Showing all posts tagged managing anxiety

As It Turns Out, Time Doesn’t Heal All Wounds.

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As It Turns Out, Time Doesn’t Heal All Wounds.

Have you ever noticed that one guy at work, the one who you’ve never liked, but couldn’t put your finger on why? Or the neighbor who, for some reason, when she smiles at you, you feel irritated? Or why you can’t stand the smell of a certain laundry detergent? Or why, even though you’re accomplished in your field, you feel like an idiot before you give a presentation?

We all have an information processing system hardwired into our brains. This processing system has evolved to help us integrate emotional turmoil into our mental health and is essential for healing. This system helps us to let go of what is not useful information and make connections to what is useful about an experience so that we can adapt, grow, learn, and face similar situations more intelligently.

Here is an example:

You have a stressful interaction with your mother-in-law while she is visiting for a holiday. You feel angry, disappointed, and resentful. Your chest is tight, and your stomach is in knots. You think negative thoughts about her (“She’s always such a cold, demanding jerk.”) and about yourself (“What is wrong with me that after so many years, I can’t seem to avoid these situations with her? Is it me?”)

You keep mulling over what happened, talk about it with friends, maybe even have a stress dream about it that night. The next day, you still feel a bothered by it but not nearly as much. You’re able to think more clearly about it and understand that you two interpret things differently and that there are ways that you can skillfully manage this. This is your brain’s information processing system at work. It’s transformed this disturbing situation into a learning experience. (You can also thank your REM sleep phase for this since this is the time during which wishes, learning/lessons, survival/stress experiences are processed through the action of “synaptic pruning.”

Because of this uninterrupted time to process, your brain was able to associate the memory of the interaction with your mother-in-law and useful information already stored in your brain (from other stressful interactions with her and others) to create resolution. You remember what happened, what worked, what didn’t, and that it isn’t personal, that this is just the way she is and that you have useful tools for interacting with her. The intense emotional reaction you felt the day before is gone.

Unfortunately, our brains do not adaptively store all of our experiences in this way. Sometimes we encounter traumatic experiences or otherwise stressful experiences that overwhelm our brain’s capacity to process and adaptively store information received during these experiences. This is often referred to as “going off-line.” It’s kind of like short-circuiting.

When we encounter extreme stress, the emotional and physical reactions we experience during the event keep the brain from identifying useful information about the situation; there is no resolve. What happens instead is that the event and its information is maladaptively stored. This means that the event and its components are stored in the brain and body as it happened. Everything you saw, heard, felt (physically and emotionally), tasted, smelled, thought remain in their original, unprocessed form.

You do your best to move through it, but whenever any of these senses are triggered, your emotional disturbance level sky-rockets and you have a reaction. Many times, multiple unprocessed events are linked to one another in such a way that if one is triggered, all are triggered. These events, while often linked to one another, are stored in isolation so that they are not linked to anything adaptive.

No amount of time will help them to integrate. It’s as though these events are frozen in time. An event could have happened 40 years ago, but when triggered it’s as though it is still happening or just happened.

Our personalities, coping skills, perspectives, and beliefs about ourselves and others can develop through the lens of these unprocessed events and impact our emotional and physical capabilities.

Research shows that it’s not just clearly identifiable traumatic events that are responsible for this outcome, but any event or pattern that our brain experienced as overwhelming.

It could be the way someone spoke to you as a child, your interpretation of someone’s behavior you witnessed at three years old or making a mistake during an academic oral exam in second grade. We don’t always know how our brains will store an event.

The good news is that we’re not stuck here. There are therapeutic tools that can help us to free ourselves from the suffering of an unconscious cycle or unprocessed event. One of the most efficacious and reliable tools is EMDR (Eye Movement Desensitization and Reprocessing) Therapy. This therapy helps us to safely contact the disturbing event or maladaptive cycle and process it, giving us a new understanding of the situation so that we can use its information intelligently.

If you would like to know more about EMDR Therapy, please call or email me. I would love to talk with you more about this process and see if it’s right for you. If you’re not quite ready to reach out yet, that’s ok, too. You can find more information on EMDR Therapy here and here.

