Anxiety: What to Do with Unhelpful Thinking Patterns

Written by Lauren Helm, M.A. 

Our last blog discussed the ways in which anxiety manifests in our minds, bodies, and actions, and how depending on the context, anxiety may be an adaptive or problematic force in our lives.  In excess, the symptoms of anxiety can be overwhelming and interfere with our quality of lives, and thus it is often a worthwhile use of our time to become well-versed in the “language” of anxiety. Namely, how does it appear, and why? Once I understand anxiety, what can I do about it? Our last blog focused primarily on the ways in which our cognitions, or thoughts, may serve to contribute to the increase or reduction of excessive and chronic anxiety. Cognitive distortions, or inaccurate thinking patterns, typically feed anxious feelings. They also may lead to avoidant behaviors, which perpetuate anxious thoughts and feelings. When the cycle of anxious thoughts, feelings, and behaviors occurs outside of our awareness, we can be left feeling baffled and as if our lives have begun to spiral out of our control.  Two evidence-based treatments provide strategies for managing unhelpful thoughts.

Cognitive-behavioral therapy (CBT) identifies how certain types of thoughts or ways of thinking in response to perceived threats actually create more difficulty for us, and potentially lead to anxiety, stress, low mood, and other problems.  Simply put, situations do not cause negative emotions; our perceptions of them do.  . Some of the unhelpful or inaccurate patterns of thinking related to anxiety include catastrophic thinking, probability overestimation (overestimating the likelihood of a negative outcome), worry or rumination (i.e. brooding), filtering out the positive and only seeing the negative, jumping to conclusions, mind reading (thinking you know another person’s intent for acting in a certain way, when this may not be true), personalizing, and black and white thinking. CBT therapists help individuals to alleviate the consuming nature of anxiety by using various strategies. However, the various approaches that are used to deal with these types of “inaccurate” thinking patterns have historically served a common purpose: correct the “thinking errors” that create anxiety. Over time, CBT has evolved and has placed more emphasis on helping people to generate more flexible, adaptive thoughts and responses to their thoughts. Instead of merely trying to replace one problematic thought with a more helpful one, CBT can help an individual to generate more balanced and healthy thoughts, and more easily identify and non-reactively respond to problematic, anxiety-provoking thoughts. In other words, if you notice that you are thinking in inaccurate ways, it is likely best to recognize that it may not be helpful to act on this inaccurate thought, and better to generate a new, alternative way of thinking about the situation that helps you to successfully reach your goals. Instead of trying “not to think” a certain way (for example, not trying to suppress or shut out a problematic thought), the emphasis is on being able to create more thoughts that are based on a more balanced review of available information and are informed by your goals in a particular situation. Rigidity, or getting stuck in one narrow way of thinking, is usually what contributes to us further being consumed by anxious thinking and behaving. Thus, increasing cognitive and behavioral flexibility (working towards developing a wide range of thinking and responding) is encouraged.

Cognitive restructuring is a CBT intervention that helps individuals get “unstuck” from the “mind traps” that thinking errors create. Generally, what is required is (1) an awareness of or monitoring of thoughts regarding a particular situation, (2) challenging the thought (i.e. “Is this a realistic thought?” “Is it helpful?”), (3) exploring the evidence for or against the thought (i.e. What are the facts?), (4) identifying other possible alternative explanations and putting the thought in perspective, and (5) generating a balanced, more helpful thought from which to act on.

Acceptance and Commitment Therapy (ACT) guides individuals in becoming aware of not only their thoughts, but also their enmeshment, or fusion, with these thoughts. Cognitive fusionrefers to how much we believe our thoughts, and thereby grant them power and “reality” in our lives. We often forget that every thought filters how we see the world, and dramatically impacts our direct experiencing of life. Regardless of how “true” our thoughts may be, they are just thoughts. Thus, ACT therapists help individuals practice cognitive defusion, reducing of the entanglement with the  thoughts. In other words, we learn how to become less attached to and controlled by our thoughts, because we learn how to see them for what they really are. We learn how to give them less power over us, and take back the power of “choosing” which thoughts we want to listen to (for example, being guided by a thought that supports us in acting in valued ways, as opposed to avoidant ways).

