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To live well with biological and psychological sensitivities that make you vulnerable to anxiety and depression, you have to change how you respond to your symptoms. Where you used to respond with avoidance, self-criticism, fear, you must learn to respond with courage, curiosity, and compassion. The mind is too mysterious to know it completely, but living by these values will reduce your suffering.
I want to teach you to observe and understand your emotional patterns, so that you can see it for what it is when it occurs and get out of it yourself. You learn a way of relating to yourself that doesn’t prevent emotion from occurring, but alleviates the suffering you have about the experience of painful emotion over time. Because it is an entirely different way of thinking about your mind, it will take some time for you to practice enough and work out the details enough to be out in front of the pattern on a regular basis.
What this means for the treatment of emotional disorders is that we have to work together to intentionally create circumstances that trigger your emotion with an attitude of curiosity and compassion, so that we can observe what’s happening and figure out the stuck points. We need to give you the opportunity and practice feeling something uncomfortable, deciding whether it is a threat, and then proceeding with confidence in your decision. We want you to expose yourself to emotion to learn how to love yourself, not to make it go away.
What this means for the treatment of emotional disorders is that we have to work together to intentionally create circumstances that trigger your emotion with an attitude of curiosity and compassion, so that we can observe what’s happening and figure out the stuck points. We need to give you the opportunity and practice feeling something uncomfortable, deciding whether it is a threat, and then proceeding with confidence in your decision. We want you to expose yourself to emotion to learn how to love yourself, not to make it go away.
You didn’t choose the brain you were born with, but how you respond to it is your responsibility. A bio-psychosocial model understands the limitations of each type of interventions as well as respecting and celebrating how different interventions can build upon one another. Regulated brain chemistry, psychological flexibility, and strong social support are all necessary components of emotional wellbeing.
If you’re seeing me, I’m assuming something happened, either due to your biological vulnerabilities or your life experience or both, that prompted you to avoid some part of your internal experience in a very specific way that is amplified the experience. We’ll discover that together and help you relate to it differently.
Time is the most precious resource that any of us have in our lives. Money may seem more important, but the wealthiest people will tell you that time is the great equalizer. Each day, we all have the same amount of time.
Psychotherapy can heal the parts of you that didn’t feel understood or worthy of being understood. Healing is painful because it will shed light on parts of your experience that are currently outside of your awareness. We naturally avoid dynamics that are painful and much of what is painful for us is outside of our conscious awareness. As you bring attention to these feelings, they will be painful to discuss at first. Experiencing feelings as feelings that peak and pass, rather than truths that haunt you, heals your pain and alleviates your suffering.
When we talk about how you feel, we’ll be able to discriminate between the parts of the situation that are problems for us to solve and the parts of the situation that are based on a painful memory or a painful interpretation of what is possibly happening.
As you surrender to the process of being cared for, your sense of self-worth and safety will increase. You’ll become less afraid and more curious about your internal world. Thinking and talking about your internal experience becomes fun, rather than burdensome. Like any other trusting relationship, as you begin to trust the psychotherapy process, to feel efficacious and curious about your experience, psychotherapy can become really productive. At that point, rather than urgently needing psychotherapy to reduce your suffering, the psychotherapy relationship becomes a long conversation that you can choose to enjoy.
Psychotherapy is helpful because it strives to not only teach you more effective ways to cope with your emotions, but it can also change the way you perceive what’s happening in your world. It can change your outlook, which changes your options.
In addition to coping more effectively, and while you’re practicing acceptance, psychotherapy is meant to help you feel integrated and secure. Psychotherapy facilitates a deep sense of security as the result of being understood and known which becomes deep self-understanding and self-knowledge.
Pride is delight or elation arising from an act, possession, or relationship. The major shift I want you to make is away from mere understanding that you have to work on your mental health, with force, with pressure, with seriousness. I want you to be elated by the way you get to grow.
We have to stay awake to our experiences to understand what’s happening within us and respond effectively. We are co-creating reality with our environments. In striving to respond effectively, we can use the human proclivity to add meaning to experience to create lives that are more and more values-driven. If you pay attention and learn to read your feelings well, you can add meaning that helps you build your life in a way that is more and more meaningful to you over time.
Shame gives us the urge to hide and withdraw. The way through shame is for you to remind yourself of your humanity and share your shame in settings where that sharing reconnects you to others.
There is a unique reciprocity in meeting someone who you might never meet in any other context of your life and feeling a sense of connection with them. In addition to the connection, if what you know about yourself and your suffering can uniquely offer them a different perspective and contribute to their healing, it feels especially good.