 

Love and Be Loved,
Natalie

6 Steps to Trusting Yourself

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6 Steps to Trusting Yourself

“The suffering itself is not so bad; it’s the resentment against suffering that is the real pain.”
-Allen Ginsberg

 

When I first started my own work with mindfulness and radical acceptance, I found myself saying, “I’ll accept this feeling/ this symptom so that I don’t have to have it anymore.” That’s… not really acceptance but it was the best I could do at the time. Since working with clients around mindfulness and radical acceptance, I have heard this sentiment hundreds of times. It’s hard to get behind the idea that accepting our pain or feelings or aversive experiences has therapeutic value, that it could ever help us to make positive changes. Acceptance and Commitment Therapy is driven by just this, accepting the hard-to-accept.

 

Acceptance and Commitment Therapy was created by Steven Hayes in the early 1980s and tested by Robert Zettle in the mid-1980s. It is a form of Cognitive Behavioral Therapy (CBT) and is based on Skinner’s Radical Behaviorism. Acceptance and Commitment Therapy’s (ACT) main objective is to help participants turn toward their feelings and symptoms instead of resisting them. The protocol helps participants learn how not to overreact nor underreact nor altogether avoid the associations with these feelings and symptoms. With ACT, we learn to accept ourselves and the experience we are having in the present moment so that we can commit to a behavior aligned with our values.

 

ACT succinctly describes the change in psychological flexibility in this way:

 

We go from F.E.A.R.

 

F- fusion with our thoughts

E- evaluation of our experience

A- avoidance of our experience

R- reason-giving for our behavior

 

To A.C.T.

 

A-accept our reactions and be present

C- choose a valued direction

T- take action

 

In the book, Acceptance and Commitment Therapy: The Process and Practice of Mindful Change by Hayes, Strosahi, and Wilson, we’re given the six core principles to help us develop psychological flexibility:

  1. Cognitive de-fusion: Learning methods to reduce the tendency to reifythoughts, images, emotions, and memories.
  2. Acceptance: Allowing thoughts to come and go without struggling with them.
  3. Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness.
  4. Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is unchanging.
  5. Values: Discovering what is most important to oneself.
  6. Committed action: Setting goals according to values and carrying them out responsibly.

 

ACT emphasizes mindfulness because presence of mind/contact with the present is the only way to change behavior. Now is the only time that we can truly choose a behavior. We habituate to looking at the world in a certain way which makes us miss important external and internal cues to help us determine what is happening in the present moment by thinking about the past or the future. Awareness of the present moment helps us to differentiate between what we are afraid is happening and what is actually happening. It helps us to describe what is happening and then make choices in response. Jon Kabat-Zinn describes mindfulness as “paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally.”

 

The “acceptance” part of ACT is problematic for some. “So then, if I’m supposed to accept my feelings and my experience, does that mean I’m supposed to accept abuse and maltreatment?” The answer to that will always be no. When we accept our feelings and experience, it means we accept the information that we are receiving and can make choices based on that information. It means that we accept that this is how it is right, not that this is how it should continue to be.

 

When we practice acceptance of what’s happening we can mindfully make choices that are in alignment with our values. I like to use this phrasing in my own life and when working with clients: “I’m going to keep choosing the same behavior of ______ because I care about______.” Or “I’m going to change my behavior to ______ because I care about ________.” So, someone might say “I am going to keep choosing the same behavior of confronting people when they treat me with disrespect because I care about my feelings and how I’m treated.” Or “I’m going to change my behavior to respectfully disengaging from an argument when it no longer feels productive because I care about my feelings and this relationship and I know that continuing in unproductive conversation usually leads to hurt feelings and resentment.”

 

Sometimes the choice is hard to make. For instance, “I choose to go to bed earlier so that I can wake up feeling more refreshed” is a great behavior goal. But what if it means sacrificing quality time spent with loved ones? This is where present moment focus and acceptance of your experience comes in handy. You might prefer to spend the time with your loved ones and wake up feeling a little more sluggish.

 

I know it’s hard to identify choices so let’s do it together. If you want to talk more about Acceptance and Commitment Therapy, changing behaviors, or anything else, please call or email me.

 

Love and Be Loved,
Natalie

Can My Relationship Be Saved?

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Can My Relationship Be Saved?