Additionally, ACT asserts that we have limited control over which thoughts or emotions we experience. The problem is less in the content of our thinking or feeling, and more in what we dowith these thoughts or emotions, or how we relate to them. In other words, we can change our relationship with our thoughts so that we can focus our energy on what is truly worthy and important to us, instead of using most of our energy on trying to simply manage or reduce unpleasant thinking.

In sum, awareness of our thinking patterns is often the first step, and changing how we approach our thoughts is the next step along the way of healing and wellness.

These two approaches may resonate differently for different people. Both CBT and ACT are evidence-based treatments for anxiety, and can help those who struggle with the reign of anxiety get back into living full and meaningful lives.

If you are interested in having assistance with unhelpful thinking patterns, our CSAM therapists are trained in both CBT and ACT. If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego). 

Resources

Cognitive Distortions and Restructuring Handout:

http://www.reconnect.salvos.org.au/common%20mindtraps.pdf

References

Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.

Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. Basic Books.

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.

Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. Worry and its psychological disorders: Theory, assessment and treatment, 239-256.

Tags: anxiety, cognitive behavioral thearpy, anxiety therapy san diego, fear, acceptance and commitment therapy, worry, ACT, stress and anxiety in san diego, psychologist in san diego,Cognitive Behavioral Therapy, CBT San Diego, Center for Stress and Anxiety Management, cognitive distortions, cognitive restructuring

That Which Fuels the Fire of Anxiety: Unhelpful Thinking Patterns

By Lauren Helm, M.A.

We’ve all felt it at some point in our lives (likely many times over, in fact), though perhaps it manifested in different ways. You may have noticed the rapidly increasing pitter-patter of your heart, the fast, constricted breaths, the growing tension in your shoulders and neck, clammy hands, or maybe a funny feeling in the pit of your stomach. The experience of anxiety is unpleasant, to say the least, and as it builds, it certainly has a way of getting our attention.

Why do we experience these uncomfortable sensations that we call anxiety? From an evolutionary perspective, fear and anxiety (two related but slightly different emotions) have a function: they keep us alive. More specifically, fear and anxiety are emotions that occur in response to a perceived threat. When we believe that something may harm us or is dangerous, we feel these emotions and they motivate us to protect ourselves from the danger, typically either by avoiding or escaping the threat. Without fear or anxiety, we may not react to truly dangerous situations in an adaptive way, and thus not survive as a species. Imagine walking along and crossing paths with a Grizzly Bear. Would it be helpful to feel no fear, and to run up and hug it? Obviously for most of us, this would not end well! Our emotions give us invaluable information about the environment and about what actions we should take, based on how we feel.

As incredible as our brains are, they also are prone to errors. We are not always able to accurately assess the true amount of danger (or safety) that may be present in our surroundings. Sometimes this means that we may miss a true threat that was present and suffer the consequences. However, in our modern day society, more often than not we experience the opposite – we overestimate the true amount of threat and thereby experience excessive anxiety as a result.

The problem with excessive anxiety is that it can negatively impact the quality of our lives in multiple ways. Prolonged, pervasive anxiety has an impact on our physical well-being, in addition to our psychological well-being. Chronic stress and anxiety can lead to a deterioration of optimal physical functioning, preventing your immune system, digestive system, and heart from performing the best that they can. Chronic anxiety may also interfere with your ability to sleep, eat, and generally function as you’d like to in life.

