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.

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.

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.

Feeling Guilty for Having Feelings?

By Annabelle Parr, MA, AMFT 

The past five months have been painful, and as our world has turned upside down, it makes sense that we may have felt some combination of anxiety, fear, sadness, depression, grief, frustration, and/or anger during this time. Despite the fact that we are in the midst of a global pandemic, our minds are really good at dismissing our very legitimate pain by coming up with all kinds of stories about how things “could be worse,” or how we “should be grateful” for what we have when others are struggling or have struggled more than us.

Perhaps the only thing that can make pain hurt more is feeling guilty for having it.

It goes without saying that pain hurts. And our minds, designed to protect us and keep us safe, want to problem solve our way out of emotions that hurt. So our minds begin to tell us these stories about our pain and how we shouldn’t have it, in hopes that it can be avoided or controlled. But do these stories truly help us move through our pain more effectively? Do they help us show up to this moment as the kind of person we want to be in the world?

Let’s start with the “it could be worse” story.

It is probably true that things could be worse.

But pain isn’t meant to be compared. Someone always has a more painful or uncomfortable situation, and if we want to compare our pain to that of others, we will find no shortage of suffering. Just because someone else has it worse, that doesn’t mean our pain is insignificant. 

And here’s the thing: we are in the middle of a PANDEMIC.

That’s really hard. It means we are all dealing with some sort of loss. And yes, some losses are bigger or more painful or permanent, but loss is loss and it hurts no matter how big or seemingly small. So yes, perhaps it could be worse. But that doesn’t mean this isn’t painful. 

What about the “we should be grateful” story? Isn’t it good to be grateful and think positive?

Gratitude is a beautiful thing, but it cannot exist without pain.

Contrary to what our minds may tell us, gratitude and pain are not mutually exclusive. In fact, they are inextricably intertwined. Because in order to experience gratitude, we have to value and care about the person or thing for which we are grateful. And we only feel pain around the things that we care about and value. So when we squelch our pain, we squelch our capacity to care, and we also deny ourselves access to gratitude.

Plus, gratitude loses its goodness when it’s used as a punishment for pain.

Using gratitude as a way to try to chastise ourselves out of our pain (“You should be grateful! Don’t you know it could be worse?”) is unlikely to be effective. The more we try to control our emotions, the more entrenched they become. Not only does this strategy tend to be ineffective, it also warps gratitude from something beautiful and meaningful to a punishment for having legitimate emotions.

It’s not pain OR gratitude. It’s pain AND gratitude.

Rather than using “it could be worse, you should be grateful” stories to try to guilt ourselves out of having any anxiety, anger, pain, or grief, we can let our pain exist, acknowledging that emotions are not problems to solve. They simply are. AND we can also intentionally choose to pay attention to what is good in our lives.  We can even use our pain to help guide our focus toward what is important to us. For example, if I am grieving the loss of hugging loved ones, I can also connect with gratitude for having family that live near me. It’s both/and, not either/or.

Gratitude is an action, as much as it is a feeling.

When we are in the middle of a wave of sadness or anxiety over this whole situation, we might not feel particularly grateful. However, we can still choose to act in a manner that expresses gratitude to those we love or appreciate. We can write thank you notes to our doctors or healthcare workers, or we can call our parents or grandparents, or we can choose to say thank you to the grocery workers in the checkout line.

None of this erases our pain, nor is it meant to do so.

Instead, it simply connects us with what matters, and helps us to show up in our lives and relationships in a manner consistent with the kind of person we want to be. It helps us be present for the goodness so that the important things don’t pass us by. And it is a reminder that our current emotional state does not control or define who we are, and we do not have to control our emotions in order to choose our actions.

So if you are not feeling grateful (or whatever you think you “should” be feeling), that’s okay.

If you value expressing gratitude, you can choose to take actions consistent with this value whether you feel grateful or not. You get to decide what you do. But you cannot force yourself to feel or not feel something. So give yourself grace, and remind yourself that even if it could be worse, that doesn’t mean this shouldn’t hurt.