Most of us want security in our relationships. We’re wired to be social so, when we feel like our social standing is threatened or that our intimate connections are unreliable, our brains process it as actual danger, and we freak out.

Some of us crave security and validation of our places and safety in our relationships but can’t seem to find partners with whom we get that. We tend to find and are attracted to people who provide us with incredible highs (and incredible lows), drama and a push-pull style of interacting. When we’re in relationships with partners who help us to feel more secure and receive validation of being loved, respected and cared for, we often feel bored. We mistake the tension-relief cycle and the excitement of the highs and lows for love. This type of behavior is common in those of us who have an anxious attachment style. We think we want security (and we do but getting it also stresses us out) and then when we get it we’re not interested.

 

Look at this scenario. Let’s say you are in the middle of a pretty unstable intimate relationship with a partner. To friends and family, the relationship is fraught with various dramas and issues; everyone thinks it’s run its course and just needs to end. You acknowledge that there are problems, but think you can work through them. You might even believe that you can’t live without your partner or that there is no one you could ever love as much. Your partner is ambivalent about your future as a couple which is weird because when you first started dating, they came on strong and made you feel like you were the only person in the world. Now, you’re lucky if you get a text back. Much of the relationship consists of a good couple of months and then a breakup or the threat of a breakup. Even when things are good, there is a lot of discord because you don’t feel prioritized by your partner and they experience you as suffocating. When it’s good, it’s really good, but when it’s bad, you feel like you might lose your mind. When you’re at work or out with friends, you are often distracted and thinking of your partner, waiting for their text or call. If they do contact you, all of your attention is fixed on them. You often threaten to end the relationship, but when an actual breakup happens, it’s either initiated by your partner or because they are the one who follows through on your threat. You think the relationship would be perfect if you partner would make only a few changes to your dynamic. After all, you’ve sacrificed a lot of your expectations and some of your values in a desperate effort to make this relationship work. You often say you’ve never loved anyone so much until now. This is also one of the most unstable relationships you’ve ever had.

 

In this example, you are exhibiting anxious attachment behavior. It doesn’t necessarily mean that you have an anxious attachment style. During the course of our lives, we are in relationships with people who might connect us to various styles of attachment. If this relationship is representative of most of your intimate relationships, then it might be more likely that you have an anxious attachment style.

 

People with an anxious attachment style (or who have enough of a propensity for it) feel themselves pulled to people who have an avoidant attachment style. The partner above is a pretty good example of someone who might have an avoidant style of attachment or at the very least displays some features. This is usually pretty rough going because while one partner craves validation and is insecure about space in the relationship, the other partner is looking for more space and is insecure about giving validation.

 

This is a pretty crazy-making, taxing cycle. To add insult to injury, the more we engage in this cycle, the more insecure we become. I know it probably feels like there’s no winning here, that you can either be with someone you love but who can’t give you the security you need or be with someone who can give you that security but not a satisfying connection. I would love to talk with you more about this. Please contact me if you would like support.

 

I recommend reading the book Attached., by Amir Levine and Rachel Heller. It’s a great resource for people struggling through these and similar patterns.

 

Love and Be Loved,
Natalie

How Do I Know If I Need Therapy?

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How Do I Know If I Need Therapy?

“So about how long should it take until I feel better?” “How long do you think I’ll need therapy?” “How many sessions should I expect to attend before my problem is solved?” I have asked all of these questions during time spent on the other side of the couch. I know what it’s like to want concrete answers and expectations met. Everyone wants a sure thing in the face of so much uncertainty.

Therapy is not exactly a sure thing. Surely, it can and does help, but it’s not as simple as basic input of time and results yielded. Results depend on client honesty (with themselves and the therapist), right fit with a therapist, client’s commitment to the work both in and out of the therapy office, and right fit with whatever therapeutic modality is used.

Therapy is almost never a quick fix, but there are quicker-fix type/brief therapeutic modalities available. Whether or not these protocols are right for someone depends on a lot- personality, history, diagnosis, whether or not a person has experienced complex trauma. Even in the best of scenarios, it still requires the practice of skills through time to maintain results.

