san diego therapy

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

By Dr. Shoshana Shea

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Anxiety Is Like A Metal Detector

By Annabelle Parr

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

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

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

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

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

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

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

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

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

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

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

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

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

When Panic Sneaks Up and Attacks

by Annabelle Parr 

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

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

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

Our body is built to respond adaptively to danger.

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

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

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

What is a panic attack?

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

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

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

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

Are panic attacks dangerous?

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

Is it all in my head?

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

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

Are panic attacks permanent?

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

Cognitive Behavioral Therapy

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

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

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

Reframing “Failure”: Trial and Error or Trial and Adjustment?

by Shoshana Shea and Annabelle Parr

How do we learn new things? Trial and error. Error is vital, but it is not the endpoint the way the phrase “trial and error” suggests. Instead, it is a signal that something needs to change. It gives us the information we need to make an appropriate adjustment to our behavior to either improve or redirect ourselves. So life is not really about trial and error, but trial and adjustment.

We embrace error and adjustment with babies.

We don’t expect an infant to come out of the womb knowing how to walk. We recognize that in order to learn, they will fall and get bruised up, and inevitably encounter pain. But we recognize failure as integral to the growth required to walk.

Furthermore, because we don’t expect instant perfection from young children, we recognize, honor, and validate each milestone on the path toward success. If walking is the end goal, then crawling isn’t failure, but rather a necessary step or adjustment towards the ultimate goal.

So why don’t we embrace erring and adjusting in ourselves as adults?

Before we even have language mastered, we are taught to avoid failure.

After we learn to walk and talk, our world shifts. Our culture exalts strength and success, yet ignores the fact that these things only come from failing and growing as a result. So we are taught that it is no longer okay to fail. That now we must present this image that we have life immediately mastered.

We are all busy hiding our mistakes, so it looks like no one is making any.

We don’t want to admit that we make errors, though one of the only things that we can say about life with certainty is that we all make mistakes. We are all trying to make it appear like we only need one trial to succeed – trial and success, never trial and error. We have created this grand cultural illusion that success is instant, fairly effortless, and painless.

We know that failure hurts.

Our instinct is to shield ourselves from that pain. It feels easier to stay well within our comfort zones, never having to feel unsure of the outcome of our efforts. It’s comfortable to be certain that we will succeed because we have aimed lower than our full potential. So we confine ourselves to crawling because we don’t want the bruises that come with learning to walk.

Here’s the harsh truth: we can choose to act on fear, but we cannot avoid failure.

As J.K. Rowling (2008) reminds us, “it is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all – in which case, you fail by default.” Failure does hurt, but we can avoid neither failure nor pain in this life. What ultimately harms us more than either of these things is our refusal to try, err, and adjust; our refusal to live and embrace being human.

Source URL: http://likesuccess.com/img4622268

Source URL: http://likesuccess.com/img4622268

Our rejection of failure…

…affects our kids, their education, and their development.

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As soon as our kids enter elementary school, we no longer allow them to fail. An “F” is a terrible thing – a sign of either laziness or lack of intelligence. We teach them to fear failure and to be ashamed of it. They learn to avoid trying new and challenging things because anything less than immediate success is intolerable.  

 …stunts innovation, creativity, and success.

In her TED Talk on shame, Brené Brown (2012) notes that TEDx should be called the failure conference. She means this as a positive thing because the people who achieve truly innovative solutions to the problems in this world are the people who are not afraid to fail, and have courageously done so over and over again.

I can guarantee that every single “successful” person that you admire failed a whole lot before they became the person that you now look up to. Their failures and mistakes helped to shape them into the admirable, wise, resilient human you now look up to.

…bleeds into every important area of our life, from our careers to our relationships to our education to our physical wellbeing.

When we do not allow ourselves to try and to err, we miss out. We limit ourselves from achieving the height of our potential because we are unwilling to face the depth of our imperfection.

When we allow a fear of failure to run our lives, we do not go after that job that is beyond our comfort zone. We do not take on that project that sounds difficult. We do not engage in the vulnerability required to open our hearts and experience real connection. We take the easy class rather than the challenging one. We do not apply to that reach school. We do not walk in to the gym or join that fitness class.