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

Five Tips to Tackle Perfectionism and Engage with What Really Matters

By Annabelle Parr

Perfection. On the surface, perfection sounds, well…perfect. A worthy aspiration. Perfection is to be without flaw, and reducing flaws sounds like a pretty solid goal. Right? For those of us who have dealt with perfectionism, we know firsthand that it’s not all it’s cracked up to be. Far from making us our best selves, perfectionism can trap us in feelings of shame, guilt, low-self esteem, anxiety, and never ending stories in our minds about how and why we are not good enough. It can cause us to limit our choices and keep our lives small in order to avoid risking failure, and thus the tumult of pain that would follow. Far from making life feel perfect, perfectionism can leave us feeling empty and lonely. 

Filtering Out Flaws and The Trap of Social Comparison

In the age of social media, it is more tempting than ever to look at the perfectly filtered moments of other peoples’ lives and to feel like your life is the only one that is anything less than picture perfect (even during a pandemic!). When you compare your lowest moments to everyone else’s shiniest ones, your biggest flops to everyone else’s top ten hits, your worst failures to everyone else’s greatest achievements, your #nofilter to everyone else at their most coiffed, you are bound to feel like there is something wrong with you.

Social media facilitates an instant internal comparison of you at your very worst to others at their absolute best. When we buy into the idea that life should always look and feel Instagramable, we are setting ourselves us for disappointment. But perfectionism has been around far longer than Facebook, so let’s look at it more closely. Why is it so tempting to compare ourselves to others and pursue perfection as if it were possible?

Perfection = Happiness ?

It’s easy to equate striving for perfection with striving for happiness, something our culture loves to sell to us as the ultimate goal. At every turn, we are told that it is our job to be happy. Quite literally. If you are not a perpetually happy employee, partner, parent, friend, etc. you *must* be doing something wrong. Somewhere along the line, you must have messed up. 

But here’s the rub: happiness is an emotion, and like any other emotion, it is fleeting. No matter how apparently perfect your life is, you will still experience the full range of human emotion, including frustration, anger, anxiety, fear, sadness, grief, joy, excitement, and awe. There is no perfecting our way out of our emotions.

In fact, the more that we believe we must be perfect, the more likely we are to feel that we are failing and the more likely we are to be caught in uncomfortable emotions about how we don’t measure up to our own impossibly high standards. We are less likely to recognize our successes because *spoiler alert* they have not launched us into the untouchable perfect zone. Far from making us perpetually happy, a desire to be perfect is a surefire way to create extra unpleasant feelings.

Perfection = Growth ?

It’s also easy to confuse striving for perfection with striving for growth or improvement. And sure, if you are constantly beating yourself up about all the things that are wrong with you and all the ways that you are screwing up, you and your growing edges might be quite familiar. OR…

Maybe you are so petrified of being imperfect that you can’t actually examine where you have room for growth. You know you’re not perfect, but you have no concrete sense of how you want to grow because it is too excruciating to reflect on where you feel you are not measuring up. 

Scenario number two: you are busting your butt hard every day. You are exhausted and burnt out, yet no matter how much you check off your how-to-be-perfect-to-do-list, somehow the list just keeps growing. No achievement or improvement seems to make a dent towards the elusive end game of perfection.

Scenario number three: you are so paralyzed with fear of imperfection that you can’t make any choices at all. Terrified to make the wrong decision, risk making a mistake or even worse, failing, you choose not to choose. Far from perfect, life feels stagnant.

So if trying to be perfect doesn’t make us happy and doesn’t guarantee us growth, what’s the point?

Before you start beating yourself up for your perfectionistic tendencies, consider why you are so determined to be perfect in the first place. Even if it is a thwarted, misguided attempt, it probably makes some sense or else perfectionism wouldn’t be such a prevalent strategy.