How does anxiety become problematic? Cognitive-behavioral therapists tend to understand most mood and anxiety disorders using the cognitive triad, which breaks down our experiences into thoughts, behaviors, and feelings. In brief, anxiety is both developed and maintained by an interplay between certain unhelpful thinking and behavioral patterns. For example, anxiety may be perpetuated by certain ways of thinking. A low threshold for perceiving threat (i.e. situations very easily feel threatening) and an attentional bias to threat (i.e. focusing and narrowing your attention on potential dangers that surround you) can contribute to feeling anxiety. In other words, if we easily feel threatened and continue to be on the lookout for threat, we will likely frequently feel anxious. Another thinking pattern that feeds anxiety is called catastrophic thinking. Catastrophic thinking occurs when our mind jumps to imagining worst-case scenarios when we are uncertain about an outcome.  For example, our mind may imagine that our loved one has been involved in a car accident because they still haven’t returned home 30 minutes after they said that they would. Furthermore, probability overestimation occurs  along with catastrophic thinking – this is when we overestimate how likely it is that the “worst-case scenario” has or will occur. When we are feeling anxious, we often feel very certain that the worst-case scenario will occur  even though realistically-speaking, the chances are much lower (or are little to none) that what we fear will actually happen. Unfortunately, we are unlikely to recognize this while we are in the midst of severe anxiety – instead, we may engage in worry orrumination (i.e. brooding) about the many possible negative “what if” scenarios, and use extensive cognitive energy to plan for or prevent potential future threats from occurring. In moderation, worrying and planning for future threats can be helpful, but when it begins to take excessive time and energy (which is quite exhausting), it becomes maladaptive and interferes with your ability to function optimally. More often than not, the cost of worrying exceeds the benefits (it may become a waste of energy) and actually feeds the anxiety that it is intending to placate.

These are just a few ways that our patterns of thinking can create and maintain anxiety. In our next blog, we will talk more about unhelpful or inaccurate thinking patterns (also called cognitive distortions) and some suggestions for creating more adaptive ways of thinking and behaving in response to anxiety.

If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego). 

Resources

http://www.webmd.com/balance/guide/how-worrying-affects-your-body

http://www.apa.org/divisions/div12/rev_est/cbt_gad.html

References

Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.

Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. Basic Books.

Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. Worry and its psychological disorders: Theory, assessment and treatment, 239-256.

Tags: anxiety, cognitive behavioral thearpy, anxiety therapy san diego, anxiety therapy, worry, Cognitive Behavioral Therapy, Center for Stress and Anxiety Management, cognitive distortions, emotion regulation, anxiety disorders, unhelpful thinking

Part 2: Thriving through the Embrace of Life: Learning to Open through the Pain

Part 2

Thriving through the Embrace of Life:

Learning to Open through the Pain

By Lauren Helm, M.A.

In the first segment of our blog on learning how to thrive, we explored the role that suffering may have in preventing or blocking our ability to live a valued, full life. Part two continues our discussion of thriving versus suffering, and introduces an alternative approach to responding to emotional or physical pain or discomfort.

“Human beings, we have dark sides; we have dark issues in our lives. To progress anywhere in life, you have to face your demons.” – John Noble 

It can be said, in a sense, that in running away from our pain, we are metaphorically running away from our demons. These demons appear large, menacing, and powerful. They wave their limbs in frightening gestures, and offer deafening roars or shrieks when we move close to them. Our instinct is to flee – to run and escape these frightening beings – for fear that irreparable harm will come our way.  However, our constant attempts to hide away from painful events leads to the cycle of suffering that prevents a thriving, full life. Thriving is not happiness without pain. To thrive is to experience the full range of what it means to be human, and to consciously move forward on a path that is in alignment with who you want to be, and with what is important to you. Life is made up of the “good” and the “bad,” or the “pleasurable” and the “painful,” but focusing on removing the bad or the painful is likely to also prevent you from experiencing the beautiful , the awe-inspiring, and the heart-warming types of life experiences.

Sometimes it just takes a little willingness to open up to all that life has to offer, even when there is pain involved. This may take a certain degree of faith or bravery, because actively taking steps forward into valued territories often entails some degree of risk. There is risk in opening up to vulnerable but deep love, there is risk in pursuing an education or career path that inspires you but has no guarantees, and there is risk in boldly moving forward when there will likely be a certain level of pain (and growth) in doing so. Openness to the fullness of life on some level requires an acceptance of all that comes with it – the ups and the downs. In fact, an embracing of the twists and turns of life may very well be what leads to the transformation and growth that fosters thriving and well-being. Remember, pain in and of itself is not the problem. Suffering-caused by efforts to avoid pain- leads to the seemingly inescapable vortex of pain, and is a beast that feeds itself through escalating distress and avoidance. It requires extensive time and energy to maintain, and yet convinces us of its necessity. However, paradoxically, the way out of suffering is in “embracing the demons.” The alternative to suffering is thriving, an embracing of life.

