ever again, but does this fear bleed over into other areas of life that prevent you from doing what matters? If riding horses is not important to you, and it doesn’t get in the way of your life otherwise, it may not be an issue.
  • What does your experience- and your fear- tell you? Your fear may be telling you that getting back on an agitated horse is indeed a bad idea. So don’t go out and get hurt if it isn’t necessary. If horses aren’t your thing, let it go and move on. Don’t let your humiliation keep you attacking something that isn’t going to service you.
  • If you want to approach your fears, what would be the smallest step? Watching a TV show about horses, visiting a barn, feeding a horse, brushing a horse, walking a horse, and hanging out with horses are all behaviors that don’t include absolute avoidance but don’t force you into a situation that is potentially unsafe. You could also ride a smaller, more mellow horse with the help of a trainer.
  • If you are going to do the smaller steps, don’t white knuckle it. Relax your facial muscles, soften your jaw, breath slowly/ deeply/ evenly, maintain an open body posture, and take in the situation fully. If this feels threatening, do a smaller step- or limit the time you spend doing the activity. For instance, you could watch a TV show about horses for one minute, five minutes, or fifteen minutes. If this doesn’t challenge you, up the ante by going out to a barn. Find your middle ground, back off when you are overwhelmed, give yourself credit for your efforts, treat yourself kindly, and challenge yourself at some point in the future when you are in a better place.

Manchester By The Sea- A Psychologist’s Point Of View On How To Work With Lee

Recently I went to see an excellent movie: Manchester By the Sea. Here are some thoughts I have about how I would work with Lee.

As a provider of clients who experience intense, severe, and painful emotions; Lee really does fit the bill. General questions that I might consider asking include: What would it take to reduce pain, survive loss, and manage or cope in a way that made things better? What would help Lee feel less stuck? What resources or connections could sustain him better, enable him to bear the weight of his pain, or enhance his quality of life? What could him grieve more fully and to get through this crisis? What is he doing that is working, and what is he doing that is not working? Could he be more likable to himself, sustain the burden or his guilt, or have more fulfilling relationships?

One agenda item I have is getting Lee to stop doing things that could potentially make his current situation worse. Often times I have clients who have severe emotional pain and it is so intense and unbearable that they are looking for any distraction to take away the pain. The distractions sometimes have a short-term effect of feeling better, which makes them hard to stop. However, in most cases these distractions can make problems worse- and are not effective long-term strategies to mitigate the severity of what they feel.

So one treatment agenda is to reduce risk taking or crisis-generating behavior. Specifically, Lee tends to get drunk, pick fights, and throw punches. The natural consequences for this behavior can result in serious injury, concussions, brain damage, head injuries, broken jaw, soreness, swelling, or other various medical trauma. Drinking heavily can result in poor decision-making, hangovers, dehydration, and liver damage. Other natural consequences of his behavior include legal problems, court dates, jail time, being seen as a threat in the community, increased relationship conflict, and isolation. Grabbing the gun of an officer might result in unintended harm to other people. Not only would Lee have the current dilemma of living with the intense and painful losses he has suffered, but he would have to address the above consequences in addition to everything he has already gone through.

Some people actually believe Lee’s behavior is justified. They would say that because he is in unbearable pain, he should be able to act the way he does. Or he should be let “off the hook” because his behavior is understandable. I would encourage those people to consider: Would you recommend your closest confident or best friend- who is deeply hurting- do something that could result in head trauma? Liver disease? Incarceration?

Another “justification” for Lee’s behavior is that he has significant guilt and self-hatred and he is trying to punish himself. After all, the law did not punish him enough! What would be an effective punishment, and how long does he need to punish himself for his actions? Are self-inflicted/ high-risk behaviors actually effective in making him feel less guilty? What if a police officer was shot by accident? What type of effective repair work needs to be done? What lifestyle habits could he change to prevent bad things from happening in the future? What would he need to do to redeem himself in the community? And what would it take for members in the community to find forgiveness, employ him, or tolerate him being around?