You see patterns of suffering of other people and you understand yourself a little better. You can see the pattern as a disorder. You feel compassion for the disorder, rather than shame about it. You start to get curious about the details of the disorder that start as very subtle thoughts or behaviors that can gradually take over your experience. My hope is that as you hear suffering in others, you both understand what’s happening for you and you reframe your attitude towards it with curiosity and compassion.
I want to teach you to respond to anxiety in a way that helps you rather than hurts you. You’ll overcome fear of fear by inviting in fear when it shows up and choosing to see it as an opportunity, not a threat.
When anxiety is challenging to identify, label, and allow, all other emotions are usually difficult to identify, label, and allow.
Sensitivity to anxious sensations occurs in all of the anxiety disorders. This trait is called anxiety sensitivity and it is a biological predisposition that runs in families and is passed down through social interactions.
Our minds are so intelligent at this point that the possibilities we can imagine for what will happen in the future, for good or for bad, are endless. And life is filled with endless uncertainty. If we imagine it, we can fear it.
The most helpful attitude toward anxiety is one where it is interpreted as normal, healthy, and an indication that you are engaging in something challenging and uncertain.
An anxiety state is an emotion that triggers flight-or-flight sensations, catastrophic thoughts, and the urge to problem solve or avoid.
Anxiety sensitivity is the fear of arousal-related sensations, arising from beliefs that the sensations will have adverse consequences such as death, insanity, or social rejection…
We want to shift our way of thinking about those triggers away from bracing and avoiding and over into opportunity.
The capacity to observe your experience of anxiety with curiosity — like you really want to know it — is crucial for willing acceptance.
Self-monitoring is the opposite of avoidance. The act of slowing yourself down, identifying, and labeling the thought as a thought shifts you from content to process and you are on your way toward mindful observation.
With a healthy mind, you can choose what you attend to and what you ignore. You can perceive all kinds of information from your environment and then make conscious decisions about how you want to respond.
Mindful emotional awareness occurs when you bring your attention to your emotion in the present moment with a nonjudgmental stance.
In the present moment, your body is breathing and working to keep you alive just fine. Try to watch your sensations as sensations. Try to observe your thoughts like words on a screen, not predictions or threats that you need to engage. Try to notice the urgency in your body and consciously slow yourself down.
In everyday life, as you notice a painful internal experience, cue yourself to anchor in the present.
As you attend to your sensation, your mind is naturally going to wander. Wandering is what minds do. You aren’t doing it wrong. In fact, you should expect the wandering as part of the exercise. You have to wander in order to notice the wandering.
Unconditional self-acceptance is the act of treating oneself with approval and worthiness, regardless of what’s happening.
Exposure has to be done the right way, meaning that the person engaging in exposure has to have the right perspective.
The moment you are triggered is an opportunity. You have the chance to use it for greater self-understanding and eventually, calmness, compassion, and connection.
If you try to use mindfulness to suppress or control your thoughts and feelings, they will increase and grow stronger.
The opposite of surrender is called paradoxical effort, where the more effort you put towards a certain outcome, the further you get from it. Paradoxical effort keeps you stuck, unable to move through uncomfortable thoughts, feelings, and sensations.
Living with an anxiety or mood disorder or OCD can feel like a lonely journey, but it often influences your relationships with your loved one too. The people you love, and the quality and quantity of those relationships, can be influenced by anxiety, mood, and OCD symptoms in a number of ways.
If your feelings often escalate, show yourself compassion first. Your suffering is real. Try to identify your first feeling. Oftentimes it’s easier to stop resisting a feeling than it is to accept it. Try to identify the interpretation that leads it to escalate and challenge that interpretation.
Helpful self-talk orients you towards acceptance. Unhelpful self-talk facilitates avoidance.
Loneliness is the feeling you experience when you believe that you are disconnected from others.
Anger is a feeling of annoyance or hostility towards someone or something that you believe has done you wrong in some way. People feel anger when there has been injustice. It is data that tells us that we or someone we love has been or could be harmed.
All anxiety disorders and OCD are associated with intolerance of uncertainty, meaning that those who experience anxiety disorders and OCD are more prone to doubting thinking than those without the disorders.
You are not your disorder. Untreated or unmanaged anxiety, OCD, and mood disorders can make you act in ways that are not consistent with your values. Your symptoms show up differently based on your biological vulnerabilities and your social conditioning.