Under the psychotherapy umbrella, there are five really (really) broad categories we use to organize treatment strategies:

Psychoanalysis and Psychodynamic Therapy:

Makes the unconscious conscious, insight oriented. Emphasis on client-therapist relationship. Brief therapy model (20 session maximum) is not the rule, but is available for single-incident trauma like an attack, rape, catastrophic event, targeting a single life shift.

Examples of Psychodynamic Therapy: Jungian, Dream Work, Attachment-based

Often used for: Increasing self-compassion, improving self-concept, self-actualization, mood disorders, relational problems, trauma, developing insight to identify and manage internal conflict, shifting external locus of control to internal locus of control, couples, families,

*Psychoanalysis: Multiple times per week. The therapist is a blank slate onto which client projects their beliefs and experiences. Relies heavily on free association.

 

Behavior Therapy:

Focuses on conditioning new behavior. Uses brief therapy model.

Examples: Applied Behavioral Analysis, Aversion Therapy, System Desensitization

Often used for: Phobias, Addiction, Anger issues, Impulse control problems, self-injury

 

Cognitive Therapy:

Focuses on changing thought pattern. Uses brief therapy model.

Examples: Rational Emotive Behavioral Therapy, Cognitive Behavioral Therapy

Often used for: Phobias, Addiction, Schizophrenia, Bipolar Disorder, Suicidal ideation, Anxiety disorders

 

Humanistic Therapy:

Focuses on cultivating personal accountability and reaching highest potential. Emphasis on free will. Uses both brief and long-term therapy models.  

Examples: Gestalt, Client-Centered, Transpersonal, Solution-Focused, Adlerian  

Often used for: Improving self-concept, self-actualization, improving communication with others, cultivating self-awareness, shifting external locus of control to internal locus of control, couples, families, existential crises  

 

Integrative or Holistic Therapy:

Often referred to as “Eclectic Therapy.” (Some practitioners will basically fight to the death in disagreement over whether or not Integrative is also Eclectic.) Uses various modalities depending on what is indicated for each client. One therapeutic modality combines various features of the previous four categories. Uses both brief and long-term therapy models.  

Examples: EMDR, Narrative, Cognitive Behavioral, Dialectical Behavior, Internal Family Systems, Gottman Method, Transactional Analysis

Often used for: All of the above

 

Some people prefer to see the same therapist for various issues they’d like to target while others seek out a different specialist to treat each issue. There’s no right way to do this, just whatever feels like it’s working for the client. Some clients come with an agenda and leave when their goals have been reached. Some stay for a while after because they like having a professional to talk to who’s all about them. Plenty of people try therapy and find it difficult to give themselves over to the process, take a more passive route to treatment, get frustrated and give up. Sometimes this is because traditional psychotherapy is not a good fit for them right now, maybe ever. There are so many other great therapeutic options. Traditional psychotherapy is not the only way to heal or feel better.

 

I know it’s overwhelming to look for a therapist and decide which kind of therapy would be best for you, especially when you’ve been dealing with a problem for years, and you’ve finally decided to take the plunge and ask for help.

 

If you describe the issue and a little bit about yourself, many of us will be able to direct you in the right direction. There are plenty of therapists who won’t do this because they are sure that they can handle it regardless of their training and orientation. While I would like to believe that this is mostly the exception rather than the rule, it happens. If you feel too overwhelmed or busy or exhausted to educate yourself on various therapeutic tools and modalities, remember that you can interview multiple therapists at a time to see who feels like the best fit for you. (You can also do this regardless of your stamina to self-educate.) Once you start seeing a therapist, you can audition us. If you’re not feelin’ it for some reason, you can switch. It’s ok not to like your therapist or to like them, but feel like they’re not actually helping you. Therapy is an investment, and you have the right to switch providers at any time for any reason. If you’re feeling like you need to discontinue treatment, I usually recommend addressing this with the therapist; sometimes it just takes a little direct communication to shift things. Even if you don’t plan on continuing your work with the therapist, honest feedback is good for both sides.

 

If you’d like to talk more about this, please email me or call and I would be happy to answer any questions. This is one of my favorite subjects!