How would treatment move Lee towards growth, movement, and decreased pain? There are several ways to approach this- the key being a sensitivity and flexibility to what Lee would be able to handle at the time he seeks help. One is a baseline ability to talk about what happened. As he pieces together his story, there may be parts that are difficult to talk about. Avoiding these topics might show up in the form of escaping, not talking about it, dissociating, becoming numb, becoming argumentative, keeping one’s distance, staying detached, avoiding intimate relationships, leaving, drinking, or even picking more fights. The difficulty is that there are multiple reminders (or stimuli) that will show up throughout his life that he may not be able to avoid. These may include:

  • Conversations about young children
  • Seeing a house fire in the news
  • Talking to his ex, Randi
  • Seeing Randi’s newborn
  • Getting news that young children die or are dying
  • Randi saying “I love you”

For instance, what if he is watching the evening news and suddenly there is coverage about a house fire? What if Lee has a building tenant who loses a child to death, and Lee is present when the tenant tries to discuss it with him? What if Randi tries to contact him again or “shows up” in an unexpected manner? Maybe Lee can try to avoid these situations in the short term, but inevitably life, reminders of life, and young children are the life that surrounds us.

Therapy would work on staying present with emotional discomfort when these topics come up; and doing so in the presence of one or more people. That means not attacking, hiding, or getting drunk. It means being willing to experience grief, pain, discomfort, or tears. It means staying in a conversation and having a willingness to tolerate the stuff that seems unbearable. The more Lee does to avoid it, the worse it is going to get.

Healing results when a person’s grief can be managed, survived, and tolerated. Healing is about experiencing, talking about, and coming to terms with what happened in the presence of others. Healing happens when people can forgive themselves and each other and can make changes to prevent bad things from happening in the future.

Healing doesn’t happen when a person is literally “stuck” in blocking out all things reminding them of pain, and lives a life where they are blind and deaf to such triggers; avoiding any stimulus in real life that will inevitably show up at some point.

Healing doesn’t happen when emotions literally control lives, and people can’t engage a full, meaningful, rich, and productive life as a result. Healing doesn’t happen when there is no compassion for self or others, when there is no forgiveness, and when there are no second chances.

 

Depressed? Anxious? Here’s What You Can Gain and Obtain

Most people who have more than their fair share of depression and anxiety are often seeking ways to decrease depressive and anxiety symptoms. In other words, they want to not be depressed and not have significant anxiety. If the symptoms are extreme or significant the person may start to avoid a lot of things, such as getting out of bed and going to places to that prompt panic attacks. Lifestyles can become restricted and the person may stop going to events or venues where they have the feelings they don’t want. Medications might be pursued, evaluated, and re-evaluated to see if they “work” or they “don’t work”.

If you are a depressed or anxious person, it might be worth considering what it is that you want more of, you would like to have, or what you value in your life. Instead of thinking what do I want to avoid start thinking about what you want to have more of in your life. What is it that would make your life more fulfilling, more engaging, more interesting, more desirable, or more alive? What is actually important to you? Sometimes people are so focused on what they are trying to get rid of they stop pursuing what they want.

Figuring out what you want more of ties in to your values, your energy, and your time. Are you sacrificing what is important to you because you are avoiding negative feelings? Have you stopped seeking activities that give you pleasure, fulfillment, obligation, a sense of contribution, or the opportunity to enhance an important relationship? If depression and anxiety interfere, this is a good time to evaluate what you might have to tolerate to go after more of what you want.

Sometimes, if people have more of what they want, their buffer against depression and anxiety can be tolerated more naturally. Some people get panic attacks at work, but because their job is important to them, they find a way to bear with them. Sometimes people get depressed when important things are lost, but because they have other important and meaningful activities in their life, the depression is bearable.

People who have fulfilled lives often have a wide range of things that give them pleasure, provide a sense of work/ mastery, invest in important relationships, and find new relationships when important ones end. Diversity and stability of the good things can help people shore up more resources when things go south and important jobs and relationships end.

 

 

 

 

When Things Fall Apart by Pam Chordron

Here are some paragraphs from this book:

“When the bottom falls out and we can’t find anything to grasp, it hurts a lot. It’s like the Naropa Institute motto, ‘Love of the truth puts you on the spot.” We might have some romantic view of what that means, but when we are nailed with the truth, we suffer. We look in the bathroom mirror, and there we are with our pimples, our aging face, or lack of kindness, our aggression and all that timidity– all that stuff.

This is where the tenderness comes in. When things are shaky and nothing is working, we might realize that we are on the verge of something. We might realize that this is a very honorable and tender place, and tenderness could go either way. We can shut down and feel resentful or we can touch and I met throbbing quality. There is definitely something tender and throbbing about that groundlessness.

Things falling apart as a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: Room for grief, for relief, for misery, for joy.”

(pages 7-8).