Knowing your values can be one of your best defenses against anxiety, OCD, and depression.
No matter how anxious you feel, you can get a hint at what you value by the content of your anxiety. Oftentimes, people value the opposite of what they fear.
Orient yourself around the therapeutic attitude of willing acceptance and create structure around a process-based goal. If your goal is to cultivate a more effective relationship with your anxiety, your process can include any behavior that gives them the opportunity to practice going towards and accepting anxiety.
When you are reflecting on the challenges in your life and deciding how to set goals to overcome them, you want to get as specific as possible about what the issue is and break the solution down to the smallest next step.
There are different types of writing exercises that are likely to be helpful for different types of suffering.
Relaxing your attempts at control of your internal experience and relating to your thoughts, feelings, and sensations with compassion and courage is a learnable skill.
Just like you can't force yourself to have good mental health, you can't force yourself to fall asleep. You can create the conditions that make good mental health more likely and you can also create conditions that make sleep more likely.
A good plan for making good mental health more likely includes both planning for increasing or maintaining your functioning and managing your distress more effectively.
The opposite of a belief problem is a workable attitude.
Worriers have a paradoxical relationship with their worries because a part of them wants to stop worrying, but another part of them thinks that worrying shows them what they care about, prevents future catastrophe, prepares them for the worst-case scenario, and keeps them from getting more anxious. Worriers want to end the incessant, intrusive flow of thoughts that pops up at unwanted times, but they frequently keep worry going on purpose, thinking that it is helpful.
Scheduled worry time should challenge the idea that worrying is reasonable.
Worry is a two-part process including an uncertain question and an attempt to answer it.
Your process for any task is your series of steps to achieve your end. Your process for brushing your teeth or cleaning your kitchen may seem to you like “that’s just how you do it…”
Like learning anything else, your body won’t give you the feelings of confidence until you’ve practiced the actions of confidence.
In the past, you have minimized, disregarded, and avoided your anxious thoughts, sensations, and feelings. Now, you’ll be identifying, labeling, inviting, and even provoking more anxious thoughts, sensations, and feelings. This identifying and labeling process is like learning the alphabet of anxiety. Per the metaphor, you won’t be able to read — that is, do what you care about in the presence of anxiety with skill and grace — until you’ve practiced the basics over and over.
How well any of us manage the pressure to fit in depends a lot on biological vulnerabilities and strengths as well as the demands of the environment at that time.
If you don’t fear a lapse in performance and embrace wherever you are on any given day, your performance in the long-run will be more consistent and more effective.
Fear of evaluation is a complex mix of biological sensitivity to embarrassment, shame, and loneliness plus reactions to previous experiences and cognitive and behavioral responses to your current life.
The right way to approach exposure to anxiety is with curiosity, compassion, and patience. Trying to be perfectly curious and compassionate is the opposite of curiosity and compassion. Getting back to the basics of developing a curious and compassionate attitude, your path is through observing what’s happening.
Productive work sounds like, “I’m going to prioritize based on my values and accept that I have limitations. Just because my mind thinks I can do something better doesn’t mean I have to do it. In fact, it definitely doesn’t mean I have to do it. If my perfectionism makes it hard for me to know when to stop, I’m going to use a conscientious model, which is a person who I respect doing the same type of task. I’m going to use what I know about how they behave as an example for deciding when it’s okay for me to stop. I’m willing to experiment and take risks knowing that I have to accept where I am to get where I’m going next. Rather than avoiding or bracing against feedback, I want collaboration so that I can grow.”
We are challenging the strategies you use to strive for excellence. We are not challenging the idea that you should strive for excellence.
Sometimes clinical perfectionism will drive you to avoid and sometimes it will drive you to over-compensate and work too hard. Your all-or-nothing thinking drives all-or-nothing behavior. If you have a habit of all-or-nothing thinking and behaving, you might not trust when to do what. You might be looking for a set strategy where you can feel in control of your clinical perfectionism. The reality is that responding well to the thinking patterns and behavioral urges that clinical perfectionism triggers requires that you are flexible and your responses are dynamic.
Clinical perfectionism is a problem of strategy, not outcome. Perfectionists have high standards and expectations for themselves and others
To overcome your positive outlook about responsibility of thoughts focus on choice and values.
Our minds can have thoughts that we don’t act on and those thoughts don’t mean anything about our character.
When you are experiencing an inflated responsibility in the present moment consider if it is thought-action fusion and what your conscientious model would do.