Maybe your desire for perfection is a desire for belonging: somewhere along the way, you developed the belief that in order to be loved and to connect with others, you had to be flawless. Or maybe it is a desire to have a life that is rich with joy: you want a life filled with that which fills up your soul. Or maybe you find it fulfilling to strive to be the best version of yourself that you can possibly be. You have been striving to be perfect because you are trying the best way you know how to fulfill a deep need or desire. In other words, even though the strategy you are using has some pretty big costs, it makes sense.

What are the costs of perfectionism?

In order to redirect our energy toward a more workable strategy for engaging in life, first let’s consider the costs of trying to be perfect. They might include, but are certainly not limited to: missing out on the joy of life’s sweet moments and triumphs; saying no to opportunities for fear of failure; low self-esteem; inauthenticity leading to disconnection in the service of appearing perfect; burnout from taking on too much all the time; perpetual anxiety and shame; stagnation; and/or decreased sense of well-being. We become limited by an unattainable standard and life gets smaller and more restricted as we try to squeeze it into the perfect little box we have constructed in our minds about how it should be.

So what is the alternative?

From an Acceptance and Commitment Therapy perspective, perfectionism is at its core psychological inflexibility. The alternative, then, is to cultivate psychological flexibility. How? 

1. You are not your thoughts.

First, we defuse ourselves from our “not good enough” stories. Every time our mind generates a thought about how we are failing or how we might fail or how we have failed and are now somehow unworthy, we remind ourselves that this is our mind trying to protect us and also that this thought is just a thought. We – at our very core – are more than the contents of our minds in any given moment. Our thoughts are not the whole truth about who we are or about the reality of a situation.

In her new book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry & Stress Using Mindfulness and Acceptance, Dr. Jill Stoddard suggests we give our inner critic a name in order to defuse – get some space from – the judgements it generates. Then, when the Critic pipes up with some new version of the “not good enough” story, we can relate to them as if they were a well-meaning friend. We can thank them for their input and desire to help protect us or motivate us, and then we can connect with what matters in this moment.

2. Pause for presence.

How do we connect with what matters in this moment when we are caught in painful emotions? We get present to what is. As Dr. Shea says, take a breath and tune in to this “painful present moment.” Identify the emotions you are experiencing and get curious about the unmet need or desire underlying your feelings.

3. Let your values guide your choices.

If we look back to the needs or desires beneath our efforts to be perfect, we can start to get a sense for our values. For example, bring to mind an area of your life in which it feels particularly important to be perfect. Now consider what this says about what is important to you. What domains of your life feel most important? If you were your ideal self in each of those contexts, who and how would you be?

For example, if it is important to you to be a perfect parent, that probably means that you value your relationship with your kids. Or if it feels important to be the perfect employee or student, that probably means that your work is important to you. Now what qualities do you want to bring to these areas of your life? Our values aren’t goals that we meet, but they describe the way that we want to be in the world. For example, maybe you want to be a loving, compassionate, present, engaged parent. Or maybe you want to be a hard-working, conscientious, ambitious employee or student.

Here is the wonderful part about connecting with our values: we get to choose on a moment by moment basis what it looks like to act in a way that is consistent with who we want to be. And here is the beautiful thing – there is no end goal. You never achieve your values permanently. They are qualities of being you can bring to any moment. And when you fail to act consistently with your values in one moment (because you will), what matters is what you choose to do in the moment following.

4. If you want to live in line with your values, you have to be willing to have discomfort.

When we are caught in needing to be perfect, it tends to be excruciating to recognize when we fall short (often). This is partially because our desire for perfection shows up in the areas of life that matter to us. Making moment by moment choices in line with our values rather than in line with a goal of perfection does not spare us discomfort. Those areas of life still matter to us and it still will hurt when we fall short of acting in line with our values, even if we have defused from our desire to be perfect.

An important piece of the puzzle is that we must be willing to have uncomfortable feelings. We can’t take away the anxiety, sadness, anger, fear, or pain that are inevitable parts of being human. In fact, those feelings often point directly toward something that we care deeply about, and if we were able to rid ourselves of those emotions we would also have to get rid of the joy, love, happiness, and awe that come from connecting with what and who is important to us.