 

Love and Be Loved,
Natalie

Stop Catastrophizing

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Stop Catastrophizing

As I was finishing up grad school, I began diligently searching for jobs in my field. After a lot of cover letter writing interviewing, I finally found an entry-level position and set up shop. A little while later I was laid off due to budget cuts. I hadn’t been in love with the job, but I’d liked it well enough and the prospect of job hunting again and being unemployed for the first time scared me. One night, I was talking to my wonderful friend about it, and I was freaking out. I don’t remember exactly what I said, but I recall verbatim her response. After I had painted us both a bleak picture of my future she paused for a minute, then said, “So, do you think you’re going to be the 80-year-old in the retirement home who just never found another job?”

She stopped me dead in my tracks, trained a spotlight on my thinking, and called it out for what it was- catastrophizing. Catastrophizing is worst-case scenario thinking. It’s pretty common and can be kind of fun when using it for affected theatrics or hyperbole. It’s much less fun when it feels more like a belief, and we’re just waiting for it to happen.

In my line of work, people catastrophize to me a lot. Sometimes they’re aware they’re doing it and sometimes they’re not. It’s my job to help them identify the behavior and get their thinking back into reality and under control.

Catastrophizing is a bit like a photo filter for our brains. And, oh, there are so many filters available to us. We can use the all-or-nothing thinking (or black and white thinking) filter, the discounting-the-positive filter, the mind-reading filter, and the blame filter. That’s not even all of them. There are countless ways for us to distort situations.

When we employ all-or-nothing thinking, we only allow for extremes. We invisibilize the whole picture, which means we invisibilize a lot of pertinent information. With this line of thinking, there are no positive outcomes for us.

Discounting the positive is a way for us to either weigh only the negative or weigh the positive in a negative way, either about ourselves, a situation, or someone else. It looks like this: “Why would anyone want to hire me? I’m young and inexperienced and don’t have a very impressive resume.”

Mind reading offers just about as much comfort. Here, we assume we know someone’s intentions. “She probably called me into her office because she wants to reprimand me for something.” “He told me he liked my presentation only because he feels sorry for me and is hoping his kindness will somehow make me believe in myself.” These are good examples of mind reading. With assumptions like these, we improve our chance at living in a state of interminable insecurity.

Using blame as a cognitive distortion is equally as useful as its sibling methods. When we use blame, we can either take none of the responsibility or more than our fair share. Something is either everyone else’s fault because they didn’t (fill in the blank) or because we didn’t (fill in the blank). “I shouldn’t have asked for that raise.” “I shouldn’t have said anything about how I was feeling.” “She shouldn’t have spoken to me that way.” “They shouldn’t have set the bar so high.” When we use blame as a defense, we don’t have to see a situation clearly which means we can stick to our patterns that have become so uncomfortable for us.

All of us fall into these distortions at some point. It’s important that we identify them and know how to handle them. We can combat them by asking ourselves questions that will help us with our reality testing. A useful question that I like to use both professionally and personally is, “What is the real evidence that this is true?” This is a good jumping off point. Any evidence we think we’ve found to support our distortion can be thoughtfully worked through and sorted. It’s best to enlist an ally when we first start challenging our cognitive distortions because we’ll likely fall into the same patterns if we don’t have a more objective outsider. Start with a trusted friend, family member, or therapist. You’ll find that you don’t have to believe everything you think.

 

Love and Be Loved,
Natalie

Live Deliberately While Managing Anxiety

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Live Deliberately While Managing Anxiety

“I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. I did not wish to live what was not life; living is so dear; nor did I wish to practice resignation, unless it was quite necessary. I wanted to live deep and suck out all the marrow of life, to live so sturdily and Spartan-like as to put to rout all that was not life, to cut a broad swath and shave close, to drive life into a corner, and reduce it to its lowest terms, and, if it proved to be mean, why then to get the whole and genuine meanness of it, and publish its meanness to the world; or if it were sublime, to know it by experience, and be able to give a true account of it in my next excursion.”

Henry David Thoreau (Walden; or, Life in the Woods)

 

I’ve always found this quote generative. It offers comfort and courage in difficult phases of life, excitement and wonder in the less complicated phases. There is a sense of permission granted, permission to make your choices, to embody fearlessness, and to share your lessons. There is perceptible encouragement to discover truth and authenticity in life, your own and the world around you.