We limit ourselves and our ability to feel joy and confidence because we are afraid to know the other side of that coin. So instead we confine ourselves to the safety of certainty.

The Rock Garden Metaphor

There is a metaphor in Acceptance and Commitment Therapy that offers much wisdom in the way of uncertainty. It is called the Rock Garden Metaphor (Follette & Pistorello, 2007). In Japan, there is a rock garden with fifteen rocks. From any given point in the garden, one rock is always hidden. In order to view the once hidden rock, one must move to a new spot. But there is no point in the garden where all fifteen rocks are within view.

Such is life. We can’t ever have all the knowledge. There is always something we can’t see or we don’t know yet. Maybe what we can’t foresee is failure or heartbreak or loss. But maybe it is success or love or joy. We won’t know until we take a leap to a new position.

So rather than wait for certainty that won’t come, we can cultivate self-awareness, do our best to make decisions in line with who we are and what we value, and take the leap of faith necessary to move forward and find new perspectives. We can evaluate afterwards how it went, what we learned, and if an adjustment is necessary. But we will remain stagnant if we wait to for that hidden rock to show itself or if we wait until we are no longer afraid to move.

Uncertainty is scary. But we don’t need to eliminate fear in order to act.

As Carrie Fisher wisely instructs us, “stay afraid, but do it anyway. What’s important is the action. You don’t have to wait to be confident. Just do it and eventually the confidence will follow.” We don’t eliminate fear by heeding it, but rather by defying it. Thus allowing ourselves to build the kind of enduring confidence that is only born when we risk failure, allow ourselves to fall and gain the knowledge that we can get back up.

Source URL: https://www.pinterest.com/pin/203787951869050945/

Source URL: https://www.pinterest.com/pin/203787951869050945/

Though acting on fear shuts us off from growth, fear itself is not our enemy.

We can be afraid, allow ourselves to feel that fear, and still choose to act in spite of it. As David Richo (1991) put it, “when change and growth scare me, I still choose them. I may act with fear, but never because of it.” Fear is actually a beautiful thing because it gives us the choice to be brave.

We can learn to welcome fear as a positive sign.

As Pema Chodron notes, “fear is a natural reaction to moving closer to the truth.” Rather than trying to eliminate fear, we can embrace it as a companion, a sign that we are moving towards growth and truth.

Source URL: https://www.pinterest.com/pin/394627986073460265/

Source URL: https://www.pinterest.com/pin/394627986073460265/

Error is vital, but it’s the adjustment that’s important.

Ultimately, life is about trial and adjustment, more than trial and error. Error will always be part of the process; however, reframing this statement can help us to acknowledge that failure is not a permanent state of existence. We will inevitably make mistakes, but this is the place where we learn to adjust our behavior. It is the adjustment, the learning, that we should focus on, rather than the error.

Furthermore, even when we do mess up, it is never an error to live our lives. It is never an error to step out of our comfort zone or take that leap of faith. We may try things and we may fail, but it was not an error to fail. It was simply a necessary step in our journey toward becoming the whole person that we are meant to be.

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

REFERENCES:

Brown, B. (2012). Brené Brown: Listening to shame. [Video file]. Retrieved from https://www.ted.com/talks/brene_brown_listening_to_shame

Follette, V. M., & Pistorello, J. (2007). Finding life beyond trauma: Using acceptance and commitment therapy to heal from post-traumatic stress and trauma-related problems. Oakland, CA: New Harbinger.

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

Rowling, J. K. (2008). J.K. Rowling: The fringe benefits of failure. [Video file]. Retrieved from https://www.ted.com/talks/jk_rowling_the_fringe_benefits_of_failure

 

Give Yourself the Gift of Kindness This Holiday Season

by Annabelle Parr

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Somehow the holidays have snuck up on us once again. Though this time of year is meant to be filled with joy and cheer, for many of us it is also filled with stress, anxiety, and maybe even sadness or pain. The holiday season does not erase preexisting struggles, and it can add an extra layer of stress on top of what we may already have been dealing with. If you are having a hard time during the holidays, you may not feel like you have permission to be anything but happy.