Metaphorically, this cycle is like feeding a hungry tiger. Dr. Russell Harris, an ACT practitioner, explains how this works: “You discover a baby tiger in your house, and it’s cute and cuddly, so you play with it. Then it gets hungry, and restless, and irritable, so you feed it – and it settles down. But over time, the more you feed that tiger, the bigger it grows - and the more food it needs, and the more aggressive it gets when it’s hungry. Now it’s not cute anymore; it’s scary.  And you spend more and more time feeding it, because you’re terrified that if you don’t, it’ll eat you! But the more you feed it, the bigger it gets” (Harris, 2007).

Acceptance and Commitment Therapy (ACT) is an empirically supported treatment that teaches clients to reduce suffering and truly thrive.  ACT is an experiential therapy and so relies on the use of metaphors and experiential exercises to facilitate learning in an experienced way. Metaphors can help us to really connect with concepts and ideas so that we can begin to apply these concepts; so that we can begin to more openly experience difficult life events, instead of automatically avoiding them. So that we can thrive.  Another commonly used metaphor in ACT that illustrates this point is the Chinese Finger Trap Metaphor. The more that you struggle with, and try to escape the finger trap by trying to pull your fingers out of the trap, the tighter the trap becomes. The struggle to control the situation and escape makes it worse. Instead, the way out of the trap is to yield, and bring both fingers closer together within the finger trap. And then it loosens, and you are set free.  Similarly, in the ACT Quicksand Metaphor, the cycle of suffering is represented by the experience of being in quicksand. If you struggle and try to fight your way out of quicksand, you sink more quickly. The way out of quicksand is to make as much contact with the sand as possible, lying on your back, and in doing so, you rise to the surface.

It is through the willingness to make full contact with life, the embracing of the many possible experiences that make us human, that we thrive. There is richness and fullness of life to be found when we creatively choose to embody meaningful living. We can start this process by letting go of trying to control the pain, and committing to act in ways that allow us to thrive.

Clinicians who wish to incorporate metaphors and experiential exercises into their therapy practice can check out Dr. Jill Stoddard’s The Big Book of ACT Metaphors here.

If you'd like to speak with Dr. Stoddard or another professional at the Center for Stress and Anxiety Management for help learning about how to “embrace your demons,” please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego).

References

Harris, R. (2006). Embracing your demons: an overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70.

Harris, R. (2007). Acceptance and Commitment Therapy (ACT) ADVANCED Workshop Handout. Retrieved from: http://www.actmindfully.com.au/upimages/2007_-_advanced_act_workshop_handout.pdf

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.

Tags: anxiety, anxiety therapy, acceptance and commitment therapy, ACT, stress and anxiety in san diego, Center for Stress and Anxiety Management, mental health, emotion regulation,anxiety disorders, fulfillment, suffering, thriving, pain, personal values

Part I: Thriving through the Embrace of Life: To Thrive or to Suffer

Part I

Thriving through the Embrace of Life:

To Thrive or to Suffer

By Lauren Helm, M.A.

“My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style” ― Maya Angelou

If you were to ask yourself, “Am I thriving in life?” what would your honest answer be?  Is there a palpable fullness, or a vibrant, colorful aliveness that paints the story of your life? There are as many different ways to thrive as there are individuals on the planet, and each person likely has a unique story to tell about what thriving means to them. What does thriving mean to you? You may not have a ready answer, but perhaps you have a general sense of what the experience is like when you are living a life that is full, satisfying, and meaningful to you. Is the experience of moving forward in life in a deeply satisfying way your current reality? Or do you only catch glimpses or taste brief moments of thriving, without being able to maintain this as a steady flow? These are challenging and potentially uncomfortable questions to ask yourself.  It may seem that living a truly vital life is without reach, where it is possible for others to attain it, but you cannot.  

“Pain is universal, suffering is optional.”