5. Finally, get present to what is.

One of the biggest costs of perfectionism is that we lose touch with the sweetness of life. We are so caught in wanting it to be perfect all the time, that we miss the bliss of both the big and small moments that come pretty darn close. When our minds are frantically searching for something wrong, we miss out on experiencing everything that might be so right. The point of being mindful and present is not to be happy all the time, but it is to bring nonjudgmental attention to what is in this moment. When we are truly present, we free ourselves up to make more deliberate decisions about how to act. We are more conscious of our thoughts and feelings, and we are more likely to catch the sweet little moments that brighten and enrich our lives.

“And now that you don’t have to be perfect, you can be good.” – John Steinbeck

John Steinbeck said it so well when he said, “and now that you don’t have to be perfect, you can be good.” The ACT perspective would say, and now that you don’t have to be perfect, you can live a life that is guided by what truly matters. You are free to connect with what is important to you and learn to live in line with who you want to be. When we need life to be perfect, we drain it of vitality. When we give ourselves the freedom to be imperfect, we free ourselves up to connect with who we want to be and what truly matters most.

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

Therapy in the Time of COVID-19 and Shelter in Place: What is Teletherapy?

By Annabelle Parr

During this incredibly stressful time of COVID-19, we are having to make major life adjustments.  With the new shelter in place restrictions, you might wonder whether psychotherapy is still an option available to you. The short answer is yes!

Telehealth, also known as video conferencing or online therapy, has been available long before COVID-19, and is an important alternative to in person care.

Traditionally, therapy is done in person. However, with the emergence of new technologies, there have been an increasing number of telehealth / video conferencing options and platforms emerging and available in the mental health field over the last decade. This means that not only do we have the infrastructure available to offer confidential, HIPAA compliant virtual therapy, but also that there is already plenty of research on telehealth and its efficacy in mental health treatment.

Prior to coronavirus, teletherapy expanded access to care to individuals who were not able to get to a therapist’s office, whether that was due to scheduling difficulties or a lack of mental health care options in their community. Now, shelter in place poses a barrier to accessing in person care for all of us. Thus, telehealth via video conferencing offers convenient access to care for everyone as we are required to stay at home as much as possible.

How effective is telemental health care?

According to the Anxiety and Depression Association of America, “from a large body of research we know that telemental health leads to high patient and provider satisfaction ratings and achieves health outcomes equivalent to in-person care across all diagnostic groups” (Yellowlees, 2020). So as long as the client is willing to engage in therapy virtually and is not an extreme risk to themselves or others, research shows that telemental health is as effective as in person treatment.

How does virtual therapy work?

Typically, telehealth involves video conferencing with your therapist using a secure, HIPAA compliant platform. No extra equipment or complicated applications are required.  Clients can use their smartphones or a laptop computer with a built-in camera. Therapists are able to offer telehealth services to patients located in the state in which they are licensed. So a therapist licensed in and practicing in California is able to offer teletherapy services to patients located in the state of California. Though not all therapists were offering telehealth options prior to COVID-19, given the current situation, many have adjusted their practices to offer video counseling options to patients in need.

What should you look for in a telehealth provider?

The same things you would look for in a therapist you would see in person: you want to ensure that the therapist you choose has expertise in the areas in which you are seeking treatment for, and you want to make sure the therapist feels like a good fit for you personally. One thing we know for sure is that the quality of the therapist-client relationship is the most important factor in producing successful treatment outcomes across settings, in-person or online. This means that in order for therapy to be effective, you have to have a solid trusting rapport with your therapist. Assuming those two conditions are present, telehealth is likely to be just as effective as working with the same therapist in person.

If you find yourself struggling, feeling stuck, and/or could use some help navigating your feelings, you could benefit from Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness, and Telemental Health Services. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.