But it’s important to remember you are not alone if you’re feeling stressed, tired, or less than joyful. The holidays can be difficult for many people and for many reasons. Engaging in the annual holiday traditions may bring back upsetting memories for those who experienced trauma, loss, or pain at this time of year. You may feel the weight of a recent change or loss, or you may notice that things have stayed the same from one holiday season to another when you desired a change. Maybe you have a challenging relationship with a particular family member that you have to navigate during the holidays, or maybe going home and back into your family system brings up unresolved conflicts or issues. Or maybe you enjoy the holidays, but you find yourself rushing around trying to accomplish everything on your to-do list within a budget of both time and money, and as a result you are unable to appreciate a time of year that you love because you are feeling so harried.

Whether your heart is feeling full of joy or full of pain, or some combination of both, here are a list of things that you can do to be kind to yourself and manage the stress that may accompany this season.

1.     Remember that “comparison is the thief of joy.” So, heed Theodore Roosevelt’s wise words, and try not to compare your holiday experience with what you see on TV, in movies, or on Facebook. And try not to set unrealistic expectations for yourself and for whatever holiday you celebrate. As Voltaire wisely put it, “perfect is the enemy of good.” Your holiday doesn’t have to be perfect to be good. So give yourself the grace for a few mistakes or snags in the plan because they are inevitable.

2.     Give yourself permission to say no. There is only so much time in the month of December. Though it is easy to feel the pressure to say yes to everything holiday related, it is important to know your own limits. Setting clear boundaries for yourself, with both your time and your finances, can help to reduce stress. Giving yourself some time to rest can allow you to more fully appreciate those things that you do choose to say yes to.

3.     Acknowledge your feelings. If you are feeling sad, anxious, lonely, or depressed, know that it’s okay. Allow yourself to feel those things without beating yourself up or feeling guilty for feeling this way at the holidays. Remember that we get ourselves into trouble when we try to avoid distressing feelings. And keep in mind that happiness and sadness can coexist. We can have moments of each, and even moments of both. But if we are busy trying to deny or avoid our pain, it’s going to be much harder to feel the joy at all.

4.     Practice self-compassion. Self-compassion means that we “mindfully accept that the moment is painful, and embrace ourselves with kindness and care in response, remembering that imperfection is part of the shared human experience. This allows us to hold ourselves in love and connection, giving ourselves the support and comfort needed to bear the pain, while providing the optimal conditions for growth and transformation” (Neff, 2016).

5.     Practice kind self-talk. Listen to the thoughts running through your mind. Do you talk to yourself the way you would talk to a friend or loved one? Or are you beating yourself up for mistakes, imperfections, or feelings you wish weren’t there? If your self-talk is less than kind, try to remember to give yourself the same grace you would give to the people you love.

6.     Breathe. Frustrated with a long check-out line? Angry that someone cut you off in the parking lot? Feeling overwhelmed with your to-do lists? One of your relatives pushing your buttons? Remember to take a breath. Focus mindfully on each inhalation and exhalation, noticing your belly rise and fall with each breath. Mindful breathing exercises can help center you and calm your nervous system down.

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7.     Take care of yourself. You know what you need better than anyone. Taking care of yourself might mean staying active and setting time aside for exercise – whether that is a long distance run or a stroll through your neighborhood. Or maybe you need a night in, wrapped in a blanket watching your favorite holiday movie. Self-care might mean surrounding yourself with your closest friends or family, or it might look like taking some time to be alone and read a good book. Ask yourself what you need and listen to your body’s response.

8.     Seek support when you need it. If you are feeling overwhelmed and everything is just too much, know that you don’t need to handle it alone. If you have too much to do, consider asking your loved ones to help you tackle a few things. If you’re feeling lonely or down, reach out to a trusted loved one to talk. If you feel you might benefit from some professional support, therapy is a good place to come work things through with an empathic, non-judgmental counselor. Talking with someone who knows how to listen and who can provide you with some coping tools can be incredibly healing.

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

References:

Neff, K. (2016). Tips for practice. Self-compassion. Retrieved from http://self-compassion.org/tips-for-practice/