If you experience a regular sense of enlivenment, this is excellent. The chances are, however, that life has peaks, and it has its valleys too. In our society, we may often misconstrue what it means to live fully and thrive. Often we equate successful living with happiness. If we feel pain, we assume that something is wrong, and we must immediately fix the situation in order to feel happy again. Unfortunately, pain simply is going to be experienced throughout our lives. It will occur, again and again, in various domains, including our relationships, career, and other life experiences. We will experience psychological pain   (i.e. painful thoughts and emotions) and physical pain (e.g. back pain or migraines). Does this mean that we will never be able to truly thrive, or live a deeply rewarding life? Certainly not! Pain, in and of itself, is just that – the experience of discomfort (in its many forms). Though it may not sound pleasant, pain is not the problem. Rather, our reactions or responses to the pain, is what leads to suffering. Suffering is pain’s more dramatic and pervasive cousin – suffering often wrenches, grips, and gnaws at us—and typically stems from our efforts to move away from our pain. It draws in all of our attention and sucks away all of our vital energy or life force. Generally speaking, to suffer is not to thrive.

It is within our nature to attempt to avoid, escape, or prevent pain. As a species, this is how we survived and persevered. However, in our modern day society, we are rarely threatened by actual physically dangerous situations that we need to remove ourselves from to survive (e.g.  if you see a rattlesnake, you turn and walk the other way instead of stepping onto it to avoid the painful bite which may also lead to physical damage). Many painful experiences that we currently face are internal experiences – the worried thought that your boss is negatively evaluating you, the anxiety in the pit of your stomach when the bills are difficult to pay, or the sadness that results from the loss of a friendship. Often, the mind reacts to these painful events in more or less the same way that it would react to a painful physical experience (such as stubbing a toe) – avoid this pain, and get rid of it right away, or else survival is threatened! Unfortunately, as our minds get to work at problem-solving how to control and get rid of a painful thought or a painful emotion, it often unsuspectingly steps onto the path of suffering.

“Tell your heart that the fear of suffering is worse than the suffering itself. And no heart has ever suffered when it goes in search of its dream.” – Paulo Coelho 

As the mind begins to systematically focus more and more time, attention, and energy to ridding itself of painful thoughts and emotions (like anxiety, sadness, guilt, anger, etc.) a paradoxical effect occurs – it begins to feed the beast. The very labeling of an emotion or a thought as “bad” creates a spiraling effect of distress. For example, if you experience anxiety, and then believe that it is a bad or harmful thing to experience anxiety (i.e. it is threatening), then you will likely feel an increase in anxiety or distress (because now you are anxious about anxiety), and also begin to do whatever you can to get rid of this threat (the escalating anxiety). You may try to control it by distracting yourself with drugs or alcohol, or perhaps you try to control it by avoiding whatever triggers the anxiety in the first place (e.g., not going to a party for fear of being disliked). Though this may reduce anxiety in the short-term and you may experience some brief sense of relief, the anxiety is unlikely to permanently disappear. In fact, it is guaranteed to reappear and your mind will likely respond to the reappearance of anxiety in a similar way, becoming like a rat on a wheel, running with all of its will and might to escape the relentless pursuit of anxiety (or any other uncomfortable thought or emotion). Thus, suffering grows, as more and more time and energy is needed to escape growing discomfort that returns again and again. Most importantly, the more attention is spent on avoiding, the less it is spent engaged in areas of life that may be important to you. “Life” can be put on hold while you invest your energy in “managing” the pain of life. Sometimes, in more minor cases, this works. But often, it can become a bottomless pit, and we can lose our way. To merely survive does not mean to thrive.

Though many of us would rather not fully acknowledge that this process occurs in our lives, it often characterizes the human condition. However, with awareness and recognition, we can begin to consciously alter how we respond, and thus begin to craft a way of living that supports thriving and fullness.

Part 2: Thriving through the Embrace of Life: Learning to Open through the Pain is the second segment of our blog which continues the discussion of thriving versus suffering, and introduces an alternative approach to responding to emotional or physical pain or discomfort.

If you'd like to speak with someone at the Center for Stress and Anxiety Management for help learning about how to thrive and relieve psychological suffering, please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego).

References

Harris, R. (2006). Embracing your demons: an overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70.