May I have the serenity to accept what I cannot control,
The courage to change what I can change,
And the wisdom to know the difference.
An excessive or inflated sense of responsibility occurs when you interpret your thoughts in terms of whether they can cause distress or harm to yourself or others. That is, having the thought in and of itself gives you a sense of guilt or responsibility.
Efficacy, mastery, and control over the environment are all markers of wellbeing in adults.
If you feel worthless, consider that it might not be the truth about you.
We all have beliefs about how we think and feel, why we think and feel, and what we should think and feel.
Second fear turns an anxiety state into an anxiety disorder because the fear of the fear creates resistance that creates more fear (and more resistance and more fear). Negative core beliefs turn a feeling into a depressive state because the interpretation of that feeling is that it means the person is helpless, hopeless, or worthless.
Rumination is a repetitive negative thinking state that is triggered by pervasive negative beliefs. It is a sticky thinking pattern that shows up habitually when triggered by certain environmental or internal states.
What does your depression sound and feel like? It’s important to hold onto the fact that depression isn’t the real you and it won’t last forever. If you’ve felt very depressed for a long time, it can be hard to access the real you.
Depression is an illness. It’s the combination of biological sensitivities plus psychological and social factors that reinforce those sensitivities. It is treatable and you can recover. Identify the symptoms of your depression, plan for it, and act efficaciously despite how you feel.
The urge to either over-control or under-control your feelings under these conditions is very common. Many people have a combination of both. Over-control of emotion includes suppression, withdrawal, compulsions, and perfectionistic control behaviors of your thoughts, feelings, and body (examples: compulsive exercise or restrictive diets). Under-control of emotion includes anger outbursts, self-medicating with alcohol and drug use, and problematic interpersonal strategies like passive aggression. In general, anxiety disorders can be seen as disorders of over-control. It's common for people to have both problematic over-control emotion regulation strategies and problematic under-control emotion regulation strategies.
You might not be avoiding what you value altogether, but you might be experientially avoiding all the thoughts, feelings, and sensations that arise when you follow your values. Notice how many opportunities for happiness open up when you give yourself permission be present in your actual life rather than trying to figure out whether that is the right decision.
The nature of obsessive thoughts is that they are unwanted and intrusive. They arrive with a spike of anxiety or uncertainty and the urge to do something that makes them stop. Behavior that you feel compelled to perform, against your conscious wishes, with the sole intention of ending a thought, feeling or sensation is a compulsion.
When you are in your head trying to figure something out or distracting or numbing yourself out from what is happening in your body, you are engaging in somatic avoidance.
The opposite of emotional avoidance is staying with emotions. Don’t just do something, sit there! When you choose to bring attention to and stay with emotion, you can know that you are on the right track if you can feel the emotion pass within a minute or two.
Emotions are evolutionarily adaptive states that motivate behavior. Every emotion has or has had some utility in the evolutionary past. After the initial surge of emotion, you can choose whether you want to keep the thoughts associated with that feeling going. Your thoughts will retrigger the sensations to keep that emotion going.
Avoidance isn’t a moral failing, a willpower problem, or a failure of character. Most likely, you are getting tricked by anticipatory anxiety. You might also have very high anxiety sensitivity, making situational anxiety very challenging to tolerate. You probably also have critical post-event processing, which undermines that natural euphoria that usually comes after overcoming a challenge.
Avoidance not only reinforces anxiety, but it also undermines potential.
As we’re striving to accept and embrace uncomfortable emotional experiences, we want to use metaphors to facilitate our personal internalization of relevant ideas, frameworks, and concepts. While the concept of going towards our internal experiences is theoretically simple, it isn’t easy to do and there are numerous nuances to it that can make it hard to remember. Metaphors fall into two major categories: identifying symptoms through personification and metaphors to help you remember effective processes.
Your incidental exposure is your real life. You're in your real life and you get triggered. What do you do? Run after the bus. That is, let yourself feel anxious and embarrassed and do what you value anyway. Do the thing that's hard even if your anxiety tells you not to do it. And, if the hard thing is to stop running, just stand there.
A major difference between intentional practice and incidental practice is creativity. Intentional practice is our creative attempt to trigger what you fear on purpose so that you have the exact opportunity you need to face your fear. We don’t have to be creative for incidental practice because life gives it to us.
Exposure is putting your body in a feared situation, letting yourself feel scared, and staying in the experience while feeling scared. Response prevention is refraining from physical or mental compulsions, reassurance seeking, or avoidance of any form after the exposure.