It’s easy to get caught up in your feelings and understanding of what is happening around you. It starts to feel like those things are absolute. Everyone falls into this. Suddenly, you’re pretty sure that your relationship is going to end or that you’re going to be fired or that you’re not lovable or that whatever has just happened is the worst possible outcome ever.

You feel contracted and paralyzed. You might stop seeing your choices altogether and feel that fear and dread have taken over your life. This starts to seem like your truth.

But it’s an illusion. Fear and dread are lying to you. You can live as deliberately and passionately and audaciously as you want to live.

About nine posts back in my article titled “What You Need to Know Before You Break Up, Divorce, or Separate”, I talk about the emotion center of the brain (limbic system or “lizard brain”) and the role it plays in shutting down the executive center (prefrontal cortex). The limbic system tells you that a trigger is threatening and scary. The logic center doesn’t disagree because it’s shut down to give way to the fight-or-flight ability, which is governed by the limbic system. Anything can be a trigger so, anything can feel threatening. It might feel that way, but sometimes it’s a lie (actually, plenty of times).

The limbic system lives for comfort, but you don’t have to. So, gently take it by its jumpy little reptilian claw and show yourself that you can live in your awareness and intention and choice. For tips and strategies on how do to this, take a look at past articles titled “Learn to Calm Your Anxiety” and “Exploring Insecurity.” You can also contact me by calling (415) 794-5243 or emailing me at natalie@nataliemillsmft.com.

What do you live for? What do you want to live for?

 

Love and Be Loved,
Natalie

Learn to Calm Your Anxiety

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Learn to Calm Your Anxiety

“’Ask me whether what I have done is my life.’ For some, those words will be nonsense, nothing more than a poet’s loose way with language and logic. Of course what I have done is my life! To what am I supposed to compare it? But for those, and I am one, the poet’s words will be precise, piercing, and disquieting. They remind me of moments when it is clear- if I have eyes to see- that the life I am living is not the same as the life that wants to live in me.”

-Parker J. Palmer, ‘Let Your Life Speak’ (pp. 1,2)

 

The author is referring to the poem ‘Ask Me’ by William Stafford, which describes the intangible of life, ebbs and flows in relationship, and sense of purpose. Both Stafford and Palmer warmly convey to the reader their solidarity. In a place where we try to manage the conflicts of uncertainty, their words are welcome impressions of unity.

Their offerings speak to a wish that many of us hold, the hope to feel a sense of ok-ness. We all want to be comforted from our pain and connected to our joy, this kind of “I’ll be ok once this happens,” thinking. Unfortunately, the more we engage in this kind of thinking, the outcome tends to be an experience of significant suffering.

There are all sorts of strategies that we employ when we are engaged in this thought. We read copious self-help books and exhaust many avenues of external guidance. We’re pretty sure that someone must have the key ingredient to end our suffering and reconnect us to our serenity- anyone outside of ourselves.

We’ve spent much of our lives creating our identities, who we are, what we do, our capabilities. We do this to give ourselves some sense of stability and grounding. Often, it’s keeping within the confines of this rigid thinking that prevents us from feeling grounded when we need it most. Kind of a catch 22, wouldn’t you say?

I encourage people to be curious about themselves, to listen to themselves. The more accessible we are to ourselves, the more accessible serenity is to us. Interestingly, a lot of people who come to see me have spent years avoiding themselves, not realizing that they have been running from the key to their very own peace. I’m not saying that it’s a mistake to ask others for help, to read self-help books, to explore your options, on the contrary. These tools can be incredibly useful. But tools don’t build the structure; you do.

To feel ok, we have to learn how to listen to ourselves.

So, how can you listen to yourself? First, quiet your mouth, your thoughts, and your body. Then, invite your innermost self to reveal itself to you. Essentially, you are allowing yourself to meet… yourself. Maybe it speaks first through a distracting body sensation, a racing thought, or an overwhelming feeling. It might be hard to make sense of it at first. You might experience fear or criticism of what you notice. Let it go. Keep going. Continue to make room for this voice. Giving yourself (and your self!) regular time, intention, and space will help you to understand what you need, how to soothe yourself, and to trust yourself. You will begin to “live the life that wants to live in you.”

 

Love and Be Loved,
Natalie