Tags: anxiety, cognitive behavioral thearpy, anxiety therapy san diego, anxiety therapy, acceptance and commitment therapy, worry, ACT, Center for Stress and Anxiety Management,therapy in san diego, emotion regulation, anxiety disorders, values, steven hayes, CSAM, meaning, fulfillment, mindful, suffering, thriving

Tips for Finding an Affordable Therapist

by Lauren Helm and Lucas Myers    

Are you thinking about beginning therapy? This can be an excellent step forward in creating the life that you want, but sometimes financial strain may act as a barrier to receiving the treatment that is right for you. Despite the potential challenges that you may encounter, read on for some helpful tips about how to find a therapist that you would like to work with and can afford to see.  

• Make sure that you are aware of your mindset while you are researching the available therapists in your area. While cost may be a major determining factor in your decision-making process, try to keep in mind that it may be better to commit to treatment with a therapist whom you feel comfortable with and is skilled in what they do. You may want to consider seeing a therapist that offers evidence-based treatments (EBTs), which are psychological treatments that have been found to be effective in treating a particular type of disorder. This may reduce the risk of spending time and money on ineffective therapy.  EBTs are often shorter-term treatments and thus the overall investment may be lower than you initially anticipated.
• It might be beneficial to think about whether a therapist’s level of training and expertise with a certain type of disorder or treatment is important to you. A therapist who is an expert in a particular type of evidence-based treatment may provide therapy for a higher fee, but also may offer you more skillfully-delivered treatment. However, there are also many graduate-level therapists who provide therapy under the supervision of experienced, licensed psychologists and offer low fees.
• Regardless, it is likely more helpful (and cost-effective) to make your psychological health a priority. A therapist can help you to reduce distress that may be leading to problems with work, relationships, and physical health.

  Here are a few more tips for selecting an affordable therapist: 

• Before your first appointment, ask your therapist about their fee.
• Discuss whether you are planning to use insurance and how that will be handled.
• If needed, ask if you qualify for a sliding scale.  If they seem like an otherwise perfect fit but you cannot afford their fee don't be afraid to say so.
• Ask if the therapist might be willing to see you on an every-other-week basis.  The overall cost of your treatment will remain the same, but twice monthly visits may be easier to fit into your budget than weekly visits.
• If they can't meet your budget, ask for a referral. They likely know someone that has a similar style and approach who may have a more flexible fee.
• If you don't have insurance, or have chosen not to use it, consider seeing an intern at a clinic. Although they are still relatively less experienced, many interns have years of excellent education. The best part about working with an intern is that you get their expertise, as well as that of the supervisor with whom they are working. Many cities or colleges have training institutes with interns on staff that can accept very low rates.

Remember, the time and money that is spent on therapy is an investment, and requires wise decision-making. Therapy is an important investment and may be a significant and cost-worthy step towards enhancing your health and well-being.  

If you'd like to speak with a therapist at the Center for Stress and Anxiety Management, please click here.

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego).

An Interview with Dr. Scarlet of CSAM: Superhero Therapy

By Lauren Helm, M.A.

In our blog “Modern Metaphor: Tapping into the Power of the Superhero to Turn Struggle into Triumph,” Dr. Janina Scarlet discussed how she uses superheroes and fictional characters in therapy as a way of connecting with values and inspiring healthy psychological change. Read below for an interview with Dr. Scarlet about how she uses modern metaphors in therapy.

CSAM: What inspired you to start incorporating fictional characters in the therapy room 

Dr. Scarlet: I wanted to incorporate fictional characters into therapy because I found that many clients found it difficult to talk about their own feelings or experiences and found it easier to identify with certain fictional characters, which made it easier for them to understand what they were going through. Too often, people who are going through depression, anxiety, trauma, or another difficult experience have no one to talk to and do not believe that anyone can understand their experience. Once they find a person or character they can relate to, they usually feel more understood, and that’s when healing can begin.

CSAM: How do you use superhero and fantasy characters in therapy? What might you do to help people access their inner superhero while working with them in therapy?