Exposure is the willing act of putting yourself in psychological and physical situations that induce fear and anxiety. Willing exposure is challenging in the moment of anxiety, but in the long-term it decreases anxiety.
If you treat yourself with compassion after you challenge your suffering, no matter the outcome, you will reduce your future anticipatory anxiety and it will be easier to see these challenging experiences as an opportunity rather than a threat.
You're in it for the long-haul with yourself. Giving up is demoralizing and will increase your suffering. Demanding perfection isn't sustainable and will create a secondary self-critical loop that makes recovery harder. Commit to yourself and your own process. Even before you recover, you'll find that you like yourself when you own and appreciate your own journey. You have hope because you have you.
Everyone has underlying biological processes that make mental illness more or less likely. Lately, environmental stress is making those who aren’t particularly biologically vulnerable more vulnerable. Whether your emotional distress or impairment is primarily biological or environmental or a combination or the two, responding to yourself with courage, curiosity, and compassion is the key to responding well.
The more triggers you have, the more likely you are to feel dread about how you will respond. But then again, the more triggers you have, the more opportunities you have to practice.
Doing nothing to resist it or make it go away is a powerful and intentional stance. Just like other parts of the anxious pattern, every time you label and actively accept what you’re experiencing, your mind is less likely to associate that experience as something to fear. The anticipatory anxiety may not dissipate in this moment, but you’re setting yourself up for success in future moments.
When you try this new approach, it will be uncomfortable at first, but eventually your anxious moment becomes an opportunity for courage, empowerment, and self-trust.
This is why your emotional disorder is a gift. Because you have to practice observing yourself, you get to develop a strategy for how you’re going to relate to yourself. Because you purposely experiment with yourself in smaller moments, you have the chance to develop a much deeper confidence in yourself that can carry you at all other times in your life.
The neurological opportunity is that you have the opportunity to do the opposite to change that pattern. Not only should you do the opposite in the exact way that the avoidance is showing up, but this is why we want to think about exposure as something that is frequent, flexible, and willing. It’s just like learning to walk and then run by practicing, getting good at it, and getting reinforcement through the feeling of confidence.
Intolerance of uncertainty is the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events.
Strategic thinking means starting with acknowledging what is going well and reinforcing it with curiosity, compassion, and courage.
Tomorrow is different than today. Your brain and mind will be in a different state and you have the chance to respond differently to whatever shows up.
The present moment is a gift even and especially when you feel anxious.
Consider thinking about self-compassion as an attitude where you are willing to stay with your experience and relate to it with openness and curiosity, rather than criticism.
Numbing out our undesirable thoughts and feelings also numbs out desirable feelings like joy, trust, connection, compassion, affection, playfulness, and creativity.
It takes humility and courage to accurately assess where you are and commit to the next step. Your emotional disorder was created, intensified, and maintained by a cycle of fear, resistance, and avoidance of your thoughts, feelings, and sensations. The skills you need to step out of this cycle are the opposite of what you’ve tried so far.
When it comes to relating effectively to emotions, turning towards your experience means observing that experience mindfully — floating through it mindfully — and not doing something to make it worse. You don’t have to be particularly warm and fuzzy about this. Just notice what’s happening, don’t criticize yourself, and don’t add anything that will make it worse.
I maintain hope because I’m curious about how life will turn out and I value courage, compassion, and connection. In general the mystery of life seems meaningful to me.
I can’t control nor perfect my consciousness. There are forces working on me and in me that I am unaware of and I’ll never have full awareness. Rather than trying to control and perfect my consciousness, I can be humble before the mystery of human life, and enjoy my exploration of it.
A reasonable philosophy of recovery is one that assumes that you’ll get re-sensitized. You’ll get anxious again and you’ll avoid again. You’ll have another intrusive thought and you’ll do something to neutralize it. You’ll have a low mood and have trouble maintaining participation in the activities you value. The resilience of your recovery is marked by how quickly you return to relating effectively to your internal experience, rather than by the absence of thoughts, feelings, or sensations.
It isn’t your fault that you have the biological vulnerabilities or the cognitive and behavioral mechanisms that maintain your illness. Your suffering is unavoidable. It is your responsibility. The way you respond can further reinforce your suffering with shame, self-criticism, and hopelessness. Or, it can give you a sense of meaning. It can make you feel courageous, curious, and compassionate.
Change as a fact of life is an experiential truth. Try to show me a thought, feeling, or sensation that has never changed in any direction in a single organism. Everything changes.