Dr. Scarlet: Usually, I ask the client to tell me if they like comic books, movies, TV shows, etc. and ask which is their favorite and why. Often there’s one or more that people can name and usually there’s a character they feel that they can relate to. We then begin by exploring what the character has gone through, what made them who they are today, and what makes this particular character special to the client. For example, if someone likes Batman, they might like that Batman is a Superhero, that he saves other people, and that he is brave and strong. This allows me to understand what kind of person the client would like to become, to get at their values. We then explore what Batman had experienced (i.e., the death of his parents, the phobia of bats, and years of isolation) and how through the terrible pain he went through he was able to become the Superhero of Gotham that he is today. We then bring it back to the client’s values and identify ways that he or she can begin to take steps to become their own kind of Superhero.

CSAM: Is there any particular issue that you’ve found superhero-therapy to be most helpful for?

Dr. Scarlet: I think that since Superheroes tap into someone’s individual value system, that they can be used for any issue someone is going through.  I believe that the biggest remedy for emotional pain is connection with one’s values and Superheroes and heroes of works of fiction, such as Harry Potter and Frodo, lend themselves very nicely to value identification.  

CSAM: You have training in mindfulness and meditation techniques, compassion and self-compassion, and biofeedback. How might you incorporate a superhero approach when using these interventions in therapy? Do they complement one another?

 Dr. Scarlet: I think that they complement each other very nicely. For most people, what they value is helping others. Unfortunately, often people don’t know how to go about that, feel too depressed to do it, or don’t believe that their efforts matter. In addition, I often find that people burn out when they don’t know how to provide compassion toward themselves. In my “Superhero training” sessions, I teach the clients about Jedi mindfulness, as well as the magic of self-compassion, and the Superhero steps behind being compassionate toward others.

CSAM: How do you think that being a therapist who uses superhero metaphors aligns with your own value-system?

 Dr. Scarlet: The person that influenced me the most was my grandfather. He spent his life helping people every way that he could. He wasn’t only a hero, he was my Superhero. He really inspired me because he showed me that it only takes one person to make a difference. I became a therapist because it was the main way I knew how to help others, and in using superhero metaphors in therapy, I find that I can make therapy more accessible to my clients. 

 CSAM: What kinds of triumphs have you seen people create in their lives when working with you?

 Dr. Scarlet: The bravest people I have ever met are my clients. They are the ones that have been most impactful to me. They face their fears every single day, and just like Batman, they do what they can to fight for what they believe in. I was working with one client with severe PTSD and agoraphobia and I will never forget the day that he was able to step out of his house with me. This person now drives and travels and in my opinion, deserves his own comic book for everything he has been able to overcome.

 CSAM: What can you tell us about the book that you are working on about using superheroes in therapy?

 Dr. Scarlet: The book will be a self-help book, on how to become the Superhero that you would like to be and will specifically focus on overcoming anxiety. It will follow the acceptance and commitment therapy format with a chapter on self-compassion, and will primarily include metaphors from comic books, fantasy novels, science fiction, and TV shows.

More about Dr. Janina Scarlet:

Dr. Scarlet earned her Ph.D. from the City University of New York. Her clinical experience includes using Cognitive-Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to help individuals with anxiety, depression, chronic pain, sleep, and other mental health and medical conditions, as well as using Cognitive Processing Therapy for PTSD. Dr. Scarlet also has experience working with a variety of mindfulness and meditation techniques, as well as compassion and self-compassion and is certified in biofeedback. In addition, she is fluent in Russian and can conduct therapy with Russian-speaking clients. Finally, Dr. Scarlet is a proud geek and is able to incorporate clients' interests into therapy, including but not limited to Batman, Iron Man, Green Arrow, Harry Potter, Lord of the Rings, Doctor Who, Sherlock Holmes, and many others. She was recently interviewed by an award winning podcast, Geek Therapy, about her use of fantasy and geek culture in therapy. Above all, Dr. Scarlet believes in establishing an active collaboration with a client and working as a team in targeting the presenting problems.

If you'd like to speak with Dr. Scarlet or another professional at the Center for Stress and Anxiety Management, please click here.

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Tags: Comic Con, ACT, Center for Stress and Anxiety Management, psychologist, anxiety disorders, CSAM, comic books, superheroes, superhero therapy